"Always carry a spare helmet - for all the beautiful people who’ll ask you for a ride." So read the copy of an ad of a leading motorcycle manufacturer. But isn’t that possible only if you have one for yourself? According to an estimate, not more than 40 per cent of the Chennaites possess a helmet and not more than 7-8 per cent wear it while riding their two-wheelers. The rest simply say that they do not wear a helmet because there is no law to enforce it. But is a law really required to make the helmet compulsary in fatal head injuries? For most of us are carefree in our attitude towards this very vital aspect.

Once again there is a talk of assessing the views of the people on reintroducing the helmet rule for two-wheeler riders in Tamilnadu. But is that necessary at all? When the issue involved is of grave public importance, as in this case, the decision should be based on facts and unbiased expert opinion. The Central Motor Vehicle Act - 1988, very clearly and unambiguously makes it mandatory. However, the enforcement is left to the respective State governments.

The question of assessing the views of people is a secondary aspect, the primary concern should be that as we move into the new millennium is it really necessary that we continue to lose our intelligent heads? Attending to road traffic accidents becomes a major part of our medical system’s workload that can otherwise cater to more primary issues. The annual economic loss due to head injuries alone is atleast Rs. 2500 to Rs. 3000 crores. Annually we lose around one per cent of the ENP in road  accidents alone, not a healthy sign for a country like ours.

The people who succumb to head injuries are generally among 20 to 39 years of age. This being the most productive age group, these deaths and injuries are not only an enormous loss of productive human resource but also have serious implications for the health budget of the country. It also needs to be understood that even with advanced and intensive medical therapy and skilled neurosurgical procedures many lives cannot be saved or otherwise become pathetically disabled imposing a great burden on the society in general and the family in particular.

The human brain can withstand only a limited amount of traumatic damage beyond which the possibility of recovery becomes remote even with the best of treatment and efforts. Thus preventive aspects of head injuries are far more important than the treatment. And it is a well-established fact that preventive measures can be highly effective in reducing deaths and injuries, specially in accidents involving two wheelers.

In most developed countries, the death and serious injuries, although still unacceptable in those countries, have come down despite significant increases in traffic volumes. However, in developing countries the epidemic of road accidents is increasing by leaps and bounds. What could be the reasons for this endemic problem? It is perhaps "this cannot happen to me" syndrome which lies at the root of this malady. Indians by nature are fatalistic and believe in a preordained sequence of events. Thus the general feeling is that if an accident has to happen, it will happen, come what may. But nothing can be farther from truth.

In 1980 the US Department of Transportation presented "A Report to the Congress on the Effect of Motor Cycle Helmet Law repeal – A Cause For Helmet Use". The monumental report besides analysing the nature of injuries and the impact of helmet use also reviewed carious other issues that were clouding people’s judgement on the efficacy of protective head gear. These included arguments that helmets caused neck injury or that they caused accidents by impairing vision, hearing or by causing fatigue or that other parts of the body were equally risk prone et al. Some of the findings of the Report pertaining to wearing of helmets are:

• Safety helmets are effective in reducing the incidence and severity of head injuries resulting from motor cycle accidents.
• Unhelmeted riders are twiceas likely to receive a head injury as are helmeted riders. And, Unhelmeted riders are three times more likely to receive a fatal head injury.
• There is no data indicating that helmet use increases accidents by impairing vision or hearing, or by causing fatigue or over-confidence.
• There is no significant evidence that helmets cause or increase the severity of neck injury in motor cycle accidents. Helmet wearers appear to have somewhat lower incidence of neck injury than do non helmeted wearers.
• Helmet laws are effective in attaining high levels of helmet use.
• The failure of motor-cyclists to wear helmet places a substantial economic burden on society in terms of insurance, emergency medical care, hospital, rehabilitation and welfare costs.

According to a British study riding a motorcycle has twice the death rate compared to a cycle, 24 times the death rate compared to driving a car and 515 times the death rate of air transport. This study conducted by the British Department of Transport between 1983-1993 confirmed that there is a much higher death rate mile per mile when riding a motorcycle compared to any other commonly used mode of transport. Even as early as 1940s, Dr. Hugh Kairns, who investigated motorcycle accidents in Britain, with a view to determining the efficiency of helmets vis-à-vis head protection found that

• Severity of injury is reduced by the use of helmets
• Frequency of fracture and the duration of unconsciousness is less for those who wear helmets?
• There is a reduction of one-half in hospital treated injuries for helmet users.

Helmets cannot prevent road accidents, they can only reduce the chances of head injury or reduce the severity of injury to the head of the rider. It cannot be proclaimed as a panacea for all hazards on our roads but as an increasing number of hi-tech two wheelers find favour with the young neo drivers, it rather becomes a necessity.

As the population of these ‘flying machines’ grows on our roads so does the risk factor of the driver being involved in an accident. That a two wheeler is inherently a risky vehicle vis-à-vis other motor vehicles has been clearly established. While a motor cycle or scooter can attain high speeds, they do not offer any protection to the riders. An occupant of car, bus, or truck has a wall rider is a sitting duck. In most cases, an accident directly involves his body and he is without any protection whatsoever.

However, protection of parts defies easy and pragmatic solutions. And, the experience of many countries and research on the subject reinforces the case for protective head gear as the priority. The strategy should be to evolve a comprehensive two wheeler safety programme and the focus should be on preventing an accident in the first place. However the million dollar question " Whether to wear a helmet or not? "has only one answer "The choice is yours, after all the head is yours."