Ask the Doctor

by VeloNews.com

• March 13, 2003
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Andrei Kivilev: Lessons learned

By Dawn M. Richardson, MD FACEP

Editor’s note: A few weeks ago we began making arrangementswith emergency room physician and cyclist Dr. Dawn Richardson to provideVeloNews.com with a regular column on medical issues facing those who participate in this sport. Scheduled to begin this week, Dr. Richardson had drafted her opening column on preparing a proper “crash kit,” the sort of basicsthat every team should carry to races in order to treat the standard fareof cuts, bruises and the ever-present road rash. The events of this weekat Paris-Nice, however, prompted her to delay that column and deal witha more critical issue.

I’m in the hurting business. As an emergency medicine physician, I dealwith the tragic consequences of injury on a daily basis. Over the 15 yearsI’ve been doing this, I’ve probably pronounced 200 people dead from headinjuries.

Two weeks ago I cared for and referred an unhelmeted 10-year-old boyfor emergency brain surgery for a skull fracture with bleeding in the brain.He had plowed his sled into a telephone pole at the park just across thestreet from the hospital. I, too, am the mom of a 10-year-old boy, so Igave his sobbing mother a hug as I told her I thought he had a shot ata good outcome. It still sucked. The next day I took my boys and a friendsledding and for the first time ever I made them wear their snowboardinghelmets. I’m a safety nazi but I’m still learning the rules.

The tragedy of Andrei Kivilev’s death hits very close to home, becausein addition to my work in emergency medicine, I’m a Category 2 road cyclist.I have had more than my share of serious head injuries, including fourmajor concussions. I’ve had facial plastic surgery that cost $10,000 froma bike crash 15 years ago. I spent six months during my senior year incollege with daily migraines as a result. This was all when I was toocool for a helmet.

I still didn’t get the message, and continued to race in my hairnetand pigtails, emulating my idol Beth Heiden, and smacking my head periodically.It took the 1987 imposition of an ANSI/Snell helmet rule by the USCF toget me to wear a real helmet. And I resented it. I had to be forcibly savedfrom my own stupidity. Aren’t my bike handling skills good enough to keepme safe? Couldn’t I be the one person who could defy the laws of physics?Helmets give me a neckache. I’m only going to the corner store. It’s notgoing to happen to me…. I had all the excuses now being used in the Europeanpeloton.

It took Dale Earnhardt’s death two years ago to get NASCAR to requirethe HANS device (Head and Neck Support), and some drivers like TonyStewart resented it and had a tantrum. The last time the UCI tried to imposea helmet requirement, in 1991, the professionals of the European pelotonhad a similar tantrum. Unfortunately, they got their way after they saton the street and refused to ride Paris-Nice, ironically the very stagerace in which Kivilev crashed on Tuesday.

It’s time to let go of the European drinkin’ smokin’ no-seat belt ‘notme’ la-la narcissism and change the rules! The one centimeter thick human skull was not designed to take hits from bike crashes, but ANSI/Snell helmetsare.

Wrecks can happen at any time. My worst was only one block from my house.You could get hit by a car like the Oxtoa brothers. Unless the UCI mandatesANSI/Snell helmets in the pro peloton, and saves the peloton from itself,Andrei Kivilev died for nothing just like Fabio Casartelli. Fabio Casartelli’scrash was freaky, Andrei Kivilev’s was routine. Who’s next?

I had a lot of stupid legal garbage in my team contract last year andI signed it under duress. But nowhere have I ever seen a contract thatrequired me to always wear a helmet on my bike so I’m more likely to beable to perform my duties as a domestique than to be drooling in my wheelchairon a Neuro-rehab ward. I’ve seen top American pros, male and female, inwarm-ups and training rides with no helmet. U.S. Postal, are you listening?Take the lead on helmets and require your riders to wear them on all trainingrides and races. Let the other teams follow.

What to do if it happens
Now that I’ve hopefully convinced you to always wear your helmet, whatshould you do when you or your training partner has a serious accident? Helmetslessen the probability of head injury greatly, but serious head injuries can still happen with a helmet. My fiancé had a 30 minute loss of consciousness wreck while wearing an ANSI helmet. It was dented and the foam was cracked and he surely would have died without it.

The first thing to remember is don’t move the victim. If he or she has immediate neck pain it may indicate a broken neck from the force transmitted from the hit. While their neck might be broken and they aren’t paralyzed yet,they cold be as soon as you start moving them. Just make your friend lie still and don’t let anyone move her. If she starts to vomit roll her like a log to the side with several people. Keep the head neck and body perfectly aligned. This will prevent choking. Call 911.

The symptoms of a mild concussion include nausea, a couple episodes of vomiting, aversion to bright lights and sleepiness but easy awakening with stimulation. This level of injury requires a trip to the hospital only if it makes you nervous, otherwise rest is probably the best prescription.

It gets much more serious if the patient experiences any of the following:any loss of consciousness, seizure, difficulty arousing from sleep, frequentvomiting, confusion or bizarre behavior, leaking of clear or bloody fluidfrom the nose or ears, trouble walking or moving the arms or legs, blurredvision, unequal pupils, slurred or confused speech, severe headache, ora depression in the skull. In those cases, call 911 immediately.

Please take this opportunity to rethink your own attitude towards helmetuse. Hassle your non-helmet wearing training buddies and the neighborhoodkids to wear a helmet even on short rides. Give your geeky ‘80’s and ’90shelmets to kids who may not be able to afford one. Lead by example.

And above all, let’s be careful out there.

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Dawn Richardson left the women’s peloton at the end of 2002after 13 racing seasons, most recently as a member of the Verizon Wireless-Cerveloteam. She is expecting her first daughter this summer. Richardson is aboard certified emergency medicine physician in practice at Saint Anne’sHospital in Fall River, Massachusetts. She is frequent contributor to SG:surf snow skate girl magazine, and is interested in health-related issuesfor cyclists, and women’s health. She welcomes medical questions pertainingto cycling, bearing in mind that if it ain’t emergency medicine she mayhave to do some work to figure out an answer. Please send your questionsor issues to “Ask the Doctor” in care of WebLetters@7Dogs.com.

Important Notice:
The information provided in the ASK THE DOCTOR column does notconstitute formal medical advice. The information provided on this publicweb site is provided solely for general interest of the visitors to thesite. The information contained in this column applies to general medicalpractice and may not reflect current medical developments or be interpretedas medical advice. Understand that reading the information contained inthis column does not mean that you have established a doctor-patient relationshipwith Dr. Dawn Richardson. Readers of this column should not act upon anyinformation contained in the web site without first seeking medical advicefrom their personal physician.