Stayin’ alive

On a day-to-day basis in Alaska, human survival sometimes still comes down to three basic factors that trace their roots back to the species’ prehistory: situational awareness, judgment and tools.

About all that has changed in modern times is a desire to foolproof the first two with improvements in the third. Safety equipment has become a defining characteristic of the mid to late 20th Century.

The use of motorcycle helmets only became common in 1941 after the British military ordered “dispatch riders” to wear them for safety.

Over the years that followed, helmet use spread to civilian motorcycles, snowmachines, bicycles, all-terrain vehicles, light aircraft and more. And as this change was underway, improvements aimed at making automobiles safer became issues of national concern.

Activist lawyer and writer Ralph Nader became famous in 1965 after launching an attack on the Chevrolet Corvair in a book titled “Unsafe at Any Speed.” The uproar that followed led to the 1966 creation of the U.S. Department of Transportation and several agencies within which would eventually be rolled together to create what is today the National Highway Traffic Safety Administration (NHTSA).

A federal mandate requiring all new motor vehicles be fitted with seat belts followed in 1968. The fixation on equipment as the answer to safety only grew in the years that followed, Safety devices started appearing on almost anything that could be safety guarded.

Avalanche transceivers – commonly called beacons – designed to save those buried in snow first came on the market in the early 1970s. The Federal Boating Safety Act of 1971 led to a 1973 federal requirement that all watercraft had to carry personal floatation devices (PFD) onboard. The law was expanded in 2002 to require that all children under age 13 wear those PFDs except when “below decks or in an enclosed cabin.” 

New Jersey in 1987 began requiring all children under age 14 wear helmets while riding bicycles. Similar requirements have been spreading across the country ever since.

Helmets started appearing on the heads of alpine skiers in the early 1990s and exploded into widespread use after Michael Kennedy, the son of assassinated Sen. Robert F. Kennedy, and popular singer Sonny Bono slammed into trees and died in ski accidents only six days apart in 1998.

And today, of course, most of the country is masked up to protect us all from the sometimes deadly SARS-CoV-2 virus.

Did it work?

How well various safety equipment has done the job of protecting people is a topic of considerable debate, but in some areas, it is clear that there was success right up to the point that there wasn’t.

Deaths in motor vehicle accidents began to drop dramatically in the 1990s as old cars disappeared from the road, near totally replaced at last by those in which seatbelts were first required, and airbags began to come into use to provide further protection for passengers.

Between 1990 and 2018, according to the data compiled at Statista, the death rate per 100,000 licensed drivers fell from 26.7 to 15.33, marking a decrease of almost 43 percent.

Since then, however, deaths have yo-yoed up and down around a 10-year average of 16 per 100,000, and they began creeping up last year as the pandemic changed life in so many ways across the country.

The NTHSA reported deaths rose 4.6 percent through the first nine months of 2020 despite a 14.5 percent decrease in the number of miles driven in that time frame. If the trend continued into the fall and early winter, 2020 is on track to top the record-breaking year of 2016 when 37,806 people died on U.S. roads.

The pandemic is being blamed.

‘The fatality rate shows an increased trend from March to September 2020 primarily due to the impact of national COVID-19 pandemic emergency situation,” the NHTSA reported. “NHTSA is continuing to gather and finalize data on crash fatalities for 2019 and 2020 using information from police crash reports and other sources. ”

The agency’s final report is not expected until the fall of this year. It is expected to show increases in deaths in both 2019 and 2020 as more complete data becomes available.

“It is too soon to speculate on the contributing factors” that pushed deaths up in 2020, the NHTSA said, but the Insurance Information Institute is already doing so. It cited the observations of Triple-I Chief Actuary James Lynch, who concluded the increase was likely caused by faster driving on less congested roads.

“There is ample evidence that drivers are…going faster than they did, particularly at rush hours,” he told the American Academy of Actuaries Annual Meeting in November. “That’s why mileage driven this year is down 12 percent, but traffic fatalities are up 4 percent.”

This trend has been seen globally, and the simple answer to the question why would appear to be that the fewer cars there on the road, the less attention people pay to their driving and the faster they go.

In Minnesota, where traffic volumes fell by more than 60 percent when a stay-at-home issue was ordered in the spring, the state highway patrol reported citing more than twice as many drivers for extreme speed – more than 100 mph – than in 2019.

“Almost immediately, the fatality rate started to go up, and go up significantly,” Michael Hanson, director of the Minnesota Public Safety Department’s Office of Traffic Safety told Medical Xpress. “It created less congestion and a lot more lane space for divers to use, and quite honestly, to abuse out there.”

It goes without saying that no one can drive 100 mph in a traffic jam. Open roads, on the other hand, allow for higher speeds and thus demand more judgment of those motorists who decide to speed.

In this regard, the highways of the pandemic look something like the country’s ski slopes where human behavior appears to have trumped safety equipment.

The ski experience

No sooner did skiers start returning to American ski resorts this year than they started dying in what has become the standard way.

Winter Park, Colo., reported its first death of the year in mid-January after a 25-year-old skier from Massachusetts hit a fixed object. CBSN Denver reported that officials said he “was wearing a helmet but it appears he lost control, hit several trees, and suffered from ‘head and facial trauma.'”

As ski and snowboard helmets became more and more common on ski slopes in the new millennium, the problem with recreationists pushing beyond the limits of their skills and running into things became obvious in the body count. This spawned a new mantra at resorts: “wear a helmet, but act like you’re not wearing a helmet.”

The message did not appear to work too well.

When the National Ski Areas Association studied data for the 2015-2016 ski season, it found the average person who died on the slopes was a 30-something, experienced, male skier wearing a helmet who hit a tree while skiing too fast.

Little has changed since then.

A peer-reviewed study published in The Journal of Trauma and Acute Care Surgery in 2019 concluded that “helmeted patients” were about twice as likely to suffer “severe injury” as those without helmets. 

Helmets did help protect those who fell over at relatively slow speeds and hit their heads, but the researchers concluded that ” hitting a stationary object was the injury mechanism most significantly associated with severe injury” and death, and those with helmets were the most likely to ski into something at speed.

“In a trend on par with national averages, the study found that during the study period, helmet use doubled from 43 percent to 81 percent. But, despite the increase in helmet use, the rate of head injury did not change significantly, decreasing only slightly from 49 percent to 43 percent,” the Valley News in Vermont reported.

“It would be ‘silly to take away from our study that helmets don’t help,’  study lead author Dr. Eleah Porter from the Dartmouth-Hitchcock Medical Center told the newspaper. “They protect against things that you can prevent with a helmet.'”

Helmets will prevent a concussion if you fall over and hit your head on hard snow on the bunny hill. They will not help much if they encourage you to ski fast and out of control until you hit a tree, a lift tower, or, sometimes, another skier at high speed.

The problem is with what has been called “risk compensation.”

As the late Dr. William Haddon Jr. and colleagues observed in a now oft-cited, 1964 study, “one can…argue that the introduction of essentially unevaluated accident prevention measures ‘can’t do any harm,’ but two potential dangers in this approach need to be noted. First, the introduction and enforcement of insufficiently evaluated measures may lead to an inappropriate choice of emphasis and may, as a result, dissipate funds, time, and public concern that might be applied to more effective measures. Secondly, the public and its government may conclude that everything that can be done is being done.”

Risk compensation has fueled a long-running debate over mandatory helmets in sports and recreation. Cyclists backing mandatory helmet laws cite there protective value, albet it limited, and studies showing helmeted cyclists appear to show better judgment in traffic than non-helmet users, and opponents argue that the main thing mandatory-helmet requirements do is discourage cycling in a world where the best way to make cycling safer is to get more cyclists on the road so motorists become conditioned to watching for them.

Cars and trucks are by far the greatest danger faced by cyclists. The U.S. Centers for Disease Control reports 1,089 people died in bicycle accidents in 2019. The NHTSA says 846 of those deaths – or 78 percent – involved collisions in traffic.

Copenhagen is generally cited as the safest place in the world to ride a bicycle because 62 percent of its residents use one for regular transportation in the city. Motorists in Denmark quickly become aware of the need to watch for cyclists on the road. Fewer than 20 percent of cyclists in Copenhagen are reported to be wearing helmets. 

Researchers who looked at risk compensation in a variety of popular sport and published in the Clinical Journal of Sports Medicine in 2004 concluded that there are risks to trying to replace judgment with helmets and other protective gear.

“It was not our intention to offer an indictment of protective equipment in sport and recreation,” they concluded. “(But) it may indeed be the case that introducing well-intentioned countermeasures is more harmful than doing nothing.”

They called for better research to “evaluate the net benefit of our interventions and minimize the ‘side effects’ of injury prevention strategies.

Researchers at the University of Vermont have since raised concerns about the side effects of mandates for face coverings in most U.S. states during the pandemic.

“Wearing masks may create a false sense of security,” they warned. “It is plausible that mandating masks could be counterproductive if the increased risk associated with an increase in contacts is larger than the decrease in risk associated with the mask itself. That is, it is possible masks may provide a false sense of security that leads to people letting their guard down and trusting the mask more than is warranted. Further research into the effectiveness of marks and behavioral responses to mask mandates is urgently needed.”

Those conclusions came after their research found the key factors associated with contracting COVID-19 were not related to masks but to “the number of contacts with adults and seniors, particularly contacts with people who are themselves COVID-19 positive. The factors that predict contacts, in turn, are working environment, living environment and, disturbingly, regularly wearing a mask outside of work. This study reinforces the concerns about risks for persons who have high levels of public contact during the pandemic.”

It’s those judgment and situational awareness issues again. When people take more risks – knowingly or unknowingly because they’re not paying attention – the dangers of bad outcomes rise.

Better safety tools can help, but as has been found with motor vehicles, avalanche safety gear, helmets, face coverings and more, they can only help so much.