Goalie Face Masks
Bicycle Helmets
Snowmobiling and Community-based Police Surveillance
Broken Glass Lacerations of Children
Ski Boots and Bindings and Lower Leg Injuries
Harvard Football, 1905
Child Injuries in Harlem
Hockey Eye Injuries in Canada
Cervical Quadriplegia from Football
Hunter Orange
Jacques Plante (Jake the Snake) was one of the most important goalies in National Hockey League history: he changed the way goalies played and looked. From 1955-1960, Plante was the goalie for the Montreal Canadian dynasty, which won five Stanley Cup championships in a row. In each of those years Plante also won the Vezina Trophy, the top award for goalies, as he allowed the fewest goals per game. Plante's roaming style of play was innovative, as he often moved out of the crease, for example to handle the puck behind the net for his defensemen on shoot-ins.
On November 1, 1959, at the old Madison Square Garden, Plante was struck in the face by a shot from the Rangers' Andy Bathgate. The game was delayed while Plante, his face bleeding and swollen, received seven stiches. The goalie told his coach he would not return to the game without a mask, one he had sometimes worn in practice. The coach opposed the idea, but without a back-up goalie, he relented. A masked Plante returned to the ice, shocking a sell-out crowd, and the Ranger players. Over the next years, Plante continued to wear the mask; he was ridiculed, called a coward, and had to endure taunts about his manhood.
Plante was the first NHL goalie to wear a mask in almost 30 years, and the first NHL goalie to wear one for more than two games. The Canadians were on a seven game unbeaten streak when Plante donned the mask; that streak continued to 18, as a masked Plante went 10-0-1 in November, and the Canadians went on to win their fifth straight Stanley Cup, and Plante the award for the best goalie. Plante won the Vezina Trophy again in 1962 and 1969. In 1962 he was awarded the Hart Memorial Trophy as the most valuable player in the entire league. By the mid-1960s, headgear was widespread among NHL goalies. The last NHL goalie to play without a mask was in 1973.
Moral: Change is hard; it's easier when change is led by the best
Sources:
Carter B. Plante changed goaltending. ESPN.com. espn.go.com/classic/biography/s/Plante_Jacques.html
Carter B. More info on Jacques Plante. ESPN.com. espn.go.com/classic/s/add_plante_jacques.html
History of Masks. http://users.aol.com/maskman30/historynf.html
Bicycle helmets can substantially reduce serious injury and death. A meta-analysis of thirteen peer-reviewed studies found that helmets reduced the likelihood of head injury by 60%. Head injury is the cause of death in the large majority of bicycle fatalities.
On July 1, 1990, Victoria, Australia (which includes Melbourne), with a population of 4.3 million, instituted a law requiring that all bicyclists wear an approved safety helmet. The law was preceded by a decade-long campaign to promote the importance of helmet use. Average rates for helmet-wearing in Victoria rose from 5% in 1982/83, to 31% in 1989-1990, jumped to 75% in 1990/91 following the introduction of the law, and continued to rise, to 83% by the middle of 1992.
In 1982-83, there were over 120 severe bicycle head injuries in Victoria. That number had fallen to just under 60 in 1989-90. The number of bicyclists with head injuries in Victoria fell an additional 70% between 1989-90, the twelve months before the law was enacted, and 1991-92. Overall cycling rates stayed about the same: bicycling decreased for children following the law, but increased for adults.
Moral: What's in the head is what separates humans from other animals, and humans are the only animals that can really protect their heads.
Sources:
Attewell RG, Glase K, McFadden M. Bicycle helmet efficacy: a meta-analysis. Accident Analysis and Prevention. 2001; 33:345-352.
Cameron MH, Vulcan AP, Finch CF, Newstead SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia-an evaluation. Accident Analysis and Prevention. 1994; 26:325-337.
Henderson M. The effectiveness of bicycle helmets: a review. Motor Accidents Authority of New South Wales, Australia, 1995. http://www.hsph.harvard.edu/hicrc/ewew
Snowmobiling and Community-based Police Surveillance
Snowmobiling is a popular winter sport, enjoyed by more than 2 million North Americans. The modern snowmobile can weigh in excess of 600 pounds and travel at speeds exceeding 90 miles per hour. In the 2000s, snowmobile accidents led to approximately 200 deaths of Americans and Canadians each year and 14,000 injuries. A Canadian study found that in 2000/2001, among winter sports and recreational activities, snowmobiling was the leading cause of severe injury and death in Canada, surpassing downhill skiing and snowboarding combined. Alcohol, speed, darkness and off-trail riding are among the common factors in snowmobile deaths.
Prior to the 1993-94 season, Sudbury, a Northern Ontario community with high rates of snowmobile trauma, created the Snowmobile Trial Officer Patrol (STOP). The STOP program carefully selected and trained volunteer deputized provincial patrol officers to patrol local trails, promoting safety, enforcing regulations, and assisting police with sobriety spot checks and alcohol interdiction efforts. In each of the subsequent three years, the 11 STOP constables checked over 2,000 vehicles, and issued close 400 warnings.
In the three pre-STOP years, there were a total of 15 snowmobile deaths in this community of about 160,000. In the three post-STOP years the number of deaths fell to 4. Non-fatal snowmobile injuries serious enough to require admission to the hospital fell from 87 to 53. Weather conditions during these two periods were similar. Other regions in Canada did not experience this type of decrease in snowmobile injury.
Moral: Increased enforcement can help reduce inappropriate behavior and resulting injury.
Sources:
Perrz JJ. Snowmobile injuries in North America. Clinical Orthopaedics & Related Research. 2003; 409:29-36.
Canadian Institute for Health Information. National Trauma Registry Report: Major Injury in Canada, 2001-2002. http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_15jan2003_2_e#report
Rowe BH, Therrien SA, Bretzlaff JA, Sahai VS, Nagarajan KV, Bota GW. The effect of a community-based police surveillance program on snowmobile injuries and deaths. Canadian Journal of Public Health. 1998; 89:57-61.
Broken glass lacerations of children
For many years in the United States, lacerations have been the most common pediatric injury that required evaluation by a physician. Broken bottle glass is generally the leading cause of these lacerations; for example, broken glass bottles accounted for 15% of lacerations seen in an emergency department at an urban Children's Hospital.
In January 1983, in an effort to reduce litter and increase conservational recycling, Massachusetts became the fourth New England state to enact legislation requiring mandatory monetary deposits on beverage containers. Between 1980-1982, Children's Hospital in Boston treated a steady yearly average of about 110 children for glass-related lacerations occurring outside the home. In 1983, that number fell to 38. The number of children treated for fractures, for non-glass related lacerations, and for glass-related lacerations occurring at home either stayed the same or increased slightly. There were no organized outdoor Boston clean-up programs during this period. The conservational "bottle bill" legislation appears to have dramatically reduced urban children's exposure to, and injuries from, broken glass in the environment.
Moral: Laws enacted for other purposes can have effects on the likelihood of injury.
Sources:
Baker MD, Moore SE, Wise PH. The impact of the 'bottle bill" legislation on the incidence of lacerations in childhood. American Journal of Public Health. 1986; 76:1243-1244.
Baker MD, Selbst SM, Lanuti M. Lacerations in urban children. American Journal of Diseases of Children. 1990; 144:87-92.
Makary MA. Reported incidence of injuries caused by street glass among urban children in Philadelphia. Injury Prevention. 1998; 4:148-149.
Ski Boots and Bindings and Lower Leg Injuries
In the 1960s, most ski injuries were to the lower extremities. These injuries tended to be more serious than those to the upper body; sprained ankles and fractured tibias were common. Progressive improvements in the ski boot (providing increased support for the ankle) and a decline in the average release torque of the bindings (also reducing twist-related problems) dramatically reduced lower leg injuries from skiing. At Mt. Snow, VT, for example, injuries per 1,000 skier days fell from 5.9 in the 1960-61 season to 3.4 in 1972-73. At Sun Valley, ID, injuries per 1,000 skier days fell from 7.4 in 1960-61 to 3.2 in 1972-73 (to 2.6 in 1975-76). The reductions were primarily due to reduced rates of lower leg injuries. Ski equipment improvements continued throughout the 1970s. At Sugarbush North, VT, from 1972-73 to 1980-81, ankle sprain injuries fell an additional 82%, and tibia fractures 69%; there was no change in upper body injuries, as no development in the sport was designed to reduce the risk of such injury. Ski areas in other countries also reported dramatic reductions in lower leg injuries between the 1960s and the 1980s.
Moral: Technological safety improvements often occur without (the threat of) governmental intervention.
Sources:
Johnson RJ, Ettlinger CF. Alpine ski injuries: changes through the years. Clinics in Sports Medicine. 1982; 1:181-197.
Tapper EM. Ski injuries from 1939 to 1976: the Sun Valley experience. American Journal of Sports Medicine. 1978; 6:114-121.
Gutman J, Weisbuch J, Wolf M. Ski injuries in 1972-1973. JAMA 1974; 230:1423-1425.
Sherry E, Fenelon L. Trends in skiing injury type and rates in Australia. Medical Journal of Australia. 1991; 155:513-515.
Ungerholm S, Engkvist O, Gierup J, Lindsjo U, Balkfors B. Skiing injuries in children and adults: a comparative study from an 8 year period. International Journal of Sports Medicine. 1983; 4:236-240.
Early American football was a tough sport, with all running plays (no forward pass), few pads, with many injuries occurring in the "bunch" or "pile" which formed after a player running the ball was tackled. After the 1905 season, the National Collegiate Athletic Association made radical rule changes designed to open up the game, reduce the number of "mass plays" and lower the injury rate. These changes included approving the forward pass and increasing to ten the number of yards required for a first down. In addition, various maneuvers were eliminated, including hurdling, tripping, striking a player in the face with the heel of the hand, and striking with locked hands. A third official was added to watch for infractions.
Team physicians at Harvard had carefully documented the injury problem among players on the varsity squad in the 1905 season; their conclusions (e.g. "the percentage of injury is much too great for any mere sport") helped spur the NCAA rule changes. Three years later the Harvard doctors compared the serious injuries to Harvard varsity players in 1905 (before the changes) with 1906-08 (after the changes). Fractures fell from 29 to 5 per year, dislocations from 28 to 3; ankle sprains from 13 to 4; concussions (all involving a loss of memory) from 19 to 4; and overall injuries from 145 to 38. The physicians credited not only the rule changes, but also better training and increased use of protective gear, for reducing the number and severity of the injuries.
Moral: Data are crucial both in highlighting the problem, and evaluating the effectiveness of interventions.
Sources:
Park RJ. Mended or ended? Football injuries and the British and American medical press, 1870-1910. International Journal of the History of Sport. 2001; 18:110-133.
Nichols EH, Richardson FL. Football injuries of the Harvard squad for three years under the revised rules. Boston Medical and Surgical Journal. 1909; 160:33-37.
Nichols EH, Smith HB. The physical aspect of American football. Boston Medical and Surgical Journal. 1906; 154: 1-8.
In 1988, Harlem Hospital in NYC admitted 273 children (aged 5 to 17) with severe injuries. Many were being injured by broken, rusty equipment on school and park playgrounds. Others were struck by cars while playing in the streets after school; there were few organized sports or after-school programs for them.
In 1988, the Harlem Hospital Injury Prevention Program began documenting the unsafe conditions in the Harlem parks, playgrounds and schoolyards-the dangerous equipment, unpadded surfaces, rodent infestation and drug dealing. Working with community groups, schools, foundations and city agencies, play areas were upgraded, and new ones built. Neighbors and parents helped refurbish the play areas. In 1991, not a single child was admitted to Harlem Hospital for a swing injury, which had previously been the major cause of equipment-related park and playground injuries.
Intensive educational programs were established for violence prevention and traffic safety. Smoke detectors and bicycle helmets were distributed either free or at reasonable cost in the community. An array of sports and arts programs were organized and expanded, including a hospital-based art studio and dance clinic, a Little League, soccer league, and winter baseball clinic.
By 1996, the number of child-injury admissions at Harlem Hospital had fallen from 273 to 120. The declines were largest for the specific problems on which the program focused.
Moral: Sometimes the crucial step is to recognize that something can be done.
Sources:
Allstate. Q & A with Dr. Barbara Barlow. See pdf.
Davidson LL, Durkin MS, Kuhn L, O'Connor P, Barlow B, Heagarty MC. The impact of safe kids/healthy neighborhoods injury prevention program in Harlem, 1988 through 1991. American Journal of Public Health. 1994; 84:580-586.
Durkin MS, Olesn S, Barlow B, Virella A, Connolly ES Jr. The epidemiology of urban pediatric neurological trauma: evaluation of, and implications for, injury prevention programs. Neurosurgery. 1998; 42:300-310.
Durkin MS, Laraque D, Lubman I, Barlow B. Epidemiology and prevention of traffic injuries to urban children and adolescents. Pediatrics. 1999; 103(6) URL: http://www.pediatrics.org/cgi/content/full/103/6/e74.
Howerton M. Safe kids in Harlem: communities mobilize to prevent childhood injuries. Children's Advocate. March-April 1998. http://www.4children.org/news/398harlem.htm.
In the 1972-73 season when data were first compiled, there were 287 eye injuries in Canadian hockey, and 20 blind eyes. In the late 1970s regulations required that in minor hockey, all players had to wear full-face protection. Currently in major junior hockey half-visors are compulsory; no eye protection is required in the National Hockey League or in adult hockey or non-organized children's ball hockey. Between 1972-2002, 311 blind eyes have been recorded in Canadian hockey, 8 of these to players wearing certified half-visors, but none to a player wearing a certified full-face protector. Because of better facial protection, rule changes (e.g. no high sticking), changes in coaching techniques and larger ice areas, reported eye injuries in Canadian hockey have fallen to 6 in 2000-01, with one blind eye.
Moral: Sports can be fun without being overly dangerous.
Sources:
Devenyi RG, Pashby RC, Pashby TJ. The hockey eye safety program. Ophthalmology Clinics of North America. 1999; 12:359-366.
Dr. Tom Pashby Sports Safety Fund. http://www.drpashby.ca/content/fundaction.htm Accessed February 2004
Cervical Quadriplegia from Football
Improvements in football helmets and face-masks in the 1960s and early 1970s reduced the danger of broken noses, lost teeth and ocular damage. Unfortunately the stronger helmets led to changes in blocking and tackling. Players were taught to use their heads as the primary point of contact, leading to an increase in cervical injury with quadriplegia. The majority of the high school and college players were rendered quadriplegic while attempting to make a tackle. Defensive backs and specialty team players were at particular risk. As a result, college and high school athletic associations changed the rules in 1976, penalizing teams when players used their helmets to spear or butt. Coaching techniques quickly changed to eliminate the use of the head as a battering ram. The result was a dramatic reduction in the incidence of quadriplegia in high school and college football, from 28 cases in 1975 to 5 cases in 1984.
Morals: Safety devices can have unintended consequences as people change their behavior; the rules of the game can be changed to reduce injury
Sources:
Torg JS, Vegso JJ, Sennett B, et al. The national football head and neck injury registry: 14-year report on cervical quadriplegia, 1971 through 1984. JAMA. 1985; 254:3439-3443.
Maroon JC. Steele PB. Berlin R. Football head and neck injuries--an update.Clinical Neurosurgery. 1980; 27:414-29.
A danger in hunting is being shot while mistaken for game; "hunter orange" clothing has been shown to increase one's visibility to other hunters. Beginning in 1987, North Carolina hunters were required to wear hunter orange clothing while in the woods. Comparing the four years before the law with the four years after, gunshot deaths of hunters "mistaken for game" fell from 12 to 2, while hunters accidentally shot and killed for other reasons remained constant at 22. In New York, between 1989-1995, 508 hunting-associated injuries were reported; of these 125 occurred when the injured hunter was mistaken for game. Although the vast majority of New York hunters were wearing hunter orange, 94% of those mistaken for game were not wearing hunting orange. Most states now require, and all strongly encourage, hunters to wear "hunter orange." Fortunately, deer seem to have difficulty distinguishing orange from green.
Moral: Clothes can save the man.
Sources:
Cina SJ, Lariscy CD, McGown ST, et al. Firearm-related hunting fatalities in North Carolina: impact of the "hunter orange" law. Southern Medical Journal. 1996; 89:395-96.
Anonymous. Hunting-associated injuries wearing "hunter orange" clothing-New York, 1989-1995. MMWR (Morbidity and Mortality Weekly Report) 1996; 45:884-87.