Response to comments about a crash involving a cyclist and a van

Since we published an article about a collision between a small van and a bicycle, a number of people have asked questions via social media about the contents of the article. We have also spoken to the family of the teenager about the issues raised.

Let us be very clear, it is not our intention to blame anyone, cyclist or van driver. If that it is how it is being perceived, then we apologise. We were certainly not in any way whatsoever trying blame the teenager for being injured in this incident. We are simply trying to highlight that collisions like this do occur and if there is something simple that can be done to minimise the level of injury then, we would aim to highlight this as it may, at some point in the future, reduce the injury to someone else. We apologise if any distress has been caused to the patient or his family.

Over recent weeks we have used social media extensively to advise drivers of keeping vehicle windscreens free of ice when setting off on frosty mornings to improve the chances of seeing other road users and the dangers of drink driving including the morning after a night out. Equally we have asked other road users to be mindful of each other.

In terms of advice relating to cycling and the use of cycle helmets, we base our advice on current available evidence and expert opinion. Although the efficacy of helmet use is often debated, the evidence for protective benefit is strong. Multiple observational studies support a protective advantage after collision, as increasing helmet use is associated with a decline in bicycle-related head injuries. Helmets appear effective at preventing minor head injuries further supporting our stance (1-4). This has been borne out in American, French and British studies, even when serious head injury and collision with motor vehicles are analysed.

We realise that critics suggest that helmet use is without merit and may lead to a decline in cycle use and loss of the associated health-related benefits. However, a recent Cochrane Database review supports the use of standardised regulated helmet use for all forms of cycling citing significant injury prevention in the higher quality studies and noting the lack of evidence to support arguments that helmet use causes significant decline in bicycle ridership.( 5-6)

We do note that the current UK infrastructure does not lend itself to safe cycle use and it is widely accepted that dedicated cycle areas separated from motor vehicles would vastly reduce the burden of injury and therefore the need for helmet use. Denmark and Holland are examples of such innovation and have proven this to be the case. A similar trial is currently underway in London on Exhibition Road, which has seen just one cycle accident in four years, and this involved two cyclists riding into each other. However, taking the current road and cycle network within the West Midlands and the United Kingdom into account, the best available evidence continues to point towards the use of cycle helmets protecting riders from facial injuries and minor to moderate, often life-changing brain injuries. Whether or not helmets protect from the most severe injuries is less clear.

There was a session at the 2014 London Trauma Conference dedicated to cycling, with speakers including a professional cyclist who works as a neurosurgeon, the lead of the London Hospitals Trauma Network and RoSPA. WMAS attended this conference and the discussions firmly supported our stance on the use of cycle helmets.

In summary, WMAS aims to provide rounded and relevant advice to the population of the West Midlands without discriminating against any particular group. This advice is wherever possible based on published research and evidence and our position on cycle helmet use falls well within these aims.

References:
1. Amoros E et al. Bicycle helmet wearing and the risk of head, face and neck injury; a French case-control study based on a road trauma registry Inj Prev 2012; 18(1): 27-32

2. Powell EC and Tanz RR. Cycling injuries treated in Emergency Departments: a need for bicycle helmets among pre-schoolers Arch Pediatr Adolesc Med 2000; 154 (11): 1096-1100

3. Cook A, Sheikh A. Trends in serious head injuries among English cyclists and pedestrians Inj Prev 2003; (9) 266-267

4. Castle SL et al. Bicycle helmet legislation and injury patterns in trauma patients under 18. J Surg Res  2010; 173 (2): 327-331

5. Thompson DC et al. Helmets preventing head and facial injuries in bicyclists. Cochrane Database Systematic Review 2000; 2)CD001855

6. MacPherson A and Spinks A. Bicycle helmet legislation or the uptake of helmet use and prevention of head injuries. Cochrane Database Systematic Review 2008; 3)CD005401

It would be better to concentrate on stopping crashes such as this happening:
We quite agree that stopping crashes happening would be the best option as people would not end up injured in the first place. In the past, we have issued advice to both drivers and cyclists about how to reduce the chances of a collision occurring. Within the article we stress that all road users should respect each other.

Why aren’t we commenting on the driving standards:
How the collision came to pass is something that we are not able to comment on as this is a matter for our colleagues in the police to determine. We were not there when it happened, therefore we try very hard not to apportion blame to any party involved, and instead concentrate on the work that our staff do.

Why don’t you say who was at fault / You are presuming it is the cyclist’s fault:
As per the above, it is not for us to say whose fault it was – driver or cyclist

You haven’t commented on the ‘rubbish’ on the dashboard of the van:
As above, this is not an area that we are able to comment on.

Why don’t you call for ‘Dutch’ style cycling facilities:
There is no doubt that the facilities for cyclists in Holland and Denmark are, in general, superb. The fact that the law means drivers have to give way to cyclists holds many benefits from a safety perspective. We would fully support moves to improve facilities for cyclists be that more dedicated cycle lanes or indeed separate cycle paths. Cycling has huge potential health benefits and improved safety arrangements would only encourage more cycling. It could also lead to less congestion on our roads which would further improves safety.

You are making up evidence or relying on hearsay to back up your support of helmets:
We hope that the above commentary with supporting references to academic papers will provide you with our reasoning behind our belief that wearing a helmet is a good thing.

We hope this covers off most of the comments made via social media and also gives an indication as to why we support the use of cycle helmets.

Once again, we would apologise to the patient and his family if, by drawing attention to the incident he was involved in to support our road safety message, we have in any way caused distress.

RRV car 1

Written by officialwmas

West Midlands Ambulance Service (WMAS) covers a geographical area of approximately 5,000 square miles and serves a population of 5.6 million people living in Shropshire, Herefordshire, Worcestershire, Coventry & Warwickshire, Staffordshire and the Birmingham & the Black Country conurbation. The Trust has a total number of 4000 members of staff and uses 864 vehicles.

2 comments

  1. Who is writing this stuff? You thought it would be sensible to get someone to lecture on road safety who doesn’t know what’s happened at Exhibition Road and who thinks Holland is a country?

    It’s about safety, right? So, since 25% of TBI injuries are suffered by the occupants of motor vehicles when will you endorse helmets for anyone who gets in a motor vehicle? This would prevent twenty times as many head injuries. So why are you picking on cyclists? The risk PER MILE of a head injury is the same for cyclists and pedestrians, so when will you endorse helmets for pedestrians? These are genuine questions, I know you delete comments but it’s about safety, right?

  2. I suspect the trouble with reviewing a medical database on this is that they are all involving data on injuries, they cannot account for the affect wearing a helmet can have in the possibility of becoming involved in a crash the first place. Drivers can take more risks around those they think are protected.

    A comprehensive study taking into account this is probably impossible, however we can say for certain that the only societies with high levels of bicycle usage among all parts of the population also see low helmet usage.

    Without commenting on the driving standards and putting yourself at legal risk, it could be perfectly fine to push for higher standards of investigation around traffic incidents involving injury to vulnerable road users. There is tremendous difficulty on this as most people drive in this country, everybody can put themselves into the shoes of the driver in the case of an accident.

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