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January 2014

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 1 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.

P. David Halstead et al: Hockey Headgear and the Adequacy of Current Designs and Standards

Sports Biomechanics Impact Research Lab, Department of Industrial Engineering, University of Tennessee, Knoxville, TN
2000. http://www.soimpact.com/Hockey_Headgear___ASTM.pdf

The CSA and ASTM hockey headgear standards are two of the least demanding standards in use and should be updated to account for new materials, a variety of hazards, and use conditions........Moreover both the CSA and ASTM hockey helmet standards need to be updated to include the more rigorous testing that many other helmets already have to endure....neither hockey helmet standard accounts for many of the obvious hazards involved in hockey. Hockey pucks can be projected at very high speeds; yet, the CSA and ASTM hockey helmet standards call for no such projectile impact tests.

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.

Andrew Morrison and Kernaghan Webb: Bicycle Helmet Standards and Hockey Helmet Regulations: Two Approaches to Safety Protection

In Chapter Six of the FTA (which came into effect on January 1, 1989), Canada and the U.S. pledged not to introduce product standards that would create unnecessary barriers to trade between the two countries. As a result, Canada can only introduce standards -related regulations if it can demonstrate that the purpose of doing so is to achieve health and safety objectives. When the proposal for regulation [of bicycle helmets] was reviewed, concerns surfaced that referential incorporation of the CSA standard into the Hazardous Products Act might constitute a trade barrier contrary to article 603. Although it was suggested that the regulation could be justified under the health and safety exception, there was no concrete evidence that the CSA standard was superior to the major American standards. The possibility of a trade dispute over a regulation that was ultimately considered to be unnecessary to achieve its safety objective, was yet another reason for withdrawing the proposal to regulate.

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 advertised 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."

It's partially a chicken-and-egg problem: There's no agreed-upon test because the major manufacturers haven't yet developed a helmet that dampens rotational acceleration. If nobody invents a concussion-reducing helmet, there's no reason to agree upon the standard for testing it.

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.” Why Helmets Can't Solve Concussions Sports Illustrated (SI.com)

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 subcommittee chairman of the giant American Society for Testing and Materials (ASTM) says 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?

Letter from Mayo Clinic doctors, 2011:

Health care providers at the Mayo Clinic Sports Medicine Center have evaluated 170 concussed athletes in the past three months. These athletes were injured while participating in a variety of sports, including soccer (no helmet), football (wearing a well secured helmet) and hockey (wearing a variety of helmet brands, including those that claim to help prevent concussions).....Please remember: Current hockey helmet designs do not prevent concussions.

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 Rink. 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.

Conversation with City risk manager Jim Kidd, 2008

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 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). There were only 217 injury reports 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%.

June 23 2010 meeting with two active living staff, recorded by Jutta Mason. (We were not allowed to take photocopies of the material home, just to take notes) - I assume that the injury numbers and the participation numbers pertain to the same time period, i.e. 2008 and 2009 - I assume that on page 2, "leisure skate programs and special events" would include shinny hockey (rather than the other category, registered instructional programs) - since the registered programs in 2008 and 2009 had 46,929 participants, multiplying that by 10 would give a ballpark number for their attendance at the sessions (arenas might have more than 10 sessions per class, A.I.R.'s less) -- that would mean a registered attendance of 469,290 in those years - so the total attendance of registered and drop-in skating programs for those years would be about 1,456,879 - the 217 injury reports during those years would mean an injury rate of .015%, with .0012% of those involving EMS (17 of the 217 injuries) - 6% of the 217 injuries were listed as shinny hockey injuries, i.e. 13 injuries - assuming that shinny hockey would not be a registered program (or rarely), that means there would have been 13 shinny injuries during 987,589 times of drop-in skating, i,.e. .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.

Analysis of the city's helmet policy steps by legal researcher Belinda Cole.

Table comparing the Ontario Government's bike helmet policy consultation and the City of Toronto's skating helmet consultations, by Belinda Cole.

We’ll send this report to Jim Hart, the general manager of Parks, Forestry and Recreation, and report back on his response.