This study examines head injuries and helmet use over 8 winter seasons at a ski resort in Andorra. The percentage of injured skiers/snowboarders using helmets increased from 10% to over 30% during this period. However, the number and severity of head injuries showed no significant changes. While helmet use may reduce minor head injuries, the most severe injuries from high-speed collisions are not preventable by helmets alone. Larger, prospective studies are still needed to better understand the impacts of helmet use and injury prevention policies in snow sports.

1. HEAD INJURIES IN SNOWHEAD INJURIES IN SNOW
SPORTS AND HELMET USE.SPORTS AND HELMET USE.
EVOLUTION OVER 8 SEASONS.EVOLUTION OVER 8 SEASONS.
Dr Escoda Alegret B (1), Gonzalez Casallo J (2), EscodaDr Escoda Alegret B (1), Gonzalez Casallo J (2), Escoda
Alegret A (1), Dr Escoda Sales JM (1)Alegret A (1), Dr Escoda Sales JM (1)
(1)Centre Mèdic Pas de la Casa- Grau Roig, Andorra(1)Centre Mèdic Pas de la Casa- Grau Roig, Andorra
(2)Hamilton Investigacio, Andorra(2)Hamilton Investigacio, Andorra

2. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
- Snow sports (mainly skiing and- Snow sports (mainly skiing and
snowboarding) are popular wintersnowboarding) are popular winter
activities worldwide.activities worldwide.
- Head injuries are relatively- Head injuries are relatively
uncommon, but they can lead touncommon, but they can lead to
potentially serious outcome.potentially serious outcome.
- On the other part the use of helmet,- On the other part the use of helmet,
despite the controversydespite the controversy over theover the
need forneed for mandatory use, is knownmandatory use, is known
to reduce the incidence and theto reduce the incidence and the
severity of some of the head injuriesseverity of some of the head injuries
found in snow sportsfound in snow sports
BACKGROUNDBACKGROUND

3. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
In the ski resort of Grandvalira,In the ski resort of Grandvalira,
Andorra, and for 8 consecutiveAndorra, and for 8 consecutive
seasons,seasons,
- we examine both the evolution ofwe examine both the evolution of
head injuries and use of safetyhead injuries and use of safety
helmet while skiing orhelmet while skiing or
snowboarding.snowboarding.
- We observe whether the eventualWe observe whether the eventual
evolution in the use of helmets isevolution in the use of helmets is
accompanied by a change in theaccompanied by a change in the
head injuries, in number or severity.head injuries, in number or severity.
OBJECTIVESOBJECTIVES

4. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
- We retrospectively examined dataWe retrospectively examined data
collected by the ski patrols and thecollected by the ski patrols and the
Pas de la Casa-Grau Roig medicalPas de la Casa-Grau Roig medical
center for the eight consecutivecenter for the eight consecutive
seasons from 2001-2002 until 2008-seasons from 2001-2002 until 2008-
2009.2009.
- We also have the number of skier-We also have the number of skier-
days for our sectors of the resortdays for our sectors of the resort
METHODMETHOD

5. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
- Control group would be the right toolControl group would be the right tool
- But as known is really difficult to disposeBut as known is really difficult to dispose
of this toolof this tool
- We consider helmet use among injuriedWe consider helmet use among injuried
as marker of the evolution on helmet useas marker of the evolution on helmet use
EVOLUTION OF HELMET USE

6. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
HELMET USE: % INJURIED USING HELMET
0
10
20
30
2001/20
02
2002/20
03
2003/20
04
2004/20
05
2005/20
06
2006/20
07
2007/20
08
2008/20
09
SEASON
%OFUSE
EVOLUTION OF HELMET USE

7. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
Among children helmet use is largely majoritary:Among children helmet use is largely majoritary:
- Children coming with their schools, ski clubs, and otherChildren coming with their schools, ski clubs, and other
organized structures (either from Andorra or other countries),organized structures (either from Andorra or other countries),
have as mandatory the use of safety helmet, so 100 % arehave as mandatory the use of safety helmet, so 100 % are
normally wearing helmetnormally wearing helmet
- For those who come individually with their parents lower ski passFor those who come individually with their parents lower ski pass
prices are aplied when wearing helmetsprices are aplied when wearing helmets
- Helmets are easily found in rental shopsHelmets are easily found in rental shops
- UNHELMETED CHILD ARE EXTREMELY UNCOMONUNHELMETED CHILD ARE EXTREMELY UNCOMON
EVOLUTION OF HELMET USE

8. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
Seeing the increasing of helmet useSeeing the increasing of helmet use
we could expect an inversewe could expect an inverse
evolution of head injuries…evolution of head injuries…
HEAD INJURIES EVOLUTION

9. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
HEAD INJURIES EVOLUTION
HEAD INJURIES
0
2
4
6
2001/20
02
2002/20
03
2003/20
04
2004/20
05
2005/20
06
2006/20
07
2007/20
08
2008/20
09
SEASON
%OVERTOTAL
INJURIES

10. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
HEAD INJURIES EVOLUTION
HEAD INJURIES IPTSD
0
0,1
0,2
0,3
2001/20
02
2002/20
03
2003/20
04
2004/20
05
2005/20
06
2006/20
07
2007/20
08
2008/20
09
SEASON
HEADINJURIES
PTSD

11. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
SEVERITY EVOLUTIONSEVERITY EVOLUTION
We have been using several, methods to
quantify the severity of an injury:
- AIS scale
- Healing time scale
- combination of both scales
- none of this systems are easy to aply, we
are trying to improve their aplication to our
data collection

12. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
SEVERITY EVOLUTIONSEVERITY EVOLUTION
An easy way to quantify the severity of the
injuries is the % of patients sent to the
hospital

13. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
SEVERITY EVOLUTIONSEVERITY EVOLUTION
% INJ SENT TO HOSPITAL
0
1
2
3
4
2001/200
2
2002/200
3
2003/200
4
2004/200
5
2005/200
6
2006/200
7
2007/200
8
2008/200
9
SEASON
%OFTOTAL
INJURIESSENTTO
HOSPITAL

14. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
This retrospective study does notThis retrospective study does not
find evidences on the benefits offind evidences on the benefits of
helmet use in the overall population.helmet use in the overall population.
Helmet use has increased, butHelmet use has increased, but
there are not significative changesthere are not significative changes
in the number or severity of headin the number or severity of head
injuriesinjuries
DISCUSSIONDISCUSSION

15. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
Children are more exposed to headChildren are more exposed to head
injuries than older skierinjuries than older skier
/snowboarders, we have no precise/snowboarders, we have no precise
data on this age group.data on this age group.
More studies are needed to confirmMore studies are needed to confirm
the massive use of helmets and itsthe massive use of helmets and its
benefitsbenefits
DISCUSSIONDISCUSSION

16. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
We do not find decrease in the % of patientsWe do not find decrease in the % of patients
needing hospitalary treatment, while helmet useneeding hospitalary treatment, while helmet use
is expandingis expanding
The most dangerous injuries usually associateThe most dangerous injuries usually associate
several localizations, are usually caused by highseveral localizations, are usually caused by high
speed collisions, and there is no evidence thatspeed collisions, and there is no evidence that
they could be prevented by helmet use.they could be prevented by helmet use.
DISCUSSIONDISCUSSION

17. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
Previous studies from other authorsPrevious studies from other authors
show that helmet use reducesshow that helmet use reduces
severity and incidence of headseverity and incidence of head
injuries.injuries.
Extremely severe head injuries,Extremely severe head injuries,
resulting from high speed collisions,resulting from high speed collisions,
cannot be prevented by helmet use.cannot be prevented by helmet use.
CONCLUSIONCONCLUSION

18. HEAD INJURIES IN SNOW SPORTS AND HELMET USEHEAD INJURIES IN SNOW SPORTS AND HELMET USE
Prospective, multicentre,Prospective, multicentre,
coordinated studies are necessarycoordinated studies are necessary
in order to improve ourin order to improve our
understanding of snow sport'sunderstanding of snow sport's
injuries and their possibleinjuries and their possible
prevention policies.prevention policies.
Making helmet use mandatory inMaking helmet use mandatory in
children seems reasonable; helmetchildren seems reasonable; helmet
use in adults should result of gooduse in adults should result of good
information including talking aboutinformation including talking about
risk taking behaviors.risk taking behaviors.
CONCLUSIONCONCLUSION

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