Assemblée législative de l'Ontario

HIGHWAY TRAFFIC AMENDMENT ACT, 1991 / LOI DE 1991 MODIFIANT LE CODE DE LA ROUTE

TORONTO CITY CYCLING COMMITTEE

TRISH WOODWORTH

ONTARIO PUBLIC HEALTH ASSOCIATION

HOSPITAL FOR SICK CHILDREN INJURY PREVENTION PROGRAM

HUGH MACMILLAN REHABILITATION CENTRE

CONTENTS

Monday 9 December 1991

Highway Traffic Amendment Act, 1991, Bill 124 / Loi de 1991 modifiant le Code de la route, projet de loi 124

Toronto City Cycling Committee

Trish Woodworth

Ontario Public Health Association

Hospital for Sick Children Injury Prevention Program

Hugh MacMillan Rehabilitation Centre

Adjournment

STANDING COMMITTEE ON RESOURCES DEVELOPMENT

Chair: Kormos, Peter (Welland-Thorold NDP)

Vice-Chair: Waters, Daniel (Muskoka-Georgian Bay NDP)

Arnott, Ted (Wellington PC)

Cleary, John C. (Cornwall L)

Dadamo, George (Windsor-Sandwich NDP)

Huget, Bob (Sarnia NDP)

Jordan, Leo (Lanark-Renfrew PC)

Klopp, Paul (Huron NDP)

McGuinty, Dalton (Ottawa South L)

Murdock, Sharon (Sudbury NDP)

Ramsay, David (Timiskaming L)

Wood, Len (Cochrane North NDP)

Substitutions:

Cunningham, Dianne E. (London North PC) for Mr Jordan

Daigeler, Hans (Nepean L) for Mr McGuinty

Clerk: Brown, Harold

Clerk pro tem: Manikel, Tannis

Staff: Luski, Lorraine, Research Officer, Legislative Research Service

The committee met at 1531 in committee room 1.

HIGHWAY TRAFFIC AMENDMENT ACT, 1991 / LOI DE 1991 MODIFIANT LE CODE DE LA ROUTE

Resuming consideration of Bill 124, An Act to amend the Highway Traffic Act / Projet de loi 124, Loi portant modification du Code de la route.

The Chair: It is 3:31. We are going to start because it is imperative that we stick to the schedule that has been set out. Otherwise people will be shortchanged in the amount of time they have to spend with the committee.

TORONTO CITY CYCLING COMMITTEE

The Chair: We have the Toronto City Cycling Committee represented here this afternoon. Welcome. Please introduce yourselves, tell us who you are, and then commence your presentation. Please try to go no longer than 3:45, so we have 15 minutes left for questions and dialogue with you.

Ms Michael: I am Marsha Michael. I am a member of the Toronto City Cycling Committee. I am the chair of the education and enforcement subcommittee.

Mr Egan: I am Daniel Egan. I am actually a member of the planning and development department for the city of Toronto, but I am one of the staff people who work with the city cycling committee and I am considered the bicycle planner for the city of Toronto.

I am going to start off by putting our presentation in context, then Marsha will wrap up by making some specific recommendations about how we see the bill coming forward.

First, I would like to thank Dianne Cunningham -- I guess she is not here yet -- and the other members here for taking on this issue, which we think is very important.

I do not think there is any question that helmets save lives and reduce head injuries. I do not think we need to spend a lot of time debating whether helmets are a good idea; we know they are a good idea, we know helmets save lives. In the cycling community for about 10 years now we have been saying 75% of bicycle deaths are as a result of head injuries. We have been promoting helmets through a number of different means for a long time.

I personally have been wearing one since 1980. I used it for the first time last Tuesday. I have never had to use it before that, but I fell on some ice and hit the back of my head on the road. Luckily, I was wearing this. It is the first time I have used it in 11 years and I am glad I had it on.

I do not think there is any question that helmets are good idea. It seems the question for this group is, how do we get helmets on cyclists' heads? How do we do that effectively and, I add, how do we do it fairly? We will present you with some specific ideas on how we do that.

When I was here last week there was a lot of debate on the rights of the individual versus the rights of society. It has been argued that you can infringe on an individual's rights to benefit society in general. Again, I do not think there is a whole lot of question around that. We have the precedent with seatbelts and what have you, where it is clearly demonstrated that there is a benefit to society in general. It seems, in our society's view anyway, to be okay to infringe on an individual's rights -- in this case, the right to choose not to wear a helmet -- where there is a significant benefit.

However, I would like to argue today that society also has a duty to the individual. As well as myself, as a cyclist, having a duty to society to be safe, to prevent head injuries, to reduce the cost to society of head injuries and deaths, I think society also has a duty to protect the safety of the individual, in this case the cyclist. To date in Ontario, that responsibility on the part of the province has not really been met. We spend a lot of money on highway safety, improving road design to prevent accidents, but we spend no money on bicycles at this point, except a little that gets spent on safety programs. We spend virtually nothing on bicycle facilities and preventing injuries, making the roads safer for cyclists.

As an example, riding to Queen's Park today, there is only one place I could find to park my bike. It is not an adequate bike rack. It is not a secure bike rack. I ended up locking it to a flagpole. To me, that does not demonstrate that there is a serious concern on the part of Queen's Park or the province for my rights as a cyclist to get around in this city by bicycle, which is a legitimate form of transportation. Unfortunately, the Ministry of Transportation bicycle policy does not recognize bicycles as a viable means of transportation in the city.

The Chair: I am going to interject at this point. None of the people who have been here, many of them bicyclists, have made that point. I am going to ask that the clerk make sure the whips' offices have that portion of your comments pointed out to them promptly so that --

Mr Daigeler: Legislative Assembly.

The Chair: Mr Daigeler, if you would not interrupt -- so that the whips' offices can do what they would have to do.

Mr Daigeler: Mr Chairman, as you are interrupting, I think any prerogative the Chairman has, the members of the committee can take as well. You interrupted the same way I am interrupting you, Mr Chairman.

The Chair: Mr Daigeler.

Mr Daigeler: Yes, Mr Chairman, I can hear quite well.

The Chair: If you and I are going to get along this afternoon --

Mr Daigeler: It is not a question of getting along. It is a point of the prerogatives you are taking yourself.

The Chair: You have already used up 30 seconds of the Liberal caucus time in terms of questions, and if you want to use up more it is okay. What I am telling you is that I appreciate that comment and I am going to ask the clerk to bring those comments to the whips' attention so that the whips' offices can do what they have to do to try to seek a remedy to that situation. I mention that because I did not want that comment to detract from any caucus time in terms of asking questions. Please go ahead. I appreciate that comment.

Mr Daigeler: Mr Chairman, can I please comment on your comments?

The Chair: No, sir.

Mr Daigeler: I think you are using your prerogative as Chairman in a way that is quite uncalled for.

The Chair: You have now used up a minute of the Liberals' time. Go ahead, please.

Mr Egan: I would really appreciate finishing off. It will not take much longer.

To summarize, it seems to me that all the onus is put on the individual, in this case the cyclist, for his or her own safety, which we have heard it argued will in turn save the government and society millions of dollars in health care costs. I am saying there is a responsibility on the part of the government also to take measures to reduce injuries, not just reduce the severity of an injury when it happens but reduce injuries to cyclists by better road design, what have you.

To illustrate that point, as a bicycle planner from the city I get calls all the time from other municipalities in Ontario. Usually what happens is that they call the Ministry of Transportation office in their area first. When they discover there are absolutely no bicycle standards at all, they call the city of Toronto because they know we are working on it. I think it is time for the province to assume that responsibility and for the city of Toronto to stop acting as a provincial cycling resource.

The Toronto City Cycling Committee supports the legislation in principle, and for us to do that is a leap of faith. We are trusting you to do it fairly, effectively and with genuine concern for the safety of all cyclists, not just the cyclists who have head injuries -- and we want to reduce those to save costs -- but all cyclists who are on the road.

To sum up, as an analogy we teach a nationally certified program for adult cyclists. It is a 21-hour course, half of which is in the classroom and the other half on the road. It is to teach people how to ride in traffic. We teach three steps to accident prevention. The first is how to anticipate and prevent accidents. The second is how to handle your bike with sufficient skill to avoid an accident that is imminent. The third is to wear a helmet. The third is the last resort. When all else fails, you want to have the helmet on. That is your insurance policy, but there is a lot you have to do before you put that helmet on your head.

That is an analogy, for the provincial government to consider the helmet legislation as important but only one part of the picture. I do not think you can lose sight of that.

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Ms Michael: I would like to give the committee a little background about the Toronto City Cycling Committee. I do not know how many of you are aware of who we are and what we do. We are a special citizens' advisory committee to city council and our mandate is to increase bicycle use and improve safety for cyclists. We advocate for cyclists of all ilks and we have particular emphasis on the bicycle as a means of transportation. We have subcommittees which deal with such items as bike lanes, bike paths, road conditions, bike parking, cyclist and driver education, which Dan mentioned, enforcement and commuter cycling programs. We are in touch with the needs of cyclists at a lot of different levels.

As Dan mentioned, we support mandatory bicycle helmet use, provided that the law is implemented in a fair and constructive manner. We prepared the report you have in front of you after in-depth consultation with our committee and members of the public to try to give you some suggestions for the areas we think are absolutely imperative to address to make the bill meet its stated intention of injury prevention.

In the time I have left I would like to mention a few of the highlight areas in the bill. The number one important thing we think that is going to be necessary to make this legislation work is implementation. In that regard, we are suggesting that you immediately establish an implementation advisory committee to ensure that the implementation is accomplished in a manner that will ensure that the stated goal of the legislation, injury prevention, is met. In that regard, we are suggesting that the committee be comprised of representatives from the cycling, medical and police communities -- all of whom I am assuming you will be hearing from over the period of this hearing -- helmet manufacturers and representatives of all the affected government ministries, Transportation, Health, Consumer and Commercial Relations and Community and Social Services. This committee would work to co-ordinate the education program and communications strategy, as well as advise on the best cost-relief measures and determine an appropriate phase-in period. Having such a body oversee implementation will provide the needed guidance to ensure the bill can meet its stated goal of injury prevention.

You will notice as you read through this report, as time allows, that all of our recommendations are in that same direction: What can we do to make this bill work? In that regard, we are also recommending that public awareness, education of the public of this law, be funded. We are asking you to consider funding of $800,000 a year until adequate quotas are met. This is somewhat comparable to the public education program that was carried on when seatbelts were introduced to bring voluntary compliance up to a point where all the onus did not have to fall on the enforcement officials, and to give cyclists the information about the laws being passed. We get calls in our office all the time from cyclists who complain that they got a ticket for not having a light on their bike because they do not know it is the law. We think it is unfair and discriminatory to enforce laws against cyclists which have been passed without public knowledge. That is one of the key reasons we are asking for education in that regard.

Accident prevention: Dan mentioned the education courses we currently hold. We are working hard to develop a pool of instructors. We are starting from almost nothing, but we are finding an incredible response among members of the public, from people who have just started cycling to people who have been cycling for 20 years -- "That's how you do it. That really works" -- on ways to be considerably safer in traffic. We are asking you to support that effort by incorporating cycling programs to child cyclists through school and community programs, which we are already doing, but we really need some assistance in our effort, and to hire cycling educators trained to offer bicycle education courses to adult cyclists throughout Ontario.

We have several other recommendations around that, but I want to highlight the key ones in this short time I have left. Cost and availability of helmets is something that we think is essential to be addressed, otherwise, if you pass a law that requires people to purchase expensive equipment, there are going to be implications to people from low socioeconomic status groups who simply cannot afford to. For instance, maybe they have $10 garage-sale bikes, a single mother or a middle-class family has four kids, and now they have to go out and pay $140 for four helmets. It is an incredible cost and we think this area has to be addressed.

Availability also: If you pass a law tomorrow that says everybody has to have a helmet, where are these 2 million helmets for cyclists in Ontario going to come from? We have been in contact with helmet manufacturers to ask them how long they need to get these 2 million helmets on to the market. We have received one reply to date which has told us that if all the helmet companies geared up today they would need a year to fill the market.

We are asking for a phase-in period, which I have already alluded to. This would be a period that would allow for increased voluntary compliance, as I mentioned, educate the public and allow the private sector to provide helmets in sufficient numbers to meet demand. This is going to take funding. Public education campaigns do require funding to purchase the media, to make people aware not only that it is a law, but why.

The wording of the legislation is another point that is very important to us, because we want the bill to work and we want it to be fair to cyclists and fair to the general public. We are suggesting, among other things, that a directive be issued that on first offence, if the cyclist brought a receipt for a recent purchase of a helmet, the fine could be waived. This would support helmet use rather than just making it a punitive law.

We are asking for the specifications that are currently commonly accepted, the CSA-, Snell- and ANSI-approved helmets, to be specified in the regulations and that failure to use a helmet shall not be admissible as evidence of negligence in court. This is because we do not want to run into a situation where a motorist or whoever causes the accident can get out of paying any damages at all for the cyclist just because he or she was not wearing a helmet. That wraps it up in 25 words or less.

The Chair: We appreciate the brief and your comments, which were pithy and pointed.

Mrs Cunningham: I will start. It is nice to see both of you again.

Mr Daigeler: Do we not go to the official opposition first? What is the rotation?

The Chair: No, Mr Daigeler. Go ahead, Mrs Cunningham.

Mr Daigeler: Could you give me an explanation about this, please?

The Chair: Mr Daigeler, as Chair, I rotate the order in which questions are put to participants so as to be fair to all three parties. Go ahead, Mrs Cunningham.

Mr Daigeler: I am sorry. I do not understand that. Normally we rotate among all three parties and we start with the official opposition. Do you not do that in this committee?

The Chair: No. Go ahead, Mrs Cunningham.

Mr Daigeler: I will verify that with my colleagues.

The Chair: That is fine, Mr Daigeler. Go ahead, Mrs Cunningham. Mr Daigeler, you now have three and a half minutes when it is your turn. Go ahead, Mrs Cunningham.

Mr Daigeler: Mr Chairman, I am astonished at the way you are chairing this committee.

The Chair: That may well be.

Mrs Cunningham: You will be even more astonished at the end of the day, I can assure you.

Mr Daigeler: If the other members of the committee accept this, I am very surprised.

The Chair: You are very quickly down to three.

Mrs Cunningham: I would like to thank you very much for coming forth today. We did have an opportunity to meet each other late last month. I am so impressed with the presentation you have made today. I am not certain whether you have an opportunity to look at the Hansards, but we will provide you with them. Because of some of your concerns, we have been asking questions with regard to the cost and availability of helmets. I think you will be very pleased that the information you have is quite correct.

We were enlightened even further that perhaps with lead time we could manufacture these helmets in Ontario, which would be helpful. We were also given a year as a reasonable amount of time. We were assured that of course American companies would come in here and do it, but we would like to have enough lead time to even get Canadian companies going. It seems they could be sold at $20 or less. That piece of information came from the CSA; Bill Coffman made the presentation. There are others.

We very much appreciate the public information part. I, like you, feel it has to be an extremely important part of any implementation. On the phase-in period, we have heard from a lot of people. My colleagues will certainly attest to that. I have not had time to look at your recommendations in detail and it will take more than my questions today to get some clarification.

We are feeling very good about your reasonable approach today because some of the cycling clubs are not happy about the bill. They are very concerned, the same way you are, but you have given us some very specific direction on how this should be implemented. I know we will be considering it carefully.

I do not think you mentioned the environmental aspect, and that seems to be a concern of the cycling clubs. It caught us by surprise. They seem to think that if people are forced to wear helmets it will deter people from bicycling. I wonder if you would like to respond to that in some way.

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Mr Egan: I think the only environmental concern is that mandatory helmet use will likely discourage some cycling. I do not think anyone knows to what extent it will, but virtually everyone I have talked to agrees there will be some discouragement. The cycling population ranges from people who ride every day all year round to people who ride a few times a year. In our business we are promoting safety as well as encouraging people to use bikes. A large part of our constituency are those people who own bikes but do not use them very often, so it is not surprising that the cycling committee is concerned about anything that might make it more difficult to attract marginal riders. We are trying to make those people who ride six times a year ride 20 times a year, 30 times a year and more often. There is no question that there will be some discouragement; no one really knows what it will be.

Mrs Cunningham: I think we have an opportunity here in this non-partisan legislation to have a very responsible implementation period and to have enforcement practices written in and everything that is important to make this thing work so that it is accepted, because we seem to be getting a lot of positive response. I wonder if you have any good advice for us around the education part. I am personally trying to get some private funding, but do you have some good advice for us around education, something you have already done or something you think we should be building on?

Ms Michael: Dan mentioned the Can-Bike programs that are already in place. We have already been working with the Toronto Board of Education teachers. The Toronto board has made it mandatory for teachers to have this course, pass and have the certificate in order to take kids out on the road. This is a start, because it also then provides the children they are teaching the adequate information.

But we cannot do it alone; it is entirely too big a job. There are 400,000 adult cyclists in Ontario. One of our members ran a computer program that said that starting from where we are now, if we do not do something drastic it will take us to the year 2139 to get all adult cyclists in Ontario educated, never mind the children.That is why we are asking that funds be provided to ensure that these education programs can go on. That means hire cycling educators, fund school programs and really take this approach as a serious grass-roots approach. It is so important to get that voluntary compliance up because the enforcement problems are legion, which I am sure you have heard already. You have to depend in large part on voluntary compliance to make this legislation work.

Mr Egan: I would like to comment on that as well. I was a bit disturbed last week when I heard there was not any government money for education. I realize these are tough economic times; we are faced with budget cuts at the city as well. If you do not believe this legislation is going to work, that it is going to put helmets on heads, is going to save lives, is going to save health care costs -- I heard a figure quoted last week of a $4.5 million lifetime cost for someone with a serious head injury -- then we should not really be discussing it, as far as I am concerned. But if we believe it is going to work, there is an enormous amount of funds we can divert from health care costs to bike education. The figure that has been quoted, $800,000 for a year to get this thing going, is small compared to the health care costs I believe we will save. I think that needs to be considered. It is not money coming out of thin air; hopefully it is money we are saving in other areas, and significant money.

Mr Arnott: I want to thank you for coming in today. I appreciate your comments and your recommendations, but I have a problem with the suggestion that $800,000 be spent on education at this time. You talk about expenditure savings. That may be true. We hope those expenditure savings in the health care field will be achieved, but when the papers are filled with news stories about hospitals possibly closing and so forth I do not know how you could justify an expenditure of $800,000. I wonder why you think that simple passage of the legislation and the associated news stories that would go along with it would not be sufficient, that people would not know that the law had been passed and that they would not start wearing their helmets without a very expensive public awareness campaign.

Mr Egan: That is a valid question. It is clear that if the law is passed some people will wear helmets. The survey results we have in Metro Toronto suggest that helmet use now among adults is anywhere from 18% to 23% and that maybe as high as 60% at this point would support mandatory helmet use if there were proper education to go along with it. But as far as we are concerned, 65% or even 85% is not enough.

Look out there. There are all kinds of laws on the books that are not enforced. It is the law to have a light on your bicycle; it is rarely enforced. A lot of cyclists do not even know it is a law. There are all kinds of laws on the books, but if they are not properly enforced and there is no proper education around them people just do not find out.

The other thing is that you cannot really compare this to the seatbelts or to helmets for motorcyclists. There is an incredible infrastructure in place for automobile drivers and motorcycle drivers. There is zero for cyclists -- zero. There are millions and millions of dollars to get at motorists to get the message through -- their licences, all kinds of stuff -- but there is nothing in place for cyclists.

Mr Dadamo: You were talking about lead time and the need to educate people. If this were to be, it would take probably about two years to do. I would like to ask you a really simplistic question. What would your group do to publicize this to better inform your people?

Ms Michael: We have a newsletter that is monthly at this point. It is called Cyclometer. It goes out to 5,000 people at this time. We also have an impending new newsletter to corporate bicycle user groups. We would advertise it through there. We would continue to advertise it in our courses, the way we are already recommending and alarming people with information about what the law really is. We issued a press release this week about these hearings to inform the public and to inform the press that they are going on. These are the kinds of initiatives we would take, and we would build on those.

Mr Waters: Getting back to the education, I recall being a former smoker and a former person who never wore a seatbelt. My children made me quit smoking, they made me wear my seatbelt, and that did not really cost us a lot; we did it through the school system. The schools did that to most of us parents. I do not live in Toronto; maybe you have a different system here in Toronto. In rural Ontario the schools did a number on us. We would get in the car and you would have kids coughing if you had a cigarette in your mouth -- you would swear they were going to die in the backseat -- or they would yell and fuss until you did up your seatbelt. Could we not do the same thing with bicycle helmets and education on driving bikes?

Ms Michael: My information is that the schoolchildren harassment mode of information was well-supported by government advertising media campaigns -- the same with drinking and driving. I mentioned that $700,000 a year has been spent over the last 10 years to change attitudes about drinking and driving. You are right. I saw somebody with their kid out of a seatbelt the other day. If their window had been open I know I would have yelled in, "Get a seatbelt on that kid." This is why we need the education and the money to fund the education to raise social awareness so that we do not need people down our throats enforcing all the time, to give the recognition that it is important to society that we protect ourselves and each other.

Mr Egan: I detect a real resistance to spending any money on cyclists. I find that disturbing. We have a pretty significant budget to spend on highway safety, which is primarily for people driving cars, and spending on transit systems, all that kind of stuff. In this province we have not made a commitment to cycling and it is probably not surprising that helmet use is so low. If you look at Australia, for example, they have had campaigns where the government spent $300,000 in one year giving rebates for helmets, and helmet use went way up. If you look at the experience in Metro Toronto, the city of Toronto now has three full-time staff working on cycling issues, promoting bike commuting, promoting safety and developing facilities and stuff. In the last five years, bike-to-work trips increased by 77%. In the rest of Metro it went down by 17%.

Clearly if you want to get things done you have to do them properly. It is not just a matter of making a law and hoping everyone goes along. Nearly half of US states now have at least a bicycle program co-ordinator in their state transportation departments or a bicycle program which co-ordinates with different cities developing education materials, what have you. We are, in this province, I would say, at least a decade behind most US states in terms of promoting bicycling and promoting safety among cyclists. It is false economy not to spend that money.

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Mr Daigeler: When did your committee come into existence?

Mr Egan: The committee has been around since 1975.

Mr Daigeler: What approximately is the membership of your organization?

Mr Egan: The city cycling committee is made up of 12 citizens appointed by city council and one council member who sits as the chair of the committee. As well, we have representatives of the Board of Education for the City of Toronto, the Metropolitan Separate School Board, the Metro police department, and we have sort of ex officio liaisons with various city and Metro departments.

The committee itself is not essentially a membership organization. It is a committee that advises city council and develops policy. We install about 250 bicycle racks a year in the city. We are just concluding a major study of bike use in the city, a bicycle route study, that is just wrapping up this month. Essentially we develop policy; we carry out programs.

To give you an idea of the scope of the committee, in Ontario we have played a key leadership role. In 1985 we held a conference called Cycling and the Law. Out of that conference came the push for helmet standards. The person on the committee who is now the chair of the CSA helmet committee, Bill Coffman, was a former member of the committee. That whole thrust came out of the city cycling committee, and as well came the push to amend the Highway Traffic Act which now allows a police officer to ticket a cyclist. Before, it was incredibly difficult to do that. We have been pushing for police enforcement for years because we realize education is not enough. You have to tell people what to do and you also have to back it up. It is the same thing with the helmet stuff.

Another example of something we have produced is the city cycling skills booklet, which is now being reproduced by the Ministry of Transportation and is acclaimed worldwide. It is the most comprehensive booklet on how to ride in and around traffic. That is picked up by the province and distributed across the province at this point. Those are the kinds of things we have developed over the years.

Mr Daigeler: I represent Nepean. I think they recently established such a committee. Do you know how many cities in Ontario approximately would have such a committee?

Mr Egan: There are a number. Ottawa has one that has been around for a few years. They have just this year hired a bicycle co-ordinator. Nepean has one, Kanata has one, Kingston has a committee, Peterborough, Toronto, Mississauga, Hamilton, Burlington, London, Windsor. Those are I believe the official committees; there may be a few I am not aware of. But I would say in the last three years they have started to sprout up and there is a real demand for this kind of stuff.

The Chair: We want to thank you very much for taking the time to come here this afternoon. Your written material will be valuable to the committee. Your comments and your responses to questions were insightful and we appreciate it and hope you will keep in touch with either Mr Dadamo, who is the parliamentary assistant to the Minister of Transportation, Mrs Cunningham, whose private member's bill this is, or whichever member you wish. Have good, safe trips back home, and I hope the next time you bicycle to Queen's Park there will be some place to lock your bike.

TRISH WOODWORTH

The Chair: We have Ms Trish Woodworth here, who is accompanied by, among others, one baby Taylor, who is, I am confident, the youngest person to attend these committee hearings -- also, quite frankly, the best behaved. I include MPPs in that consideration. Ms Woodworth.

Ms Woodworth: Ladies and gentlemen, I cannot say it is a pleasure being here today. As I go on with my presentation, you will understand why.

Bill 124 is still actively under debate, and while many members have spoken in support of that bill, others have expressed concerns about the areas of costs and enforcement. Further to my reading of the Hansard reports from Thursday, June 27, 1991, and in particular the comments of the member for Essex South therein, I feel duty-bound to take up the challenge Mr Mancini presented, "in order that we may face the situation and all of its circumstances."

Unlike Mr Mancini, I will endeavour here to remain focused on the salient points and not digress from them. We are not talking about air bags. We are not talking about seatbelts on school buses. We are talking about the mandatory wearing of helmets by cyclists and the means by which these life-saving devices can be made accessible, affordable and enforceable.

As so appropriately pointed out by Mrs Dianne Cunningham, a member of the committee and the member for London North, recreational cycling has become the second most popular year-round activity across this country. Given that hockey and football are probably the two most popular sports, it would be virtually unimaginable to consider these pastimes without the use of the appropriate safety equipment. What we are in essence speaking about here today is creating a climate of enlightenment in order to change people's attitudes about maintaining and in effect preserving a quality of life.

As with the majority of commodities we are inclined to purchase, the demand for that product shapes the framework for the pricing. As people's awareness increases, the desire to maintain and thereby preserve an existing way of life creates a sufficient challenge for the market to adapt to that demand and, as a result, the prices at the very least become competitive and eventually fall.

As with other commodities, the range of both quality and price is vast and varied. Only increased demand will ensure both maximum quality and minimal cost for the average consumer. At the very least, one local cycling club in the Kitchener area discourages membership by those who are unwilling or unprepared to purchase the necessary safety equipment. I am quite sure there are other cycling clubs that have adopted a similar safety-based philosophy. In fact, there are also a number of cycle shops in Kitchener that are currently offering a 25% reduction on the price of a helmet when purchased with a bicycle.

Current information suggests that prices now vary from $40 to nearly $100 for the purchase of a helmet, and while there is no question that some designs could be improved upon, these changes will only come about through consumer demand.

My discussions with a number of safety experts in this area confirm that something similar to a motorcycle helmet would offer far more protection. A hard outer-core shell, a second layer of high-quality fibreglass and an inner core of protective foam would be ideal and would much better protect the area surrounding the neck and the stem of the brain.

Cycle shops would no doubt be prepared to offer incentives with regard to multiple purchases and perhaps even individual price packages to accommodate specific needs. Speculation is that owner-operators of cycle shops and sporting goods stores may be inclined to lower the purchase price of a bicycle and throw in the helmet free in order to address the pressing need for cyclists' safety.

As the popularity of cycling rapidly increases, so must grow a network of enforcement for a mandatory helmet law. If memory serves me, it is the mandate of all law enforcement agencies to serve and protect. Nowhere is there a more demonstrative manner in which to comply with this stated purpose than to adopt a system which saves lives from its inception.

Mr Mancini's points regarding an already overworked and underfunded police force are both well taken and well known. Consideration should perhaps be given to examining a civilian population charged with the responsibility of administering a system of warnings, citations or fines, as appropriate. History already dictates that some enforcement agencies have turned over the responsibility for parking infractions to municipal authorities, as any of us here who has been ticketed will attest. The significant point to be taken from this experience is that a civilian body could quite likely be engaged to carry out the workings of this type of enforcement program. A system such as this does not place a further burden on our existing law enforcers, and furthermore, moneys collected by way of fines issued for miscreants could be directed into an ancillary fund geared towards public education and awareness in this vital area.

A system of licensing all cyclists would prove most useful in terms of locating offenders of a mandatory helmet law and either levy a fine, order that person to produce a receipt for a helmet within a reasonable period, or in some cases both. Furthermore, an adequate licensing system would be a definite asset for the law enforcement officers and hospital staff to identify injured cyclists.

In preparing my presentation today I promised myself that I would not use statistics, knowing that you quite likely know them far better than I. However, on the morning of July 14, 1991, I was the mother of a bright, intelligent and vital 25-year-old daughter, Lynda Woodworth. At 3 o'clock that afternoon Lynda was struck by a car on Northfield Drive in Waterloo. Eight days later at 12 pm on July 22, 1991, Lynda was pronounced brain-dead, and I became the mother of a statistic.

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As she was not carrying any identification at the time of the accident, for 10 1/2 hours Lynda remained a Jane Doe, and it was only through the sheer tenacity and dedication of our Waterloo Regional Police Force that I was eventually contacted as her next of kin. A serial number on the can of iced tea that was found at the accident was traced back to the convenience store where she bought it. When the staff of that store confirmed that she was a regular customer, the police assumed that she either worked in the area or lived in the area. Police, armed only with the set of keys that were found at the accident, went from that point and tried every key in every door of every apartment until finally one key fitted what was Lynda's apartment. From there, my name and my telephone number were found and I began to live every parent's worst nightmare. The young officer who contacted me had the unfortunate task to inform me by telephone, as no address was evident, so we might look at licensing and having a next of kin on the licence.

Lynda's was the first bicycle fatality in the regional municipality of Waterloo. Since that time there have been three other fatalities in the same area, and to my knowledge none of those cyclists was wearing the proper equipment. A recent conversation with the neurosurgeon who cared for Lynda during those eight days and the information the nurses at the intensive care unit provided to me indicate that had my daughter been wearing a helmet, while she would have sustained some injuries, she would have lived.

The newspaper article I have attached was picked up by a national news service and reprinted in many of the daily newspapers across the country. The nationwide response I have received concerning this issue and the demand for Bill 124 to be passed into law is phenomenal and it cries out for your approval.

Trusting that my information has indicated more than just a passing or a frivolous interest in the issue of mandatory helmet requirement, I strongly suggest to all members that regardless of the actual cost of a helmet, there is an absolutely incalculable cost that I would defy any of you here today to reasonably bear. Imagine, if you can, the cost of not just burying a child, but your child. To bury your child is to have your very soul torn from you without benefit of anaesthetic. If there is anyone here today who continues to maintain that they can afford this cost, then I would argue that they possess not a formidable wealth but a poverty which springs from the soul itself.

The Chair: Ms Woodworth, I want to thank you for that. I also appreciate that MPPs Mike Cooper and Will Ferguson have taken time out of their schedules to listen to your submission this afternoon.

Mr Waters: I thank you again for coming in and I am sorry about your tragedy. My question would have to do with the little character in the first row back there. I have asked this question several times, and I am somewhat concerned. I have seen it. In fact, I actually did it as a parent: I strapped a child into a seat behind me and off I went on my bicycle. While if he falls, quite often the rider can step free, those poor little tykes cannot. I am just wondering what your feeling is on that type of thing. I do not believe there is a helmet, because you would need a neck brace with it, I would believe.

Ms Woodworth: Right. To be honest with you, I do not totally agree with strapping a child to the back of a bicycle in any case, and I never have. I think it is very dangerous. You are absolutely right; you can walk away from it but the child cannot. A helmet is not going to stop head injuries. It is not going to stop cyclists from falling. But as we have heard here from many other people, I am sure, the cost of supporting someone who has a brain injury is phenomenal. We do not have the proper facilities here in Ontario, so we have to send them somewhere else.

Had Lynda lived, it would have cost anywhere from $8 million to $10 million to support her life and a quality of life she was used to. It is not that we live extravagantly, but she was a paralegal who was studying for the bar. Not only have I lost a lot, but the community itself has lost a lot.

To go back to your question, I do not agree with strapping little kids on the backs of bicycles in the first place. They initially were built to ride and to be driven by one person, not two.

The Chair: Mr Daigeler, one question, please.

Mr Daigeler: Thank you very much for bringing your very difficult situation to us and for the interest you are showing in trying to prevent similar happenings. I am wondering what the response has been to the campaign you are involved with. You have given us some examples here, but perhaps you could expand a little.

Ms Woodworth: We have in Kitchener-Waterloo -- I do not suggest they are really unique councils, but they are very good councils. They have a bicycle safety committee which is not an advocacy group but a demand group. We are looking at demanding that the regional municipality of Waterloo make it a mandatory bylaw. We have often been used as an example when it comes to things for trial because we are one of the larger regions. So I can really see the offspring of this, the snowballing effect.

The other things that are happening that I think are really marvellous -- not that the situation is marvellous, but the public awareness. I have had phone calls from Mr Ed Good, who is the chair for the Canadian Head Injury Coalition in Vancouver. I also put him in contact with a gentleman named Tim Edgar, who lost his son on October 1 of this year. They are going to bring a bill similar to Bill 124 before the BC Legislature. I have had phone calls from every major city across Canada in support of this bill. You have before you just a smattering of people who are supporting it. Neurosurgeons, safety officers -- everyone is supporting it.

I feel that if we had a licensing situation, that is where the education would come from. When we go to get our licence, we know very little about the rules of the road. By licensing a bicycle and having cyclist shops and cyclist clubs follow through with that and making sure you do have the adequate equipment and do have a licence to drive that bike -- you are using a roadway, so why not license it? Why should they not be made aware of the proper rules of the road? I think education will come through licensing, through that process.

I know I am rambling here, because I am still frothing inside. The support is there, the awareness is there, and I really think that you, as politicians -- that is why we elected you to the Ontario Legislature, to make these rules for us that we cannot make ourselves, to make them laws. It is not a political issue; it is a human issue, it is a people issue. That is why we elected you.

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Mrs Cunningham: I would like to thank you sincerely for coming. I think you are awfully brave. It has not been very long since Lynda's death, and she would be so proud of you today, so you are just going to have to carry on and make sure this happens, with the rest of us on this committee who are working so hard.

We have been overwhelmed by the articulate, responsible presentations before this committee. People care about his legislation, but they also want it to happen in a very responsible way, fair way. I hope you will stay in touch with my office. We have even had a recommendation for an advisory committee to the government, and I personally think that is a great idea, because although I know something, and you do, too, from a very real, personal point of view, there are experts who have come before this committee. I think Ontario is leading the way. The people who have come before the committee -- I believe there is nowhere that people can get better advice. We have been so appreciative, and you have added significantly today. Thank you.

Ms Woodworth: I would add a little to that. As you well know, Waterloo has an excellent university. As we speak, a group of grad students in Australia is looking into this whole bicycle safety issue, and I am sure it would share its information with you. Dr Bishop, the chair of the kinesiology department at Waterloo has just been given the Trillium grant to look into the impact on helmets for cyclists. I do not know if you are aware of that, but he would be more than happy to share his information with you.

The Chair: Ms Woodworth, the whole committee thanks you sincerely for coming here this afternoon, for sharing your thoughts with us and for making an outstanding and a very insightful presentation. You have aided us substantially, so we can but say thank you. I know I speak for the whole committee. Have a good, safe trip back home. Mrs Cunningham, the sponsor of the bill, or Mr Dadamo, the parliamentary assistant to the Minister of Transportation, would be pleased to hear from you on an ongoing basis to make sure you are kept aware of how these things develop.

Ms Woodworth: I know if Lynda were here she would be -- she is sitting on my shoulder.

The Chair: That is great, and 15 years from now, when none of our names are known to any of the public, Taylor can read this transcript and recognize that --

Ms Woodworth: She sure can. As a matter of fact, when she gets her first tricycle, she is going to have a helmet. That is where we have to begin.

The Chair: Take care. Thank you.

ONTARIO PUBLIC HEALTH ASSOCIATION

The Chair: We have, from the Ontario Public Health Association, Mrs Heather Edgar, a member of the board of directors. We have 15 minutes. If you would please make your comments -- you have given a summary of the issues you want to raise -- and then leave enough time for at least a couple of questions or points to be made by members.

Mrs Edgar: I am very honoured to be here today. I was asked by the board of directors to present to this committee, not only because I belong to the Ontario Public Health Association but because I also have a very personal interest and have been quite active in my own community regarding the bicycle helmet issue.

In reviewing the discussion that took place in the Legislature in June, it became quite clear to me that I really had nothing to offer this committee in terms of convincing you that bike helmets are a good thing. It seems that everybody is agreed they are a good thing, that they do prevent head injuries and that they can prevent deaths.

I thought what I would do today is try to highlight a few of the issues that I think are key ones for us to consider when we are promoting this legislation.

The first and foremost, to me, is that we recognize that bicycles are not kids' toys. Bicycles are vehicles. They are used on our roadways. They are expected to comply with the rules of the road, as are any other vehicles on those roadways, and I think we must recognize that although children ride them, they are methods of transportation.

Once a brain is damaged, it is damaged for life. Whether that damage takes place at the age of 60 or at the age of six years, the damage is permanent. We do not have a cure for that.

As we have heard, the cost to the family is tremendous in terms of the emotional drain of losing a child or the emotional drain of having to deal with a brain-injured child or family member over a prolonged period. The financial cost to families is great, and the financial cost to society of dealing with the after-effects of brain injury is also significant. We know that bike helmets work and are able to reduce these costs.

Our society has accepted responsibility for legislating protective equipment for other things. We know that seatbelts save lives, and we have legislated that. We know there are many injuries caused by unprotected skulls in hockey games, and we have legislated that. We expect people to protect themselves when they are engaged in activities in which they can be injured.

The issue of cost is a real one. Many of our children are affected by poverty, and the idea of a family of four who are barely meeting their daily bills spending $160 for bike helmets is pretty prohibitive. However, we also realize that a family whose children are growing up in poverty has enough to cope with already. They do not need the additional strain and stress of trying to cope with a brain-injured child or family member.

I do not believe the entire responsibility for looking after our communities rests with the Legislature. I believe that we as communities also bear responsibility for the people who live within our communities. We can mobilize, and we do mobilize. We have food banks, much as we may like to think we should not have the need for food banks. We have community kitchens. We have Christmas cheer. We are able to mobilize our communities to work to the benefit of our less advantaged members.

Coalitions and groups of various organizations are able to pull together mass orders for helmets that significantly reduce the cost of the helmet. In my own children's school, helmets were made available to anyone who wanted to order through the school at a cost of $20 per helmet. That is 50% of the cost you would pay for a similar helmet in a retail store. We were able to do that not only through parents' groups, but also through our association with retailers and with community service groups in the community. The helmets that were ordered through this particular program also were not the standard dull white bicycle helmet. We were able to order ninja turtle helmets, which were quite a hit with the younger children. We were able to order helmets that kids actually did not mind putting on their heads.

We know corporations have participated in sponsoring rebates on helmets and that they can be approached to do this as well.

Another suggestion could be the elimination of taxes to assist in bringing the cost of helmets down in the retail stores, and also to show the support of the government in recognizing that bicycle helmets are essential pieces of equipment, that they are not non-essential.

I was particularly interested in the discussion earlier about education issues. One thing we have discovered is that going into schools and telling kids they should wear helmets does not do it. In our community, which is the community of Simcoe county, and specifically in the Barrie area where our coalition was working, we had public health nurses who went into groups of school students and talked to them about bike helmets. They all knew that bike helmets were a good idea, but were they wearing them? For the most part the answer was no, they were not wearing them. Some of them actually had them hung up in their closets at home. The primary reason the kids were not wearing them was because they did not look cool; they looked like nerds if they were wearing helmets. The peer pressure was such that they did not want to be the ones who stood out. We need to make helmet use a norm within our society so that the one who is not wearing the helmet is the one who does not look cool, not the other way around.

One of the things our coalition did within our community was to apply for and receive a $10,000 health promotion seed grant. The purpose of that grant was to promote bicycle helmet use in the Barrie area. One of the things we did with that money was spend approximately $5,000 on the production and airing of a television commercial aimed at children. Both children in the commercial wore helmets. One wore a neon green helmet that was admired by his friend in the commercial. This commercial was aired specifically at times when children were going to be watching television, for example, during the ninja turtles cartoon show, where we knew we would capture children.

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The latest statistics gathered in the Barrie area suggest that bicycle helmet use in the area has increased over the last one to two years, to a level of approximately 17%. This is really pretty phenomenal. We believe these types of promotions can work to encourage children to wear helmets. We know there are neighbourhoods within our city where the wearing of bicycle helmets has become the norm. Some of the other things we have done with our community are to work with service clubs such as Rotary or Kiwanis, to work with the police and to jointly sponsor bicycle rodeos which not only focus on bicycle helmet use but also focus on bicycle safety.

We had many, many young children come with their parents. They went through a safety circuit and they were awarded points for each area they passed. They were also awarded points for wearing a bicycle helmet to the rodeo. We sponsored, with the Ontario Head Injury Association, draws for free bicycle helmets and were able to distribute a few that way. There are many opportunities for us to promote bicycle helmet use in the schools, in the community and via the media.

Those were the key issues I wanted to share with you today from my perspective, and also to share with this committee the support of the Ontario Public Health Association for the amendment to this legislation.

Mrs Cunningham: You got a lot in during that 15 minutes. We heard from others in the Barrie area who gave us some good information and advice around the education programs and I am sure we will put it to good use. We thank the Ontario Public Health Association for its support.

From the point of view of public education, you mentioned the television ad you made. You spent about $5,000 on that.

Mrs Edgar: That included production and air time. That was aired through the CKVR television station, which is Barrie-based but has quite a wide viewing audience. I have had people from even Guelph comment that they had seen that particular commercial.

Mrs Cunningham: Great. That is something we could possibly use around the province, as it has already been done.

Mrs Edgar: It has been shared in other areas and was shown, I believe, at a public health meeting. I know one of our public health associates up in northern Ontario had indicated they were planning to use it up there as well.

Mrs Cunningham: If we call you, that is something we can have access to.

Mrs Edgar: Certainly.

Mrs Cunningham: I know initially it will be difficult to come up with the funding. It will not take some of us too long a period of time to make sure we have the kind of dollars in place that we have heard about today, but certainly initially we will want all the help we can get. We would appreciate that coming from your association.

Mrs Edgar: Actually, the commercial was done through the coalition and we have a copy of it at the Simcoe county district health unit. That is my place of employment and it was through that organization that I was working on the bicycle helmet committee. I would be glad to leave a calling card with you.

Mrs Cunningham: That would be great. We need that.

Mr Dadamo: As Mrs Cunningham was saying, Dr Brian Morris was here from Barrie last week.

Mrs Edgar: Yes, Brian was part of our committee.

Mr Dadamo: Very enthusiastic, and a very fine presentation, I want to add. When we do the synopsis of this whole thing and put our booklet together after we have heard from everybody, we may want to use Barrie as an area of intense wealth. It has afforded us with a lot of information.

I understand, as I think you mentioned, that 17% of bike riders in Barrie are wearing helmets.

Mrs Edgar: That was the last figure I quoted. I believe that was one of Brian Morris's studies that he has been doing some follow-up on.

Mr Dadamo: Our studies show that the awareness factor should be about 25% in order for the majority of people to realize it is cool to wear a helmet. We are all concerned and we are all in agreement as adults -- and most of us have children -- that our kids should be wearing helmets. The grown-ups should be wearing helmets. Everybody should, because it makes sense. But kids in schools are still maintaining the status quo that it is not cool to wear a helmet. What I am concerned about, among other things, is how we are going to get that driven home to them, that it is cool to wear them, or at least it might save their lives.

Mrs Edgar: One of the difficulties, as you mentioned, is numbers. If he is the only child in that entire school wearing a bicycle helmet, he is not going to feel very good about it. If we are looking at it as a school population, we can perhaps concentrate first on those schools that have many of the children living in the neighbourhood and promote through parents' groups, as well as some of the other ways we have been doing it; for example, concurrently have an ad campaign, television commercials, work with the groups within that school and also sell them at the same time. Apparently if there is a reduced cost of helmets, that will promote more people to buy them.

If we can get a lot of helmets into one school community and then get children starting to wear them at the same time, I think we will have a much better chance of raising the number of kids who do wear them.

Mr Dadamo: Are we out of time?

The Vice-Chair: I am sorry, I apologize. Thank you very much for coming in. We will keep you apprised of what is going on. It was an excellent presentation.

HOSPITAL FOR SICK CHILDREN INJURY PREVENTION PROGRAM

The Vice-Chair: The next presenters are the Hospital for Sick Children injury prevention program. Would you please step forward. I understand you are going to set up.

Dr Wesson: We can start talking while they are setting up, if you like.

The Vice-Chair: We have to get you to introduce yourselves for the sake of Hansard so maybe we can start with that.

Dr Wesson: My name is David Wesson. I am one of the surgeons at the hospital. We represent the hospital as a whole and also the Hospital for Sick Children and Kiwanis injury research and prevention program.

The people who are sitting with me are Ms Laura Spence, a nurse who is really spearheading all of our community injury prevention work; Dr Pat Parkin, who is a paediatrician with a strong interest in injury prevention; Dr Des Bohn, who is a staff physician in the intensive care unit and unfortunately has to treat a lot of the kids who come to the hospital with bicycle-related head injuries; and Dr Xiaohan Hu who is an epidemiologist who is providing some of the scientific foundation for our injury research activities.

There are really three components to our presentation. The first is a short videotape which will allow us to present to you at least an idea of what happens to kids who survive severe bicycle-related head injuries. I think you have heard a bit about fatalities and the statistics tend to be kind of numbing, but we have a short video which contains some information and some opinions from two kids who were involved in this type of injury.

We are going to tell you a little about our educational program we have developed and piloted, first in the city of Toronto and then more recently in the borough of East York, which actually is a program which works. It is something that has been of proven value in increasing bike helmet use by kids.

Next, we will present some information about parental attitudes that we have gleaned from questionnaires through our Be Bike-Smart Week at East York schools and through a phone survey about parental attitudes towards cycling behaviours that we have been doing more recently. This information indicates very strong support among parents of children in the province, at least in Toronto anyway, for mandatory bike helmet legislation.

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As a slight aside, attached to the outline of our submission is a coroner's inquest report that I participated in a couple of weeks ago in Sudbury, where a child was hit by a car on a highway and died of a massive head injury. You will see that the first recommendation of this coroner's inquest is that mandatory bike helmets be introduced in the province of Ontario.

The final thing, and we are not experts on enforcement of legislation, is that we thought we should give you our opinions about some practical issues around this legislation and what we think you can do to help make it work.

Let me briefly give you some background as to why we became so interested in this. Back in 1985 we were looking at all the trauma statistics from our hospital and we found that 20% of all fatalities in the hospital over a two-year period related to injuries caused by bike accidents. This led us to a review of all the Ontario coroners' statistics, which was facilitated by Jim Young, who is now the chief coroner for the province.

It confirmed that a very high proportion of all trauma deaths among children in the province are related to bike accidents. The actual statistic for the province as a whole is 15%, so 15% of all children who die of traumatic injuries in the province were hurt when they were riding their bikes. The vast majority of these deaths were caused by head injuries and none of the cases we have reviewed was wearing a bike helmet.

That is why we became so interested in this as clinicians involved in treating patients. This is unique in the sense that there is a known prevention strategy, namely, bike helmets. If we knew how to prevent cancer, we would be fighting just as hard to do that, but here is one example of a major health problem for which a solution is apparent, and we feel very strongly that we should do our best to get this legislation passed. I am going to turn over to Des Bohn now, who has the perspective of the intensive care unit and will show you the video.

Dr Bohn: This video was made for two of the TV stations in Toronto at the beginning of the summer when we were obviously going to experience the first rush of bicycle injuries.

[Audio-visual presentation]

Dr Bohn: I think no one speaks more eloquently to this point than the victims themselves. It is unfortunate that in society we always have to learn our lessons the hard way.

I can give you two perspectives on this issue, first from being a physician who has to care for children who suffer severe head injuries after cycling accidents, and second, as I mentioned in the video, as a cyclist myself. I use my bicycle as my primary form of transportation to get to and from work every day.

It was brought home to me as a physician shortly after I joined the staff of the intensive care unit, when a 12-year-old child who was riding his bicycle through the streets of Toronto hit a curb, fell off his bicycle and was admitted to the hospital with a severe head injury with an intercranial haemorrhage. It so happened that the child's mother was a nurse in the hospital, so I learned at first hand the devastating consequences of a severe head injury. That child went on to die. It has been very eloquently expressed to you this afternoon by a former submission at this committee hearing what devastating consequences on a family result from the death of a child. This child was 12 years of age and I am sure this family has never got over the death of that child.

In July of this year an eight-year-old child was hit by a delivery truck while riding his bicycle. That child survived but has never left hospital since the accident, and probably will never leave hospital.

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The devastating economic and social consequences of an injury of that severity are incalculable. They are incalculable to those of us who work in caring for these children medically, and also to society which has to support a child with a severe injury of this nature who may in fact survive 10 or 20 years but will be permanently institutionalized.

From my perspective as a cyclist, I frankly feel ashamed at times when I see the way our laws regarding bicycles are enforced in this city and in this province. I think it is time we took some measures to protect the cyclist from probably his or her own folly, but really to prevent the consequences of injury which can be, I think, readily reduced by the enforcement and wearing of bicycle helmets.

Dr Wesson: Laura Spence is now going to tell you a little about the educational program which we set up in response to this perceived need. We felt right from the beginning when we discovered this problem that legislation was the answer, but we also realized that legislation would only be possible in an environment where the general public and the politicians were informed about the issue and had acquired a degree of acceptance of this. We thought the most efficient way to get them out to the community was through the school system, and that is how the Be Bike-Smart Week program got started.

Ms Spence: Our first helmet fair was organized by Martha McKeown, a city of Toronto public health nurse at Whitney Public School in the spring of 1990. The week of activities for parents and students was designed to promote bicycle helmets. We had information on the need for helmets and the effects of head injuries sent home to the parents, and an evening lecture was given to the parents by our staff. Activities such as poster contests, fashion shows, helmet fittings and helmet sales were organized for the students. The event was highly successful. An 80% increase in bike helmet use was seen by our observer.

A questionnaire was also mailed to all the parents of the school to gain feedback about the program and to ask general questions about bicycle safety issues. Of the 110 questionnaires received, 88% thought bicycle helmets should be mandatory for all child cyclists and 81% supported legislation for all cyclists.

Dr Wesson: Being sceptics, we thought we should test the effectiveness of this intervention in a controlled fashion. The Ministry of Transportation was kind enough to fund a prospective trial of this program in the borough of East York this summer. This study was carried out by Dr Parkin.

Dr Parkin: Let me tell you that after the initial success with the bike helmet fair, we established a Children's Bicycle Helmet Coalition in the city of Toronto in 1990. We had a five-year objective that was threefold: first, to reduce children's cycling fatalities by 50% over the five years; second, to double helmet use each year to a level of 40% by 1994; and third, to do what we are doing here today, which is to explore the feasibility and possibility of mandatory legislation.

In 1990, in both East York and Barrie -- you heard a little about Barrie today -- we did a surveillance study and found that in children five to 14 years of age only 3.5% were wearing helmets. We looked at issues that might help us understand why children do not wear helmets. We found a trend towards higher helmet use in children who lived in areas of higher average family income; however, this was not in any way as strong as the evidence that we found about the relationship between peer group pressure and parental influence.

We found that when kids were riding bicycles with adults who wore helmets, who we presumed were their parents, their helmet use rose dramatically, up to 86%. That is a dramatic increase, from the baseline of 3.5% to 86%. We concluded from that study that the factors associated with helmet use included average family income and, probably more important, peer pressure and parental influences.

In 1991 we studied the effectiveness of our educational program in the borough of East York. We delivered an educational package with the public health department to two schools in some of the higher socioeconomic areas and two schools in some of the lower socioeconomic areas in East York. We have just done our preliminary analysis. Across the entire board of East York, our helmet rate has increased from 3.5% in 1990 to 16% this year. What I want to point out to you is that in the high socioeconomic areas the rates rose very dramatically, up to 48%. We had no difficulty sensitizing this population to this very important issue. Unfortunately we were slightly less successful in the lower socioeconomic areas, and their helmet use only doubled from the baseline of 4% to 8%.

We should also tell you that we asked in the questionnaire about mandatory legislation. Approximately 80% of all parents in those schools that participated in the program felt mandatory legislation was something they were in favour of.

Let me reiterate what we have concluded: Bicycle helmet use among children is low, but it is slowly increasing; socioeconomic factors do play an important role; positive peer group pressure is an important factor; parents are very important role models, and that is why legislation is important for adults as well; educational programs to address children and their parents are very effective; parents seem to be ready for legislation and, finally, we need to develop some special strategies to address economically disadvantaged children.

Dr Wesson: Finally, Dr Hu has some comments on a study he is conducting right now.

Dr Hu: We are currently conducting a randomized digital telephone survey to examine the parental attitudes, their knowledge and their attitudes about bicycle practice and injuries in children. One of the questions we asked in the survey was specifically whether they support legislation that will mandate bicycle helmet use in children. Of the 521 responses we have to date -- we are still conducting that survey -- 423 confirmed they would support such legislation, and that is 83%. Only 45 families said they were against such legislation, and that is only about 8.6%. There were also 43 parents who said they had no idea about this legislation at all. Both our school-based program and also a population-based survey have confirmed that such legislation is a popular one and will get support from the majority of communities.

Dr Wesson: Dr Bohn is going to finish with what we think are some practical suggestions for this legislation.

Dr Bohn: This afternoon you have heard some very graphic testimony regarding the devastating consequences of bicycle-related head injuries. We have done some very careful research to show there is a wide acceptance among the public at large for the introduction of compulsory bicycle helmet usage.

However, we are practical people and we realize we will not be able to change the world overnight. We do accept that there are some valid concerns regarding issues such as cost, education and enforcement. We have read the report from the Toronto City Cycling Committee, and it would be largely in agreement with most of the points it raises in that.

We realize things like cost can be a disincentive to families investing in bicycle helmets, but there are programs such as the Canadian Medical Association-sponsored program which reduce cost to parents by using a sponsor certificate that allows them to reduce the cost substantially.

We think the public still needs to be educated, that this is a good thing and this is the right thing to do. Money must obviously be invested in an education campaign so that this is universally accepted as a good piece of legislation.

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The enforcement issue is worrisome to the Toronto police, who feel it would be difficult to enforce, but I think our point would be that we cannot afford not to enforce it. We have seatbelt legislation. I think that is another issue where it is not enforced. We have legislation on the books and we are not enforcing it. Something like seatbelt legislation is clearly shown to be lifesaving, yet we are not enforcing it vigorously enough.

If you educate the public that this is the right thing to do, it will accept enforcement as being the right way to implement the legislation. I am not saying we should advocate enforcement as soon as the legislation is enacted. There obviously must be a lead time so that the public will accept this, but at some stage the issue of enforcement must be taken on by those people who are paid to enforce our legislation.

Getting children to wear helmets is going to be a difficult thing, but peer pressure is something that counts very much in the way children view things like bicycle helmets. Adults have a great role to play here in providing a very good role model for children, but if we can get people like the Hell's Angels to wear motorcycle helmets, we can get children to wear bicycle helmets.

I think this is good legislation. This is lifesaving legislation. We recommend it to you highly.

The Chair: Thank you, people. Mr Dadamo, a brief question. No lengthy preamble, please.

Mr Dadamo: Oh, my goodness; there is never any time.

They say doctors do not make house calls, and here we have five. Thank you very much.

If the child is riding a bicycle and trips over the curb, bang, hits his or her head, at what point is all the damage done? Do you have to have a hairline fracture? Do you have to toss the brain around?

Dr Bohn: The first example I quoted to you in fact was a low-velocity injury. If a child is hit by a car when riding a bicycle, that is a high-velocity injury and the injury to the brain is going to be enormous with or without a skull fracture. A skull fracture is neither here nor there. The first example I used was an example of an everyday accident. When you were a child, how many times did you fall off your bike?

Most of the time it is a bump or a bruise and that is it, but this was a child who had a low-velocity injury. His bike hit a curb, he tipped off his bike and his head hit the curb in such a way that it caused a brain haemorrhage from which he died. A bicycle helmet would have saved his life without a doubt. You can dispute the second example, that the child could have been saved by a bike helmet, because that was a high-velocity impact injury, but in the first example there is no doubt about it.

Dr Wesson: The short answer is that in the majority of cases, the damage is done right at the moment of impact. Primary brain injury is really the problem here. Sometimes haemorrhage creates a secondary insult, but in most cases the damage is done at the moment of impact.

Mr Dadamo: I have to be brief, the floor director says. Even wearing the helmet, if you take a good, substantial blow, that is going to protect you?

Dr Wesson: You have probably heard already.

Mr Dadamo: You take a hard jolt with the helmet on, but the brain still gets --

Dr Wesson: The whole problem is how you decelerate the brain, and that is what the helmet design is intended to do. It is to give you an extra few milliseconds and a few millimetres through the egg-carton, crushable inner lining of the helmet so you do not stop quite as suddenly. That can make all the difference in the world.

Mr Daigeler: Could you tell me more about the survey you initiated? What is the population base for your survey?

Dr Hu: The population base of the survey covers the whole of Metropolitan Toronto. We are using a randomized digital dialling technique to ensure that representatives of all the population will be covered.

Mr Daigeler: It is a random sample of the total population?

Dr Hu: Exactly.

Mr Daigeler: And 80%, you said, are in favour of --

Dr Hu: It is 83% to be exact.

Mr Daigeler: What was the question you asked?

Dr Hu: The exact question is, would you support legislation that will mandate children wearing helmets on particular roads as required for motorcyclists? That is the exact question we used in this survey.

Mr Daigeler: This surprises me. I am just a substitute member on the committee today so I do not know whether any other surveys have been done in that regard. Are you aware of other surveys, and how does that result compare with these other surveys?

Dr Hu: I do not think such a survey has ever been done either in Metropolitan Toronto or in Ontario. There are similar comparisons in the States. Most of the surveys were done at the local level for a specific program like a school program. They generally have a low response rate because those who do not participate in the program, let's say parents who have busy schedules, are not interested in it and will not get involved, so you generally have some low response rates. Plus, the population you are targeting depends on where the school is located. It may only reflect a certain socioeconomic status in the families, so that is not a good representativeness of all the surveys we are talking about.

Mr Daigeler: If the results of that survey are available, could you make that available to me, please?

Dr Hu: Of course. When it is complete we will certainly provide all the details and all the statistics you need. As I said, our target is looking at close to 700 telephone surveys. We are now getting close to 600 and we are still compiling for another 100. We should be finishing up in about another two weeks. This research is funded by the Easter Seal Society.

Mrs Cunningham: Thank you very much for appearing before the committee. Every time somebody comes we learn something new. I did want to observe that you are doing very well on your mandate so far with regard to your Children's Bicycle Helmet Coalition five-year objectives. If we can get this one out of the way, then we can worry about the other two. I thank you for your support. I have said it before.

I am interested in this study as well. It is not that everyone is as lucky as we are. At the same time as we are trying to persuade the politicians in this province that it is important, we do not normally have a bright young scientist like yourself doing some extremely credible research. You may laugh, but you can answer my question any way you like. The one piece of literature we have all been so impressed with is the one that was published in the New England Journal of Medicine. Where are you going to publish yours?

Dr Hu: As soon as we have compiled all the statistics that are convincing and we are sure it has post-scientific merit that is acceptable by a reputable journal.

Mrs Cunningham: Good response. We have a very humble scientist here. That is it.

The Chair: People, thank you very much. You probably know you are the third group of professionals from the Hospital for Sick Children. All of us have been impressed with the dedication and commitment and generosity of goodwill coming from the staff at that hospital.

You, as your colleagues before you, have made an invaluable contribution to this committee's considerations. All of us thank you. We appreciate your work and we trust you will keep in touch with Mrs Cunningham, who is the author and sponsor of the bill, and with Mr Dadamo, who is the parliamentary assistant to the Minister of Transportation. They likewise will be trying to keep you advised of how things develop. I trust that if we need your help again, you can come to our aid.

Dr Wesson: You can count on us.

The Chair: All of you, thank you very much. We appreciate it. Take care, people.

1710

HUGH MACMILLAN REHABILITATION CENTRE

The Chair: The Hugh MacMillan Rehabilitation Centre; Dr Peter Rumney, director of the head injury rehabilitation program. Good afternoon, doctor. Please tell us what you will. Try to leave us at least 15 minutes out of your 30 minutes to ask questions and we will try to distribute the remainder of the time as equally as possible among the three caucuses.

Dr Rumney: I think I will be at somewhat of an advantage during my presentation, because my friends and colleagues from the Hospital for Sick Children have done most of my presentation already. I have passed around a brief handout, which just gives you an outline of what I am going to be talking about.

I must open by saying that we at the Hugh MacMillan Rehabilitation Centre feel that if this upcoming legislation is passed, it will be a godsend. It is quite clear that the legislation is straight and to the point. I wish it could be applied to all bicycle riding on all terrains, but it is a good start to reduce the incidence of head injuries while on highways. Some of the issues that have been brought forward have been mentioned by yourself and other members in discussions in the House about cost, and certainly, as Dr Bohn and his team and Dr Wesson discussed, the cost of helmets is a very related sort of thing. The initial cost of approved bike helmets was in the neighbourhood of $80 per helmet.

I have given Mr Dadamo two demonstration helmets, one which is old and somewhat scuffed that was first produced at $80, and the new one that is available on the CMA write-in option. Its cost to consumers is $20. The one that is scuffed up that you have in your hand is $80 and the bright, shiny one is $20. They are both equivalent in their safety. In fact, the newest one has CSA approval, which is superior to the Snell Foundation and the ANSI legislation. With mass production, cost has been driven down by market forces. In the United States, when Dr Rivara and his team in Seattle started pushing helmets, the cost was $45 to $60 US. The average cost now is $25 and that is with no coupons, just straight production.

The Chair: There might be some questions about the helmets themselves that would best be posed now.

Ms S. Murdock: I have one. These are both for adults? I see it says medium to large in here.

Dr Rumney: That specific helmet is available for adolescents, youths and adults, and when it is delivered it also comes with five different insertable pads to make the fit secure and safe. There are three other models for younger children, two because of size and one because of interest. You can now get the teenage mutant ninja turtle helmet model.

Ms S. Murdock: Are the smaller ones cheaper?

Dr Rumney: No, the price for production is more or less the same; the price is roughly $20, except for the teenage mutant ninja turtle one, which is $25 for the additional colour and decorations.

I will come back to the older helmet a little later, but I want to tell you that the cost to the health care professions and to us as consumers and taxpayers is enormous. Dr Bohn said it was incalculable. I do not contradict him, but I can say that it is easy to calculate the initial cost and then we can extrapolate from there. I asked our health records to pull all the admissions to the Hugh MacMillan head injury program over the last five years.

We regularly have 60 new admissions per year to the head injury program, and that is just children, anybody from newborn up to age 19. We had 21 admissions over the five years of children and young adults as a result of bicycle accidents, none of whom were wearing helmets. Out of that there were 1,809 days in our facility, and we are a relatively cheap OHIP facility. Our per diem rate is somewhere in the neighbourhood of $400 to $450 a day. That means that the total cost varied somewhere between $723,000 and $904,500 for their stay alone at our facility in the last five years. That does not include costs at the Hospital for Sick Children, hospital outpatient visits, follow-up visits at clinics, seeing physicians, getting their medication or anything else.

Each one had a mean stay of 86 days. That is a mean cost in the neighbourhood of $39,000. You saw the videotape by HSC. The one lady and one gentleman are graduates of my rehabilitation program. Each one spent in excess of three months with me on the adolescent ward recovering from their accidents. The first one was a low-velocity accident. The gentleman ran into his mother, also on a bike, and flipped off the bike. In the second, the girl was struck by a truck. It was a high-velocity accident.

The cost of disability is much harder to ascertain, but we know the lifelong cost to the health care system for spinal cord injuries is $1 million per person. I would submit that the lifelong cost of traumatic brain injury, because life expectancy in essence is unchanged if you live past those first 48 hours, is very close to that $1 million per head. In addition, the loss of income and the increased expenses in education, health care, attendant care and social services start to extrapolate the whole calculation significantly.

We know that cost of death is also extremely high. I am saying it is unmeasurable because it is hard to quantify, but traumatic brain injury is a killer of young people. The peak incidence of traumatic brain injury is between 15 and 24 years of age. In the bad old days before the 1970s, everybody died. Things are getting better in that people are not dying directly as a result of their multiple injuries; they are dying as a result of their head injuries, but not their body injuries. Those that can be saved and revived go on to have lifelong disabilities that interfere with learning, lifestyle, vocation, recreation and all components of their life.

We know by Dr Rivera's study that there is an 85% decrease in lifelong disability and death as a result of the use of an approved helmet. We also know that public awareness is changing. You have heard of the statistics Dr Hu and his group at the Hospital for Sick Children have brought forward, as well as Dr Wesson and his group. We are even seeing the people I thought we would never get. The bicycle couriers, the men and women who are actually cycling their legs out for the dollar, are wearing helmets because they find they are living longer, earning more money and are not being laid off as quickly because of disability.

We have personal testimonials, and you should never practise medicine by personal testimonials, but it gets to the heart very quickly. The first bike helmet here is one I have collected from a staffer, the helmet of my social worker. She was riding home when she was cut off by a Mustang, thrown over the hood, landed on her head, pivoted once and then landed on her knapsack. If you look at that helmet you can see it has a few skid marks on the top, nothing significant. If you look at the inside it looks almost identical to the one Mr Kormos has, but this one is unusable because it has been in a major accident. As a result of this, her injuries included bruises on her back, a twisted elbow and minor whiplash, but she was able to return to work three days later. If she had not had the helmet, she would have been one of the statistics admitted to my head injury rehab program or its equivalent for adults. Similarly, my speech-language pathologist and my neuropsychologist have also had various bike and motorcycle accidents and have been saved by helmets, so to me there is undeniable proof within my own staff.

The encouraging thing is that government legislation can lead as well as follow public awareness. I had the pleasure of meeting with Dr deGraaff from Melbourne, Australia, where they have enacted similar legislation for mandatory bike helmet use and seatbelt use. Also, they have speed guns on radar so there is constant monitoring of vehicle speed. All these measures came into existence one right after the other, and he has documented in his own practice an almost 50% to 70% decrease in admissions to the rehabilitation programs because of this.

The other thing we are seeing is support in the other sectors. The police clearly are supporting us. They are advocating by bringing together such works as the Amazing Spiderman's educational comic book called Hit and Run. This is something put together to appeal to adolescents and younger children. It is using the Spiderman theme, but it is scripted in Toronto at the SkyDome with the Blue Jays, so it has popular appeal. In addition, the Ontario Head Injury Association, which I am sure has made presentations to you, or will, has its younger-age-group educational book on facts for use of appropriate headgear. I am having trouble keeping these in my waiting room at the rehabilitation centre. I am not a public practitioner providing care to healthy newborns and other healthy children; I am seeing a very select population of the disabled. These are going to their friends, relatives and siblings.

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Finally, the Toronto cycling association is strongly in support of this. We know the Seattle experiment has shown an increase in usage from their initial 3% to roughly 16%. It is nice to see the Toronto bike helmet coalition has gone from roughly 3% to 16% in a year, as opposed to three years.

In addition, the economic numbers for the Sandoz company, which has underwritten the cost of this helmet distribution through the CMA, are quite supportive. I have heard from one of the representatives that they have sold more than 60,000 helmets this year across Canada. They were hoping they would perhaps sell 16,000, because the United States offer, which has been similar, has been 160,000 and of course we always factor by 10.

The CSA regulations are excellent. They are probably the world leaders in design for these helmets, similar to the CSA regulations for hockey helmets, led by Dr Pashby and his crew.

We are trying to do our best by educating, advocating and taking it to the public. We know we cannot separate cars and bicycles. Our streets, roadways, cities and highways are not designed to do that. Other areas have done this and have made a significant impact, but if our society is to continue as it is, and I am sure it will, this is the best effort we can bring forward and we have good, scientific evidence that it works.

Basically, I would like you to put me out of a job. If you can do this and some other things in the future, I think I can get those 21 admissions over five years to a much lower number. I can do other things and I am hoping you can help us in this.

Mrs Cunningham: I am going to ask a couple of questions about things you have not talked about with regard to the Hugh MacMillan Rehabilitation Centre. One of the great concerns of all members of the committee is for the people who do survive and need the rehabilitation your centre provides. I wondered, when you talked about the stay in hospital or the stay at your centre, if you could enlighten the committee as to what kinds of things would happen after the stay in your centre; where these people would go and what kind of ongoing support they may need.

Dr Rumney: The variability within head injury rehabilitation is extreme so you can get all positions on the spectrum, but I can give you an average scenario. Someone is transferred to our facility roughly two to four weeks after a traumatic brain injury from the Hospital for Sick Children or another trauma centre. They spend, on average, 80 to 100 days in our assessment and treatment program, getting physiotherapy, occupational therapy, speech-language pathology, neuropsychology, social work, recreation and creative arts therapy.

At the time of discharge, we try to bring in the community support services to co-ordinate their return to their home, school and the community at large. In most cases, this is a request for the home school to modify its school program: reduce the course load, stagger the academic and nonacademic subjects and provide special education support services, as well as counselling support services.

We often refer them to outpatient facilities for ongoing therapy in speech OT and PT. These are in short supply, as I am sure you are well aware. In many cases we now turn to private providers for this because the waiting lists for the public facilities are so long and the new no-fault insurance is able to provide some support for these families when a motor vehicle accident is involved. This may be a process of three to six months of ongoing physiotherapy and occupational therapy and, if they are lucky enough, a similar length of time in speech-language pathology support on a weekly basis.

In most cases the counselling issues may go on for a matter of six months to a year, perhaps two years, depending on the family and the social circumstances. Someone like Mr Finora was able to get back into school and pick up more or less where he left off roughly a year to a year and a half after his head injury. Another of my patients will never be able to complete high school and go on to post-secondary education in the manner she would have prior to her injury.

The other thing is that the community support services available are relatively few, such as the Head Injury Association of Toronto, the Ontario Head Injury Association and their other chapters in various communities around, but these are family-support networks that are informal and do not provide direct services. They may be a communication base for families and they may be an informal support network, but very few of them have formal, regular, dependable counselling services available.

Finally, when one finishes education and goes to vocational support, it becomes a real challenge, because the need for appropriate vocational assessment and rehabilitation in the field of head injury is very scarce and hard to come by.

Mrs Cunningham: These questions may seem irrelevant, but I am trying to share, because we have the opportunity of having you here this afternoon, Dr Rumney, the challenges we have in Ontario.

Are you aware of the new medical services and other American services, and how many of the people you know would choose to go for that kind of rehabilitation? I probably asked the wrong question, but we are aware that many go outside Ontario for assistance. I wonder if you could talk to us about that.

Dr Rumney: We know that in the last year, according to statistics shared at the Ontario Head Injury Association conference in November 1990, roughly $24 million to $28 million was sent south for rehabilitation services as a result of traumatic brain injury in one year.

There are over 700 rehabilitation centres in the United States to provide care on a private basis for a traumatic and acquired brain injury. Of those facilities only a handful, perhaps 30, are truly paediatrically based head injury services.

With respect to the types of services they deliver, they are more or less equivalent in their construct and their depth of services available to the facilities here within Metropolitan Toronto and in Ontario. The advantage is that the waiting lists are virtually non-existent because when they start to become overrun with clients they hire new staff, as they have more funding. That is a real advantage in almost immediate response time.

The second thing is that they have a track record of work in this field for a period of between five and 10 years. If you look at the established head injury rehab programs in Canada, few that they are, they also have similar track records. Ours has been in existence since 1978.

One disadvantage is that it is driven by private funding, and if the funding runs out you are discharged.

The other major disadvantage is that it is not done in the home community. The one lasting thing we have learned is that things learned by a person after a closed head injury are not easily generalized. If you learn how to take the bus in Seattle, or how to make your bed and take care of your shopping and your apartment in Austin, Texas, it does not necessarily mean you are going to be able to do it in North Bay, Toronto or any other place. The best place for these people to learn to cope with the new challenges and problems in their lives is within their own communities. I must admit I cross-refer to them when they have a service we do not have, such as behaviour-based services, but it certainly in my mind is a second-best answer.

Sorry, I get up on the soapbox every once in awhile.

1730

Mrs Cunningham: I enjoy that. It saves some of us doing it at times. We will do it here and you can do it out there.

Dr Rumney: Fair enough.

Ms S. Murdock: Dr Rumney, I want to thank you very much for coming. Both you and the doctors before you have been mesmerizing with your information.

I have two things. I want to make a comment, and the other is to ask a question. The first is that in looking at the helmets, I think the Minister of Industry, Trade and Technology should be informed that one of them is assembled in Mexico and the other is made in the United States, and maybe we should be looking at targeting another industry.

Mrs Cunningham: We are, Sharon.

Ms S. Murdock: We have to do that for sure.

The question, though, is in relation to the CSA approval of the helmets. I am wondering what the CSA standard is as compared to to the American standard, whether it is different and how it would be affected by free trade, basically.

Dr Rumney: I could not comment directly on the effects of free trade. I am afraid I do not understand that fully, but from my understanding, the ANSI and the Snell Foundation regulations were the first two regulations for helmet design. The CSA was later in development and, from my understanding, is superior with respect to the ability of the helmet to minimize a puncture wound and to minimize the specific types of kinetic energy distribution, in other words, the type of impact transmitted to the head and to the brain.

This is something that might slow down the acceptance of a foreign-designed helmet, only to the extent that CSA has to test it, accept it, approve it and then let it go on. As you said, the Proaction helmet is CSA-approved, but it is assembled in Mexico, it has been designed in the United States and it did have to pass this approval before being accepted.

I would like to see a fully Canadian- or Ontarian-produced product to market, but there are numerous helmets that have passed CSA approval quite quickly. The ones that have not are often the ones that have a soft shell over the top, cloth with no polycarbonate or similar plastic that is an impact-resistant shell.

Ms S. Murdock: Is the thicker styrofoam safer, or is that a fallacy to the uninitiated?

Dr Rumney: Roughly, the styrofoam thickness is a factor, the density of the styrofoam itself is a factor. From what I have been told, the more important thing is how well it fits. If I put this helmet on a small child and it is loose and wobbly, it would be actually a detriment. If, however, I put this helmet on a child with the appropriate padding so that it is tight, snug and comfortable, then the impact resistance is excellent.

The other question that came in the last presentation was, when does the accident occur? It occurs at the point of impact and it can be so small that it is deceiving. It can be so frightening to see someone who has no bruise, no fracture, no swelling, no lump, and who is comatose. You do a CAT scan and it looks almost normal. They are comatose for a week and they wake up and forget things for three months. They are permanently disabled because of cognitive memory and thinking problems, but are physically perfect. I am afraid I have seen that all too often.

Mr Waters: I think what Ms Murdock was getting at was that under the free trade agreement, the CSA will be harmonized and downgraded to the US standard.

Dr Rumney: I hope not.

Mr Waters: It will be; that is part of the agreement.

Dr Rumney: Perhaps we can bring Underwriters Laboratories up to ours.

Mr Waters: That is not the way it works, unfortunately; we only wish. I came out of the wiring industry and had the same thing happen to us. My question, once again, goes to the old helmet. If I were a parent, how could I tell that a helmet was no longer serviceable? Children, being children, will not tell me when they have fallen or will use it for a football. How do I know that it is no longer serviceable?

Dr Rumney: Any significant damage to the polycarbonate shell. This plastic is virtually bulletproof, so any significant trauma tells you that there has been a more-than-subtle impact. The other way to critically appraise it is by taking the inside liner out. If you inspect the liner and you can see indentations, grooves, dents or other imperfections, then you know this has had a significant impact. It is going to take more than a drop on the ground to do this. It usually takes an impact where someone has fallen off their bike while riding, skateboarding or rollerblading, or has been hit by a car. It is easiest to make that judgement historically and say: "Did you fall? Tell me about it. All right, we have to get you a new helmet." But there are some things that are fairly easy to teach to the public.

Mr Waters: On the topic of education, I had said earlier on about our children harassing us and demanding that we do not smoke and that we wear seatbelts, and they were quite successful at doing those things through the school system. I was wondering whether you think this is the appropriate place to work on the education not only of our children for their sake, but of our children for our sake, as their parents.

Dr Rumney: Definitely. I am hoping that a generation from now we will be looking back at these proceedings and saying it is so obvious that this should be done. One of the things the Ontario Head Injury Association has done has been to put this information packet together, but it also has developed a curriculum for the public schools that is free to anyone who requests it. There is about a 50-page activity booklet and curriculum support available to teachers upon request from the Ontario Head Injury Association. We have just recently collaborated with them with respect to some minor funding to try to get this out to the school boards as much as possible.

The other thing I do in my capacity is in-services to school boards around Metropolitan Toronto and southern Ontario. I take my demonstration pack with me wherever I go to try to encourage them to do the same and to put it in their health curricula.

The Chair: Dr Rumney, I want to thank you very much for your time this afternoon, for your interest in this matter and for sharing your expertise with us. You have made a valuable contribution and we are all extremely grateful. I trust you will keep in touch with either Mrs Cunningham, who is the sponsor of the bill, or with Mr Dadamo, who is the parliamentary assistant to the Minister of Transportation, the honourable Gilles Pouliot. Both of them, I am sure, will do their best to keep you updated as to how things progress through this committee and then into the House.

Dr Rumney: Thank you very much.

The Chair: Thank you, sir. Take care.

That completes the matter of participants with respect to submissions on Mrs Cunningham's bill. However, we have a matter to deal with, and that is the standing order 123 reference, which has been dealt with by the subcommittee. The only thing being sought is unanimous consent that notwithstanding the standing orders, it does not supersede Mrs Cunningham's bill, Bill 124. Is there unanimous consent in that regard?

Agreed to.

The Chair: Thank you. That completes the matters for this afternoon. We are going to be back here on Wednesday at 3:30 promptly. I remind people that it is really unfair to people who come here -- many if not all of whom are very busy people; most of them are -- to either keep them waiting or to foul up the schedule such that they cannot appear at the time they expected to and make their submission at the time they expected to.

Thank you for the committee's co-operation this afternoon. We will see you on Wednesday at 3:30.

The committee adjourned at 1740.