Wednesday 29 March 2017

#CityCycling: 'There are accidents where helmets are a great thing. There are others where a helmet doesn’t work' - hospital consultant

The number of cyclists on our roads is increasing, and so are the number of incidents.
The number of cyclists on our roads is increasing, and so are the number of incidents.

Geraldine Gittens

Five cyclists have been killed on Irish roads this year to date.

Last year, 12 cyclists were killed, a jump from five in 2013.

Compared to the rest of Europe, Ireland has the lowest cycling mortality rate along with Spain and Greece, according to the European Transport Safety Council.

However, the number of cyclists on our roads is increasing, and so are the number of incidents.

“My belief is that the numbers are increasing. There are more cyclists on the road and there are more accidents,” said Dr Mark Delargy, a Consultant in Rehabilitation Medicine at the National Rehabilitation Hospital, Dun Laoghaire.

“Currently on our waiting list we have an adult whose brain injury is so catastrophic that the person is most likely to remain in long-term care for the rest of their life.”

“In our care we have a series of very unfortunate sports cyclists, some of whom broke their necks and are paralysed for life.”

“These are very sad events.”

Around five of the 110 beds at the National Rehabilitation Hospital, Dun Laoghaire, are occupied by an injured cyclist at any one time.

The number of cyclists injured on Irish roads reached a 10-year high in 2012, when 630 cyclists were injured. Some 53pc (335) of these injuries occurred in Dublin alone.

There was also a 200pc increase in cyclists with spinal trauma injuries being referred to the National Spinal Centre over a four year period, an RSA review found earlier this year.

“These catastrophic injuries are relatively uncommon but my personal knowledge is that among those people who take part in the charity cycles, there have been more fatalities than one would care to imagine  - with the good-heartenedness of people who are cycling for the good of others, and through bad luck, death occurs. The cycling world knows these stories and we grieve for them because it always seems so unnecessary.”

“People who come off their bikes and need treatment in the NRH are those who have brain injury, spinal injury, and those who might have lost a limb in the process of their accident.”

Dr Delargy, in his fifties, was knocked down while cycling last year. His knee ligaments were torn in the accident and he was out of action for a few months. On top of that, he has had many “near misses”.

Yet he cycles to work every day.

“I have been knocked down once and I’ve had many near misses. You’re so shocked that you end up shouting at the car driver for their complete disregard for your safety.”

“My knee ligaments were torn and I couldn’t do anything for months. But I got good rehab and I can cycle again.”

“I’m more cautious than I was before. I suffered a sense of invincibility. Cyclists believe they’re invincible and the people who don’t cycle are afraid to and they won’t do it.”

“The sorts of injuries I’ve seen this year include a broken neck with paralysis, the loss of a limb and devastating brain injury rendering the individual into a vegetative state.”

Recent research here shows that in direct impacts between cyclists and cars, the main areas of injury are to the torso or lower limbs, and a helmet offers little extra protection

But it is in secondary impacts – usually with the ground, or windscreen, or bonnet – that the helmet provides significant protection.

In 26 out of 32 secondary impact cases, helmets would have reduced the cyclists’ head injury by around 75pc, the research cited by the European Transport Safety Council (ETSC) shows.

“I personally won’t leave the house without a helmet and I’m a proponent of helmets, but the worldwide research on helmets is not crystal clear,” Dr Mark Delargy said.

“There are several views on helmets. One of the views is that helmets are not essential, and that I believe is true for low-speed travel. This is borne out by the practice of every major city in Europe. On the city bikes in Paris, Dublin, Marseilles, for example, you do not observe people wearing helmets.”

“There are accidents where helmets are a great thing. There are others where a helmet doesn’t work. When a truck runs over you, a helmet will not save you.”

“There can be freak accidents where you topple over. If you’re crossing a road and your wheel gets stuck in a Luas track and topples over and your head hits the pavement, it would be very helpful to wear a helmet.”

“It’s the feature of the speed that determines the risk.”

 “There is a capacity to cycle bikes without helmets at low speed. Where helmet regulation comes into play is for children because they have a more vulnerable head, or for adults who are going at high speed,” he said.

From statistics about car and bicycle collisions, one pure fact can be drawn, Dr Delargy says.

“For car versus bikes, the scores for bikes is zero in terms of the damage that’s done to the car. Cyclists come off worse.”

“For an ostensibly healthy and good, practical activity, bad can come from that. Tragedy comes from swimming but we wouldn’t ban swimming.”

“Good roads, good bikes and courteous drivers - that’s the green ticket. Our drivers who blank the rules of the road should be made to answer for belligerently disobeying the rules of the road.”

 “When a vehicle hits a cyclist, I don’t think it’s ever been known that the driver comes off worse.”

The Road Safety Authority recommends that all cyclists wear helmets and high visibility clothing.

“Cyclists should also wear helmets and high visibility equipment so they can be seen at all times,” an RSA spokesperson said.

“Motorists should also pay greater attention to their speed, particularly in urban areas, as four out of five drivers are breaking the speed limit in these zones. They are also increasingly more distracted with one in 12 drivers on a mobile phone while driving.”

“From the latest ETSC’s report on cyclist mortalities between 2011-2013, it was encouraging to see that Ireland is below the EU average and third lowest in Europe for road cyclist deaths per million habitants.”

“However, in 2014, there was a worrying increase of seven cycling deaths on our roads compared to 2013, from five to 12 fatalities,” the spokesperson said.

“We would advise cyclists be vigilant at junctions and to watch for cars making a turn and give plenty of room for them to do so.”

Dr Delargy is keen to point out that a badly fitted helmet, or a low-quality helmet, will not provide adequate protection.

“There are good helmets, bad helmets, and helmets that are too loose as you hit the ground.”

Current EU helmet standards require impacts of up to around 15-20km/h to be absorbed.

Ireland has the largest proportion of cyclists wearing helmets in Europe (46pc), followed closely by Switzerland (43pc) and Finland (41pc), according to the ETSC.

Dr Delargy points out that alcohol is a far greater cause of accidents causing brain injury in Ireland than cycling.

A two-year national audit of over two thousand patients with significant traumatic brain injury in Irish hospitals found that out of 2,000 patients, 70 were cyclists (3.5pc).

“I see the full spectrum of life and the biggest challenge is to how society is drinking. Too much at home and a fall down the stairs, you can get a brain injury from that.”

“The health benefits of cycling outweigh the challenges. We are getting more admissions through alcohol than we are through cycling.”

The Bike to Work scheme, introduced in 2009 and providing an allowance to employees to purchase a new bike and safety equipment up to €1,000, has proven effective in getting more people on their bike. However, there are challenges, Dr Delargy says.

“The good of the bike to work scheme is challenged by the fact that people are tempted to buy higher speed bikes than a standard racer bike.”

“The attractiveness of the bike to work scheme inveigles you into buying a better bike, a lighter, faster, ‘go harder’ bike. One possible impact of the bike to work scheme is that Dublin is awash with higher quality bikes because people are topping up the grant and buying better quality bikes and they’re going harder and that’s increasing the number of accidents.”

“You want to keep people healthy and trouble-free year after year, and maybe to try and identify a good quality bike with a better breaking system.”

“There has been an explosion of interest in cycling in Ireland. We’re seeing a lot more leisure cycling - sporting people who are going essentially as hard as they can on high quality bikes and that then puts them at risk because at higher speed, you’re going to suffer a more serious injury.”

“I was at a patient conference in Berlin and I saw hundreds of bikes being used by cyclists around the city which were a complete contrast to the bikes in Ireland. All of the bikes in Berlin were heavy duty, sedately cycled commuter bikes.”

“Our cyclists are the lycra wearing groups in light, high quality bikes and they’re going hard. Our cyclists are probably out on their own. We have a freedom within cycling that we can cycle dangerously and drivers find that very, very difficult and very challenging.”

 “Cycling can be dangerous but like swimming, it’s good for you, it’s good for your psyche and good for your health. We should encourage cycling as much as possible.”

• More than four in every 10 cyclists injured were cycling for leisure purposes, while one in 10 was cycling to work.

• Over half of all cyclists (53pc, or 335) were injured in Dublin, by far the most dangerous county. It is followed by Cork (7pc, or 46), Galway (5pc, or 33), Limerick (4pc, or 25) and Louth (4pc, or 24).

• Drivers are most likely to strike cyclists while taking right or left turns, accounting for 40pc of injuries. Almost half of all cyclists were injured at junctions.

• Over half (57pc) of those injured were aged 25-49. Sixteen children aged 0-9 were injured, and 57 aged between 10 and 16.

• Three-quarters were injured in periods of good visibility.

The details come as the number of people cycling to work rose by almost 10pc between 2006 and 2011, according to the Central Statistics Office, with some 36,000 cycling to work and another 21,000 travelling by bike to school and college. Men account for most cyclists on the roads (75pc).

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