The big debate: should cyclists be forced by law to wear helmets?

Ryan, who had just completed his GCSEs, spent four months in a coma with doctors warning he would be in a persistent vegetative state for the rest of his life. Nowadays he remains paralysed on the left-side and his short-term memory is poor and personality permanently altered, although he has managed to return to a local college where he is studying media.  

His father admits Ryan will never be able to lead an independent life but still he counts himself as one of the more fortunate. As a paramedic for the East Midlands Ambulance Service, Mark Smith is regularly confronted with the reality of what crashing a bike without wearing a helmet can mean.

The most recent ambulance call-out he was involved in occurred only a few months ago: a man in his early 30s cycling home along an unlit road in poor weather without wearing a helmet or high visibility clothing who was hit by a car.

“Unfortunately he suffered huge head trauma that proved fatal,” the 48-year-old says. “We may not be allowed to force people to wear them but when you see the results of not doing so it does make me extremely angry.”

Were Mark Smith to have his way, his son would have been required by law to wear a helmet. So too, the man killed on that dark Midlands road. Every year more than 100 cyclists are killed and more than 3,000 seriously injured. 

For Mark, making helmets compulsory is the most obvious of government policies. And yet it remains one of the most complex and polarised road safety debates of our time.

In recent days the issue has again come to the fore. Last week, the transport minister Jesse Norman was forced to deny any upcoming plans forcing British cyclists to wear protective headgear after it emerged the proposal will be considered as part of the Government’s ongoing cycle safety review which was launched in September.

The brain injury charity Headway, of which Mark Smith is an ambassador, is among those submitting evidence to the review in support of enforced wearing for helmets. Yet critics of any such plans – which include ardent cycling campaigners such as the former Olympic cyclist Chris Boardman (whose mother was killed in a collision with a pick-up vehicle while on her bike) and Cycling UK – remain vociferously against any proposal.  

In an article on the British Cycling website published last Sunday, Boardman, who is the organisations' policy advisor, cried shame on the government for even discussing the issue again. He wrote that wherever helmet use has been made compulsory in the world (Australia, New Zealand, parts of Canada and on the island of Jersey for children), there has been no corresponding drop in head injury unless there is also a drop in cycling rates. A Cycling UK spokesman, meanwhile, claimed last week that the “effectiveness of helmets is not the black and white issue many think it is”.  

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In 2010, Donal McNally, head of the bioengineering research group and professor of bioengineering at Nottingham University, was knocked off his bike. He cannot remember the incident, nor can the shocked driver, although he has since discovered he was hit on the rear wheel causing him to backflip over the car landing on his head and suffering three compression fractures in the neck – each of which could have killed him.

Without his helmet, Professor McNally says, he would have been killed or left permanently disabled. But following his recovery he discovered there was little real scientific evidence to back up his claim. In 2013 he published a paper where he used computer modelling technology to simulate crashes involving adults and children with and without cycle helmets. The study found children wearing a helmet had the probability of a fatal outcome from a non-vehicle collision reduced by 99 per cent and in a collision involving a vehicle reduced by 40 per cent. While in adults the findings were less stark, the simulations still proved helmets were effective in reducing the risk of severe injury.

This is corroborated by one of the first case controlled studies of cycle helmet safety ever undertaken which was published in Australia (the first country to make cycle helmets compulsory in the 90s) around the same time as Professor McNally’s work. 

The authors of the study examined 6,745 cyclist casualties resulting from collisions with vehicles in New South Wales and found helmet use to be “significantly associated” with reduced head injury by up to 74 per cent. For skull fractures and open head wounds that figure rose to 78 per cent and 80 per cent respectively.

“I think helmets make a significant difference to the outcome,” Professor McNally says. “Whether you make them compulsory or not goes a bit beyond the science but I make my children wear them and resent a bit paying the healthcare costs of people who don’t. At the moment people aren’t getting a balanced picture because the anti-cycling helmet lobby are vociferous and very good at what they do.”

The arguments against wearing helmets are two-fold: cyclists wearing helmets feel emboldened to take greater risks (although there is no clear evidence to back this up) and drivers supposedly give non-helmeted cyclists a wider berth.

The latter claim is touched upon in a new report published by colleagues of Professor McNally at Nottingham University in conjunction with Nottingham University NHS Trust in the Journal of Transport and Health.

The study of 76 cycle accidents found "no evidence" that those who wore reflective clothing "were at reduced risk". Instead it found "increased odds of a collision crash" among cyclists in reflective clothing, perhaps because they "may have adopted more exposed road positions in the belief that they were relatively conspicuous".

However, even the report authors claim the results should be treated with caution because it was based on a small group of volunteers. The researchers also conclude by saying a larger authoritative examination is required. Indeed in August a far more exhaustive Danish study of 6,793 cyclists published in in the journal Safety Science directly contradicted these claims, finding there were 47 per cent fewer accidents causing injuries if a bright yellow jacket was worn.

The counter-claim most frequently cited by anti-helmet campaigners is one conducted by a psychologist at the University of Bath called Ian Walker. In 2006 Dr Walker attached a computer and electronic distance gauge to his bike and cycled on roads, interchanging between a cycle helmet, no helmet and, bizarrely, a blonde wig. The results showed motorists passed more closely when he had the helmet on (an average of 8.5cm nearer).

“If you are hit on the head then it’s best to have a helmet on,” Walker says. “However my study suggests it’s possible the chance being hit on the head goes up.”

For Walker – as with many cycling campaigners – we should in fact be focusing at other safety solutions such as segregated cycle lanes and better infrastructure. “If your goal is to save lives by passing a law then this is not the one,” he says.

The most recent Government figures for 2016 show it is still more dangerous to be a pedestrian rather than a cyclist in Britain, with 448 fatalities recorded compared to 102 (a figure that has stayed roughly stable since 2008). “The risk to my head is slightly greater walking around than it is cycling and nobody is suggesting pedestrians wear helmets,” Walker says. “As a culture we have agreed cycling is a dangerous thing and are prepared to be afraid of bicycles.”

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Perhaps the only thing those on either side of this debate agree on is that cycling is good for you. In his British Cycling article, Chris Boardman cited a recent study by the University of Glasgow which showed that people who regularly commute by bike almost halve their chances of dying from heart disease and cancer compared to people who drive. “In fact their chances of dying prematurely by any cause, drops by 41 per cent,” he wrote. “Let those numbers sink in.”

Boardman’s fear is that any measure which reduces the likelihood of people travelling by bike will “almost certainly kill more people than it saves” – citing figures from Australia which show a dramatic drop in the number of cyclists following the imposition of the helmet law. However those figures have been refuted by academics in some quarters.

In July 2014, the island of Jersey became the first part of the British Isles to introduce a similar law on cycle helmets, making it mandatory for all under 14-year-olds to wear one. The vote followed years of campaigning by a founding member of Headway, Andrew Green, whose nine-year-old son Christopher was left severely disabled as a result of brain injury after being knocked off his bike without wearing a helmet.

Green, who was appointed MBE in 2006, is a senator in Jersey (the equivalent of an MP) and serves as deputy chief minister and minister for health and social services. Since the law was passed he says there has not been a single prosecution over anybody flouting the law and no discernible drop in cyclist numbers.

While the figures are not immediately available for whether or not the helmet law has reduced injuries among young cyclists, anecdotally those working on frontline services claim it has had a major impact. Nicholas Payne, 52, is an accident and emergency consultant specialising in paediatric care at Jersey General Hospital and ardent cycle safety campaigner.

“We have definitely seen less severe head injuries in children,” he says. “Those that come in not having worn a helmet usually require much more intervention than those without them. Very few people on the medical side don’t believe in helmets.”

Another medical professional, Mark Wilson, a professor of brain injury at Imperial College London and an air ambulance doctor, argues a similar law should be imposed in Britain. Wilson is joint author of new research published this September that studied 129 cyclists with serious head injuries treated at St Mary's Hospital in Paddington, London, between 2011 and 2015. 

The study found fewer skull fractures and subdural haematomas among cyclists with helmets, although Wilson accepts there are some specific types of brain injury where protective headgear does not make a difference – such as shearing, where the brain rotates inside the skull.

“My view is if you get hit on the head by anything, something that dissipates the energy transmitted is probably better than not,” he says. “I think for children who don’t understand the risks and benefits it should be compulsory. In adults, where do you draw the line?”

When he heads out on a bike himself, Wilson, like his fellow consultant Nicholas Payne, opts to wear a cycle helmet. And perhaps that is where the truth lies.

The debate may continue to rage but when you have seen enough bloodied cyclists lying unconscious on a hospital bed, you want to give yourself every chance you can.