“There ought to be a law
that parents must die first.
When I was lighting the
funeral pyre of
my son I thought, should it not have been him
lighting mine instead”
- A grief
“The Hindu” an organization
involved in providing information and educating the people is
indeed “living the values they espouse”. Launching a year long
safety campaign, the staff of the Hindu took a pledge to wear
helmets. Without such proactive measures head injuries will
continue to be a public health hazard. Unfortunately statistics
do not reflect the agony and misery faced by the individual
family when the breadwinner dies or is critically injured. It is
also forgotten that even a minor injury to the unprotected brain
takes a serious toll. For every death there are a hundred head
injury victims working at sub optimal efficiency.
Literature worldwide, unequivocally
states that additional protection to the head with helmets,
reduces the severity of any force, reaching the brain. In
industrialized countries death rates have decreased by 18%
due to use of helmets, seat belts, air bags, better roads and
speed limit control, while in developing countries the death
rate has increased by 13%. In India only 950
neurosurgeons are available to treat head injuries for 1150
million.. 70% of head injuries are preventable as they occur due
to negligence and ignorance. 2600 crores (1% of the GDP of
India) is the annual loss due to road traffic accidents alone.
With 11,000 new vehicles being registered every day in India
the two wheeler population is growing 20 times more than the
human population . A head injury death occurs every four minutes
making it the sixth commonest cause of death. Millions of
man-hours are also lost .
Reversing a very severe
primary brain injury is not possible, medically or surgically.
Use of protective headgear is
the simplest, quickest and most effective method of reducing the
number of severe head injuries. Use of helmets, does
not require funds or sophisticated technology. Minor
individual inconvenience, has to be sacrificed for the common
good. Freedom does not mean absolving responsibilities.
The reluctance to wear
helmets is not because there is any serious opposition to its
use. It is because of “this cannot happen to me”
syndrome. A young (71% of head trauma victims are motorcyclists
in the age group of 20-39 years) healthy individual will
never voluntarily accept the fact that he/ she is at a
risk for a serious head injury and by the time this is realized,
it is often too late It is believed that use of helmets is
not made compulsory due to differences of opinion among the
public. Ascertaining public
opinion speaks volumes for the statesmanship of the authorities.
Acting on them does not. Even public
opinion, depends on the design of the study, the size of the
sample etc. In one study 92%
of non users said that they did not use helmets “ because it is
not compulsory ” 95% of the entire group were of the opinion
that making use of helmets compulsory was the simplest and best
way to ensure constant compliance.
Several studies have shown that
compliance is near perfect only when Big Brother is watching all
the time. Is it unreasonable for society to expect that laws
already enacted in public interest (Section 129 of the Motor
Vehicles Act stipulates that all two wheeler users
shall wear protective head gear), will be enforced ?
In 1999 when the author was the Secretary of the
Neurological Society of India , the NSI impleaded itself as a co
respondent in a Public Interest Litigation filed in the high
court of Madras (Special Original Jurisdiction) In W. P.
No.19587 OF 1999, Though 7 years have passed the matter is
still to come up for hearing. One reads of courts suo moto
taking cognizance of a newspaper report – alas this does not
seem to apply to writs dealing with human lives. Many High
Courts have ruled that use of helmets should be compulsory.
However some states including Tamilnadu believe that compulsion
should not be resorted to. 80% of the 9500 head injuries treated
by the author in Chennai during the last 30 years have been
two-wheeler drivers or pillion riders.
deaths due to brain injuries were encountered in the helmeted
group compared, to the large number of deaths amongst two
wheeler drivers, with unprotected skulls.
A helmet bears the brunt of the impact reducing
the actual mechanical shearing forces reaching the brain. The
severity of brain damage is reduced. Irreversible brain
damage becomes potentially reversible.
Severity of head injury, death due to head
injury, incidence of skull fracture, occurrence of fits,
duration of hospitalization and cost of treatment is higher in
the non helmeted group
Society is or should be
concerned whether a two-wheeler driver uses a helmet or not.
In spite of large number of accidents, the chances of sustaining
a head injury is less than .01%. Naturally the desire to use
protective headgear is far less. How does one make a 2 wheeler
user wear a helmet. Education ? , increasing public awareness,
? Incentives ? Disincentives ? Compulsion ? Studies have
shown that when helmet use is voluntary, it is used by 40-50 %;
when it is compulsory it is almost 100 %; no other
approach has succeeded in raising helmet use to anything close
to these levels. Public laws are aimed at protecting human
beings and society. Can society exist without laws and
enforcement. Enforcement is one way to demonstrate that
individuals are cared and protected. (EEE) Education,
Engineering and Enforcement should be the strategy to reduce
two-wheeler deaths and injuries.
“Freedom and Democracy”
is standing in the way of enforcing an already existing law.
The greatest enemy of individual freedom is often the
individual himself. Individual inconvenience has to be
sacrificed for the common good. Freedom does not mean absolving
responsibilities. No one objects to the use of seat belts when a
plane lands or takes off. This minor inconvenience is accepted
as a part of safety regulations. Any parent,
widow or children of a fatally head injured victim, the
insurance companies doling out crores of rupees, the medical
superintendents whose beds are always occupied with serious head
trauma, the disabled patient who is now a liability to the
family , the hundreds of survivors who are working at sub
optimal levels and the thousands with minor head trauma,
responsible for millions of man hours lost will testify to the
consequences of a head injury .
Not enforcing the law
on the grounds that individuals have a right not to wear
a helmet is taking a “forward” step in a backward
direction”. The pen is mightier than the scalpel. With a
signature, more lives in Tamil Nadu can be saved than even if
all the neurosurgeons in this state spend their entire life time
operating only on serious head injuries. Helicopter ambulances,
state of the art critical care head injury units and specially
trained neurosurgeons in every town can at best salvage a few
more. An ancient Talmudic saying goes thus “ He who saves one
life says the world entire” When a plane crashes once in two
years, commissions of enquiry .are set up. When a fatal head
injury occurs every four minutes and we have incontrovertible
scientific evidence that protection to the head would make an
irreversible brain injury reversible, the authorities are wary
of even enforcing an existing law.
Making two wheeler users
wear helmets does not require funds or expertise. All that it
requires is a change in mind set.