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 Helmets
Effectiveness in different jurisdictions
Head injury can be reduced by:
Safer removal of helmets
The most effective intervention currently available to reduce motorcyclist injuries is the motorcycle helmet. A systematic review of the effectiveness of wearing motorcycle helmets in reducing deaths and head and neck injury concluded that motorcycle helmets appear to reduce the risk of fatal injury (Liu et al., 2003). The authors note that there was also some evidence that the effect of helmets on mortality was modified by speed. From five well-conducted studies they found that motorcycle helmets reduced the risk of head injury by around 72% however that some poorer quality studies suggested that helmets have no effect on the risk of neck injuries or facial injury. Liu and colleagues also concluded that there was insufficient evidence to demonstrate whether different types of helmets (i.e. open-faced versus full-face) are more or less effective in reducing injuries.
There is evidence for the effectiveness of helmets on reducing fatalities as well as serious injuries. Lee, Chen, Chiu, Hwang, and Wang (2010) found Quality-Adjusted Life Years (QALYs) for those who wear helmets can save an average of five quality-adjusted life-years among those sustaining head injuries. A reduction in injuries has also been found using police-report crash data. Keng (2005) found a reduction in head and neck injuries by 53% and fatality from these injuries by 72% and in an adolescent sample, a higher prevalence of severe injuries and other face and head injuries were found among unhelmeted, compared with helmeted, adolescent riders (Lin, Hwang, Kuo, 2001). 
Effectiveness in different jurisdictions
There is also evidence of the effectiveness of helmets in a number of jurisdictions. Nakahara, Chadbunchachai, Ichikawa, Tipsuntornsak, and Wakai (2005) and Kanitpong Boontob, and Tanaboriboon (2008) both investigated motorcycle crash victims by using hospital records from the Trauma Centre of Khon Kaen Regional Hospital and another 16 hospitals across Thailand. The researchers found that unhelmeted riders had a higher risk of fatality than helmeted riders. In particular, Kanitpong and colleagues (2008) found that non-helmeted riders were 2.48 times more likely to receive a head injury and 1.7 times more likely to suffer a more severe head injury then helmeted riders. These results show the benefit of helmet use, however, they are based on hospital samples only, thus, excluding those who died at the scene and those with less severe injuries. Ouellet and Kasantikul (2006) and Kasantikul, Ouellet, and Smith (2003) however investigated crash scenes monitored through hospital and ambulance dispatch centres. These investigations found that unhelmeted riders were about three times as likely to be killed as helmeted riders (both) and that 8.7% of unhelmeted riders suffered brain injury compared to 2.4% of helmeted (Ouellet, & Kasantikul, 2006). Furthermore, helmeted riders tended to have a higher somatic injury severity than unhelmeted, who were more likely to die with little or no somatic injury, suggesting helmeted riders were less likely than unhelmeted riders to die in minor crashes (Kasantikul et al., 2003). Similar helmet effectiveness studies have also been conducted in Indonesia showing 32% and 15% of helmeted motorcyclists who visited four emergency departments in Yogyakarta received head injuries or serious head injuries compared with 52% and 29% of unhelmeted patients (Conrad, Bradshaw, Lamsudin, Kasniyah, & Costello, 1996).
Increasing wearing rates
One of the effective ways to encourage helmet wearing is to mandate wearing. In Thailand the effect of motorcycle legislation was investigated by Ichikawa, Chadbunchachai, and Marui (2003). They examined motorcycle patients admitted to the Kohn Kaen Regional hospital pre and post legislation enforcement (i.e., excluded time period when program was being implemented but not enforced). They found a 33.5% reduction in injuries from pre- to one year post-enforcement. Hyder, Waters, Phillips and Rehwinkel (2007) cite a 1999 study by Umar and Law that found the introduction of the Malaysian Motorcycle Safety Program in 1997, which included the use of motorcycle helmets, resulted in a 32% reduction in motorcycle causalities.
Community programs have also been trialled in an attempt to increase helmet wearing, for example, the Community Youth Helmet Use Project, an 18-month program based on the Helmets manual. It began in 2008 and aims to work with 120 villages in Thailand to develop innovative and sustainable ways to encourage helmet use among young people. Throughout 2008 village and district workshops have been organised in which community leaders develop proposals and are trained in good practice for helmet use.
Improving the crash performance of helmets 
There is also continued importance in improving the performance of helmets. For example, it has been estimated that a 30% increase in helmet absorbing characteristics would convert 50% of the severe injuries to less severe injuries (Mellor & St Clair, 2005). Further work is being undertaken to minimise the cost of advanced motorcycle helmets and to develop a possible consumer information scheme for motorcycle helmets.
Increasing the helmet test area has potential to improve the performance of helmets and remove some helmets that do not appear to provide sufficient coverage (bucket styles). Minor oblique impacts were capable of producing a variety of head injuries, ranging from minor unconsciousness to severe brain damage (Nairn, 1993).
Pegg and Mayze (1980) reported that a full-face visor is helpful in preventing respiratory burns that may result from a crash fire, but the authors argued that standards should ensure helmet visors do not melt when a fire does occur.
Improving the retention performance of helmets
Most in-depth studies have found a small number of cases in which the helmet was dislodged, despite evidence that the chin strap had been secured. For example, Huybers (1988, cited in Nairn, 1993) reported that the "coming off" rates of helmets varied from 7 percent to 36 percent.
While improvements to straps etc may need to be investigated, much of the problem may be due to a combination of incorrect fastening and poor fit. Of significance here is an earlier study by Mills and Ward (1985, cited in Nairn, 1993) which found that the position of the chin strap pivots and the correct fit of the helmet at the rear are important factors in the prevention of helmet rotation and loss.
Further, Cooter et al (1988, cited in Nairn, 1993) suggested that the rotation of a full face helmet following impact on the rider's chin guard may cause fatal damage to the brain stem. Krantz (1985) reported a similar injury mechanism in 5 out of 132 helmeted motorcyclist fatalities. The preparation and implementation of an education program concerning correct fit and fastening, targeted at both riders and helmet retailers is recommended (Nairn, 1993).
Tsai, Wang, and Huang (1995) investigated the effectiveness of different helmet types in motorcycle crash victims admitted to emergency care hospitals in Taipei. They found that helmet use reduced the relative risk of head injury when comparing those with head injuries to equivalent on-road controls (photographed later) and when compared to non-head injury emergency room controls (to relative risks of .64 and .54 respectively). Also it was found that full face helmets had a better protective effect than partial or full helmets (those that cover the top of the head only).
Also in Japan research shows that the benefit of helmets is particularly noticeable for full-face compared to open-faced helmets (Hitosugi, Shigeta, Takatsu, Yokoyama, & Tokudome, 2004). However, this latter study also reports that while helmet use can reduce brain contusions they are less effective for neck injuries, injuries remote from the point of impact and injuries resulting from angular acceleration, which again supports the need to consider other safety elements in a crash as well as crash prevention.
Safer removal of helmets
There has been concern voiced by riders and paramedics that injuries may occur or be worsened in the process of removing helmets from injured riders (particularly full-faced helmets). Programs for training emergency services personnel in correct procedures for removing helmets have been developed in the United States but these are not widely known or used (Motorcycle Safety Foundation, 2001). No published evaluations of these programs were found.
See also: Helmet wearing legislation case study
Information sourced from A review of potential countermeasures for motorcycle and scooter safety across APEC (Full report and References [PDF, 304KB]).
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