Ski patrollers: reluctant role models for helmet use.

Ski helmets reduce the risk of traumatic brain injury (TBI), but usage rates are low. Ski patrollers could serve as role models for helmet use, but little is known about their practices and beliefs. A written survey was distributed to ski patrollers attending continuing education conferences. The questions addressed included helmet use rates, prior TBI experiences, perceptions of helmet risks and benefits and willingness to serve as safety role models for the public. To assess predictors of helmet use, odds ratios (OR) were calculated, after adjusting for skiing experience. Ninety-three ski patrollers participated and the main outcome was self-reported helmet use of 100% while patrolling. Helmet use was 23% (95% CI 15-32%). Common reasons for non-use included impaired hearing (35%) and discomfort (29%). Most patrollers believed helmets prevent injuries (90%; 95% CI 84-96%) and that they are safety role models (92%; 95% CI 86-98%). However, many believed helmets encourage recklessness (39%; 95% CI 29-49%) and increase injury risks (16%; 95% CI 7-25%). Three factors predicted 100% helmet use: perceived protection from exposure (OR = 9.68; 95% CI 3.14-29.82) or cold (OR = 5.68; 95% CI 1.27-25.42); and belief that role modelling is an advantage of helmets (OR = 4.06; 95% CI 1.29-12.83). Patrollers who believed helmets encourage recklessness were eight times less likely to wear helmets (OR = 0.13; 95% CI 0.03-0.58). Ski patrollers know helmets reduce serious injury and believe they are role models for the public, but most do not wear helmets regularly. To increase helmet use, manufacturers should address hearing- and comfort-related factors. Education programmes should address the belief that helmets encourage recklessness and stress role modelling as a professional responsibility.