Natasha Richardson was a beginner on a nursery slope when she sustained her
serious head injury this week. These slopes are the easiest of ski areas, so
gentle that they are almost flat. We also know that she wasn't wearing a ski
helmet.
Certainly the circumstances of her accident at Mount Tremblant in Canada will
make skiers think - and there are now 200 million of us and 70 million
snowboarders in the world.
The opinion usually trotted out on the slopes is that skiing accidents are
either a) the fault of someone else who is being irresponsible, or b)
unfortunate freak happenings. Note the absence of any sense of personal
responsibility. Alcohol, often in generous quantities, is a normal part of
lunch in the mountains, and most adult skiers don't wear helmets.
I don't mean to adopt a high moral tone here. I'm talking about the holidays I
have been on for three decades, and the ludicrous double standards that so
many skiers adopt. We wouldn't dream of driving after a drink, but we throw
ourselves down steep slopes at excessive speed after several.
We would never get on our bikes without first buckling on a helmet, but we ski
in woolly hats. We also believe that our behaviour is acceptable. Such is
the exhilaration of skiing that we like to reason that the only risk on the
slopes comes from nutters who are skiing too fast for their ability and lose
control on a slope that is out of their league. Richardson's accident shows
that this is not always the case.
Inevitably, the reporting of serious ski injuries can give the impression that
skiing is a dangerous sport, and that is probably what most of us think. In
truth, the figures show that, compared with other high-energy sports, it
isn't.
The most comprehensive ongoing study of ski injuries is by Dr Mike Langran, a
GP who works in Aviemore in Scotland and runs the www.ski-injury.com
website.
The number of skiing injuries requiring medical attention is consistent
throughout the world, he says: between two and four for every thousand
people skiing or snowboarding in a day, and slightly higher in Greece and
Japan. The risk of dying is 0.7 deaths per million skier visits, and 0.46
deaths per million for snowboarders. Langran doesn't regard skiing as
dangerous.
“If you have a busy season you see more injuries because more people are out
there, but if anything the risk has gone down in the past five years because
of carving skis that help people to turn and stop better, better bindings
technology and improved management of the slopes, which are kept in better
condition than in the past.”
There is no information about whether accidents are more likely to happen on
difficult slopes, but it is known that beginners are the most vulnerable.
Most snow sports injuries happen because of a fall, because the individual
is out of control, often travelling too fast, and on a slope that is
inappropriate for their ability.
About 10 per cent of accidents involve colliding with another person or
object, 5 per cent are related to using lifts, and 5 per cent are caused by
equipment failure. And - contrary to the hardened belief of most skiers -
they are more likely to cause a collision than a boarder is.
There is also evidence that accidents happen more often in the afternoon - on
the post-lunch run when people may have been drinking alcohol and are likely
to be tired.
“Anything that reduces your awareness and increases your sense of bravado,
like alcohol, isn't a good idea when you're skiing,” says Langran. “By the
end of the day your eyes and legs are not as sharp as they were at the
start, and that's why we see so many Friday-afternoon accidents.”
Langran acknowledges that the use of helmets remains open to debate. He wears
one but prefers not to dictate to others. “The risk of dying on the slopes
remains so small that I think it should be down to the individual,” he says.
“In Scotland 40 per cent of skiers wear them now, compared with 5 per cent
in 1997, but we haven't seen a reduction in the number of injuries, and
that's disappointing.
My advice would be, by all means wear one but don't think that they make you
invincible. There is anecdotal evidence that people who wear helmets take
more risks and are involved in more serious accidents.”
In January the pro-helmet lobby was quick to note the death of Beata
Christandl, a mother who became the 17th skier to die in an accident on the
piste in Austria this season. She was involved in a high-speed collision
with Dieter Althaus, a German politician, who survived. Christandl was not
wearing a helmet; Althaus was. The Austrian authorities reacted swiftly -
the new law requiring all children under 15 to wear a helmet when skiing
will be enforced from Saturday.
“Crashes at 30 mph are like falling on to concrete from a second-floor
balcony,” said Christian Kaulfersch, a local A&E doctor.
The helmet regulation already exists for children under 14 in Italy and those
under 13 in Slovenia. Andorra, Lapland and Norway provide free helmets for
children, although no one believes that the cost - at £50 or so, no more
than a mountain lunch for two in many resorts - is the reason why so many
people don't wear them.
The drive to make helmets compulsory for children has been sustained by the
belief that their softer tissue makes them more vulnerable, says the Ski
Club of Great Britain. Certainly there is evidence that helmets can prevent
or reduce the severity of many minor or moderate head injuries, but there is
no data to show that they protect against fatal head injuries. If you are
skiing fast and hit a tree, for example, a helmet is unlikely to protect
you.
This is the kind of point often made by those who eschew helmets; they also
point to the somewhat muddy evidence about helmets and neck injuries. One
Canadian study reported in the British Medical Journal suggested that the
possibility of helmets increasing the risk of neck injury could not be ruled
out.
The Ski Club of Great Britain believes that this confusion is behind the
stubborn refusal of so many skiers to wear a helmet. Other commentators
point out that there is a cultural element to consider.
Mark Frary, the Times ski correspondent, doesn't wear one, although he notes
that the number of helmet-wearers in Europe is slowly increasing. In the US,
where the prospect of litigation is ever-present and where authorities have
created slow areas and reprimand irresponsible skiers (and where drinking
alcohol is discouraged), the take-up is now 60 per cent.
“It's more ingrained in the culture in the US,” says Frary. “In Europe people
grumble that helmets are hot and sweaty, and argue that the evidence for
them isn't conclusive - that there is no data to show that they save lives.
I don't wear one because on the piste I feel in control. I know that's
possibly an arrogant point of view - there are other people on the slopes
who could crash into you - but I'm weighing up the risks and I've decided
that I'm not going to wear one for the time being when I'm not going
off-piste.”
As the editor of www.welove2ski.com,
Peter Hardy skis between 80 and 100 days a year and would no more set off
for the piste without his helmet than he would neglect to wear ski boots. “I
did a test run recently and found that I was skiing at 60 miles an hour
regularly,” he says. “Any confident skier would cruise at 40 miles an hour -
and a groomed piste has the consistency of concrete and is just as hard when
you hit it. I think it's madness not to wear a helmet.
“I know people say that if they wear a helmet they will feel so safe they will
try anything - that's ridiculous. They also say that you can't hear when
you're wearing one - well, that's rubbish too. And they're not too hot: mine
is like a colander.”
Hardy points out that the data proving that seat belts save lives emerged only
after belts became compulsory. He has seen terrible accidents on the piste
and 15 years ago fell 600ft while skiing. That he wasn't badly injured on
that occasion was down to luck, he believes. But he has worn a helmet ever
since.
Dr Langran recommends choosing a helmet designed specifically for snow
sports that meets one or more of these standards: ASTM F2040; Snell RS98;
CEN 1077.
www.ski-injuries.com
www.timesonline.co.uk/wintersports
Head injuries: what to look out for
At least a million people with head injuries, 200,000 of them children, are
seen in A&E departments across the UK every year. It's not the lump or
bump on the outside of the skull that bothers doctors - though these can be
alarmingly large in young children -but the risk of similar swelling on the
inside that can compress the brain; with catastrophic consequences if
missed.
Internal swelling - often caused by bleeding from a damaged blood vessel - can
follow a relatively minor knock or fall, and take hours, sometimes weeks, to
become obvious. An adult or child might appear to have recovered by the time
they are seen by a doctor, but then gradually deteriorate after this lucid
period as intracranial pressure increases and the brain becomes compressed.
So what do doctors look for in an outwardly well person who has suffered a
blow to the head?
Was the person knocked out? If so, it means that he or she received a
significant blow and needs to be seen by a doctor who, depending on the
case, may want to do a skull X-ray (children with fractured skulls are ten
times more likely to develop internal bleeding). And they will probably want
to admit the patient for 24 hours' observation.
Has he or she vomited? This is comparatively common after even a trivial blow
to the head in young children, but more than three vomits over a four-hour
period warrants a trip to A&E. And I would want my toddler checked out
after one bout if other factors were present. It's less common in adults and
should therefore be taken more seriously.
Other alarm bells include excessive drowsiness, irritability (particularly in
young babies) and any form of seizure. All should prompt a call for help.
Young children are unlikely to complain of worsening headache, but older
children and adults will. Take them seriously and get it checked before
reaching for the Calpol or painkillers.
Older people are particularly prone to slow bleeds, which can take days or
weeks to develop. Beware the elderly neighbour or relative who develops a
persistent headache and is becoming increasingly confused some time after a
fall (often forgotten).
Doctors look for a number of signs including changes to the pupils.
A larger than normal pupil that does not constrict briskly when exposed to
bright light (a torch) indicates serious trouble and trends in blood
pressure and pulse rates, which rise and fall respectively if pressure
inside the skull is higher than it should be.
It all sounds scary but serious problems are unusual - only 1 in 100 of those
admitted for observation end up requiring specialist treatment, such as
neurosurgery to remove a clot - and the lion's share of those are adults.
Children's heads are surprisingly resilient!
Dr Mark Porter
The risk of death or injury
1 death in 1,000,000 days' skiing is the fatality rate for winter board
sports.
In these terms, canoeing (1 fatality in every 750,000 trips) is worse - and
scuba diving is five times as risky.
2.8 injuries per 1,000 days spent skiing or snowboarding is the injury rate
and it compares badly with that of other sports. Parachutists, for instance,
may be ten times more likely to die with each jump than skiers are with each
day spent at Val d'Isère but, assuming they survive, they are two thirds
less likely to be hurt.
365 is the average number of consecutive days you would have to be skiing or
snowboarding before experiencing a reportable injury. If you spent the same
time playing rugby, the chances are that you would not still be playing by
the end of the year.
67,000 rugby injuries require a trip to Accident and Emergency in the UK every
year, and studies of competitive rugby players have found there is one
injury per person for every ten games played - or around two injuries per
match. That rate makes rugby a more dangerous sport than boxing, mountain
climbing and even - for those feeling patriotic - American football.
1 death in 8,200 pregnancies.
If all these statistics encourage a little risk aversion, then it is worth
considering that by that logic we might as well stop being human beings -
quite literally. Giving birth carries a greater risk of fatality than any
sport.
Sources: Health and Safety Executive, Rospa, National Ski Area Association,
British Parachuting Association, Ski-Injury.com, Sportsmed, ABC
