Because traumatic brain injury is not reversible or curable, at our current level of medical knowledge and skill, prevention is still the best way to avoid the disabling effects of a TBI. Remarkably adults still ride in cars without wearing their seatbelts, and they still forget or neglect to properly fasten infant car seats. A tragic example from the newspapers is the needless death of Kansas CIty Chiefs linebacker Derrick Thomas 2/8/2000. He suffered head injuries and severance of his cervical spinal cord from a car accident, because he chose not to wear his seatbelt while driving with friends at night in bad weather.
On 1/30/2000 the national BIA reported that 30% of children still ride unrestrained in cars, and that 85% of infant car seats are not properly fastened. A new TBI occurs every 15 seconds in our country. Each day one child dies and 50 others sustain permanent brain injuries from bicycle accidents. Nationally the rate of helmet wearing by child cyclists is very low. This is not acceptable.
However, there are some bright spots. In Seattle, WA, physicians Abe Bergman and Fred Rivara developed a program for subsidized production of safer bike helmets with instruction on proper usage for school age children, and reduced the rate of TBIs from childhood cycling accidents by two-thirds. BMW has just begun selling a car with improved seat and headrest design to lower the incidence of TBI in rear-end auto crashes.
NHTSA is taking steps to reduce the incidence of TBI. One example is collecting and releasing data concerning the relative risk that a given automobile will “roll over” in an accident along with an easy to understand ranking scale. Another, is its recommendation that all states enact laws to require child safety seats for all children lighter than 80 pounds. As of August 2000 California was moving to enact a law requiring car safety seats for children younger than 6 or lighter than 60 pounds.
Here in California, as a result of lobbying by our state brain injury association, the legislature enacted a helmet law effective 1/1/92 requiring all motorcycle riders to wear a helmet. In 1991 there were 512 deaths and 16,910 injuries from motorcycle crashes in California. Although motorcyclists made up just 4.2% of licensed drivers, they accounted for 11.3% of all motor vehicle fatalities and 17.5% of all severe injuries, and most of them did not carry medical insurance, so taxpayers footed the huge health care bills to treat their catastrophic head injuries.
As a result of that law, and police enforcement, fatalities from motorcycle accidents dropped 30% and injuries dropped 20% in 1992, and have continued to decline since then. Consequently total medical care costs for injured motorcyclists dropped by $35 million (a 35% reduction) in 1993. See, “Putting a Lid on Injury Costs: The Economic Impact of the California Motorcycle Helmet Law.” by Wendy Max, Phd et al. in Journal of Trauma, Injury, Infection and Critical Care Vol. 45, Issue 3 (Sept. 1998). Yet, every year Harley Davidson finances a sophisticated lobbying effort to repeal that law, and every year the Brain Injury Association of California Board of Directors must drive to Sacramento and counter-lobby legislators to block repeal, and save the law.
Traffic fines for non-compliance with the motor cycle helmet law have raised over $1 million per year for public funding of TBI rehab services to persons who cannot afford it.
