Abstract
To the Editor:
I read with great interest the letter from Dr Vargyas 1 concerning the use of ski helmets in the backcountry. I agree wholeheartedly that prevention is the cornerstone in reducing the incidence of ski and snowboarding injuries in the backcountry as well as during resort-based skiing. However, I must strongly disagree with his suggestion that the use of a ski helmet be labeled a “second- or third-tier recommendation.” The debate over the effectiveness of ski helmets has already confused the public and industry alike to the point that even ski professionals have erroneous information concerning the use of helmets and a low adoption rate. 2
Simply put, ski helmets have obvious limitations, but well-conducted research in the peer-reviewed medical literature has demonstrated that they are an effective tool for the prevention of traumatic brain injury in snow sports.
3
There are no downsides to the use of ski helmets. Although I share some of Dr Vargyas’s concerns over “gadgets” in lieu of appropriate behavior, the use of ski helmets does not increase the likelihood of riskier behavior (risk compensation). Scott et al
4
phrased this more eloquently than I am able to:
Until published studies reveal that snow sport helmets produce risk compensation, there is little reason to presume helmets cause guests to ski or snowboard beyond their abilities and place themselves and others at greater risk of injury. This should provide comfort to industry leaders and injury prevention advocates alike. They should not be reluctant to recommend ski helmets based on fears of risk compensation.
Although I am hopeful that competition in the helmet industry will improve the current quality of helmets, it is unlikely that we will ever be able to produce a ski helmet that protects against high-velocity impacts. Consequently, it is the responsibility of the skier to ski under control at all times. However, it is interesting to note that research published in this journal found that even ski professionals ski at relatively slow speeds (<15 mph) in the gladed areas that backcountry skiers are likely to encounter. 5
Those of us who are passionate about the backcountry enjoy the beauty and isolation of skiing in remote areas. However, this isolation produces its own set of challenges, which furthers the importance of helmets. A serious head injury in the backcountry is obviously exponentially more difficult to deal with than one occurring within the confines of a resort. In the backcountry, even a mild traumatic brain injury may have much more profound implications than at a resort. A concussed skier may be confused, unable to recognize that an injury has occurred, and have great difficulty navigating back to their starting point without significant help from partners or rescue personnel.
An important ethic among backcountry skiers involves a code of self-reliance and personal responsibility. The backcountry skier must be responsible to skiing partners, to family left behind, and, very importantly, to rescue personnel who may be put at great risk and inconvenience in the event of an accident in the backcountry. We recently witnessed an event in the northern Vermont backcountry, in which an injured skier was mildly concussed after hitting a tree. More than 50 rescuers were called away from their homes, families, and workplaces to extract this skier from the backcountry. If there is even a modest likelihood that the use of a no-risk intervention such as helmets can prevent such a scenario, do we not have an obligation to clearly promote this option?
Regardless of the speeds involved or other factors associated with trauma encountered during an avalanche, would we all not prefer to have a helmet on ourselves or a loved one in the event of an accident? My personal, and sometimes heartrending, experience on the slopes as well as in the pediatric intensive care unit causes me to urge us to please keep the message clear for the public: “Be aware of the special issues involved in backcountry skiing, particularly in avalanche terrain, and make responsible choices. A ski helmet is just one part of these choices. Protect your head at all times, and always wear a helmet.”