Richard Vipond, MPH 2012
Snowsports are becoming increasingly popular in New Zealand with increasing numbers of locals and overseas visitors enjoying the many ski fields throughout the country. Over recent years attention has been given to increasing injury numbers and their associated health care and Accident Compensation Corporation (ACC) costs, particularly head injuries. Three deaths in one season (2010) on one Canterbury ski field led to a Christchurch coroner suggesting compulsory helmet legislation should be considered. High profile deaths overseas from head injuries on ski fields have prompted proposals for compulsory helmet requirements from the international media. European countries such as Austria and some states in the USA have already passed or are considering helmet legislation for youths on ski fields. However there is a lack of published research which has looked at what the results of compulsory helmet use may be. There is also a paucity of New Zealand specific data on the subject.
This research aimed to assess the evidence in support of compulsory helmet legislation for ski fields. To do this a number of key research questions had to be answered.
- How many head injuries occur on ski fields in New Zealand?
- What is the evidence on the potential for compulsory helmets to significantly reduce head injury numbers and their severity?
- How many people in New Zealand already wear a helmet for snowsports?
- Are there practicality issues which may impact the feasibility of introducing or enforcing compulsory helmet legislation for snowsports?
Three data collection methods were employed in addition to searching for published literature regarding ski helmet effectiveness.
Data was collected from selected primary and secondary health care facilities regarding the 2010 ski season in order to determine typical demographics of injured skiers/boarders, to quantify how large a burden these presentations are on the facilities, and to determine the percentage of patients with a head injury on a ski field who were wearing a helmet.
An observational study was undertaken in order to estimate the percentage of skiers/boarders in New Zealand who voluntarily wear a helmet. New Zealand specific research on this subject has not previously been undertaken.
A series of interviews with selected ski field managers was undertaken. Thematic analysis was performed on the data generated to highlight practicality and feasibility issues of helmet legislation.
A meta-analysis of studies regarding the effectiveness of ski field helmets concluded a helmet decreases the risk of head injury by 35% (95% CI 0.55-0.79). The majority of the injuries prevented however are minor cuts and grazes. Anthropomorphic device testing demonstrated that helmets are severely limited in their ability to prevent head injuries even at average speeds, or in children. Helmets also seem to provide little benefit in preventing serious injury or death, reflected by steady numbers of each per year in the USA despite helmet use nearly tripling over the last 8 years. 50% of fatally wounded skiers/boarders in the USA in 2010 were wearing a helmet.
Health care facility data along with ACC and international data demonstrated that the demographics of injured skiers/boarders in New Zealand and internationally is comparable. The most commonly injured on a ski field are young and male. Snowboarding is more likely to result in a head injury than skiing. Head injuries from ski fields do not constitute a large burden for secondary care facilities in the South Island, and account for only 10% of all ski field injuries - internationally they account for 15-20%. The majority of ski field head injuries are minor and represent no ongoing problems for the patient or expense for ACC.
42% of people with a head injury from a ski field in 2010 were wearing a helmet when they had their accident.
The observational study estimated that around 57% of people in New Zealand voluntarily wear a helmet on a ski field. This is comparable with estimates from Australia and the USA.
Ski field manager interviews highlighted a number of issues with the implementation of helmet legislation, primarily regarding supply and storage issues for the ski fields. Policing of the legislation would also require some careful consideration.
Evidence suggests that compulsory helmet legislation would not be effective in significantly reducing either injury numbers or expenses for ACC. Furthermore, helmets would not be effective in saving lives or preventing serious injury.
While it is important to consider initiatives which decrease the burden of illness on society, ski field head injuries do not appear to be common enough to demand government intervention in the matter. Government time may be better spent addressing issues which do affect a significant number of people in New Zealand.
Helmets are already worn by nearly 60% of snowsports enthusiasts. Intervention therefore would only be focusing on the remaining 40%, which suggests alternative programs which increase voluntary use should be given greater priority. Furthermore, over 40% of people with a ski field head injury in 2010 were wearing a helmet. This supports the notion that helmets are limited in their ability to prevent injury, and that legislation would not significantly reduce injury numbers.
Ski field manager interviews identified a number of potential issues with helmet legislation. While none of these would be considered prohibitory, when taken in consideration with the previous points they act to further diminish support for helmet legislation.
Evidence in this project concludes that helmet legislation for the compulsory use of helmets while skiing or snowboarding should not be given government priority.