Statement on General Helmet Use

The American College of Surgeons Committee on Trauma (ACS COT), through its Subcommittee on Injury Prevention and Control, prepared the following statement to educate surgeons about the effectiveness of general helmet usage in preventing severe traumatic brain injury and to encourage surgeons to support appropriate legislation in their respective states. The ACS Board of Regents approved the statement at its June 2016 meeting in Chicago, IL.

Helmet use is widely accepted as an effective means of preventing severe traumatic brain injury (TBI) in bicyclists and motorcycle riders. Previous ACS statements on helmet use are as follows:

• Statement on bicycle safety and the promotion of bicycle helmet use
• Statement in support of motorcycle helmet laws

In addition, there is an increasing appreciation of the significance of concussive injuries and the long-term effects of repetitive trauma to the head. In light of these trends, helmet usage in other recreational activities has become increasingly popular. The ACS supports the following:

• Traditional helmets are designed and tested to protect against severe TBI using primarily linear acceleration models. This strategy may not be the most effective for protection against concussive and repetitive injuries, which have a rotational component.^1,2 We strongly support research in helmet design to specifically evaluate performance in protection against concussion and repetitive injuries.
• Design of head protection should be targeted to the specific activity, age, gender, and level of competition.
• Sufficient data are available to support helmet usage for participants in alpine sports (skiing and snowing boarding).³ Although some data would suggest an increase in risk-taking behavior with helmet usage, the benefit of helmet protection remains strong.⁴
• There is strong support for wearing a motorcycle or motorsports helmet when riding all-terrain vehicles.⁵

Note

The COT finds that, at present, insufficient evidence is available to make any statement regarding helmet usage in specific sports, such as lacrosse and soccer.

References

1. Hoshizaki TB, Post A, Oeur RA, Brien SE. Current and future concepts in helmet and sports injury prevention. Neurosurgery. 2014;10(75);Supplement 4:S136-S148.
2. McIntosh AS, Andersen TE, Bahr R, et al. Sports helmets now and in the future. Br J Sports Med. 2011;45(16):1258-1265.
3. Hume PA, Lorimer AV, Griffiths PC, Carlson I, Lamont M. Recreational snow-sports injury risk factors and countermeasures: A meta-analysis review and Haddon matrix evaluation. Sports Med. 2015;45(8):1175-1190.
4. Thomson CJ, Carlson SR. Increased patterns of risky behaviours among helmet wearers in skiing and snowboarding. Accid Anal Prev. 2015;75(2):179-183.
5. U.S. Consumer Product Safety Commission. All-terrain vehicle safety. Available at: www.cpsc.gov/pagefiles/112051/540.pdf. Accessed July 15, 2016.