Cyclist injuries summary: pre and post 1992 helmet law enforcement in Western Australia

West Australian hospital cyclist admissions: 1985-2000


1985 - 623
1986 - 660
1987 - 630
1988 - 698
1989 - 596
1990 - 638
1991 - 730
1992 - 574
1993 - 633
1994 - 644
1995 - 660
1996 - 715
1997 - 754
1998 - 850
1999 - 862
2000 - 913
WA cyclist injury numbers


Hospital Admissions Data: Number and Percentage of Cyclists Admitted, Western Australia, 1987-2000 (single years) (Source: 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)


For the convenience of readers, this page provides a compilation of graphs, tables and other data from elsewhere on this site concerning cyclist injuries in Western Australia before and after 1992 bicycle helmet law enforcement.

The basic legislative results for body and head injuries can be determined by scanning this page for about 10 minutes.


cyclist hospital admission numbers


The data above from Australian Helmet Experience: Is There Any Reliable Evidence That Australian Helmet Legislation Works? (researcher Bruce Robinson from the Bicycle Federation of Australia) shows the decline and immediate increase in Western Australia hospital cyclist admissions after law enforcement on July 1, 1992. Narrows and Causeway river bridge data suggest that in 1995 there were 36% less weekday cyclists than in the 12 months prior to law enforcement.

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.

Bicycle crashes

Period 1981-1983 1984-1986 1987-1989 1990-1992 1993-1995
Number 1804 1882 1930 1962 1976



bicycle helmet laws


Research from Bicycle Crashes and Injuries in Western Australia - Road Safety report RR60 commissioned by Main Roads WA, RoadWatch and UWA, dated March 1998 and authored by Delia Hendrie, Carol Kirov and Susie Gibbs


The graph below is extracted from the WA Road Safety Council's Reported Road Crashes in Western Australia 2006.


cyclist hospital admissions


A study obtained by the ABC in December 2009 shows cycling injuries are being grossly under-estimated. The same study was also reported the following day by The Australian newspaper.

The under-estimation of cyclist injuries by Australian authorities was reported six years earlier in Pedal cycle injuries in NSW: A comparison of data sources, published in the Dec 2003 issue of Road & Transport Research.

Similar findings can be found in Emergency presentations by vulnerable road users: implications for injury prevention, published by the Injury Research Centre at the University of Western Australia.




West Australian cyclist fatalities 1951-2008 *

1951 - 13
1951 - 9
1952 - 10
1953 - 19
1954 - 12
1955 - 15
1956 - 7
1957 - 8
1958 - 13
1959 - 12
1960 - 6
1961 - 15
1962 - 6
1963 - 8
1964 - 8
1965 - 13
1966 - 10
1967 - 4
1968 - 8
1969 - 9
1970 - 4
1971 - 2
1972 - 4
1973 - 7
1974 - 1
1975 - 7
1976 - 7
1977 - 10
1978 - 8
1979 - 4
1980 - 6
1981 - 4
1982 - n/a
1983 - n/a
1984 - n/a
1985 - 5
1986 - 15
1987 - 4
1988 - 7
1989 - 7
1990 - 9
1991 - 8
1992 - 1
1993 - 5
1994 - 6
1995 - 5
1996 - 10
1997 - 6
1998 - 6
1999 - 2
2000 - 2
2001 - 5
2002 - 6
2003 - 1
2004 - 3
2005 - 4
2006 - 3
2007 - 4
2008 - 3

* Department of Transport Office of Road Safety


Road Safety in Australia (PDF 122kb) shows the average annual cyclist road fatality rate in Australia from 1980 to 1990 was 88 and from 1992 to 2002 it was 45 - a reduction of 49%. Over the same timeframes, annual average motorcyclist road fatalities fell from 382 to 195, also down 49%. The annual average road fatality rate for pedestrians fell by 40% (541 to 324). Vehicle passenger fatalities fell by an average 39% (768 to 470) and vehicle driver fatalities fell by an average 28% (1127 to 816).

Note: In the United Kingdom, cyclist deaths fell from 256 in 1990 to 114 in 2003 - a drop of 56%. The UK does not have mandatory bicycle helmet laws and people were not discouraged from cycling during the 1990s.

In its April 1995 issue of Cycling in the West, the Bicycle Transportation Alliance of Western Australia writes: "Comparisons with data from previous years suggest that compulsory helmet legislation has not been nearly as successful as predicted in reducing the cyclist injury rate.".

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)


The serious head injury data provided by the minister to the WA parliament in 2000 can be tabulated thus:


serious cyclist head injuries

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.


Percentage of hospitalisations for injuries sustained in cycling crashes by site and nature of injury

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


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.

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 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.


Distribution of Cyclists Admitted to Hospital by Body Region of Injury, WA, 1988-1998
(single years)

Western Australia, 1988-1998

Injury * 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
Head 222
(31.8%)
148
(24.8%)
163
(25.5%)
177
(24.2%)
116
(20.2%)
143
(22.6%)
126
(19.6%)
160
(24.2%)
147
(20.6%)
141
(18.7%)
175
(20.6%)
Upper Extremities 118
(16.9%)
133
(22.3%)
139
(21.8%)
206
(28.2%)
177
(30.8%)
216
(34.1%)
193
(30.0%)
199
(30.2%)
226
(31.6%)
274
(36.3%)
274
(32.2%)
External 133
(19.1%)
134
(22.5%)
121
(19.0%)
140
(19.2%)
91
(15.9%)
99
(15.6%)
103
(16.0%)
107
(16.2%)
114
(15.9%)
88
(11.7%)
90
(10.6%)
Lower Extremities 96
(13.8%)
91
(15.3%)
87
(13.6%)
99
(13.6%)
92
(16.0%)
87
(13.7%)
98
(15.2%)
88
(13.3%)
122
(17.1%)
107
(14.2%)
118
(13.9%)
Face 49
(7.0%)
33
(5.5%)
41
(6.4%)
41
(5.6%)
48
(8.4%)
39
(6.2%)
55
(8.5%)
48
(7.3%)
56
(7.8%)
40
(5.3%)
49
(5.8%)
Abdomen 22
(3.2%)
16
(2.7%)
19
(3.0%)
19
(2.6%)
11
(1.9%)
14
(2.2%)
19
(3.0%)
13
(2.0%)
11
(1.5%)
24
(3.2%)
25
(2.9%)
Spine 10
(1.4%)
3
(0.5%)
15
(2.4%)
14
(1.9%)
7
(1.2%)
8
(1.3%)
16
(2.5%)
7
(1.1%)
16
(2.2%)
11
(1.5%)
15
(1.8%)
Chest 5
(0.7%)
8
(1.3%)
13
(2.0%)
6
(0.8%)
13
(2.3%)
10
(1.6%)
16
(2.5%)
17
(2.6%)
13
(1.8%)
14
(1.9%)
10
(1.2%)
No Injury 43
(6.2%)
30
(5.0%)
40
(6.3%)
28
(3.8%)
19
(3.3%)
17
(2.7%)
18
(2.8%)
21
(3.2%)
10
(1.4%)
55
(7.3%)
94
(11.1%)
Total 698
(100%)
596
(100%)
638
(100%)
730
(100%)
574
(100%)
633
(100%)
644
(100%)
660
(100%)
715
(100%)
754
(100%)
850
(100%)

* 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


In relation to above, it might be noted that in 1999, cyclists comprised 23.6% of all serious road crash hospital admissions and in 2000 cyclists comprised 25.9% of all serious road crash hospital admissions, almost equalling car drivers as the predominant road user group admitted to hospital. By 2000, Main Roads WA surveys show cyclists numbers in WA had recovered to pre-law levels.

Average length of hospital stay1 by nature of injury

Western Australia, 1981-1995

Period
Injury 1981-1983 1984-1986 1987-1989 1990-1992 1993-1995
Skull fractures 13.1 7.9 7.6 8.4 11.0
Facial 3.6 2.6 2.8 2.4 1.8
Intracranial 2.3 3.0 2.5 2.1 2.2
Other head 2.3 2.0 2.1 2.5 2.6
Spinal2 120.0 24.1 38.0 14.7 15.1
Lower limb fractures 12.3 13.5 12.1 9.1 8.0
Upper limb fractures 2.7 2.5 2.4 2.0 1.6
All other fractures3 13.9 10.8 12.4 11.8 6.7
Dislocations/sprains 2.8 2.5 4.1 3.7 2.5
Superficial 4.8 4.1 4.8 3.6 3.0
Internal 16.3 8.6 8.5 5.6 6.4
Other 4.7 6.3 5.1 4.6 2.5


1 Average length of hospital stay was calculated from the total length of stay for all admissions for the same bicycle crash and the diagnostic category was derived from the major diagnosis of the first admission.
2 Includes one case where the length of stay was 330 days.
3 All other fractures include multiple fractures, excluding those involving head.


Measuring road crash injury severity in Western Australia using ICISS methodology (PDF 232kb) by A. Chapman and D. Rosman from the Department of Health in Western Australia was presented to the Insurance Commission of Western Australia Road Safety 2008 WA Forum. The paper analyses the severity of all road crash injuries in WA from 1988 (pre bike helmet law) to 2006, showing an increase in the severity of cyclist injuries since the helmet law was enforced in 1992.


WA cyclist injury type


Hospital Admissions Data: Percentage Distribution of Cyclists Admitted by Body Region of Injury, Western Australia, 1988 - June 30 1999 (single years) (Source: 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))


Below is extracted from Serious injury to land transport accidents, Australia, 2005-06 by the Australian Institute of Health and Welfare.


australian land tranport accidents


The proportion of head injuries to cyclists is better than pedestrians but worse than car occupants who don't wear helmets, and much worse than motorcyclists - suggesting that hard shell rather than soft-top bicycle helmets are more effective. The data also shows a very high proportion of upper body injuries, consistent with a significant increase in upper body injury numbers following helmet law enforcement, and it appears helmets were most effective in preventing injury to the lower limb.

Following is a summary of WA Health Department data 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)
Skull fractures 93/94/95 - 44 ( = average 15 per year)

Facial 89/90/91 - 198 ( = average 66 per year)
Facial 93/94/95 - 201 ( = average 67 per year)

Intracranial 89/90/91 - 458 ( = average 152 per year)
Intracranial 93/94/95 - 403 ( = average 134 per year)

Other head 89/90/91 - 36 ( = average 12 per year)
Other head 93/94/95 - 17 ( = average 6 per year)

Spinal 89/90/91 - 23 ( = average 8 per year)
Spinal 93/94/95 - 19 ( = average 6 per year)

Lower limb fractures 89/90/91 - 220 ( = average 73 per year)
Lower limb fractures 93/94/95 - 197 ( = average 66 per year)

Upper limb fractures 89/90/91 - 388 ( = average 129 per year)
Upper limb fractures 93/94/95 - 542 ( = average 180 per year)

All other fractures 89/90/91 - 29 ( = average 10 per year)
All other fractures 93/94/95 - 29 ( = average 10 per year)

Dislocations/sprains 89/90/91 - 30 ( = average 10 per year)
Dislocations/sprains 93/94/95 - 37 ( = average 13 per year)

Superficial 89/90/91 - 307 ( = average 102 per year)
Superficial 93/94/95 - 249 ( = average 83 per year)

Internal 89/90/91 - 44 ( = average 15 per year)
Internal 93/94/95 - 43 ( = average 14 per year)

Other 89/90/91 - 116 ( = average 39 per year)
Other 93/94/95 - 117 ( = average 39 per year)

Total 89/90/91 - 1924 ( = average 641 per year)
Total 93/94/95 - 1898 ( = average 633 per year)


Below is a West Australian Health Department graph comparing hospital admissions for injuries sustained in bicycle and vehicle crashes from 1981 to 1995. There is no reduction in cyclist admissions after helmet law enforcement in 1992 and it can be argued that the increase in vehicle crashes from 1992 coincided with July 1992 enforcement of the bicycle helmet law that caused tens of thousands of people to abandon cycling and instead drive their cars, increasing the injury risk for all road users. The increase in vehicle crashes linked to reduced cycling is explored by The Australian newspaper in 2008.


Age-standardised rates of hospital admissions for injuries sustained in bicycle and vehicle crashes


west australian hospital admissions


Total number of reported vehicle occupant and cyclist hospitalisations in Western Australia
per hundred thousand population by year.



west australian car crashes


Total number of reported road crashes in Western Australia by year.
Source: Main Roads WA Traffic Accident System



west australian car accidents


Number of reported road crashes in Western Australia by year and crash severity.
Source: Main Roads WA Traffic Accident System
* Raw percentages provided

See Analysis of Road Crash Statistics Western Australia 1990 to 1999 (PDF 384kb)


Road crash casualties and rates, Australia, 1925 to 2005 (PDF 209kb) published by the Australian Transport Safety Bureau shows numbers of persons seriously injured in road accidents across Australia:


1980 - 32,054
1981 - 32,108
1982 - 30,654
1983 - 28,080
1984 - 28,795
1985 - 29,248
1986 - 29,169
1987 - 29,698
1988 - 29,705
1989 - 28,483
1990 - 24,961
1991 - 22,528
1992 - 21,512
1993 - 21,557
1994 - 22,133
1995 - 22,368
1996 - 21,989
1997 - n/a
1998 - n/a
1999 - n/a
2000 - 26,963
2001 - 27,471
2002 - 27,934
2003 - 28,422
2004 - 28,864
2005 - 30,574


The figures above suggest that despite stricter drink driving laws introduced nationally in 1991, lower speed limits and tougher penalties, something happened in the early 1990s that reversed a previously steady decline in road trauma. Was it population? Below are ATSB figures on seriously injured casualties per 100,000 population across Australia:

1980 - 218.1
1981 - 215.2
1982 - 201.9
1983 - 182.4
1984 - 184.8
1985 - 185.3
1986 - 182.1
1987 - 182.6
1988 - 179.7
1989 - 169.4
1990 - 146.3
1991 - 130.3
1992 - 123.0
1993 - 122.0
1994 - 124.0
1995 - 123.8
1996 - 120.1
1997 - n/a
1998 - n/a
1999 - n/a
2000 - 140.8
2001 - 141.5
2002 - 142.2
2003 - 143.0
2004 - 143.7
2005 - 150.3


Mandatory bicycle helmet laws were enforced across Australia in different states from 1990 to 1992, resulting in an approximate 30% decline in public cycling participation. Many discouraged cyclists instead have driven their cars since 1990, each adding an extra tonne of high speed metal to Australian roads with a consequent increase in risk to all road users including car occupants, pedestrians and cyclists.

In New Zealand, injuries to all other road users also show an anomalous increase in 1994 when mandatory helmet legislation was enforced, following a 10 year downturn, although the downturn resumed from 1996 to 2000. See chart below.

cyclists vs traffic injuries Cyclist vs traffic casualties 1951-2009 Cyclist vs traffic casualties 1951-2009


Australia and New Zealand are the only two countries in the world with nationally enforced all-age bicycle helmet laws which affect the driving frequency of adults, and thus traffic density. It is logical that decreased cycling will result in increased motoring with a consequent impact on crashes/injuries involving all road users, and all data from both countries supports this assumption.

In a jointly-sponsored report published in August 2010, the Australian Local Government Association, the Bus Industry Confederation, the Cycling Promotion Fund, the National Heart Foundation of Australia and the International Association of Public Transport estimate that government encouragement of active transport such as cycling, walking and public transport could save 16,000 lives a year with annual Australian health-care savings of more than $1.5 billion a year.




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