Increasing Severity Of Bicycle Injuries Leads To Concerns About Cycling Infrastructure
Main Category: Sports Medicine / FitnessAlso Included In: Public Health
Article Date: 14 Oct 2009 - 1:00 PDT
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Record-high gasoline prices, the slowdown in the economy, and increasing environmental sensitivity are leading more people to bike to work or for play. But an adequate infrastructure may not be in place to protect cyclists from serious injury according to surgeons who presented a new study on the issue during a scientific paper session at the 2009 Clinical Congress of the American College of Surgeons.
The researchers found that the severity of injury and hospital length-of-stay for bicycle injuries at one trauma center has increased significantly over the past 11 years. Despite the wide-spread attention paid to the importance of wearing helmets, helmet use did not change during the time period of the study, and more than 33 percent of 329 bicycle injury victims had a significant head injury. Even more alarming, the number of chest injuries increased by 15 percent and abdominal injuries rose three-fold over the last five years. "We were astounded by that data," said Jeffry Kashuk, MD, FACS, associate professor of surgery at the University of Colorado School of Medicine and senior attending surgeon at the Rocky Mountain Regional Trauma Center at Denver Health Medical Center, Denver. "We're talking about injured spleens and livers, internal bleeding, rib fractures, and hemothorax [blood in the chest]. Those kinds of injuries are reflected by an increase in injury severity score," he added.
The study was conducted in Denver, which has one of the most well-developed bicycle path networks in the country. "Denver is very much a bicycle community. If we are seeing an increase in injuries in a metropolitan area that has fairly mature bike infrastructure from the standpoint of bike pathways, there's reason for concern about what's happening in metropolitan areas that don't have that level of maturity. There seems to be a significant increase nationally in the use of the bicycle for urban transportation. If our data is a microcosm of what is going on nationally, we may be on the cusp of an injury epidemic," Dr. Kashuk said.
Researchers at the University of Colorado hope to obtain funding so they can expand the study nationally and generate data that will support better safety standards and raise community awareness about the lack of cycling infrastructure. "On a local and national level, people need to be aware of the fact that a push for bike transportation for the sake of health, the environment, and lower transportation costs has real potential to raise medical costs because our infrastructure may not be ready for it," Dr. Kashuk said. "Look at all the safety factors that have been incor-porated in automobiles and streets and highways. If even a percentage of that kind of investment went into safety vis-a-vis bike paths and community infrastructure, we would protect people from major injury."
Zachary Hartman, BA; Ernest E. Moore, Jr., MD, FACS; Walter L. Biffl, MD, FACS; Catherine C. Cothren, MD, FACS; Jeffrey L. Johnson, MD, FACS; Carlton C. Barnett, Jr., MD, FACS; and Angela Sauaia, MD, participated in the study.
Source: American College of Surgeons (ACS)
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Infrastructure Not The Way To Reduce Bicycle Accidents
posted by John Schubert on 15 Oct 2009 at 4:49 pmAs a bicycle safety specialist for more than 30 years, I welcome the fact that your doctors have brought forth some interesting, if sobering, data ["Increasing Severity Of Bicycle Injuries Leads To Concerns About Cycling Infrastructure"].
However, I think you are making assumptions that may lead to erroneous conclusions, and you should examine those assumptions carefully as part of your future work.
Specifically, Dr. Jeffry Kashuk wrote, "Denver is very much a bicycle community. If we are seeing an increase in injuries in a metropolitan area that has fairly mature bike infrastructure from the standpoint of bike pathways, there's reason for concern about what's happening in metropolitan areas that don't have that level of maturity."
What's the assumption there?
The assumption is that bicycle-specific infrastructure lowers the accident rate.
But that assumption has never been proven. Indeed, the city of Cambridge even stopped claiming that it was so seven years ago.
To be clear, I am not dissing all bicycle specific infrastructure. Earlier this week, I myself went riding on an off-road canal towpath. As always, I found it extremely pleasant. Facilities like that towpath encourage cycling, encourage public health, and make communities more livable. That particular towpath even serves as a commuter route, linking three cities and some in-between bedroom communities. No problem there!
But in many cases, bicycle-specific infrastructure is simply dangerous. Despite the best efforts of those of us who serve on standards committees, most bikelanes and sidepaths have design defects that exacerbate known accident types.
Let's look at what causes accidents:
Approximately two thirds of bicycle accidents do not involve a collision with a motor vehicle. They involve a simple fall, loss of control, or collision with another bike, a pedestrian, a fixed object, a dog, etc. Rarely are such accidents affected by infrastructure. Most such accidents are nonreportable, and most of the reportable ones have minor injuries. But some do cause catastrophic injury or death.
Of the remaining one third of bicycle accidents, which are collisions with motor vehicles, we can divide them into various categories.
One category division would be bicyclist fault versus motorist fault. This one is very roughly half and half, and the traditional rule of thumb has been that the older the cyclist, the less likely that the accident would be his/her fault. (Child cyclists are usually at fault in bicycle/motor vehicle collisions, a sad fact that is a predictable result of their inability to think of their place in a traffic interaction.)
Another category division is key: would the mechanism of the collection be affected by infrastructure? And, to get to my core point, how would it be affected? Most bicycle/motor vehicle collisions occur at intersections, and these collisions tend to be exacerbated by infrastructure -- because adding a bike lane or sidepath makes people enter intersections from unexpected positions, resulting in increased collisions. Studies from Helsinki, Copenhagen, Berlin and Amsterdam all show this. So did a study from Davis, California, which led to Davis removing some of the more dangerous infrastructure designs -- but that study has been buried by the forces of political correctness.
Because separate infrastructure is popular, and lobbied for by bicycle-industry-supported groups, and because most of the public doesn't understand how it increases accidents, a simple request to do a safety review on all proposed infrastructure can be wildly unpopular, and such a review may be the target of vicious attacks. I've been called a lot of names for pleading that we not make taxpayers pay for infrastructure that can maim or kill us.
One of my colleagues in bicycle safety has a day gig with NASA, designing the propulsion systems for unmanned vehicles that we send to other planets. What he says about advocating for safe bicycle facility design is this: "It isn't rocket science. It's harder than rocket science, because it's so hard to get people to pay attention to the facts."
To be sure, there are occasions when infrastructure is critical. Slippery steel-decking bridges are one example. But no previous study has shown a crying need for infrastructure to prevent specific crash mechanisms, and I predict yours won't either.
What I hope you can make your future study do is look at accident prevention through new eyes -- the eyes of knowing the details of bicycle accident causes and countermeasures. If you were to link particular injury types to particular accident mechanisms, that would provide data I don't believe has ever been reported before.
In many cases, you'll find that the best prevention is teaching elementary cycling skills. Many riders are very deficient in basic skills.
I stand ready to assist you, should you have further questions.
John Schubert
610/282-3085
schubley@aol.com
Limeport.org
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