By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Dave Mirra's gravity-defying stunts knock out the competition on the BMX bicycle circuit. But keeping bike-riding kids from getting knocked unconscious may be an even tougher challenge.  

That's because some kids resist wearing life-saving helmets and protective gear.

"Everyone worries about being cool or looking cool," says Mirra, who holds the record for the most X Games gold medals - in any event. "But I learned pretty early that when you're wearing pads and you fall, it doesn't hurt as bad."

For Mirra, that was a lesson well-learned because he didn't always wear his gear.

And paid the price.

"I've had a lot of injuries that could have been prevented if I'd been wearing safety gear," admits the 29 year-old Mirra, whose autobiography "Mirra Images" is out now. "I have had a few major injuries and a lot minor ones.  I broke my shoulder. The most serious was I lost my spleen. I hit the ground super, super hard on that one."

Riding with protective gear is arguably a lot cooler than lying in a hospital bed, a place where many "cool" kids chill out for lengthy rehabilitations.

Whether it's practice runs or competition, Mirra gears up. "When I ride, I wear a full face helmet, elbow pads and knee pads," Mirra says. "I feel naked now without them."

When it comes to exposure to accidents, bikes are among the more injurious activities.

According to the Consumer Products Safety Commission, there were 627,170 bicycle-related injuries in 2000. The National Center for Injury Prevention and Control says kids 15 and under account for 59% of these - some of them very serious.

The Insurance Institute for Highway Safety estimates 140,000 children are treated in the emergency room each year for head injuries caused by bicycle accidents.

These figures do not include children bruised, cut, or knocked senseless who rested, got up, and were not treated; either because their parents did not think the injuries serious, or because the riders never informed their parents of the accident.

Despite parental prodding to wear safety gear, many kids do not.

"My son told me that all the guys in the neighborhood call him 'pad boy' because he wears the safety gear," says Alan Nager, physician and director of emergency and transport medicine, Childrens Hospital, Los Angeles.

"I've talked to countless numbers of parents who tell me they know all about the protection equipment but their child refuses to wear it and they allow this," Nager adds. "But I told my son he wasn't going riding without protection."

Concussions

Without the safety gear, tragedies are inevitable. National Institute for Highway Safety figures indicate that there were 668 bicycle accident deaths last year.

Head injuries are typically the greatest concern for doctors and safety experts, because they often expose riders to a wide range of physical and cognitive deficits.

Concussions are the tip of the neurological iceberg that may follow a blow to the head. Concussion is defined as reversible paralysis of nervous functions following brain trauma. The victim may - or may not - temporarily lose consciousness and such injuries can affect school performance, attention, and long term memory.

"Concussion is basically a direct force injury," Nager states. "Your brain sits in fluid within the confined space of your skull. With any direct force, once you stop suddenly your brain can still continue moving. This may have minor, short term effects on the brain."

Concussion severity varies widely, but whenever any of the following appears the victim should immediately be taken to a hospital:

• A severe fall
• Loss of consciousness
• Dizziness
• Seizure
• Amnesia
• Vomiting

Nager further cautions that if the person is confused, listless, lethargic, very sleepy or difficult to arouse, they should also be checked out by a physician.

"If the child is less than two, and they have received a goosebump on the sides or back of the head, then this has been correlated with a greater possibility of an intracranial bleed," Nager explains. "But not to cause panic, this doesn't mean a goosebump always indicates a brain bleed."

Bleeding displaces brain tissue, and within the closed skull compartment there is no extra space. The result can be damage to the brain from compression. For this reason, aspirin or ibuprofen should not be given to the victim, as they increase the risk of intracranial bleeding. Tylenol is instead recommended.

An even stronger recommendation is wearing a safety-rated helmet which frequently prevents concussion and often saves lives.

"We had a child come in who was hit by a car and the helmet was literally crushed," Nager recalls. "But this kid left our emergency department without really a scratch on him. If he hadn't had that helmet, it would have been a far worse outcome."

Preventing with protection

Smaller kids are more at risk when riding and taking falls.

"The smaller the child, the more important they wear a helmet because their head is proportionately larger than their body," Nager says. "They are going to tend to fall head first." Additionally, their slower reaction time means they're less likely to get their hands out in front of themselves to absorb the impact.

Nager stresses that supervision and enforcement are critical.  For him, the first, second and third rules of bike riding for kids are, "Supervision, supervision, supervision." The other critical component is enforcement - parents must make sure their child wears their gear.

There are five essential factors in preventing or reducing bicycle injuries:

• Proper equipment - "Spend the extra money on a certified helmet," Mirra emphasizes. "This is an area where you don't want to save money."
  
  
• Maintenance - To operate a bike safely, the bike itself needs to work properly and fit your child appropriately. Handle bar and seat heights should be customized to each child. "It's super important to maintain the bike and make sure the brakes are working properly," Mirra advises.
  
  
• Wear the equipment - "Parents need to set the tone early and be very strict about the rules," Nager says. "If you don't wear your safety gear, you don't go riding. This applies to skateboards, in line skates, scooters and the newer motorized scooters."  It also applies to adult role models. Parents should set an example for their kids and also wear helmets.
  
  
• Be aware of surroundings - Parking lots, streets, and other roadways are dangerous and unacceptable areas to ride.
  
  
• Know your limits - "A lot of hard work and planning goes into learning and mastering these tricks and jumps," Mirra says. "It took me a lot of years to even get to the point to where I would try some of these tricks."

Mirra adds there are competitive advantages in wearing safety gear all the time as well.

Because spills are inevitable, safety gear maximizes practice time, resulting in increased consistency and better performances.

"You can keep riding and have longer sessions instead of having to take a few weeks off because you're injured," he notes. "There are guys out there who don't wear safety gear and will hook some big stuff, but they're taking a way bigger than me."

Some 'tricks are for kids', but safety risks are not.

"The bottom line I think is if you're a parent and you're buying a bike, you have to buy the safety gear," urges Mirra, who will host MTV's Road Rules. "If you can't afford both, don't buy the bike."

Dave Mirra's website

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 12/20/2003  -  Donnica Moore, M.D.