Cycle helmets are essential safety gear for cyclists of all ages. They can't prevent a crash happening in the first place, and they don't protect you in all types of crashes, but they do significantly reduce your chances of serious head injury in a crash. In fact, the protection they offer to your head could save your life - many studies from around the world have shown that if you wear one, the risks you face when cycling are a lot lower.

A review of international research on cycle helmets by the University of Newcastle concluded that there is considerable scientific evidence that cycle helmets are effective in reducing the incidence and severity of head and brain injuries, and that there are even greater safety benefits for child cyclists [1]. Another review (which looked at five academic studies, and is cited by the British Medical Association as being particularly reliable) concluded that helmets reduce the risk of head injury by 85%, brain injury by 88% and severe brain injury by 75% [2].

If a cyclist is knocked off their bike, there is a good chance their head will hit the road, or another hard object. About half of cyclist admissions to A&E relate to head and facial injuries [3]. A helmet dramatically reduces the risk of skull fracture when a cyclist’s head hits something. It also reduces their chances of concussion and helps to protect their head from cuts and scrapes.

Wearing a helmet is recommended for all cyclists, but is especially important for children. Children have less control over their movements on a bike and are more likely to make errors of judgement. Child cyclists are also smaller and therefore harder for drivers to spot and their skulls may be less strong. Brake recommends that children get into the habit of wearing a helmet on every journey on any surface, as many child cyclist injuries occur off-road and close to home.

The British Medical Association (BMA) recommends that all cyclists, but especially children, wear a helmet, and supports a law making helmet wearing compulsory [4]. The World Health Organisation promotes helmet wearing as a key way to reduce head injuries among cyclists.

Dean Haslam

Dean Haslam, 12, was told by doctors that his cycle helmet had saved his life after he was knocked down by a car. He strayed into the path of the car on a road near his home, and was flung across the car’s bonnet and onto the road. His cycle helmet was smashed into three pieces and Dean was treated for leg injury, bruising and shock at a local hospital. Dean’s parents are calling for cycle helmets to be made compulsory for child cyclists.

What the surgeon says

Dr Tim Coats is a Professor of Emergency Medicine at the University of Leicester and sees first-hand the horrific injuries suffered by cyclists in road crashes. He divides fatal injuries into three categories: later deaths, which might have been prevented with better (neuro) intensive care; early deaths, due to bleeding, which might have been prevented by better immediate care; immediate deaths, in the first few minutes, where the surgeons can do nothing to help. These deaths could only be prevented by prevention. Wearing a cycle helmet is a preventative measure. Many head injuries belong to the last category, says Professor Coats. In these cases, prevention is the only solution.

Helmet wearing rates

Cycle helmet wearing rates remain low in the UK; although the proportion of adults wearing a helmet has increased slightly in recent years, the level of helmet wearing among children has remained static. On major built-up roads in 2008, 35% of adult cyclists were observed to be wearing helmets, an increase from 31% in 2006. Just 18% of child cyclists were observed to be wearing helmets (the same as in 2006), with a particularly low rate of 13% among boys. Helmet wearing rates are significantly higher in London than the rest of the country: the overall helmet-wearing rate in the capital is 70% [5].

The law

Compulsory helmet wearing has been successfully introduced in several countries. In New Zealand, a law passed in 1994 made cycle helmet wearing compulsory for all age ranges. It increased helmet wearing from around 20% for adults and teenagers, and 40% for younger children, to more than 90% in all age groups. Researchers in New Zealand have concluded that the law has reduced cyclist head injuries significantly. The large increase in helmet wearing reduced head injuries by between 24-32% in non-motor vehicle crashes, and by 20% in motor vehicle crashes, found the research, which looked at hospitalisations for head injuries among cyclists.[6]

Canada, the Czech Republic, Iceland, Spain and some states in the US and Australia have introduced similar legislation. Many have concluded through academic research that there has been a reduction in head injuries among cyclists through increased helmet wearing [7]. 

Attempts to introduce legislation in the UK are yet to prove successful. In 2004, Eric Martlew MP introduced a Ten Minute Rule Bill (Protective Headgear for Young Riders), to make helmet wearing compulsory for children. The Bill was unsuccessful, but gained support from a wide range of organisations including the Royal College of Nursing, the Royal College of Paediatrics and Child Health, Brake, the Child Accident Prevention Trust, the Children’s Brain Injury Trust, Headway (the brain injury association), the Royal Society for the Prevention of Accidents. 

One argument put forward by anti-helmet campaigners is that compulsory helmet wearing puts off people from cycling, and therefore is unhelpful in reducing carbon emissions and promoting healthy lifestyles. However, international evidence does not indicate that cycle helmet laws result in a long-term drop in cycling. Although some studies have indicated that laws may result in a temporary decline, the medium to long term effective is likely to be negligible.[8] International experience therefore suggests that helmet wearing laws can be introduced successfully without resulting in a long-term decline in cycling.

Other measures we need to make cycing safer

Brake argues that we don't only need a law on cycle helmets. We need measures by Government to make our roads safer for cyclists - and Brake believes that this is the most important way to encourage more people to cycle. Brake is calling for far more traffic free and segregated cycle paths, and reduced speed limits and better speed limit enforcement on rural and urban roads. A survey by Brake and Direct Line indicated that as many as one in three non-cyclists would be persuaded to cycle in their were safe routes connecting their home to local facilities [8].

Advice on choosing a helmet

1. Make sure your helmet is standard-approved with a recognised safety certification such as British (BS 6863 or BS EN 1078), American (ANSI Z90.4 or SNELL) or Australian (AS 2063) National Standards. Ideally a helmet should also have a British Standard Kitemark.

2. Check it is the right size - a helmet should fit snugly and securely on the head with a minimum use of pads. Do not buy a helmet that a child will “grow” into.

3. Buy a brightly coloured helmet that can be easily seen by other road users.

4. Remember that the polystyrene layer inside the helmet, which compresses to absorb the force of an impact, can only be compressed once, so helmets should be replaced after any knock or crash.

Advice on wearing a helmet correctly

1. Loosen all the straps.

2. Place the helmet squarely on your head, sitting just above the eyebrows and NOT tilted back or tipped forwards.

3. Do up the chin strap, securely fastened and not twisted.

4. Adjust it so that it tightens firmly under your chin, with only enough room for two fingers to be inserted between chin and strap.

5. Adjust the back straps. The back and chin straps should meet just below your ear lobe. Be sure the chin strap stays in as straight a line as possible.

6. To test the helmet is correctly fitted, make sure you CAN’T tilt the helmet backwards far enough to uncover your forehead, tilt it forward enough to cover your eyes or ears, or tilt it sideways enough to uncover the sides of your head.

Useful links

www.bma.org.ukwww.bhit.org
www.bhsi.org

[1] Bicycle helmets: review of effectiveness (Department for Transport, 2002)
[2] Thompson DC, Rivara FP & Thompson RS (1999) Helmets for preventing head and facial injuries in bicycling. Cochrane database of systematic reviews 1999, Issue 4, CD001855
[3] Bicycle helmets: review of effectiveness (Department for Transport, 2002)
[4] Cycle Helmets (British Medical Association, 2010)
[5] Cycle helmet wearing in 2008 (Department for Transport, 2009)
[6] Cycle helmet effectiveness in New Zealand (Povey L J, Frith W J, Graham P G. Accident Analysis and Prevention, 1999; volume 31, pp 763-770)
[7] For examples of international research on helmet wearing laws see http://www.bma.org.uk/health_promotion_ethics/transport/promotingsafecycling.jsp?page=6
[8] Sheikh A, Cook A & Ashcroft R. (2004) Making cycle helmets compulsory: ethical arguments for legislation. Journal for the Royal Society of Medicine, 97, 262-265
[9] Brake and Direct Line Report on Safe Driving: A Risky Business (Brake, 2011)