Skiers should wear helmets

It often takes a tragedy to raise public awareness regarding safety. During an athletic event, there are only two ways in which an athlete can suddenly die: cardiac or neurologic. The latter is typically the result of a traumatic brain injury.

Actress Natasha Richardson experienced a seemingly minor fall on a beginner ski slope and struck her head. After some initial symptoms she felt better and did not see a need for medical attention. Shortly after, she lapsed into a coma and subsequently died.

This frightening scenario is a principal focus of attention for sports medicine specialists.

Traumatic brain injury is a general term describing a range of damage that includes relatively mild concussion to severe brain hemorrhage. Bleeding can occur within the brain itself (intracerebral hemorrhage), below the dural membrane surrounding the brain (subdural hemorrhage) or outside the dura (epidural hemorrhage).

Epidural hemorrhage can be the result of relatively minor trauma to the temporal portion of the skull resulting in a tearing of the superficial temporal artery. Arterial bleeding is rapid and increases pressure in the skull with the brain eventually being pushed downward through the skull base.

A period where symptoms improve after the initial hemorrhage can be seen in epidural hemorrhage such as that experienced by Richardson. This “lucid period” can vary anywhere from a few minutes to hours. It is during this period that medical personnel must rely on clinical suspicion and take action that may be life saving.

This tragedy has reinvigorated the discussion of mandating the use of helmets on ski slopes. Helmets have proven to be effective in reducing brain injury in cycling and other sports. Ski helmets have the additional benefit of being comfortable, warm and waterproof in addition to offering brain protection.

Hopefully, common sense will prevail and more skiers and snowboarders will begin to wear helmets, and there will not be a need to legislate safety.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC, in Norwich. E-mail him at aalessi@wwbh.org, or listen to his podcasts, comment on his blog or buy his book at backushospital.org.

2 comments:

Anonymous said...

For a helmet to have prevented Natasha Richardson's brain injury, it would have to have been between the skull and brain.

The brain sloshes around within the cranium when you move fast, such as in a fall where you attempt to keep your head up, making the brain hit the skull even harder.

While there are some preventable brain injuries that a helmet could minimize, Ms. Richardson's was not one of those. And while skiers may reduce risks of some head injuries by wearing a helmet, such as whacking a tree, it would not have helped in Ms. Richardson's case.

Let's not use this tragedy to force every skier to wear a helmet needlessly.

Dr. Alessi said...

The human skull was designed to protect the fragile brain. Helmets add to this protection.

Epidural hemorrhages are the result of tearing of the superficial temporal artery typically by a fracture of the temporal bone. Helmets protect the brain against fractures especially in low-impact trauma such as what was experienced by Ms Richardson.

The example given by the anonymous blogger is more typical of what is seen in subdural hemorrhage with a contracoup injury. Helmets cushion the entire cranium in these incidents as well.

I agree with anonymous that it is a sad day when we must force people to protect themselves.

I disagree that we cannot learn from tragedies such as this. A perfect example is the safety innovations in NASCAR's "Car of Tomorrow." Many of those changes were the direct result of Dale Earnhardt's death.

Is there any better legacy than to know that others were saved.