Cyclist injury data before and after
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Western Australia's compulsory bike helmet law was enforced from July 1992. As outlined in the March 2005 issue of the Health Promotion Journal of Australia (PDF 88kb), the number of regular cyclists in Western Australia almost doubled between 1982 and 1989 from 220,000 to 400,000. During this time, the numbers of cyclists admitted to West Australian hospitals and reported deaths and serious injuries per 10,000 regular cyclists fell by 48% and 33% respectively. In 1993, the year after helmets became mandatory for cycling, total recorded cyclist injuries almost doubled, partly due to improved hospital coding, and have since been rising steadily to reach consecutive records in 1997, 1998, 1999 and 2000. Total cyclist head injury figures were higher in 1995 and 1996 than during any year before the law was introduced, an exception being 1988, and the proportion of cyclist upper body injuries almost doubled between 1988 and 2000. Females represented 30% of the 630 cyclists admitted to West Australian hospitals in 1987. In 2000, females represented 20% of the 913 cyclist hospital admissions. |
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The proportional drop in female hospital admissions began in 1992, the year of law enforcement, adding to anecdotal evidence that women in particular are dissuaded from cycling because of helmets. The Health Promotion Journal of Australia reported in 2003 that Australia has a disproportionately low number of female cyclists (PDF 228kb). Read more about female cycling numbers.
Police statistics also show a marginally higher proportion of helmet wearing crash victims required hospital treatment, compared to those not wearing a helmet. Pre and post law comparisons of WA serious head injuries and fatalities of cyclists (PDF 32kb) can be made based on the following data from the WA Morbidity Data Base given to the Legislative Assembly of the West Australian parliament on June 27 2000 by then WA Transport Minister Murray Criddle: WA adult cyclist serious head injuries - 5 year comparison pre law / with law Pre law - Average annual number of serious head injuries to WA adult cyclists aged 16 and over 1987/88 to 1991/92 = 18.4 With law - Average annual number of serious head injuries to WA adult cyclists aged 16 and over 1992/93 to 1995/96 = 14.8 This is a reduction of 19.5% (Bridge surveys show cyclist decline of 25-30%) WA juvenile cyclist serious head injuries - 5 year comparison pre law / with law Pre law - Average annual number of serious head injuries to WA juvenile cyclists aged 15 or under 1987/88 to 1991/92 = 13.8 With law - Average annual number of serious head injuries to WA juvenile cyclists aged 15 or under 1992/93 to 1995/96 = 9.6 This is a reduction of 30.5% (more than 50% decline in schoolchildren cycling from 91 to 96 according to Bikewest) WA adult cyclist fatalities - 7 year comparison pre law / with law Pre law - Average annual number of fatalities to WA adult cyclists aged 16 and over 1985/86 to 1991/92 = 4.2 With law - Average annual number of fatalities to WA adult cyclists aged 16 and over 1992/93 to 1998/99 = 4.7 This is an increase of 12% (Bridge surveys show cyclist decline of 25-30%) WA juvenile cyclist fatalities - 7 year comparison pre law / with law Pre law - Average annual number of fatalities to WA juvenile cyclists aged 15 or under 1985/86 to 1991/92 = 3.2 With law - Average annual number of fatalities to WA juvenile cyclists aged 15 or under 1992/93 to 1998/99 = 1.4 This is a reduction of 55% (more than 50% decline in schoolchildren cycling from 91 to 96 according to Bikewest / figures skewed by 9 deaths in 85/86)
Table: number of serious head injuries to cyclists in Western Australia by financial year and age of cyclist, compared to average weekly counts of cyclists using the Causway and Narrows bridge paths from October-December of that year. The data used for this graph is crude but nevertheless shows the law does not appear to have produced any obvious benefit in terms of reducing serious head injuries relative to the amount of cycling. Below is a West Australian Health Department table showing the number and age-standardised rates of hospital admissions for injuries sustained in bicycle crashes from 1981 to 1995. Note an increase in cyclist admissions during the three years after 1992 helmet law enforcement, despite an estimated 30% reduction in overall cyclist numbers on West Australian roads, a 50% reduction in cycling to school and about 80% of cyclists mandatorily wearing helmets that are supposed to reduce head injuries. Bicycle crashes
Below is a West Australian Health Department table showing the percentage of cyclist injury types sustained in Western Australia hospital admissions between 1981 and 1995.
Western Australia, 1981-1995 |
| Site | Injury1 | 1981-1983 | 1984-1986 | 1987-1989 | 1990-1992 | 1993-1995 | Total |
| Head | |||||||
| Skull fractures | 3.4 | 5.6 | 4.7 | 3.4 | 2.3 | 3.9 | |
| Facial | 6.9 | 9.1 | 11.6 | 11.5 | 10.6 | 10.0 | |
| Intracranial | 38.0 | 35.3 | 27.1 | 22.3 | 21.2 | 28.6 | |
| Other head | 1.1 | 1.2 | 1.7 | 1.5 | 0.9 | 1.3 | |
| Total | 49.5 | 51.2 | 45.2 | 38.7 | 35.0 | 43.7 | |
| Non-Head | |||||||
| Spinal | 0.2 | 0.4 | 0.6 | 1.3 | 1.0 | 0.7 | |
| Lower limb fractures | 11.1 | 10.1 | 11.2 | 11.0 | 10.4 | 10.8 | |
| Upper limb fractures | 15.7 | 14.7 | 16.4 | 22.9 | 28.6 | 19.8 | |
| All other fractures2 |
0.7 | 0.9 | 1.1 | 1.5 | 1.5 | 1.2 | |
| Dislocations/ sprains |
1.1 | 1.2 | 1.4 | 1.8 | 1.9 | 1.5 | |
| Superficial | 13.2 | 13.8 | 15.7 | 14.8 | 13.1 | 14.1 | |
| Internal | 2.9 | 2.2 | 2.2 | 2.4 | 2.3 | 2.4 | |
| Other | 5.5 | 5.5 | 6.2 | 5.7 | 6.2 | 5.8 | |
| Total | 50.5 | 48.8 | 54.8 | 61.3 | 65.0 | 56.3 |
Notes:
1. See Appendix Table A22 for groupings of ICD9-CM major diagnosis codes into injury categories.
2. All other fractures include multiple fractures, excluding those involving head.
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The table above shows the proportion of head injuries had been falling before the mandatory bike helmet law was introduced in 1992. The actual number of skull fractures was 64 in 1990-1992 and 44 in 1993-1995 (-31.25%). Surveys indicate the number of cyclists on the Narrows dropped by 28% between 1991/92 and 1995/96. On the Causeway bridge, cyclist numbers dropped by 36% between 1991/92 and 1995/96. The actual number of intracranial injuries was 423 in 1990-1992 and 403 in 1993-1995 (-4.8%). The estimated percentage of West Australian cyclists wearing helmets increased from 39% in 1991 to 77% in 1995. Skull fractures usually don't inflict long-term disability and intracranial injuries mostly require less than one day of hospital treatment. Nevertheless, both injury types can be serious. The decline in skull fractures in the three years after helmet law enforcement amounts to an average seven per year. The decline in intracranial injuries in the three years after helmet law enforcement also amounts to an average seven per year. That's an average 14 less head injuries per year from a total bike ownership of more than 750,000 West Australians, and with tens of thousands of people giving up cycling after the law was enforced. The actual number of head injuries fell marginally after helmet law enforcement. However, upper limb fractures rose sharply. Cyclist upper extremity injuries in Western Australia increased from 118 (16.9% of all injury locations) in 1988 to 274 (32.2%) in 1998. Research by McDermott et al. (Trauma, 1993, p834-841) found a significant increase in neck injuries for helmet wearers. 3.3% of unhelmeted riders sustained neck injuries while 5.7% of helmeted riders sustained neck injuries - a 75% greater risk among helmet wearers. The study compared 366 helmeted riders and 1344 non helmeted riders admitted to hospital in the Australian state of Victoria before helmets were mandatory.
* No neck injuries because cyclists with a neck injury also sustained injury of the same severity to a higher ranking body region. Table B9 / Bicycle Crashes and Injuries in Western Australia, 1987-2000 - Road Safety report RR131 (PDF 840kb) commissioned by Road Safety Council, dated November 2003 and authored by Lynn B. Meuleners, Arem L. Gavin, L. Rina Cercarelli and Delia Hendrie Although head injuries represent a smaller percentage (or proportion) of overall cycling injuries, this is mostly because of a much greater number of upper body injuries within the smaller pool of cyclists on the roads. In other words, upper body injuries replaced head injuries as the dominant injury following helmet law enforcement but mostly because the actual number of upper limb fractures rose so sharply. Various factors explain the overall (all body) increase in injuries, which add to the public health / pollution / transport infrastructure consequences of having fewer cyclists. These include greater risk-taking when wearing a helmet, an increase in head surface area likely to contact or graze a solid object, and greater brain injury through the added rotational force of the helmet - particularly soft tops which grip the road surface (see eMedicine for more detail). A further reason for the failure to reduce overall injury numbers is that tens of thousands of citizens who have abandoned cycling are instead driving their cars, increasing traffic density and further endangering all road users including pedestrians, other motorists and the remaining cyclists. West Australian Health Department data allows a comparison of injury rates during the three years before and the three years after all-age mandatory bicycle helmet law enforcement in 1992. Following is a summary of the Health Department data linked above, showing actual and averaged numbers of hospitalised cyclist injury types in Western Australia on an annual basis:
Skull fractures 89/90/91 - 75 ( = average 25 per year)
Facial 89/90/91 - 198 ( = average 66 per year)
Intracranial 89/90/91 - 458 ( = average 152 per year)
Other head 89/90/91 - 36 ( = average 12 per year)
Spinal 89/90/91 - 23 ( = average 8 per year)
Lower limb fractures 89/90/91 - 220 ( = average 73 per year)
Upper limb fractures 89/90/91 - 388 ( = average 129 per year)
All other fractures 89/90/91 - 29 ( = average 10 per year)
Dislocations/sprains 89/90/91 - 30 ( = average 10 per year)
Superficial 89/90/91 - 307 ( = average 102 per year)
Internal 89/90/91 - 44 ( = average 15 per year)
Other 89/90/91 - 116 ( = average 39 per year)
Total 89/90/91 - 1924 ( = average 641 per year) Surveys consistently show that cyclist numbers fell by approximately 30% from 1992 to 1995 (three years of helmet law enforcement). When this 30% reduction in public cycling numbers is considered, the above results suggest a slight improvement in skull fractures and a worsening in intracranial injuries (which should have averaged close to 100 per year following law enforcement). Despite far fewer cyclists, the numbers of non-head injuries either remained fairly static or, in the case of upper limb fractures, worsened markedly. West Australian hospital cyclist admissions: 1985-2000
1985 - 623
The influence of the bike helmet law in achieving these hospital stay improvements can be observed through a breakdown of head and non-head injuries. This West Australian Health Department table indicates that while non-head injuries continued the recovery time improvements which began well before law enforcement, there has been a possible worsening in head injury recovery times. West Australian cyclist fatalities 1985-2003
1985 - 5 DEATHS Note: In the United Kingdom, cyclist deaths fell from 256 in 1990 to 114 in 2003. It might also be worth noting that in 2006/07, preventable errors in West Australian hospitals killed 30 patients (* West Australian Health Department Sentinel Event Report 2006-07). According to a report tabled in parliament by the West Australian Auditor-General in October 2007, an estimated 45,000 mishaps are harming patients and jeopardising treatments in hospitals every year, with 820 adverse events in 2006 rated as critical, causing serious harm or death. These include medication errors and patients falling. Should helmets be mandatory in West Australian hospitals? Age-standardised rates of hospital admissions for injuries sustained in bicycle and vehicle crashes 
According to the Australian Commonwealth Department of Transport, one third of all car journeys are estimated to be three kilometres or less and the average length of each bike trip is 2.5 km. Every day, Perth residents make 240,000 car trips that are less than one kilometre long. America's Injury Prevention magazine published an article in 2003 titled Safety in Numbers: more walkers and bicyclists, safer walking and bicycling (PDF 140kb) which concludes that policies increasing walking and bicycling can improve the safety of other road users. Home Page
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