It's not exactly an everyday event to crash your bike and hit your head hard on the concrete -- but, unfortunately, it's also not by any means rare.
Everyone has a story; mine is no more "special" than anyone else's. It's not exceptionally dramatic and, fortunately, it has a good outcome (so far...). But I'm writing to write about it now because I just appreciated that my story actually lacks a pretty central detail held by ALL "wear your helmet to avoid tragedy" stories *I've* ever heard, at least.
The key element that my accident lacks: A CAR.
<--- No car required to look like THIS.
I'm fortunate to be surrounded by really smart people -- and by virtue of being "really smart people," by definition most people in my life wear a helmet when they engage in activities in which they are not 100% in control of their own motion: biking, rollerblading, skateboarding, etc. But because it's not 100% universal, I want to understand why. Yesterday, I had an idea. As a physician-in-training, I consider it a my top priority in connecting with human beings to understand their motivations for doing AND not-doing important acts to further their basic ability to function. The latter is exceptionally important. Deep-down, there are REASONS that people do not take their medications, monitor their blood pressure or blood sugar, quit smoking/drugs, engage in moderate aerobic exercise. Not everyone is aware of those reasons -- but they're there. And it's going to be an important part of my job to tap into those reasons and work through them, as a partner in a person's care. If you understand WHY someone holds certain beliefs, reflective of their values, you can work together to accomplish specific positive objectives in a way that remains consistent with those values. Motivational interviewing is an important clinical skill, which is why I try to incorporate aspects of it into my Spinning classes.
Back to helmets. I think that it would be fairly easy to design and conduct a study of the factors that contribute to people's decisions to NOT wear a helmet during activities that require one. Why this is important: if one can appreciate an individual's specific reasons NOT to do something, one can target interventions SPECIFIC to those very reasons. The more I sit here thinking about how I can't budget the time/energy to do this study now, the more ideas I have about how easy it would be to actually do it -- and the more I'm entertaining commitment to it. Yes. I'm going to do this study. (Uh-oh: this sounds like an idea subject to 2009 Life Policy #1 -- must take action on new idea within 12 hours. Clock starts ticking now.)
I remember as a little kid, not wanting to wear a helmet when I rollerbladed because it "looked dorky" and "nobody else was doing it." Safety statistics wouldn't have done a thing to engage my REASON for not wearing that helmet. There were great campaigns in the late 80s/early 90s that appealed to that very rationalization: that is, that helmets were "cool" and that everyone wore them. I don't think that perception is the issue anymore; maybe it is... I guess we'll find out.
Present public health efforts to encourage helmet use are largely based on on the true concept that getting hit by a car is common, and injuries/deaths can be prevented by helmet use. It can, and it does. Helmets save lives, as supported by literature so extensively accepted by the general public that I don't feel compelled to cite any of it.
It follows that if one anticipates being near cars --> wear a helmet to avoid tragedy. But is it the case that people who do not anticipate being near cars do not consider that this message applies to them?
With the development of car-free bike paths and roller parks and everything else out there to promote safe recreation, this does nothing to specifically connect with the entire premise of the most central theme of helmet promotion efforts.
Yesterday, I was in a pretty bad bike accident. There was no car involved, other than the kind Vermonter who stopped by to wait with me as I awaited an ambulance. I wasn't doing anything dangerous. I wasn't going too fast, or climbing terrain that surpassed my abilities. I crashed because... I just did. I crashed because, sometimes, shit just happens. My front tire got stuck in a deep groove at the dirt-concrete interface, and I couldn't steer out or clip out in time.
BAM. Hit the concrete hard. REALLY hard. The sound of your own head hitting the concrete is truly quite unique.
I hurt badly. I was dizzy and throbbing and bloody. Way too much blood for this to be ok, I reckoned. I was alert enough to consider medical interventions (tracking my own finger, asking my riding partner to look at my pupils) and alert enough to arrange for friends to come pick up the bikes 25 miles from the hospital as the ambulance loaded me into the truck. Alert enough to appreciate that I always rode with my cell phone (as many people do NOT, during "quick spins"). Alert enough to appreciate that I always rode with my helmet.
I landed on the visor projection, which was dented in and cracked from the impact. My old helmet (which I wore as recently as 9 months ago) didn't have that extensive an extra projection.
I'm lucky. Lucky to have not sustained any fractures. Lucky to be training at an OUTSTANDING institution with a team that took such outstanding care of me. Lucky to have such generous, selfless friends who dropped everything to come to my aid.
But everyone who has met me since yesterday has asked me things like: "WHERE WERE YOU WHEN YOU GOT HIT?" -- "HOW FAST WAS THE CAR GOING?" -- "DID THE DRIVER STOP?"
It's not about the car. Sometimes it is. Often it is -- and when it is, it is always tragic. But it's not always about the car.
I reckon that the majority of my readership wears helmets. But I also reckon that you know people who don't. Why don't they? Is it because they don't perceive danger, riding/skating in a cars-free environment? Is it because they perceive of themselves as superstars at their sport, IMPOSSIBLE to accept the possibility that they could fall? Are they 100% confident that, if they fall, that they are 100% in control of how they land?
What can we do to encourage people to consider this paradigm -- simply, that they CAN fall?
It IS always that there is a chance that, no matter where one is or how skilled one is, that one can fall. And if one falls, sometimes one cannot control how one lands. Sometimes shit just happens, where "shit" means, in my case, "you hit your head on the concrete and are a bloody mess on the side of the road."
By writing this post, it is not my design to change the world. However, I do hope -- if nothing else -- that this prompts someone to start this conversation with SOMEONE in their lives.
By at least considering that we CAN fall (independent of external stimuli), the decision to wear a helmet vs. not wear a helmet truly does become a no-brainer.
*UPDATE* Psychological Effects of Heart Rate Monitor Use Study
12/21/2010: Preliminary results were reported at Indoor Cycle Instructor in October 2010. Manuscript in preparation. Once published, results will be made available on this site and at ICI.