Neck Brace Effectiveness Study from the Moto World

safety

(James McMahon) #1

This popped up today as a press release (H/T to Josh Lane for spotting it). It provides some stats over the last ten years from a Wisconsin based EMS provider for motorsports. Check it out, ponder what you think on the depth of the study and what might apply to karting.

Also, further reading on neck braces here:


A Study Provided by Great Lakes EMS, Inc. (Action Sports EMS)

Great Lakes EMS is an ambulance service catering to the amateur motorsports world, specifically motocross and racing in the Midwestern USA. Safety and the study of rider injuries and safety gear has been their focus since 2013, and they have amassed 10 years of data that they want to share with the motorsports industry.

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Great Lakes EMS says that the data they choose to share is state certified and is based off of real documented patient cases recorded in their ambulance-run data system, as required by DHS rule in every state in which they provide care. By providing this information, they hope to make safety gear better and provide manufacturers real data as proof that they are on the right track.

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Here is the report Great Lakes EMS provided related to real-world neck-brace statistics pulled from their database from the last 10 years:

Neck Brace Effectiveness Statistics by Great Lakes EMS Inc (Action Sports EMS).

Introduction/Background

Action Sports EMS is an ambulance service catering to the amateur motocross industry in five states. Founded in 2008 in Northern Wisconsin we have managed to procure some of the largest motocross venues in the Midwest. Our annual coverage includes multiple area and regional Loretta Lynn qualifiers, Flat track grand nationals, ISOC, sno-cross events, and more. We work directly for the AMA providing care and transport at various events, often managing over 1000 riders in a single weekend.

Over the years we have overheard and had conversations about the positives and perceived negatives of wearing various kinds of safety gear, in particular neck braces. Regardless of make or manufacturer people seem to think they are “bad.” This perception may be based on old designs, personal experiences, social media commentary, and/or a total lack of knowledge when it comes to body mechanics.

Riders from age 6 to age 50+ have shared some horrific fallacies about neck braces, much of this information is coming from other riders during what we call “campfire talk.” More frustrating are trainers with junior riders feeding this information to parents and young riders. Some examples:

  • A neck brace will break your collarbone.
  • You cannot look up a hill or jump so don’t wear one.
  • You cannot compete wearing one of these and not many Pro’s wear them.
  • They will break your upper back and cause nerve damage or paralysis.
  • They are uncomfortable.
  • They restrict movement.
  • They are stupid looking.
  • None of them fit right

We as a team feel our riders need to be educated on the mechanics of a neck brace, what it can and cannot do. Furthermore, we must dispel these myths about a product designed to help protect the cervical spine and potentially save a life. The same can be said for seatbelts and air bags many decades ago.

We feel the results of this actual patient data is proof that neck braces are providing the results intended since their creation. This is something the manufacturers of these devices have known for several years, and we hope the extensiveness of this report (and other reports like it) will finally show people real-world data. We feel the manufacturers are on the right path and the data from the study will back up their claims.

Data Collected

*Data is collected for all patient contacts per DHS rule in any state a provider is licensed.

Data in this study has been collected from January 2009 to October 2018, (nearly 10 years) and includes 9430 total patients, 8529 of which fall into the criteria pertaining to wearing (or not wearing) a neck brace, along with Cervical Spine and/or Clavicle injuries, and/or deaths recorded during this time. The other 901 pre- date the “Yes brace or No brace” question, so data from these instances was excluded. This case study strictly isolates data pertaining to these injuries, as well as accompanying factors like hospital admit, ALS transport (Advanced life-support ambulance or flight service), spinal immobilization, fatal injury and more.

Of the 8529 recorded patients, 4726 of them were toggled as “NO” which indicates neck protection was not in place at the time of injury and when the record was created. 3803 were toggled “YES” which indicates neck protection was in place at the time of injury and when the record was created.

Statistics

1. A Critical Cervical Spine injury is 89% more likely without a neck

Over the course of the 10-year study, there were 239 recorded cases of Critical Cervical Spine injuries without a neck brace, and 26 with a neck brace.

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2. Death is 69%+ more likely (due to Cervical Spine Injury) without a neck brace*

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Over the course of the 10-year study, there were 4 recorded cases of death caused by Critical Cervical Spine injuries without a neck brace, and just 1 with a neck brace.

*It should be noted that the patient who experienced death with the neck brace had a full Cervical Spine Fusion from a previous injury, and received a blunt force (part of the motorcycle) directly to the back of the neck. Since the injury falls into our report criteria the accident is included in this report, but the circumstances are worth mentioning.

3. A Non-Critical Cervical Spine injury is 75% more likely without a neck brace.

Over the course of the 10-year study, there were 702 recorded cases of Non-Critical Cervical Spine injuries without a neck brace, and just 109 with a neck brace.

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4. A Clavicle (collarbone) fracture is 45% more likely without a neck brace.

Over the course of the 10-year study, there were 443 recorded Clavicle fractures without a neck brace, and 291 with a neck brace.

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5. Cervical Spine injuries sustained without a neck brace are more severe, require greater care.

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As shown in the left above, of the 239 Critical Cervical Spine injuries without a neck brace (Shown in black), 100% (239) of them required a hospital admit (Yellow) and ALS transport (Orange), compared to just 73%, and 42% for neck brace wearers respectively (Right chart, same colors).

Of the 239 Critical Cervical Spine injuries without a neck brace, 87% (207) received Spinal Immobilization (Red), where as of the 26 Critical Cervical Spine injuries with a neck brace, 76% (22) were immobilized.

6. A Cervical Spine injury of any kind is 82% more likely without a neck brace.

Over the course of the 10-year study, combining all critical and non-critical Cervical Spine injuries, 945 injuries were recorded without a neck brace (20% of 4726 people), and 136 with a neck brace (3.5% of 3803 people).

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Conclusion

9430 recorded accidents over nearly 10 years is a substantial sampling of real-world data pertaining to neck braces, and in every instance above neck braces are an exponential improvement in rider safety. We will continue to record this data for many years to come, and we feel with time these statistics will only continue, if not improve if more people continue to adopt this technology. While we cannot definitively rule out that the device (or any device) could potentially play a negative role during an accident, we feel it is important to mention that no device known to man is 100% effective, and that same rule applies to neck braces.

Our hope is that people see this, educate themselves on the benefits of wearing a neck brace, and make an informed decision regarding their safety when riding their motorcycle. The numbers don’t lie, and we highly recommend everyone consider wearing any protection item that can help contribute to their safety.

We are an EMS service that is simply looking out for rider safety. This is real world data collected over many years, and has in no way been manipulated to show a benefit or detriment either for, or against neck braces. Keeping you safe is our passion and it is our duty to share what we have learned while catering to the motorsports industry and to our moto-family for the good part of a decade. It should be noted that just like your bike, helmet, boots, etc, any equipment worn must be properly fitted according to manufacturer’s instructions in order to provide maximum benefit and wearability. Improperly fitted equipment can cause unexpected results, and may hinder your ability on the motorcycle, and may even lead to injury and/or death.

Quick Reference Terms

  • Cervical = “neck” made up of seven vertebrae C1 – C7 Clavicle Injury = “Collarbone”
  • ALS = Advanced Life Support Ambulance or Flight Service Hospital Admit = Admitted to Surgery, ICU, or Floor
  • Spinal Immobilization = Long Board Cervical Collar
  • Non-Critical = “Stinger” Neck Pain, Decreased range of motion. Assessment in Ambulance release signed

Source: Great Lakes EMS Inc. / Action Sports EMS – Ambulance data reporting system.

Equipment used data capture parameters in patient care worksheet : Helmet, Goggles, Boots, Knee Braces, Neck Brace, Chest Protector, Gloves, Body Armor, Bike, ATV, Motocross, Flat Track, Hill Climb, Woods.

Disclaimer:

All data contained within, and related to this report is the sole property of Great Lakes EMS, Inc., and shall not be used by any entity, company, manufacturer, or organization as a means to market and/or contribute to the sales and/or profit of goods or services without written and legal consent of Great Lakes EMS, Inc. The data contained in this report is and was strictly collected for informational and statistical purposes, and is not designed to endorse any product, service, or company, nor does the data relate to, or assume that all products designed for these types of injuries will provide any benefit(s) to the user. Great Lakes EMS, Inc. and its members, volunteers, contributors, and alike are not medical doctors, nor are they attempting to solicit medical advice in any form. Great lakes EMS, Inc highly encourages you to speak with a medical professional, and/or representative/sales agent for specific brands/manufacturers in your area should you have any questions or concerns regarding products you intend to use, as well as your health, safety, or otherwise.

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More studies and information can be found at https://www.actionsportsems.com/safetystudies or www.actionsportsems.com


(James McMahon) #2

My immediate thought is…

Causation is not correlation, but this is still something more to go on than rhetoric and anecdotes and I appreciate they took the time to compile the data and study.


(Joseph Costanza) #3

Yeah it seems like a fairly well done study, quite a large sample. As James said, correlation is not causation and maybe there’s a bias in those who voluntarily choose safety equipment like a neckbrace and the way that they ride versus those who forego a neck brace.

But with that said, there appears to be a strong correlation; effect size would have been nice, but its enough where I will probably get another one for when I go riding :man_shrugging:t4:


(Emmanuel Baako) #4

My thoughts… I"m more concerned with whether the design of some neck braces increase the probability of injury.

If neck braces do not irrefutably prevent injury but also cause no harm or discomfort, then I will absolutely recommend wearing one.


(Liam Sergeant) #5

The question I would wonder is whether neck braces provide the same benefit for karting given what I assume is quite a different mechanism of injury.

Forgive my ignorance as I’ve never ridden motocross, and what little motorcycle experience I have is very limited. But would the main mechanism for neck injury in a crash from a motorcycle be from head into the dirt.

I understand the HANS devices used in car racing are more appropriate for dispersing the large forces involved with impact and the whiplash effect. Does a typical foam doughnut style neck brace provide much protection from this?


(Liam Sergeant) #6

I should add that I’ve been to plenty of road bike crashes and those with major injury are not typically cervical spine so I am aware that head into dirt is not typical motorcycle accident.

Hence why motoGP riders etc don’t have neck protection more armour style protection.

I would hazard a guess that typically kart crashes are more closely related to sports bike crashes than car or motocross?


(Bobby Tifft) #7

As someone mentioned in a facebook comment, this is all great information, but it means nothing without relative percentages of a whole. There can be fewer neck brace related injuries, but if fewer people wear neck braces, that doesn’t necessarily mean that they are safer. In fact, the opposite can be true even with the exact information cited in the article. We need to know the other half of the story in addition to controlling for other factors such as rider bias, etc.

Example: if 75 people were injured without, and 150 people crashed without one, 50% of crashes resulted in injury. If 25 people were injured with one and 25 people crashed with one, 100% of the crashes resulted in injury. This article is misleading and obviously biased in addition to the skewed data presented.


(James McMahon) #8

I guess I’m missing something here. I thought they used the data from each rider/patient they dealt with.

That may be imperfect, for example we don’t have any data on the types of crashes, but I would be hesitant to 100% dismiss it based on the fact that they only measured those incidents.

I’m having a hard time saying that this is critically flawed to the point of being if zero use. But I’m not a statistician.

Study data does seem to be lacking in the ounkci domain, we had a good discussion on that in this topic


(Dom Callan) #9

I sort of doubt that The Great Lakes EMS folks did this to sell neck braces.


(Bobby Tifft) #10

I don’t think they have malicious intent or conflict of interest either, but the article did not come across as having neutral bias to me. Again, even if this information gives the amount of people they saw, we still don’t know the overall ratio of riders that wore a neck brace (including the riders they didn’t see). If more riders did not wear one, it would make sense that more riders without one would get hurt, statistically. Additionally, we don’t know the nature of the incidents. How many riders crashed hard and walked away without contacting EMS, for instance.

For reference, I own an Alpinestars, Atlas and a Leatt brace and switch between wearing them as well as not wearing one at all fairly often for both karting and riding moto.


(Bryan Hall) #11

I agree that this data seems to be mainly or completely from motocross events, not moto GP or something more related to sprint and road race karts. Not that it is valueless, but knowing what equipment they used and the general type of injury position would be helpful to see how relevant this is.

I’ve been looking into what moto GP uses to protect riders, as once you leave the kart you are effectively in the same situation. Sliders, the upper back bubble that I believe is there for aerodynamic reasons - but should also act to make the helmet and upper back more as “one” - those specific things that seem to help avoid injuries.


(Matt Martin) #12

Bobby,

They did state how many wore them and how many didn’t:

Of the 8529 recorded patients, 4726 of them were toggled as “NO” which indicates neck protection was not in place at the time of injury and when the record was created. 3803 were toggled “YES” which indicates neck protection was in place at the time of injury and when the record was created.

The purpose of this analysis was to evaluate critical neck injuries with respect to neck-collar usage, not other injuries (outside of collarbones).

I’d also be curious to how it pertains to other injuries. However, neck and spine injuries tend to be the most life altering: loss of life, chronic back pain thereafter, various paralyses and everything in between.

The head (brain) is the only other part of the body which is more critical to life. To think that people used to argue that helmets were a hindrance to various activities; but, that argument doesn’t hold much water these days; and I think that’s what the EMS team is looking to highlight - it’s possible that there are correlated injuries; but will they be as bad?

Perhaps you could reach out and ask for the dataset, I’d surely like to analyze it for myself.


(Matt Martin) #13

The MotoGP riders also use air-bag suits which serve to decrease the loading to the body and reduce the range of motion of the neck in crash scenarios:

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I have considered looking into these setups for karting, too.

However, let’s all keep in mind that most motorcycle accidents (among professionals running modern 4-strokes) are low-sides and i’d argue at higher speeds than our karts. I think dirt bikes in some ways are more similar given that speeds are more similar to karting, the chance for bike-to-body contact is higher - if you’re flipping a kart, or getting hit by another, the chances of kart-to-body contact are high. I think large karting risks to the neck are:

  • flipping and having the kart’s force exerted into the ground - through your neck.
  • being ejected from the kart and landing in a way which exposes your neck to large forces
  • being impacted by another kart at head/neck level
  • a combination of those three

(Liam Sergeant) #14

I don’t want to distract from the conversation and am an advocate for any safety gear requirements that are appropriate/effective.

I just find it an interesting discussion thinking about what safety gear we need and what sports to compare against. I’m not so sure motocross is the right comparison to be honest as all our gear is rated/tested to slide not dig. However, as someone said above, if they provide some safety benefit, even if it’s not the exact designed one that still makes it worthwhile investigating.


(Spencer Uzri) #15

Matt’s summation of the potential, relevant accident scenarios seems reasonable, & I can’t see a neck brace being anything but a benefit. YMMV, of course. I use a Leatt, & it doesn’t inhibit the necessary rangrme of motion necessary for driving, but it definitely won’t allow the head/neck to bend acutely (when wearing a helmet).