At the age of 15, Garion St. Jean was as safety-conscious as an adrenaline-pumped teenager can be. Years of snowboarding lessons had prepared him for a job as an instructor at Horseshoe Resort in Barrie, Ont. He made a habit of inspecting his gear before riding and never hit the slopes without a helmet.
But on a crisp Monday in January, 2011, Garion's snowboard caught an edge and sent him flying head-first. His brain bashed around in his skull, leaving him in a coma for a week and in hospital for four months.
More than a year after the accident, Garion still has occasional lapses in short-term memory and trouble multitasking. But he is lucky to be alive, says his father, Noel St. Jean. Without a helmet, the impact of the fall "would have exploded his head."
Traumatic brain injury is the leading cause of death and disability for people aged 1 to 19, says Peter Rumney, physician director of the brain injury rehabilitation team at Holland Bloorview Kids Rehabilitation Hospital in Toronto.
Road accidents account for the vast majority of severe brain injuries, he says. But at peak times such as March Break, "you certainly see an uptick in all sorts of injuries on the ski hills."
Anecdotal reports suggest that helmet use is on the rise in Canada, probably boosted by media coverage of hockey player Sidney Crosby's concussions, actress Natasha Richardson's death after a minor fall on Mont Tremblant (she was not wearing a helmet) and Canadian freestyle skier Sarah Burke's recent death after a horrific crash.
Data from the National Ski Areas Association in the United States show that helmet use among skiers and snowboarders has more than doubled in the past decade.
But Dr. Rumney, who treated Garion during his rehabilitation in hospital, cautions that wearing a helmet "won't guarantee protection."
Kids tend to push their limits at ski hills, zooming down treed runs, which carry a greater risk of collision, or tucking their bodies in a racer's crouch, he says. Children who don't have the capacity to stop quickly are "like little missiles out of control."
Head injuries are more common among snowboarders than skiers because of the sport's popularity and because it's harder to stop on a snowboard than on skis, Dr. Rumney says.
He adds that teens are often unaware that alcohol and recreational drugs impair their judgment and reaction time. "The biggest risk is really the teenagers who decide to have a couple of beers and then do a couple of runs."
Teenaged brains are particularly vulnerable to damage from sports-related concussions, according to a recent study from the University of Montreal. Deficits in working memory – the ability to hold and process information for short periods of time – may linger for up to a year after a concussion, researchers found.
In rare cases, cognitive impairments due to concussions can be lifelong. Nevertheless, 90 per cent of people will make a complete recovery from a concussion within two years, "provided they have no further trauma," Dr. Rumney says.
Early assessment is crucial to prevent the risk of doing more damage. Fortunately, Dr. Rumney says, there is growing awareness that a person does not have to be knocked out cold to have a serious concussion. A minor fall such as Ms. Richardson's can be life-threatening if it's on the side of the head near the temple, where the skull is thinner, adding to the risk of fracture, disruption of an artery and internal bleeding, he explains.
Symptoms of concussion include headache, nausea and dizziness after a blow to the head. Some people experience changes in colour perception and sense of smell, Dr. Rumney says. He urges parents to watch for signs of confusion in a child after a fall and ask simple questions about the recent past, such as "What did you eat for lunch?" A child who seems disoriented and cannot remember what happened in the past 10 minutes should be taken off the ski hill and evaluated by a physician, he says.
For Garion, there was no question that the injury was severe. He was removed by helicopter from Horseshoe Resort and spent months relearning how walk, talk and eat. Now 16, he is doing well in school and has regained most of his cognitive abilities. But he is frustrated to be missing out on snowboarding season and limited to sports such as tennis and golf, his father says. "It's tough," Mr. St. Jean says. "He's an exceptionally competitive kid."
Although Garion is expected to make a full recovery within two years, a neurologist has warned him to take a permanent hiatus from high-speed activities and all contact spots, Mr. St. Jean says. "He explained in no uncertain terms that Garion cannot put himself at risk ever again."
Helmet safety goes beyond just strapping one on. Here are some tips from Robert Williams, an avid snowboarder, pediatric anesthesiologist and critical care specialist at Vermont Children's Hospital at Fletcher AllenHealth Care.
Ski and snowboard as if you weren't wearing a helmet. Although they can be life-saving, helmets are of little help in high-speed, head-on injuries and offer no protection against neck and other types of injuries.
Use a helmet designed for skiing or snowboarding. Bike helmets are designed with different impact characteristics and different areas of protection and should never be worn as a substitute for a ski helmet.
Ensure that the helmet fits properly. Ski helmets are not something to grow into. The helmet must fit properly to function safely. Consult a knowledgeable salesperson at a reputable store.
Buy a helmet that meets industry standards. Helmet standards in place include CEN (the least rigorous standard), ASTM and Snell (the hardest to meet standard for certification).
Act as a role model for your kids. If parents expect their children to wear helmets and ski or snowboard responsibly, then they should do so as well.
Establish a firm rule regarding helmet use. Don't hesitate to tell a child that "no helmet equals no skiing or snowboarding."
Help kids make their helmets look cool. Consider spending a few extra dollars and letting the child choose a cool design or stickers for the helmet at the time of purchase.
Source: University of Vermont College of Medicine