John Dunn: Helmets really are a no-brainer

Thursday 27 February 2020 | Published in Editorials


John Dunn: Helmets really are a no-brainer

OPINION: After working in hospital emergency wards, surgeon John Dunn knows well the cost of not wearing helmets. Mamas, papas and mokopuna are just as vulnerable to serious brain damage as drunk speedsters, he says.

Helmets save lives. Full stop. Don’t waste energy debating it. It’s established, factual and inarguable. Recent columnists who suggest “there is no evidence” are at best misinformed and at worst misleading. Trauma surgery is a long-established discipline and the research has been done.

It is time to elevate the debate above prejudice and emotion. We need to examine the brutal facts. The “wind in your hair” argument is actually a “gravel in your scalp” reality. People avoid helmets because of heat, hair, or hey-I-can’t-be-bothered.

So the debate comes down to a trade. What, as a society, are we willing to trade for mainly young, mainly male, lives? Basically it’s convenience. “I’m just going down to the shops/church/school/work”.

Let’s drill down on that. It takes literally four seconds to click it on, the same to click it off.

You wouldn’t go out without underwear. Think of this as “overwear”. Most fatalities occur on short trips and all trips on Rarotonga are short.

Lives are being sacrificed on this altar of “convenience “. And it’s a lot of lives, roughly five a year – but 10 in the past year. That is truly scandalous.

That 2019 figure represents about 0.1 per cent of the island’s population. The equivalent figure in New Zealand is 0.007 per cent. If people died on Raro roads at the New Zealand rate, there would be at most one person dying each year.

So there is an inescapable problem.

There is also an inescapable solution: helmets.

Let’s profile the problem, which is easy. The deaths are almost all young, male, drunk and occur at 2300-0300 hours between the seawall and Kiikii motel. And they ALL die of head injury.

Opinion writers understandably ring-fence this culprit group and finger-point. “They are already breaking a bunch of laws – we don’t need another”.

True. However the current legislation is layered and clunky and therefore ineffective. The Police are faced with a drop-down menu of decision making. Are they under 25, over 400mcg, doing over 40kph, or a tourist? It’s too hard and results in unintended consequences like harassing tourists in the daytime.

There are, I agree, immediate measures that will help enormously. These include dropping the legal limit to 250mcg like New Zealand and Australia. Believe me, at 400mcg you are d-r-u-n-k. At 800-1000mcg you can barely walk let alone drive.

Also doing frequent checks on Thursday-Saturday in the danger zone at the danger time is essential. That’s not rocket science. Resources need shifting to that catchment.

Similarly, driver behaviour must change. Not only the suicidal boys but also the obstructive riders/drivers. At present if you are helmet-less you are by definition limited to 40kph and holding up traffic.

Effectively there are two speed limits, which doesn’t work. At least keep well left and certainly don’t ride two abreast. Twenty years ago society was, literally, slower. Drivers would patiently follow Papa doing 35kph on the white line from Queen’s Rep to Black Rock.

Not anymore. Some overtaking is going to happen, which is a frequent cause of fatality. Slow drivers don’t HAVE accidents but they do CAUSE them.

I would strongly argue that helmet usage should be universal. Slow and sensible riders are not immune and may become an innocent third party statistic. It is only a matter of time before a Mama, Papa or mokopuna dies.

No matter who you are, or how drunk, the final common pathway to mortality is when your unprotected head slams into something solid. For the sake of your tamariki, stop whinging about helmets.

I remember all the same arguments getting trotted out in NZ in the 70s when helmets became compulsory. As a teenaged rider then, I was irritated at my “loss of freedom”.

Forty-five years of motorcycling and several falls later, I have cause to be thankful to those legislators.

I have much hope and optimism for our young people. In many ways they are smarter and more responsible than my generation with many issues like the environment. The leading causes of death in this age group are violent: trauma or suicide. Both are largely preventable.

An interesting phenomenon is occurring in New Zealand, Australia and Europe. Millennials and Generation Y drink a lot less than their elders. And it is seriously uncool to drink and drive.

The New Zealand road safety campaign adopted the slogan, “mates don’t let mates drive drunk”. I think similar positive peer pressure will come to bear in Rarotonga.

Laws must be workable. A zero alcohol level and a curfew are over-simplistic and impractical. They would unnecessarily impact a large blameless group, and tourism. It should remain legally possible for adults to have two glasses of wine with dinner and ride home at 1015pm.

Allow me to outline the harsh reality of Road Traffic Crash death. The mechanism of injury in increasing order of frequency is either major vascular disruption (like thoracic aorta transection), cervical fracture-dislocation (broken neck), massive abdominal trauma (liver, spleen, gut), or catastrophic head injury.

This last is by far the most common, and could be called “the Raro Disease”. Most die at the scene. The head is massively staved in with skull fragments penetrating and disrupting the precious grey and white matter shutting down all functions and causing haemorrhage.

It’s not pretty. Helmets prevent this. End of story.

Trauma is divided into sharp and blunt. Sharp includes stabbing and low velocity shooting and kept me out of bed for two years when working in South Africa. Surgically it’s fairly straightforward – sewing up holes.

Blunt is what we see in New Zealand and Rarotonga. It’s predominantly road-related. The surgery is more challenging.

Our heroic local theatre team, led by my colleague Dr Deacon Teapa, do superbly well with limited resources – no sub-specialists, ICU, or CT scanner to help. Dr Deacon may well plate the ankle, take out the spleen and drill the skull – a combined range of ability beyond any New Zealand surgeon, myself included.

But despite having done intensive neurosurgery training, I know there is little one can do with major head injury. The outcome is largely determined when the head hits the tarmac. Pulling out bits of bone and dead brain is a thankless task.

Beyond fatality there is also the burden of chronic head injury in survivors, with all its tragic mental and physical disability. The cost to both the individual and society of these injuries is often invisible but huge.

Even an apparently mild knock can result in debilitating post-concussion syndrome. This can entail personality change, headaches, irritability and aggression, lethargy and loss of jobs and relationships.

Finally, the issue of cost. One writer had estimated all these helmets will cost $1.6m. That must be challenged.

She quotes a retail sum. With some organisation and imagination the helmets could be sourced and made available at roughly half that (wholesale) or, better still, rented out as happens with child car seats in New Zealand. It just requires the political will.

Furthermore, in terms of the macroeconomics, helmets win hands down. Health economists, in an effort to distribute finite resources, actually put a dollar value on an individual human life – which runs to millions each. The younger a person is, the more valuable they are assessed as, in terms of lost productivity and more.

It’s a cold calculation but an easy one.

One life saved could buy helmets for Africa. Or Rarotonga … it really is a no-brainer.

· John Dunn FRACS is a NZ based Cook Islander and Visiting Surgeon to Rarotonga Hospital.