First published in ITIJ 100, May 2009
The tragic death of actress Natasha Richardson following a skiing accident has renewed a transatlantic debate over whether ski helmets should be made mandatory. Jenny Sims examines the arguments
Natasha Richardson was not wearing a ski helmet when she fell on a beginners’ slope in the luxury resort of Mont Tremblant, Canada, in March. She refused medical treatment at the time but was escorted back to her hotel by her ski instructor. An hour later she complained of a severe headache and was taken to the local hospital by ambulance. After being stabilized she was transferred by another ambulance to a major medical centre in Montreal, 50 miles away. The following day an ambulance took her to the airport where she was flown to a New York hospital where she died of a brain haemorrhage caused by a ‘blunt impact’ to the head.
Experts agree the 45-year old actress’s death was a ‘freak accident’ and there is no way of knowing whether a ski helmet would have saved her life. But ironically, only three weeks before, emergency care doctors in the resort had called for a meeting with the sports minister as part of their campaign to make wearing helmets mandatory in all Quebec ski resorts. Currently, helmets are only mandatory in areas designated for snowboarders
Some experts have suggested because Richardson initially refused treatment and was then transported by ground-ambulance instead of being flown by medevac helicopter. President of The Association of Air Medical Services (AAMS), Sandy Kinkade, said her death should serve as a caution to adventuring vacationers everywhere. AAMS would like ‘everyone to wear a helmet whenever engaging in sports-related activities that involve the risk of head injury, and to know the signs of traumatic brain injury’.
On the contrary, the research shows that, overall, people who wear helmets are more likely to die than those who don't.
Of the 14 deaths from head injuries in Quebec resorts between 1990 and 2004, 12 were not wearing helmets, according to the local coroner’s office. Richardson’s death may have strengthened the medics’ case, but resort operators oppose legislation because they say it would be difficult to police. Instead, they want to promote greater safety awareness among skiers and boarders.
This polarisation of views is mirrored across America and throughout Europe, and depends to a degree on people’s interpretation of various studies of ski deaths and injuries. Overall, helmets are more popular in the US, where according to the National Ski Areas Association, 43 per cent of all skiers and snowboarders wore helmets in the 2007-2008 season. Only Italy and southern Austria have introduced legislation to enforce the wearing of helmets.
Lead by example
Although all European ski schools insist children wear helmets, until recently only the Italian government had made this legally compulsory for all skiers under the age of 15. Then on 1March, the federal province of southern Austria also made it mandatory for under-15s. However, this move was triggered not so much by logical debate, but a much-publicised skiing fatality in Austria on New Year’s Day, when Dieter Althaus, prime minister of Thuringia, Germany, who was wearing a helmet, collided with a 41-year-old Slovakian mother of four, who was not wearing a helmet and later died. Charges have been brought against Althaus, who suffered head injuries in the accident, and ski helmets have soared in popularity in both Austria and Germany since.
The Ski Club of Great Britain says that though wearing a helmet reduces the risk of head injury by between 29 and 60 per cent, it does not reduce the risk of a ‘serious’ head injury. Alyn Morgan, club spokesman, explains: “At speeds over 20 kilometres per hour, it won’t make much difference. And the death rate has not declined as helmet use has risen.” These facts are borne out by a number of studies but some pro-helmet industry representatives seem either to be unaware of the fine detail, or have overlooked their significance.
Louise Doherty, spokesperson for TravelInsuranceGuide.com the insurance comparison website suggested: “It's likely that compulsory ski helmets would contribute to a fall in serious head injuries on the slopes, reducing costs to insurers and potentially allowing providers to reduce premiums for their customers.”
Richard Doubleday, sports director at Perkins Slade, a specialist sports insurance broker to over 250 governing bodies of sport and recreation throughout the UK, said: “It’s an irrefutable that if all skiers wore helmets there would be less serious injuries, but there has to be freedom of choice. No doubt if insurers could wave a magic wand they would have everyone wearing a helmet.”
Ben Smart, UK corporate and travel director for Mondial Assistance, believes: “Industry reports suggest that for every 10,000 people on the slopes on any particular day, no more than three people will sustain a head injury requiring medical attention. Out of all these people with head injuries, the majority (90 per cent) of the injuries are minor cuts and bruises. However, the fact remains that injuries sustained by the other 10 per cent are potentially much more serious and often deadly and therefore, it should go without saying that wearing a helmet will reduce the risk of injury.” He went on to state that offering a discounted premium on travel insurance for wearing a helmet is certainly worthy of industry consideration but would be subject to detailed analysis of claims data. And from my his personal experience, Smart says he would even extend this to body pads and impact vests, which help protect against back and spinal injuries from snowboarding. “But more crucially, the industry should be working together to ensure people actually take out insurance cover in the first place,” he concluded.
John Dacey, lifestyle claims manager at AXA, said: “Our view is that wearing helmets is a matter of freedom of choice. We believe skiers are informed of the risks, and we don’t make it a condition in our policies or have any plans to make wearing of helmets mandatory.” Meanwhile, Malcolm Tarling, spokesman for the Association of British Insurers, said they hadn’t yet entered the debate, adding: “In general, anything that serves as a precaution to reducing risk and improving safety is to be encouraged. However, if you are asking if we should decline assistance to people who don’t wear helmets the answer is no.” That would, indeed, be a draconian measure, and no-one appears to be suggesting it.
The UK’s leading expert on ski safety, Dr Mike Langran, an Aviemore GP, and board member of the International Society for Skiing Safety, summarised: “Helmets and head injuries are an emotive issue but I think it is important to stay objective and not make a knee jerk reaction without looking at the facts.” According to Langran, about 40 per cent of individuals worldwide now wear a helmet. In the US, where annually 55 million people take to the slopes, there is an average of 39 deaths a year, a rate of one per 1.4 million participants. And around three in every 1,000 ski enthusiasts require medical attention. “On the basis of facts, it is my personal view that we should encourage, but not force people to wear helmets,” he said.
Of the 14 deaths from head injuries in Quebec resorts between 1990 and 2004, 12 were not wearing helmets
Mike Welby, co-founder and director of Dogtag, the specialist sports insurer, said he sees more and more people wearing helmets every year. “Certainly there are more children wearing them, and as a parent it’s difficult to insist if you don’t wear one yourself.” He says that discussing helmet use is valuable in raising awareness of other major safety issues such as skiing dangerously because of alcohol or insufficient ski lessons. “If people are wearing helmets it’s a sign they are thinking of safety.” The Dogtag directors think eventually, through increased safety awareness, widespread wearing of helmets ‘will happen – like people stopping smoking’.
Chris Exall, wintersports consultant and expert witness, is absolutely certain that over the next 10 to 15 years more and more people will be wearing helmets. However, from his research into peer-reviewed global medical literature and other studies of ski accident deaths and injuries, he says the incontrovertible evidence is that helmets will not prevent someone dying if they have a hard impact head collision above a speed of 15 miles per hour. On the contrary, the research shows that, overall, people who wear helmets are more likely to die than those who don't. "That's because they are often young males: high-risk takers, skiing too fast or out of control, or boarders doing jumps in terrain parks," said Exall. "In light of the data, perhaps insurers should consider making helmet-wearers pay a 10 per cent premium," he added, tongue in cheek. A former ski racer, he added: "It's like driving a car. You need to look where you're going and avoid risky behaviour."
Fashion is also a factor in influencing the increased uptake of helmets. Exall warns that standards vary, though. "The best protection would be from a motorbike helmet, but these would be too heavy for most skiers and snowboarders." However, new materials’ technology is developing lighter weight solutions and manufacturers are experimenting with styles that include gadgetry from MP3 players to mobile phones. In fact, helmets are already ‘de riguer’ with many teenage boarders, freestyle skiers and paraskiers. New technology may well make the new generation of ski helmets just as ‘cool’ with the average recreational skier in the future – and no legislation to make helmets mandatory would be necessary.