No pain, no gain? Preventing cycling injuries in a world of expanding waist-lines. Rob Benington Injury Prevention Manager, Avonsafe Co-ordinator NHS Bristol

Cycling is good for you Physical activity is strongly associated with improvements in: Mental wellbeing Risk of cancer Weight management Cardiovascular health Reduced CO2 emissions/ urban liveability, etc. NHS Bristol wants more people to cycle more often and for longer.

Injuries are bad for you Injury is not inevitable We can reduce risk of injury and increase health benefits at the same time.

“Injuries do not occur by chance “Injuries do not occur by chance. They are largely preventable, non-random events, and not “accidents”. Certain groups of people with certain characteristics are more likely to be injured. By studying how injuries vary within a population, we can begin to gain an understanding of the factors that lead to injury, and how the risk of injury may be reduced”. Injury Prevention, British Medical Association, 2001.

c. 13% of all attendances at emergency departments are admitted. “A total of 3,192 people were killed or seriously injured on UK roads while riding a bicycle last year”. The Times, 5-11-12 A total of 17,653 English cyclists were admitted to hospital with an injury during 2011-12, an increase of 1,611 (9%) on 2010-11. www.hesonline.nhs.uk c. 13% of all attendances at emergency departments are admitted. Ormel, 1999 Serious: an injury for which a person is detailed in hospital or any of the following –fractures, concussion internal injuries, crushings sever cuts or lacerations, general shock requiring medical treatment c. 135,700 cyclists from England and c. 160,000 from the UK were admitted to hospital or treated in an emergency department during 2011-12. NHS Bristol, 2012

Cyclist injuries resulting in admission (England) 2011-12 Collision: Pedestrian / animal 117 Collision: Other cyclist 396 Collision: 2-3 wheeled motor vehicle 76 Collision: Car, pick up truck or van 2,450 Collision: Heavy transport vehicle or bus 180 Collision: Railway train or railway vehicle 2 Collision: Other non-motor vehicle 24 Collision: Fixed and stationary object 681 Non-collision incident 12,301 Other and unspecified 1,426 Total Cyclists 17,653 (Total car occupants) 14,573

Travel and transport injuries Non-collision injuries

What stops people cycling?

Non-collision cycling incidents Caused 69% of cycling-injury admissions in England between (2006-11) Caused c.95,000 cyclists to seek emergency treatment last year in England Are preventable On average, cause less serious injuries than collisions but can be fatal. (70% cause no injury that requires treatment). Require more research Impose a removable barrier to starting cycling, keeping cycling and encouraging others to cycle.

Latest findings… www.tinyurl.com\avonsafecycling 1. Slippery road surfaces 2. Poor road surfaces 3. Kerbs and rail lines

Risk management 1. Remove the risk 2. Avoid the risk 3. Mitigate the risk 4. Accept and adapt to the risk 5. Take the risk

2. Avoidance

3. Mitigation

4. Adaptation www.icebikes.org

5. Acceptance – Informed consent (Thanks to the Highways Agency who designed the poster)

keeps cyclists cycling. Keeping cyclists safe, keeps cyclists cycling. www.tinyurl.com\avonsafecycling Rob.benington@bristol.nhs.uk