The global interest in the wellbeing of Michael Schumacher, seven-time Formula One world champion, following his skiing accident in the French resort of Meribel at the end of December, has put the issue of helmet use in winter sports firmly back on the agenda. Questions to be answered include: how much of a difference to head injury does wearing a helmet actually make; does wearing a helmet encourage dangerous and fast skiing/snowboarding; and should travel insurers insist that their policyholders wear the extra protection on offer? Mandy Langfield investigates
Let’s first address the Schumacher accident, where medics have said that the helmet Schumacher was wearing almost certainly saved his life. The anaesthetist who treated Schumacher, Jean-Francois Payen, said that he might not have survived the fall at all had it not been for his helmet: “Taking into consideration the very violent shock, his helmet did protect him to a certain extent, of course. Somebody who would have this kind of accident, without a helmet, certainly, he would not have got here.” Schumacher was still in hospital in a medically induced coma as ITIJ went to print. A recent study into helmet efficacy by UK insurer Direct Line (see ITIJ 156, January 2014, Direct Line announces ski helmet study results) showed that skiers wearing helmets experience at least two-thirds less g-force than skiers without helmets, representing a greatly reduced risk of suffering a serious head injury. The study was carried in conjunction with the Transport Research Laboratory, whose group testing manager Mark Riddell commented: “When you consider that during the collision at 20 kph, the head experienced a force of nearly two tonnes, this is an incredible amount of strain to be put under.” He concluded firmly: “This research certainly supports the argument to wear an approved ski helmet on the slopes from a safety perspective.”
Whether or not Schumacher was wearing an ‘approved’ ski helmet has yet to be established, but one could assume that, given his experience of driving in Formula One, he is no novice when it comes to helmet safety, and it probably wouldn’t be an area he would skimp on when choosing such gear. The skis and helmet he was wearing were reported to be rented, however, and are in the possession of the police, who are examining them for defects. A brief look around the Internet – the type of research the average skier or snowboarder might do before they go on holiday – shows that a variety of prices and styles of helmet on offer, but with very little information about what ‘approved’ headwear is. Approved by whom; and for what? With prices for adult helmets ranging from £40 to £500, more information for consumers about what to look for from a helmet would be useful. Is the £40 example as good as the £500 one? Who knows? A prolonged search did eventually uncover information about helmet standards, with some interesting results. According to the SkiHolidayExtras website, there are three standards that helmets adhere to: CEN 1077, ASTM or Snell RS-98. CEN 1077 is the most common, but also, warns the website, the least stringent of the three options. Snell RS-98 and S-98 certification standards are tougher, with Snell-certified helmets being required to withstand at least 30-per-cent more impact force than the CEN 1077 standard prescribes. There is also, according to the website, no common international standard enforced by any national body, leaving it up to the skier or snowboarder to figure out what they need.
Schumacher’s accident occurred in a small off-piste area, located between two main pistes in Meribel, and he was reportedly helping a child who had suffered a fall in the deeper snow just before he hit a rock with his ski, and was propelled into another rock, which he struck with his head. He wasn’t going quickly, according to his manager, but was just very unlucky. From a travel insurer’s perspective, while most policies do exclude injuries that occur while the person is skiing or snowboarding in an off-piste area, it is safe to assume from a PR point of view that Schumacher’s insurer, if he has one, will not be making an issue out of the fact he wasn’t on the piste. Assuming that University Hospital of Grenoble is treating him as a European citizen, then the cost to the insurer should be limited.
Does wearing a helmet save lives?
The evidence is mixed – Direct Line’s study shows that the severity of injury can be significantly reduced as a result of wearing a helmet, but not all the research is as positive. According to the US National Ski Areas Association (NSAA), helmet use by skiers and snowboarders increased again in the 2012-13 season, with 70 per cent of all skiers and snowboarders wearing a helmet, setting a new record for helmet use in the country. Despite this statistic, the NSAA say that there has been no real reduction in the number of snowsports-related fatalities or serious brain injuries. There is little doubt that helmets make a difference when it comes to preventing less serious head injuries, such as scalp lacerations, but according to Jasper Shealy, professor emeritus at Rochester Institute of Technology, helmets do not prevent injuries such as the tearing of brain tissue. Shealy has been studying snow-related injuries in Vermont for 30 years, and says that helmets might not be able to protect the wearer against what he termed ‘rotational’ injuries. His research, he added, has failed to register a decline in head injuries as a result of helmet use. He concluded: “The helmet does a very good job at protecting against skull lacerations and skull fractures, but it doesn’t seem to have much effect on concussions or traumatic brain injuries. Our guess is that this is due to the fact that those injuries are occurring at such a magnitude of energy that they overwhelm what a helmet can do for you.” A review of 16 studies on ski and snowboarding injuries was recently carried out by the Eastern Association for the Surgery of Trauma in the US, in which the unanimous conclusion of the authors was that helmets save lives. Dr Adil H. Haider, trauma surgeon and professor of surgery at Johns Hopkins University, said: “They (helmets) protect against serious, even fatal head injuries. There really is a great case to be made for wearing helmets. By increasing awareness and giving people scientific proof, we hope behaviour changes will follow.”
The helmet does a very good job at protecting against skull lacerations and skull fractures, but it doesn't seem to have much effect on concussions or traumatic brain injuries
A study published in 2012 by the Western Michigan University School of Medicine found that the number of head injuries among skiers and snowboarders in the US increased by 60 per cent over a period of seven years (2004 to 2010), while helmet use increased at almost the same pace over the same period. A March 2013 study by the University of Washington found that head injuries among adolescents as a result of snow sports increased by 250 per cent between 1996 and 2010.
Medicins de Montagne, a group of physicians working in the French Alps, cites figures that show that the proportion of serious injuries suffered by skiers in France has increased over the past decade too. In 2001, 3.95 per cent of injured skiers were ‘heavily wounded’, whereas in 2012 the proportion of heavily wounded skiers as a percentage of the total number of injured skiers was 5.2 per cent.
Thomas Buchsein, medical director of FAI, a German air ambulance operator, drew our attention to a meta-analysis of 12 medical studies into ski helmets undertaken by a group from the University of Calgary in Canada. The analysis found that head injuries accounted for 19 per cent of all accidents on ski slopes; it found that skull fractures and traumatic brain injuries are clearly the main cause of death in ski slope accidents; and it found that ski helmets reduce the risk of head injury by more than 33 per cent. Buchsein, who also works on rescue helicopters in Germany, is clear in his view that helmets save lives, and that he sees no difference between skiing and other popular sports in terms of risk: “I see no big difference in terms of head injury risk between biking and skiing: any activity that involves speed, human skulls and hard surfaces clearly, and without any doubt, calls for head protection.”
What many statistics surrounding this issue are lacking, it seems, is a ratio comparison – with skiing and snowboarding now accessible to the masses, how many more inexperienced skiers are hitting the slopes in comparison to the increased number of accidents that are occurring? One has to take into account the increased popularity of snow sports over the course of the study periods – with skiing and snowboarding becoming more mainstream, and the slopes used by a greater number of people, the ratio of injuries to skiers may now be completely different, meaning that in terms of danger, skiing might not, in fact, have become more dangerous. With large numbers of people trying skiing and snowboarding for the first time, it is inevitable that more injuries will occur.
The snowsports terrain has also changed significantly in the last 20 years, and the introduction of half pipes and other areas designed to help snowboarders perform tricks, have meant greater access to riskier terrains. At the same time, Dr Marc-Hervé Binet, a physician working in the ski resort of Avoriaz, France, said that impact injuries are the result of improved piste management: “Now everything is flat, not very good skiers are still able to ski very fast. They are not able to control their speed, and so we have more collisions.” Another element of safety that must be considered is: do helmets encourage risky behaviour by the wearer? Chris Davenport, a professional skier, thinks so: “The equipment we have now allows us to do things we really couldn’t do before, and people’s pushing [of] limits has sort of surpassed people’s ability to control themselves.” Nina Winans, a sports medicine doctor at Tahoe Forest MultiSpecialty Clinics in California, said that moves by resorts to build terrain parks and improve access to difficult terrain has also impacted on skier safety: “There’s a push towards faster, higher, pushing the limits being the norm, not the exception. So, all of those factors – terrain parks, jumping cliffs and opening terrain that maybe wasn’t open in the past – play into some of these statistics with injuries.” A study by California State University into the possibility that helmet wearing encouraged risky behaviour, however, found no evidence to support the theory.
Dave Byrd, director of risk management for the NSAA, said the increased usage of helmets, in North America at least, was the result of campaigns by ski resorts, helmet manufacturers and medical professionals, along with high-profile snowsports fatalities such as those of Sonny Bono and Natasha Richardson. The state of New Jersey in the US has actually mandated the use of helmets for children under the age of 17, International Travel & Health Insurance Journal 12 NEWSANALYSIS as has Nova Scotia in Canada, and certain European countries – Italy and Austria – mandate their use for children under the age of 14 and 15 respectively. However, NSAA research has shown that 70 per cent of snowsports-related deaths are men in their late teens to late 30s.
ITIJ spoke to Russell Dadson of Snowcard Insurance Services, a provider of winter sports cover in the UK. He said: “We do not make it a condition of cover that helmets are worn. Head injuries still make up a minor proportion of claims, less than five per cent, so there is no major insurance concern at the moment.” He added: “Helmets are estimated to reduce the severity of head injury by roughly 50 per cent, but they will not prevent serious injury from a major trauma [such] as in Schumacher’s case. His was an unusually severe injury which, rather than highlighting the need for helmet use, highlights the need for insurance. I expect the cost of his treatment to run into the tens, if not the hundreds of thousands of euros. Whether this is being covered by the French state (in full or in part) or his private insurer, it is a clear example of why insurance should be taken [out] to cover the unforeseeable, extreme accident and its unknown consequences.” Paula Gardner, spokesperson for Essential Travel, the only insurer in the UK to make the use of helmets mandatory by its policyholders, agreed that the need for insurance should be the message given to the general public in the wake of the skiing accident that Schumacher suffered. The cost of the helicopter airlift from the slopes, she said, was significant, and the speed with which it then transferred Schumacher to hospital was also vital in terms of the survivability of the accident. For the uninsured skier, Gardner added, the cost of the helicopter ride would cause serious financial injury in addition to the physical ailments. While Essential Travel was unable to share any claims data with regards to whether or not the company had received fewer claims for head injuries since the introduction of mandatory helmet wearing into its policies, Gardner was able to say that so far this season, the company has not paid out any large losses for head injuries sustained by its policyholders.
What can be done to make winter sports safer?
Take scuba diving – in order to scuba dive solo for the first time, one has to pass a series of quite rigorous tests and examinations, pass first aid courses, and undergo health screening. In order to ski solo, one simply has to buy the ski pass and rent the kit. Should it be this easy for people to put themselves in danger? Or, if they insist on putting themselves in danger, should there be mandatory third-party liability insurance sold as part of the ski lift package? Dadson of Snowcard pointed out another interesting facet of the problem – do the tour operators selling the skiing holidays to novices have a duty of care to insist they spend at least the first couple of days in a ski school to stop the newbies endangering themselves and others on the slopes? According to Bronwen Courtenay-Stamp, partner and head of the travel, tourism and insurance team at Stones Solicitors, it would be very difficult for ski tour operators to police their clients once they hit the snow – the companies are reliant on information provided by clients, who may not always be telling the whole truth about an incident. “Generally,” she said, “when booking a ski holiday, there is no onus to comment on skiing ability and even if a client booked a beginner’s pack, this would not necessarily mean that the client had no skiing experience at all. It would be impossible to place a duty of care on tour operators to ensure their clients go on ski lessons during their holiday, and tour operators would not want to take on the responsibility.” Courtenay-Stamp continued: “It is unlikely that a tour operator would be held responsible for the injury their client caused to another skier.”
Head injuries accounted for 19 per cent of all accidents on ski slopes
What about ski patrols? In Canada during the busiest seasons, there are marshalls patrolling the slopes whose job it is to discourage reckless behaviour and try to catch people who cause accidents and ski offwithout stopping. As Dadson points out: “It is probably time for Europe to deal with increasingly busy slopes.” Not to mention those skiers who have enjoyed one too many glühweins at lunch-time in the plethora of Alpine bars.
Reaching a consensus
The vast majority of analysis undertaken shows that helmets reduce the chance of serious injury being sustained by winter sports participants. They are not infallible, clearly, as people still suffer fatal accidents while wearing them; but when it comes to taking care of ourselves on the slopes, it seems pretty cut and dried that taking care means wearing a helmet. To bring the question back to the travel insurance industry, where small print throughout the policy dictates that the policyholder is not ‘reckless’ with their safety, will there come a time when people are considered reckless when they aren’t wearing a helmet? As the number of people choosing to go on skiing holidays continues to grow, hopefully there will be a generation shift that sees helmets becoming as ubiquitous on the slopes as garish clothes.