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The Horse Has Left the Barn

Guest post by Dr. Karen Smith, Professor, Physical Medicine & Rehabilitation and Associate Dean, Continuing Professional Development

“The horse has left the barn”

This thought crosses my mind when I hear people talk about recognizing the signs and symptoms of concussion. This is not to minimize the importance of recognizing and responding appropriately when one occurs, something that could have helped rugby player, Rowan Stringer who died in 2013 after suffering 2 concussions within one week. Since 2015, Ontario has an education policy on concussion awareness, prevention, identification and management in publicly-funded schools in Ontario. In my opinion, however, we still need to maintain our vigilance towards prevention of concussion and there is much that can be done.

My clinical practice is in Physical Medicine and Rehabilitation, specifically acquired brain and spinal cord injury rehabilitation. In my almost 30 years of practice, I have felt at least some of my time needs to be spent trying to put myself out of business! That is why I have served on the Board of the Kingston Chapter of ThinkFirst for many years.  ThinkFirst was started by Canadian Neurosurgeon, Dr. Charles Tator, who had a vision to prevent injury in children and youth. ThinkFirst Canada has joined with Safe Communities Canada, SMARTRISK, and Safe Kids Canada to become a National charitable organization dedicated to preventing injuries and saving lives under the name Parachute.

The bottom line message in injury prevention is not to discourage but to encourage activity while practising safe behaviours including taking smart risks, wearing the right gear, getting trained, driving sober (which includes any substances as well as not driving while distracted, angry or sleepy).

The three pillars of injury prevention can be described as the 3 E’s: Education, Environment and Enforcement. Education includes providing evidence informed recommendations on safe play, use of appropriate safety equipment, concussion recognition and management amongst many others.  Environment refers to how the built environment can reduce injury such as bicycle lanes that are totally separate from other vehicular traffic.  Enforcement refers to the bringing in laws and regulations to reduce injury such as the mandatory wearing of helmets under age 18 in Ontario, child seat legislation and others.

“Research shows that a properly fitted helmet can decrease the risk of serious head injury by over 80 percent. Head injury rates among children and youth cyclists are about 25 per cent lower in provinces with helmet laws, compared to provinces without. Only four provinces in Canada currently have cycling legislation in place that cover all ages. Legislation, in conjunction with ongoing education and enforcement programs, is necessary to make helmet use the norm. Both helmet use and cycling should be promoted to keep kids healthy, active and safe.”  www.parachute.org/policy/item/246

With all this evidence supporting the use of helmets, the coordinator for our Kingston Chapter of ThinkFirst spent one hour at the corner of Union St and University Ave one fine October morning from 11:15 am until 12:15 pm.  He counted the number of students on bicycles and on skateboards and counted the number of students wearing helmets.  None of the 18 students on skateboards were wearing any helmet! The recommended helmet for skateboards is a multiple impact helmet which gives more protection to the back of the head than a bicycle helmet.

Only 22 of the 140 students on bicycles were wearing a helmet!  That means 86 % of students were not wearing a helmet. Eighty-six percent of this great University’s future leaders, innovators and scholars are not protecting their greatest asset…….their brain.

There are many helmets available for bicycle riding and they do not need to be the top of the line or the most expensive ones to give protection from lacerations and brain injury.  They should be certified and you can look for a number of different logos as evidence that the helmet has been tested including Canadian Standards Association (CSA) among others.  Also the helmet needs to fit properly. Fitting and safety standards can be found on the following website.  http://www.parachutecanada.org/active-and-safe/item/engineering-equipme…

If you are under 18 years of age helmets are required by law and you risk a fine if you are not wearing one.  In addition, there are a number of other guidelines ands regulations that you should be aware of such as the use of lights, reflectors, bells and rules of the road.

If you can’t afford a helmet or you’ve recently dropped or damaged yours or you just don’t know where to get one in Kingston…….please contact our office at thinkfirst.kingston@gmail.com  or maybe you are interested in helping us reach out to the children and youth in our region. We have worked over the years with a number of bright and engaging Queen’s students from a variety of Faculties, your passion is always welcomed. Just remember if you ride your bike to come meet with us……….wear your helmet.

Michael Storr

Thu, 06/22/2017 - 12:51

As I drove into work today, I bravely traversed the intersections of Albert/Earl, Earl/University and Division/Union. I am not surprised at the 86% figure of helmet use described as I saw no one with helmets.The behaviour of cyclists is a factor. None of them even pause at 4 way stops. It would be valuable to do a survey as to how many cyclists know, under Ontario’s Highway Traffic Act (HTA), a bicycle is a vehicle, just like a car or truck.
From the MTO website:
Cyclists
-must obey all traffic laws
-have the same rights and responsibilities as drivers

PS I have never seen the law enforced

Michael Storr

Ray Viola, MD, Palliative Medicine

Thu, 06/22/2017 - 12:52

Thanks, Karen. It amazes me beyond comprehension when I see a family riding their bikes together and the children are wearing helmets, but the parents are not. Who is the role model?

Ray Viola, MD, Palliative Medicine

Suzanne Maranda

Thu, 06/22/2017 - 12:52

I’ve only once fallen in the street when a roller-blader ran into my bicycle – she turned abruptly without looking. We were not going fast, and did not get hurt – but I sure was happy that my helmet stopped my glasses from breaking into my face. I would encourage everyone, not just the younger than 18 years old to wear a helmet. Thank you Karen for all the prevention work. Safe riding!

Suzanne Maranda

Karen

Thu, 06/22/2017 - 12:52

Thank you for your replies. I agree. Part of our goal locally is to provide and fit helmets for children and youth in our region. We hope to make wearing a helmet a habit or second nature…..kind of like riding a bike!

Karen

Chris Frank

Thu, 06/22/2017 - 12:52

Different sports have different cultures- mountain biking culture is such that you would never go on the trails without a helmet and it is a given that you will be harassed by other riders if you don’t. Street bikes at the concrete skate parks rarely wear them Understanding how that culture shift happens for one activity and not for a closely related one may help improve uptake for riding around town on a board or a bike.

Chris Frank

Stephen McNevin Meds 80

Thu, 06/22/2017 - 12:53

When I was in my final year of residency at the University of Manitoba I was cycling to work one day when I ran into a car going the wrong way on a one way street.I got an ambulance ride to work that day and have a legitimate sounding excuse for my poor handwritting but what I most remember is the sound of the resounding crack of my helmet as it smacked into the pavement instead of my head. Helmets save lives!

Stephen McNevin Meds 80

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