More helmets, fewer injuries

In 2009, more than 350,000 people in the United States sought treatment for snow sports injuries — primarily sprains, strains and limb fractures. About 23 percent were treated for head injuries. Although most of these were minor bumps and lacerations, head trauma remains the leading cause of accidental death and disability among recreational skiers and snowboarders.

Yet in the past decade, the number of serious head injuries has declined, due in large part to the growing use of protective headgear. During the 2002-2003 season, just 25 percent of skiers and snowboarders in the United States wore helmets. In 2009-2010, 60 percent did, according to the National Ski Areas Association.

Surprisingly, the decline in injuries hasn't been matched by a corresponding decrease in fatalities. Several factors account for this discrepancy, according to Todd M. Emanuel, R.N., injury prevention coordinator for Mayo Clinic's emergency services in Rochester, Minn.

"Skiers and snowboarders tend to ignore a bump on the head, not realizing that snowpack— especially if it's well skied — can be as hard as concrete. And they don't take into account how hard or far they fall." As a result, he says, people with serious head injuries may not seek or receive prompt medical care.

Moreover, helmets don't necessarily decrease fatalities. Headgear protects against blunt trauma at speeds up to 17 miles an hour, but even intermediate skiers typically go twice that fast. Eight of the 39 people who died in ski or snowboard accidents in 2008-2009 were wearing helmets.

Even so, Emanuel emphasizes that helmets clearly reduce the risk and severity of nonfatal injuries. "Some studies indicate that helmets lead to a 50 percent reduction in head trauma. And helmeted skiers and snowboarders with head injuries have better outcomes and less neurological impairment than those not wearing protective gear. A helmet can turn a potentially serious injury into a minor one," he says.

The coolness factor

From 2006-2011, the emergency department at Saint Marys, one of Mayo Clinic's hospitals in Rochester, treated 53 injured skiers and snowboarders. Just 17 percent were known to have worn helmets. "It makes a strong case for the benefits of a helmet when you see that most of the patients in our Level I trauma center weren't wearing one," Emanuel says.

He adds that many of the arguments against helmets, such as interference with peripheral vision or hearing, aren't accurate. As for the coolness factor, perceptions of helmets are changing as more ski teams and adults wear them. "And," Emanuel says, "kids who grow up wearing helmets usually continue to do so."

To help promote recreational safety and helmet use in particular, Mayo Clinic conducts educational programs in area middle schools. The clinic also works with smaller rural hospitals to ensure that providers quickly recognize head-injured patients whose condition is deteriorating.

"Many head injuries that seem mild at first can rapidly turn into serious traumatic brain injuries," Emanuel explains. "We encourage hospitals to transfer patients with head injuries to a higher level of care sooner rather than later. It's much better to err on the side of caution."