Safety on the Slopes

Safety on the Slopes

By Dr. Christopher Magovern

Skiing and snowboarding are two of the most popular sports in this country.  It’s estimated that 9.9 million Americans hurtle down snow-covered slopes every year — and anyone who skis or boards knows that falling is an accepted part of the learning curve for beginners, and an inevitable event among even the most experienced of skiers and boarders.

Thankfully the risk of injury is low.  The risk of being injured on the mountain is 1 in 500, the risk of sustaining a serious head injury is 1 in 5,000, and the risk of being killed on the mountain is 1 in 1 million. In this regard, skiing and snowboarding are safer sports than bike riding or swimming.

Nonetheless, head injuries can and will occur on the mountain, so it is important to take steps to prevent an injury and to know what to do if an injury occurs.  The most common head injury occurs from falling and hitting the snow or ice.  This is a particularly common injury for beginner skiers or boarders.  Skiers usually strike the side of their heads, and boarders usually strike the back of their heads.  Another, more dangerous injury occurs from colliding with a stationary object, commonly another skier or a tree.
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In an effort to limit head injuries on the mountain, your goals should be to: 1) prevent these sorts of falls in the first place, 2) decrease your risk of head injury by wearing a helmet, and 3) if you do sustain a head injury, be able to recognize the symptoms and know when to seek medical attention.

The first line of defense against head injuries is to ski responsibly — that means always ski under control. When you stop, make sure you’re in a spot where others can see you, and stay away from trees, unless you really know what you’re doing — they’re unforgiving.

The second line of defense is to wear a helmet.  Can wearing a helmet make a difference? You bet it can.  A helmet will reduce the risk of head injury, but it won’t make you invincible.  What we’ve learned about wearing helmets is that it will decrease your risk of head injury by 20 percent to 50 percent, it can mean the difference between a major head injury and a minor head injury, and it can mean the difference between a minor head injury and no injury at all.

Do helmets have limitations? Of course they do. If you’re barreling down the mountain at 60 mph like Franz Klammer, injuries you sustain in a fall may overwhelm the protective capabilities of a helmet.

The average recreational ski or snowboarding helmet is designed to provide protection when skiing at speeds of less than 15 mph.  Because it is common for skiers and boarders to reach speeds of 25-40 mph on some intermediate trails, recognize that, at these speeds, a helmet may not provide complete protection.  For a helmet to provide proper protection at those speeds, it would have to be 7 inches thick, 20 inches wide, and weigh 10 pounds … and that’s simply unrealistic.

The bottom line is that although helmets cannot provide ultimate protection for all falls, they will prevent or lessen the degree of head trauma for most falls — and because there’s no good reason not to wear a helmet, just strap one on.

In the past, one of the biggest reasons not to wear a helmet was that it was perceived as being “uncool.”  Today that is just the opposite; you look “cooler” with a helmet.

More and more Americans are wearing helmets when they ski or snowboard.  In some ways, it took a tragedy to bring the importance of wearing helmets to the forefront of the American public.  In 1998, within days of each other, Michael Kennedy and Sonny Bono both died as a result of head injuries they sustained while skiing. Both of them hit trees. Neither of them were was wearing a helmet.

These events revolutionized the ski helmet industry.  Ten years ago, virtually nobody wore ski helmets; five years ago, 25 percent of skiers wore helmets. Today, more than 60 percent of skiers and boarders wear helmets, including 80 percent to 90 percent of children.  The most underrepresented population continues to be 18-24-year-olds, who wear helmets only 48 percent of the time.

In order to get the most protection from your helmet, it’s important that it fit properly.  First of all, never use a bicycle helmet or skateboarding helmet; they are not designed for skiing or snowboarding. Your helmet should be snug, but not tight. As parents, many of us “hand down” clothing and athletic equipment to our younger children; use caution when doing this with helmets, as a helmet that is too big won’t provide proper protection. A helmet isn’t something that your child should “grow into.” Finally ensure that your chinstrap is always fastened securely.

As recently as 2011, 46 states in this country had motorcycle helmet laws, 37 states had bicycle helmet laws, and not a single state had any law mandating the use of helmets on the slopes. Our European colleagues have been ahead of us in this regard — in 2009, Austria mandated that all children less than 14 years old must wear helmets.

But things are changing; in April 2011, Gov. Chris Christie of New Jersey signed a bill that mandates that children less than 18 years old must wear helmets while skiing or snowboarding or their parents will face fines that range from $25-$50.  Similar legislation is pending in New York.

Finally, the last line of defense against head injuries on the mountain is to be able to promptly recognize an injury when it occurs, so treatment is not delayed.  There is no better story to tell than that of film star Natasha Richardson, to reinforce the importance of this.

In 2009, Natasha Richardson was skiing in Canada and fell on a beginner trail. She hit her head. She was not wearing a helmet.  Initially she felt fine; she returned to her hotel room, but developed a headache. By the time she eventually sought medical attention, she lapsed into a coma and ultimately died.  Neurosurgeons have speculated that she might be alive today if:  1) she had been wearing a helmet, and 2) her symptoms had been recognized earlier.

This tragedy underscored the importance of recognizing the symptoms of head injury before it’s too late.  These symptoms include being knocked unconscious, drowsiness, confusion, garbled speech, inability to walk, vomiting, or headache.  Remember that these symptoms might occur immediately, or may not present for hours after the event.

Natasha Richardson’s tragedy, like that of Michael Kennedy and Sonny Bono, woke up the public to the importance of safety on the slopes.  In the year following Richardson’s death, helmet sales in the United States soared 23 percent, and emergency room physicians in Canada reported a 30 percent increase in evaluations for head trauma — not because there were more injuries, but because there was now a heightened awareness of the symptoms of a potential head injury.

Skiing and snowboarding are great sports … in fact they are among my family’s favorites.  As you can see from the above, with a few small safety precautions, everyone can have fun of the slopes.  See you on the mountain.

Dr. Christopher Magovern is an ABC News contributor and a cardiac surgeon at Morristown Medical Center in Morristown, N.J.

Safety on the Slopes

Safety on the Slopes

By Dr. Christopher Magovern

Skiing and snowboarding are two of the most popular sports in this country.  It’s estimated that 9.9 million Americans hurtle down snow-covered slopes every year — and anyone who skis or boards knows that falling is an accepted part of the learning curve for beginners, and an inevitable event among even the most experienced of skiers and boarders.

Thankfully the risk of injury is low.  The risk of being injured on the mountain is 1 in 500, the risk of sustaining a serious head injury is 1 in 5,000, and the risk of being killed on the mountain is 1 in 1 million. In this regard, skiing and snowboarding are safer sports than bike riding or swimming.

Nonetheless, head injuries can and will occur on the mountain, so it is important to take steps to prevent an injury and to know what to do if an injury occurs.  The most common head injury occurs from falling and hitting the snow or ice.  This is a particularly common injury for beginner skiers or boarders.  Skiers usually strike the side of their heads, and boarders usually strike the back of their heads.  Another, more dangerous injury occurs from colliding with a stationary object, commonly another skier or a tree.
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In an effort to limit head injuries on the mountain, your goals should be to: 1) prevent these sorts of falls in the first place, 2) decrease your risk of head injury by wearing a helmet, and 3) if you do sustain a head injury, be able to recognize the symptoms and know when to seek medical attention.

The first line of defense against head injuries is to ski responsibly — that means always ski under control. When you stop, make sure you’re in a spot where others can see you, and stay away from trees, unless you really know what you’re doing — they’re unforgiving.

The second line of defense is to wear a helmet.  Can wearing a helmet make a difference? You bet it can.  A helmet will reduce the risk of head injury, but it won’t make you invincible.  What we’ve learned about wearing helmets is that it will decrease your risk of head injury by 20 percent to 50 percent, it can mean the difference between a major head injury and a minor head injury, and it can mean the difference between a minor head injury and no injury at all.

Do helmets have limitations? Of course they do. If you’re barreling down the mountain at 60 mph like Franz Klammer, injuries you sustain in a fall may overwhelm the protective capabilities of a helmet.

The average recreational ski or snowboarding helmet is designed to provide protection when skiing at speeds of less than 15 mph.  Because it is common for skiers and boarders to reach speeds of 25-40 mph on some intermediate trails, recognize that, at these speeds, a helmet may not provide complete protection.  For a helmet to provide proper protection at those speeds, it would have to be 7 inches thick, 20 inches wide, and weigh 10 pounds … and that’s simply unrealistic.

The bottom line is that although helmets cannot provide ultimate protection for all falls, they will prevent or lessen the degree of head trauma for most falls — and because there’s no good reason not to wear a helmet, just strap one on.

In the past, one of the biggest reasons not to wear a helmet was that it was perceived as being “uncool.”  Today that is just the opposite; you look “cooler” with a helmet.

More and more Americans are wearing helmets when they ski or snowboard.  In some ways, it took a tragedy to bring the importance of wearing helmets to the forefront of the American public.  In 1998, within days of each other, Michael Kennedy and Sonny Bono both died as a result of head injuries they sustained while skiing. Both of them hit trees. Neither of them were was wearing a helmet.

These events revolutionized the ski helmet industry.  Ten years ago, virtually nobody wore ski helmets; five years ago, 25 percent of skiers wore helmets. Today, more than 60 percent of skiers and boarders wear helmets, including 80 percent to 90 percent of children.  The most underrepresented population continues to be 18-24-year-olds, who wear helmets only 48 percent of the time.

In order to get the most protection from your helmet, it’s important that it fit properly.  First of all, never use a bicycle helmet or skateboarding helmet; they are not designed for skiing or snowboarding. Your helmet should be snug, but not tight. As parents, many of us “hand down” clothing and athletic equipment to our younger children; use caution when doing this with helmets, as a helmet that is too big won’t provide proper protection. A helmet isn’t something that your child should “grow into.” Finally ensure that your chinstrap is always fastened securely.

As recently as 2011, 46 states in this country had motorcycle helmet laws, 37 states had bicycle helmet laws, and not a single state had any law mandating the use of helmets on the slopes. Our European colleagues have been ahead of us in this regard — in 2009, Austria mandated that all children less than 14 years old must wear helmets.

But things are changing; in April 2011, Gov. Chris Christie of New Jersey signed a bill that mandates that children less than 18 years old must wear helmets while skiing or snowboarding or their parents will face fines that range from $25-$50.  Similar legislation is pending in New York.

Finally, the last line of defense against head injuries on the mountain is to be able to promptly recognize an injury when it occurs, so treatment is not delayed.  There is no better story to tell than that of film star Natasha Richardson, to reinforce the importance of this.

In 2009, Natasha Richardson was skiing in Canada and fell on a beginner trail. She hit her head. She was not wearing a helmet.  Initially she felt fine; she returned to her hotel room, but developed a headache. By the time she eventually sought medical attention, she lapsed into a coma and ultimately died.  Neurosurgeons have speculated that she might be alive today if:  1) she had been wearing a helmet, and 2) her symptoms had been recognized earlier.

This tragedy underscored the importance of recognizing the symptoms of head injury before it’s too late.  These symptoms include being knocked unconscious, drowsiness, confusion, garbled speech, inability to walk, vomiting, or headache.  Remember that these symptoms might occur immediately, or may not present for hours after the event.

Natasha Richardson’s tragedy, like that of Michael Kennedy and Sonny Bono, woke up the public to the importance of safety on the slopes.  In the year following Richardson’s death, helmet sales in the United States soared 23 percent, and emergency room physicians in Canada reported a 30 percent increase in evaluations for head trauma — not because there were more injuries, but because there was now a heightened awareness of the symptoms of a potential head injury.

Skiing and snowboarding are great sports … in fact they are among my family’s favorites.  As you can see from the above, with a few small safety precautions, everyone can have fun of the slopes.  See you on the mountain.

Dr. Christopher Magovern is an ABC News contributor and a cardiac surgeon at Morristown Medical Center in Morristown, N.J.

January 23, 2012 • 6:33 pm • Comments Off

Don’t hit the slopes without a helmet, experts warn

Don’t hit the slopes without a helmet, experts warn

By Karen Kaplan, Los Angeles Times

February 11, 2011, 3:44 p.m.

Professional skiers and snowboarders wear helmets. And if you don’t wear one too, you’re running out of excuses.

So say a trio of researchers from the University of Innsbruck’s Department of Sport Science in Austria. Writing in an editorial this week in the British Medical Journal, they weigh the pros (many) and cons (few) of wearing protective headgear on the slopes.

Emergency room doctors and ski patrol rescuers say that between 9% and 19% of skiing and snowboarding injuries are head injuries. What’s more, a report last year in the Canadian Medical Assn. Journal found that traumatic brain injury “is a leading cause of death among winter sports participants,” according to the editorial.

The researchers considered several arguments against wearing helmets and refuted them in turn. Here are their arguments:

Wearing a helmet will reduce my field of vision: A randomized, controlled study compared the average reaction time of people wearing ski helmets and people who wore plain old ski caps, and there was no difference between the two groups. (However, people who wore ski goggles had slower reaction times, suggesting that this popular piece of gear limits one’s visual field, and people don’t seem to mind too much about this.)

Wearing a helmet will entice skiers and snowboarders to take greater risks: If helmets give people a false sense of security about their safety, perhaps they will take risks that wind up making them worse off than they started, the theory goes. However, studies have shown that while risk-takers do travel faster on the slopes (33 miles per hour versus 28 mph in one study), skiers and snowboarders in both groups are equally likely to wear helmets (59.2% versus 59.7%). What’s more, skilled skiers were more likely to wear helmets, though skilled skiers who considered themselves risk-takers wore helmets at about the same rate (29.8%) as those who did not (30.2%).

Wearing a helmet will make it harder for me to hear another skier coming my way: In fact, one out of every 10 injuries involves a collision between multiple skiers (90% occur when skiers hit their heads on snow, trees or other fixed objects). In addition, a study last year in the Clinical Journal of Sport Medicine found that while people wearing helmets could not hear the whoosh of a nearby skier or snowboarder, they had no trouble hearing voices, including warnings shouted by others.

Wearing a helmet will increase the risk of an injury to the cervical spine: This theory is put forward because the helmet increases the ratio of head-to-body weight, especially in children. But two studies published last year debunked this notion.

Need more convincing? The study from the Canadian Medical Assn. Journal found that skiers and snowboarders who wore helmets were 35% less likely to sustain a head injury than their helmet-less counterparts, and for kids younger than 13, the rate of head injuries was reduced by 59%.

March 2, 2011 • 11:39 am • Comments Off

If you wear a helmet, ski or snowboard as if you’re not wearing one.

If you wear a helmet, ski or snowboard as if you’re not wearing one.

By Jasper E. Shealy, PhD (updated Feb 2011)

Jasper Shealy, PhD, has been studying ski injuries for 40 years and snowboard injuries for 25 years. His interest in head injuries in skiing and helmets stems from the Sugarbush Resort in Vermont, where he has been a co-researcher with Dr. Robert Johnson and Carl Ettlinger for more than 30 years. Dr. Shealy is currently the vice-chair of the ASTM F27 Committee for snow skiing, and is a U.S. technical delegate for International Standards Organization (ISO) standards relating to snow skiing.

The use of helmets in alpine sports is on the rise. As of 2009/10 season 57% of all skiers and snowboarders used a helmet. We know that helmets can be an effective means of reducing the potential severity of a head injury if the wearer is struck in the head, or if the head strikes something. As a person who has devoted the majority of my professional life to research aimed at making skiing safer you might think that I would be happy with the trend of increased helmet use. Well I am, but I do have a few reservations. Why, you might ask, do I have reservations about more skiers using helmets on the slopes? Let me tell you why. The answer is complex and perplexing.

A little known and poorly appreciated fact is that helmets may not be as effective as you might think. By virtue of the design of helmets, they are more effective at preventing, or moderating skull fractures (0.1 percent of all skiing injuries) than concussions (2.4 percent of all skiing injuries). Alpine sports helmets have a hard outer shell that serves to blunt the concentration of force that is characteristic of a fracture. The helmets typically have a relatively soft inner liner that serves to cushion the blow and thus reduce the severity of the deceleration that the brain experiences. The evaluation criterion used by ASTM (others are similar) usually involves measuring the impact deceleration resulting from a free drop of 2.0 m, (which is equivalent to 14.1 miles per hour) onto a solid fixed object. The headform (equivalent to your brain) impact attenuation requirement is that the deceleration should not exceed 300 g. Most medical authorities believe that significant brain damage will begin to occur at about 150 g and go up from there; by 250 g, serious brain injury is practically a certainty. That is a modest level of protection given that the average maximum speed of skiers and riders on well groomed blue cruiser trails (where most of the fatalities take place) is on the order of 27 mph. It is clear that a helmet is not a panacea, particularly if the threat is that of a head impact with a tree on the margins of the trail (the most common fatality scenario).

Numerous studies show that increased use of a “safety device” like a helmet can alter the behavior of the user and in some cases may even ultimately lead to the unintended consequence of increased overall injuries in the long run. Insurance underwriters and actuaries use a term “moral hazard” to describe the behavior of humans, when they do things that they might not do if they did not have insurance, such as building houses on flood plains or on hurricane-prone coastal zones. This same behavior has been noted in virtually all areas of human endeavor. In general, when the cost (financial or physical risk) of some activity is reduced, there is a tendency on the part of human to be less careful in the pursuit of that activity. If padding, helmets and body armor in ice hockey reduces the perceived cost of playing in a very aggressive manner, players will increase the level of aggressive play. Since helmets and other protective gear became mandatory in the 1970s, the number of catastrophic injuries in ice hockey has increased dramatically. Numerous examples abound to demonstrate this point. Cars equipped with antilock brakes systems (ABS) are involved in more single car collisions than cars without ABS. Not because cars equipped with ABS are less capable, but because humans drive cars equipped with ABS differently than cars without ABS.

The U.S. Consumer Product Safety Commission (CPSC) has found to their dismay that as the use of helmets for bicyclists went from less than 18 percent in 1991 to 50 percent in 1998, the per capita rate of head injuries increased (not decreased) by 50 percent over that same period of time. This finding certainly contradicts the logical notion that increased use of bicycle helmets would result in decreased number of head injuries. In 1999 the CPSC predicted that if all skiers used a helmet there would not be any head related fatalities in skiing. The fact of the matter is that the rate of fatalities in skiing has not changed from the time when virtually no one wore a helmet to the present time (2010) when almost 60% of the population uses a helmet. Among the fatally injured skiers, the helmet utilization is equal to or greater than the general population. Head injury deaths do occur to helmeted skiers and riders. This is stark evidence that the circumstances of the typical fatality scenario is so violent that it overwhelms any mitigating benefit the helmet might have; not that helmets are not a good idea, they just have significant limitations.

In our studies of potentially serious head injuries in skiing, we have unfortunately seen much the same result. In our study at Sugarbush Resort, a ski area in Vermont, the use of helmets has increased from virtually zero prior to 1995, to approximately 75 percent today (2009/10). While we have seen a decrease in the number of head injuries for helmeted and versus non-helmeted skiers, we have noticed that the severity of the head injury is higher for helmeted skiers that non-helmeted. For non-helmeted skiers, only 23 percent of all potentially serious head injuries are more serious than a mild concussion. For helmeted skiers, 67 percent of their potentially serious head injuries are more severe than a mild concussion. This is due in part to the fact that a helmet essentially rules out several classes of head injury, for example there are no scalp lacerations or skull fractures to helmeted skiers; the overall risk of any injury above the neck has gone down by about 30%. We have also found that helmeted skiers ski faster than non-helmeted skiers, this is true for our control group, it is true for all injuries, and it is true for those skiers sustaining potentially serious head injuries. We cannot say that wearing a helmet makes you ski faster (it may be that people who tend to ski fast are the ones who buy and use helmets). Clearly in our study, the helmeted skiers are sustaining a disproportionate number of the truly serious head injuries, i.e., the moderate to severe concussions, and closed head injuries. From a biomechanical perspective, it is obvious that the users frequently find themselves in a situation where the simple use of a helmet is not enough to prevent serious head injury. Perhaps they are skiing too fast for the circumstances, or taking chances that are ill advised. Maybe they feel that the use of the helmet permits them to engage in activities that they might not engage in if they were not wearing a helmet (skiing in the trees) or at a higher level (skiing faster) than they might otherwise choose. A false, or exaggerated, feeling of security can lead to people increasing their level of risk-taking. This off-setting behavior, especially in young skilled males, appears in skiing and snowboarding to negate to some degree the benefits of wearing a helmet.

What can we take away from this lesson? If you are going to wear a helmet, ski and ride as if you aren’t wearing one. Don’t alter your behavior, don’t take more risks or ski or ride faster because you’re outfitted in a helmet. Make sure that you remain in control and ski and ride responsibly.

Finally, it is important to keep head injuries in perspective. The incidence of serious head injuries in alpine skiing and snowboarding is not as frequent as you might think. During the past 29 seasons in our study, only 2.6 percent of all medically significant injuries in skiing are what we call a potentially serious head injury (PSHI). PSHI’s are defined as any diagnosed concussion, skull fracture, closed head injury, and/or death due to head injury. Of that 2.6 percent, 0.1 percent are skull fractures, 2.4 percent are concussions, and the other 0.1 percent is everything else that has the potential for serious neurological damage. To put this in a context, the comparable figure for bicycles is 32 percent. 32 percent of all injuries to bicyclists that are treated in hospital emergency rooms would meet our PSHI criteria. While the risk of a PSHI in skiing is not zero, nothing in life is risk free. If you are not part of the truly high risk group, i.e., relatively young (late teens to early forties) adult male skiers who are at least intermediate or better in ability, your risk of such an injury is really quite low.

In my opinion, the use of a helmet is an effective part of an individual program to increase one’s safety on the slope. The use of a helmet should only be done if it part of an overall program, and under no circumstances should the use of the helmet be allowed to adversely affect the behavior of the user. Most important, do not have unrealistic expectations as to what a helmet can do, and ski safely and responsibly. Again, wear a helmet, but ski and snowboard as if you aren’t wearing one! I wear one, and would not go skiing without one, so should you.

• 10:58 am • Comments Off
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