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Case Study: Helmet Saves a Life

biking coupleThe following article was published in the summer 2007 issue of UW Health's Level One newsletter for emergency medicine health professionals:
 
A recent news story highlighted a Madison man whose head was run over by a truck after being thrown from his bicycle. The helmet was almost split in two, and he walked away with only a minor concussion. AMAZING!
 
Similar to the man above, BT is a 17-year-old male who was riding his bike, crossed a road and was hit by a car. He initially struck the windshield with his HELMETED head, and then when the car stopped, he was thrown to the ground.
 
He was unconscious immediately but was waking up upon EMS arrival, approximately 6 minutes post-crash. Amnesic to the event, he could only state his name, but didn't know where he was, how he got there or the date and time of day. He complained of pain in his neck, head, abdomen and right wrist.
 
EMS Primary Assessment
  • Airway: Patient able to vocalize, no obstruction noted. The bike helmet was intact but dented. EMS stabilized his spine, removed the helmet per protocol and applied a rigid collar.
     
  • Breathing: Respiratory rate 16, nonlabored
     
  • Circulation: Pulses strong bilaterally, BP 128/72
     
  • Disability: Glasgow Coma Score (GCS): Eye opening-spontaneous = 4, Verbal response-confused = 4, Motor response-follows commands = 6, total is GCS 14. Patient remains confused en route to the hospital.

On arrival to the emergency department, he is not as confused, but remains amnesic to the event. Primary survey does not change. Secondary survey reveals several areas of abrasions and contusions, but no gross deformities of any long bones.

 

Due to the loss of consciousness, a CT of his head was obtained that was NORMAL. He had C-spine tenderness but films were negative. He was maintained in a collar. His abdomen remained tender and a CT was obtained that showed a small spleen laceration. He remained hemodynamically stable. His right wrist had a non-displaced fracture that was casted. No other fractures were noted.

 

Both of these stories would have much different outcomes if not for the use of helmets. Abrasions, contusions, fractures and even spleen injuries can heal, but head injuries can cause permanent disabilities.

 

Helmet Guidelines

 

According to the National SAFE KIDS Campaign, 75% of bicycle related deaths among children could be prevented with a bike helmet. They recommend that the helmet bears a CPSC (U.S. Consumer Product Safety Commission) label.

 

Helmets need to fit correctly: they should be snug, but not too tight, and should not rock back and forth or side to side. The helmet needs to be centered on the top of the head. People who wear their helmets tipped back have a 52% greater risk of head injury.