Helmet or Hell met? 

 
Dr. K. Ganapathy, 
Neurosurgeon, Apollo Hospitals,  Chennai , India.

“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 stricken father.  

 

                                                                                                        

“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. Only two 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.

 
 
 
 
 

 

 

 

 

 

 

 
 
 
 

 

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