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posted January 9, 2014

 

Special Helmets Issue

A rink safety story:

On a wintry day soon after Christmas, a mother decided to take her small children out to one of the city’s skating trails. She bundled the kids into their snow suits, packed a snack and the new skates and the helmets and a change of clothes in case of a fall into wet snow, and – because one of the kids was just learning to skate – a portable plastic skate-aid. Then the family got on a bus with all their stuff, trying not to lose their balance when the bus drove off before everyone was sitting down. At the other end of the ride, they got off and walked 20 minutes to the rink. They got their skates on, skate aid reassembled, helmets adjusted, and went out onto the ice.


Two minutes later, a rink guard skated up to them and told them to get off the ice right away. The bike helmets the kids were wearing are not allowed, the guard said. All children under six must wear a hockey helmet certified by the Canadian Standards Association (CSA) – no other certification will do. The mother said, “but we’re not playing hockey!” No matter, said the rink guard. The helmet is to protect the kids against banging their heads if they have a fall on the ice, and bike helmets won’t do that.

The mother had done her research before she bought her kids their helmets. She showed the rink guard the certification sticker inside the helmet, from the American government’s Consumer Products Safety Commission (CPSC). At this point the rink staff summoned her supervisor to help her deal with the mother’s resistance. The mother explained to the two rink staff that the CPSC certification means the helmet has been tested to withstand falls from seven feet high and a collision with a solid barrier (like a tree) while moving at 14 miles per hour. The kids were neither of them more than four feet high and they skated at speeds way below 14 miles an hour, on their new skates. As the kids watch anxiously, the mother asked, “Don’t you see that my kids are just fine with these helmets? It took us so long to get here, and my kids were so excited to come – please don’t keep us from skating.”

But the staff were firm. No rational argument could prevail against the city’s rule: only CSA-certified hockey helmets would do. So the mother took off all the skates, packed everything up, and took everyone back home after a memorably painful experience. She shared the story with her friends, and some of them decided that the extra expense of buying another set of helmets was not worth it, especially when there was no logic to it. Barring an unmonitored frozen pond nearby, skating would not become a family activity while their kids were young.

This same scene plays out in the same way every season at all Toronto rinks. Chalk up another point for the bubble-wrap movement, another loss for outdoor play.

The “what if” argument:

But what if even one child, wearing a non-CSA, non-hockey helmet, were to trip and fall and hit their head on the ice and die?

Well, actually, little kids almost never die of short falls. In fact, a very large survey published in 2008 by a California/ Utah/ Kentucky collaborative of medical researchers showed that in the case of falls of less than 1.5 m in vertical height, affecting young children up to five years old, the number of deaths was less than one in a million children. This confirms that little kids are made partly of rubber, a well-known fact (and a blessing) to parents.

But even if a child doesn’t die of a fall, what if she still gets a concussion – isn’t that worth preventing?

Any good helmet will help lessen the size of a bump or a cut on a kid’s head – a bike helmet as well as (or better than) a hockey helmet. But when it comes to concussions, helmets won’t prevent them – not bike helmets, not snowboarding helmets, and not hockey helmets either.

Read on....

Rules and laws:

The rule requiring hockey helmets at Toronto rinks is not based on a provincial or federal law but on a management policy devised at a meeting of the directors of Toronto Parks, Forestry and Recreation in 2004. The Toronto policy says that the only acceptable helmets are hockey helmets certified by the Canadian Standards Association (CSA).

This requirement for Canadian-only helmet certification is probably illegal under article 603 of the Free Trade Agreement. The only actual law concerning helmet use in Ontario is the one requiring bike helmets for children and youth under 18. That law does not specify the CSA as the only acceptable certifier – because the legislators were told that privileging the Canadian standard could be interpreted as constituting a trade barrier under the Free Trade Agreement. The only legal exemption to “creating unnecessary barriers to trade” would be if there was concrete evidence that the CSA standard was superior to the major American standards for protecting the health of the helmet user. And the legislators were persuaded that there is no such evidence.

The concussion data:

But the real problem concerning helmet standards is bigger than contravening the Free Trade Agreement. Evidence is mounting that none of the helmets available from any country can do what they’re thought to do – protect the helmet user from getting a concussion. A good helmet can help protect a skater against a skull fracture or getting a bloody gash to the top of the head – even if the skater were to drop seven feet in free fall or run smack into a hard immovable barrier like a tree or hockey boards, at 14 miles an hour. But the story is different for brain damage caused by concussions.

As far back as the 1970s, UCLA brain researchers asked the medical community to "discard the magical notion that wearing a helmet on the head is sufficient to protect against impact brain damage." As more helmet rules came into effect, head injuries – for hockey players, for snowboarders, for football players – didn't go down. They mostly went up. The New York Times recently reported on a study at the Western Minnesota School of Medicine, on head injuries among skiers and snowboarders in the United States. “It found that the number of head injuries increased 60 percent in a seven-year period, from 9,308 in 2004 to 14,947 in 2010, even as helmet use increased by an almost identical percentage over the same period. A March 2013 study by the University of Washington concluded that the number of snow-sports-related head injuries among youths and adolescents increased 250 per cent from 1996 to 2010.”

The Mayo Clinic’s Dr.Michael Stuart, who is also the Chief Medical Officer of USA Hockey, says “There is no scientific evidence to prove that the hockey helmet reduces the risk of concussion.”

Even the Bauer helmet company has a disclaimer on its website, saying that there’s no guarantee that any of the international hockey helmet certification standards which the company applies when making helmets, will reduce the risk of concussion.

Making a better helmet (to prevent concussions):

It seems that maybe it can’t be done. Lots of companies have been trying. But engineers like Dave Halstead, the helmet chairman of the giant American Society for Testing and Materials (ASTM) say that "The likelihood of preventing concussions with a better helmet is almost zero."

Neurosurgeons describe the brain as being a bit like a bowl of Jello. When you shake it, it may develop little fissures which – in the case of a brain – can interrupt the connections between the neurons. And no helmet so far devised can prevent the brain from shaking inside its skull when there’s an impact on the head – even, sometimes, a pretty small impact.

How to reduce concussions on Toronto’s rinks:

What can be done to prevent concussions at rinks, if wearing CSA-certified hockey helmets won’t do it? More and more sports advocates are saying that wearing a helmet may give people a false sense of security. What matters more, they say, is the form of the activity. If a significant part of a game involves hitting each other or slamming into each other, or bodies moving at accelerating speeds as fast as the speed of a car, over uncertain terrain, there will surely be concussions as well as broken bones. If a game doesn’t have those elements so much, it will have fewer concussions. In order for a game to be fun and challenging, there will always be injuries. But the benefits – the pleasure of the game and the effect on bodily well-being – should outweigh the drawbacks.

In the case of hockey, there is now mounting pressure in professional hockey to reduce hits to the head and fighting, to disallow body-checking in youth hockey leagues, and to teach young hockey players techniques for protecting themselves (especially their heads) during games. Progress!

The case of shinny hockey:

For hockey there’s another remedy as well: expand opportunities for all sorts of ordinary people, of all ages and abilities, to play non-contact shinny hockey. The rules are: no checking, no raising the puck, and no body armour necessary. Many players choose to wear gloves and some add shin pads. The game is also called pond hockey, a reminder of its roots in Canada’s wintry landscape. The game works when people are careful of one another – which they have to be, since there’s no body armour and therefore no excuse for being rough. People who tend to push or hit are thrown out of the game by the other players.

When Toronto’s Parks and Rec directors decided to require little kids to wear hockey helmets, they decided at the same meeting that all hockey players, of any age, would have to wear CSA-certified hockey helmets too. They made no distinction between shinny hockey and full-armour hockey. It’s possible that they had so little experience of the two sports that they didn’t understand the difference. They had no data on shinny hockey injuries, just a generalized “what if” worry about risk and liability.

How mandatory helmets for shinny hockey reduced participation in the game:

When the helmet rule began to be enforced, the number of shinny hockey players plummeted, especially youth. People who play shinny want to play a different game than body-armour hockey. The small unstaffed tennis-court rinks in Etobicoke suddenly got crowds of new shinny players, while the helmet-enforcing hockey-board rinks nearby might have six players during their open-shinny time. Some rinks whose shinny numbers shrank added new explicitly “unsupervised” times. They had nightly lineups of youth waiting to go on after the rink guards left the ice. A few rinks had nasty altercations between the rink guards and shinny players. Word got around that one rink guard got two teeth knocked out by an angry shinny player who refused to leave the ice for being helmetless. That brought in the health and safety rule-makers. Rink guards were told that they should announce the helmet rule but not put themselves in danger to enforce it.

Some rink management staff were in denial about the problem, insisting that helmet compliance was almost 100% except at rogue rinks like Dufferin. But in 2009 we did some counts at a sample of rinks across the city. Rinks with hockey boards in Etobicoke and North York had near 100% helmet use for shinny. In contrast, the rinks in Toronto/East York varied from 5% to 30% helmet use for shinny. The other difference? Rinks in Toronto/East York had from four to eight times higher numbers of shinny players, compared to the rinks where helmets were enforced. Shinny players have been voting with their feet.

Liability:

Well, it’s good to have more people playing outdoor sports, but what about lawsuits against the city? In fact, there have been very few. In 2006, CELOS asked the city’s Freedom of Information staff about injury claims between amalgamation (1997) and 2006. This was the response: “The search by staff of Insurance and Risk Management, Corporate Finance, has found a list of all rink injury claims. Staff state that of the total of five claims, two occurred on indoor rinks during organized hockey games, and the other three occurred during public skating on outdoor rinks.” In other words, in nine years of mostly helmetless shinny, there were 0 claims relating to shinny hockey.

Injuries:

Everybody knows that Canadians don’t tend to go to court as much as Americans do. Maybe the absence of lawsuits is not so surprising. But what about the lost work time, and the cost to the health care system, for concussions resulting from helmetless shinny hockey? No such statistics existed, but we thought a start could be made by estimating the number of skating-related injuries at city rinks. Rink staff are required to file an incident report for each injury. In 2010, after some persuasion, the city’s recreation director assigned one of his staff to do a quick count. First she went through the rink census numbers for 2008 and 2009, to find out the approximate number of skating visits. According to the city’s census, in those two years Torontonians went skating at their city-owned ice rinks just under 1.5 million times – about half a million times for registered skating programs, and almost a million times for drop-ins (shinny hockey or just pleasure-skating). Then she pulled the incidence reports off the shelf. There were only 217 injuries reported for those skating visits. 17 of the injuries required an ambulance. And only 13 of the 217 injury reports involved shinny hockey. In other words, the shinny hockey injury rate measured by the city’s incident reports was tiny -- about .0013%.

Re-opening the conversation:

We think that the city’s injury measurement is probably a little too low. More thorough research could be fairly easily done using existing city data. In general, though, if CSA-certified hockey helmets don’t prevent concussions any more than other helmets do, and if the injury rates are vanishingly small for both little kids and shinny players, and if the helmet rules are reducing the number of skaters, the city should revisit the helmet rules now. This time they could welcome wide-ranging rink user input instead of just making a decision at a closed meeting at City Hall.

We’ll send a copy of this report with a cover letter to Jim Hart, the general manager of Parks, Forestry and Recreation, and report back on his response. update: On January 31st, 2014, we received this response

Two very different examples of sports waivers

On the one hand: a shinny waiver letter, from the Town of Banff in Alberta. The town requires full hockey equipment to be worn for shinny hockey, but obviously they don’t think that’s enough. This is what you have to sign to be allowed to play shinny:

“ACKNOWLEDGEMENT OF RISK: I am aware that playing or practicing to play/participate in any sport can be a dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risks of playing or practicing to play/participate in shinny hockey include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the muscular skeletal system, and serious injury or impairment to other aspects of my body, general health and well being. I understand that the dangers and risks of playing or practicing to play/participate in shinny hockey may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life.”

Editor’s note: Maybe oil painting would be a better free-time activity, or chess....

On the other hand: here is some good sense, in the Ski and Snowboard Helmet policy, City of Toronto, approved Dec 2009 (and a surprising contrast to Toronto’s Skating and Rinks policy):

Parks, Forestry and Recreation Division endeavours to operate safe Ski and Snowboard Centres for all participants, staff, volunteers and permit holders. A component of safety includes the usage of approved Ski and Snowboard helmets [but helmets are required only for lessons]....This policy does not apply to tow ticket users or those who have requested accommodation and signed a waiver....[The policy recognizes] that all people may do the same or similar things in various ways, each being effective. [The policy] means to remove the barriers that prevent people from gaining access to and fully participating in important activities such as.....[the use of] facilities.... [Even for lessons, the policy allows] exemption from or adaptation of the Ski and Snowboard Helmet Policy when requested by a staff or participant... when the completed Ski and Snowboard Helmet Waiver is submitted to the Community Recreation Programmer.

Editor’s note: This is the policy on paper. But when we asked at the ski hill, none of the on-site staff had ever heard of the helmet waiver. However, for skiing or snowboarding outside of lessons, wearing a helmet is only “recommended,” not mandatory. Why not the same for skating, starting now?

Municipal helmet policies for skating at (mostly) outdoor rinks, across Canada

The important distinction is “helmets recommended” (your own choice of what kind of helmet to wear, or no helmet) and “mandatory” which at Canadian rinks seems to mean only a helmet approved by the Canadian Standards Association – no U.S. or European helmet certification accepted.

Pleasure skating:

Ottawa, Toronto and Halifax are the only three cities we could find that require kids to wear a hockey helmet for pleasure-skating (in Ottawa, at indoor rinks only). In Ottawa and Halifax, the helmets are free to borrow on-site.

In indoor or outdoor rinks in Vancouver, Calgary, Edmonton, Regina, Winnipeg, Montreal, and Fredericton, helmets are recommended, which means that if the kids are wearing a bike helmet, or a snowboard helmet, or the hood of their snowsuit, that’s fine. That’s true for outdoor rinks in Ottawa too.

Shinny hockey:

We asked only about outdoor rinks. Vancouver has no outdoor boarded rinks. Toronto (with 51 city-run outdoor rinks) and Mississauga (with three city-run outdoor rinks) were the only cities we could find where helmets are mandatory for outdoor shinny hockey. There are a lot of outdoor rinks in cities across Canada. Calgary has 5 city-run rinks plus upwards of 45 community-run outdoor rinks, Edmonton has 5 city-run rinks plus over 20 run by community groups, Regina has 42 city-run rinks, Winnipeg has 40 city-run rinks plus an unspecified number run by community groups, Ottawa has just over 250 community-run rinks, Montreal has just under 250 city-run rinks, and Fredericton has 8 city-run rinks. (Halifax has no outdoor hockey rinks.) All of these rinks, including those that are supervised at times, either recommend helmets for shinny hockey or have no signs up at all.

The Toronto “Skating and rinks policy” from 2004

This policy justifies its mandatory helmets requirement as applying only to “programs where there are higher risk of injury.” But that’s where some better research could really help. A more thorough revisiting of the city’s outdoor rink “incidence reports,” improving on the city’s back-of-the-envelope calculations in 2010, can answer the question – what do these reports show us about the actual injury risk in non-contact shinny hockey and for little kids learning to skate? Such an analysis might be helpful right across the country – because, without exception, none of the cities we contacted had based their helmet decisions (including mandatory helmet use for indoor skating and shinny hockey) on any actual injury data that they could pass on to us. Not on any lawsuit counts either. Just guesswork.

References/sources


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