Assemblée législative de l'Ontario

HIGHWAY TRAFFIC AMENDMENT ACT, 1992 / LOI DE 1992 MODIFIANT LE CODE DE LA ROUTE

CHILDREN'S HOSPITAL OF WESTERN ONTARIO

CONTENTS

Wednesday 6 May 1992

Highway Traffic Amendment Act, 1992, Bill 124

Children's Hospital of Western Ontario

Dr Jane M.R. Gillett, director, pediatric neurologist

STANDING COMMITTEE ON RESOURCES DEVELOPMENT

Chair / Président: Kormos, Peter (Welland-Thorold ND)

*Vice-Chair / Vice-Président: Waters, Daniel (Muskoka-Georgian Bay/Muskoka-Baie-Georgianne ND)

Conway, Sean G. (Renfrew North/-Nord L)

*Dadamo, George (Windsor-Sandwich ND)

Huget, Bob (Sarnia ND)

Jordan, Leo (Lanark-Renfrew PC)

*Klopp, Paul (Huron ND)

*McGuinty, Dalton (Ottawa South/-Sud L)

*Murdock, Sharon (Sudbury ND)

Offer, Steven (Mississauga North/-Nord L)

Turnbull, David (York Mills PC)

*Wood, Len (Cochrane North/-Nord ND)

Substitutions / Membres remplaçants:

*Cunningham, Dianne (London North/-Nord PC) for Mr Jordan

*Fawcett, Joan M. (Northumberland L) for Jordan

Sutherland, Kimble (Oxford ND) for Mr Kormos

Ward, Brad (Brantford ND) for Mr Huget

*In attendance / présents

Clerk / Greffier: Brown, Harold

Staff / Personnel: Anderson, Anne, research officer, Legislative Research Service

The committee met at 1717 in committee room 1.

HIGHWAY TRAFFIC AMENDMENT ACT, 1992 / LOI DE 1992 MODIFIANT LE CODE DE LA ROUTE

Resuming consideration of Bill 124, An Act to amend the Highway Traffic Act / Loi modifiant le Code de la route.

CHILDREN'S HOSPITAL OF WESTERN ONTARIO

The Vice-Chair (Mr Dan Waters): It has been agreed by all three parties that we start at this point in time, so I will call the meeting to order.

Today we have with us Dr Jane Gillett from the head injury clinic at the Children's Hospital of Western Ontario. Welcome to the committee, and the floor is yours.

Dr Jane M. R. Gillett: Thank you. Given how informal everything's been prior to this, I think maybe I'll keep things on an informal basis. I'd like to start by thanking you all for asking me to be here.

I mentioned my background a bit already, but I'll just go into it a bit more. I'm a paediatric neurologist on staff at the Children's Hospital of Western Ontario and an assistant professor at the University of Western Ontario both in paediatrics and in the department of neurosciences. I also am the director of the paediatric traumatic brain injury rehabilitation team that runs out of the children's hospital in the Thames Valley Children's Centre. For those who aren't familiar with it, the Thames Valley Children's Centre is the London equivalent to the Hugh MacMillan Rehabilitation Centre here in Toronto. I think most people will at least know the Hugh MacMillan centre.

I've been on staff there since August of 1990 and have looked after all the traumatic brain injuries that have gone through the intensive care unit there since August of 1990. I feel very strongly that the wearing of bicycle helmets is a very important measure both for health care costs and to prevent long-term damage. I'm going to talk strictly from a paediatric perspective and not even mention the benefits on an adult side of things, because I think you've been addressed by several adults already, or at least physicians who look after adults. So we'll pass that one by.

To start off with, I thought I'd describe a case I looked after. I'm calling him Joey just for the sake of a name; that's not his real name. He was the youngest of four children and he was riding his bicycle after school in June of 1990 and was struck by a car. He was not wearing his bicycle helmet. When the emergency crews arrived at the scene he was without vital signs, which means he had no pulse and no respiration. They managed to resuscitate him and take him to the local emergency department where he was deeply comatose, and they transferred him then to the Children's Hospital of Western Ontario to the intensive care unit, which in London we call the paediatric critical care unit.

At that point he had a scan done to see the extent of his damage. It was noted that he had haemorrhages and blood in the frontal lobes of his brain and his temporal lobes on both sides, the thalamus on the left side, which is a very deep structure within the brain that is the major relay station for the entire brain, and the corpus callosum, which is the major connector between the two sides of the brain.

He was in the hospital for a total of 15 months. He was in the intensive care unit for four weeks in a coma, on a respirator getting complete support and was finally extubated and transferred to the ward. He remained in a coma. In other words, he was unresponsive to stimulation for another six months. He gradually emerged from his coma at that point and then stayed in hospital partly for therapy and partly because the extent of his damage was so vast that he was unable to go home until his home was modified to allow wheelchair access and his parents to look after him.

He required a G tube initially, which is a tube that goes into his stomach to feed him. He had a tremendous amount of nursing care, and now that he's at home he requires somebody to come in to help him in the morning to get dressed and bathe him because his mother works on the family farm and has farm chores.

He requires feeding assistance. Someone has to feed him and his food has to be modified so that he's able to eat it. He is aware of his family and he certainly laughs when somebody makes a joke or teases him that he has a girlfriend, but he is unable to communicate in any way other than laughing or making noises.

He is very restricted in his motor capabilities. He's wheelchair-bound or in a bed. Despite extensive medical manipulation he is still extremely stiff and unable to move. We're still investigating experimental possibilities for fixing this.

He has help that comes in every morning, as I mentioned. He has external help that comes in at night-time so that his mother can do some chores. He gets some form of relief during the planting season and the reaping season because the parents are out on the farm for 18 to 20 hours a day and Joey needs somebody to look after him all the time.

He goes to school, but he doesn't get any cognitive benefit out of it. He's unable to learn from it, but he is getting a lot of social interaction and it does give his mother a break, so that has been a benefit as well.

You can see that Joey's life has been markedly changed. I feel very strongly that if he had been wearing his bicycle helmet at the scene the chances of his having a cardiac-respiratory arrest would be very remote and his injury would not be nearly as severe. He would not need to have been in the hospital for as long and he would probably not need to have his home modified, nor would he need to have as much help in the home. If he had been wearing his bicycle helmet it wouldn't have prevented the accident but it would have prevented a lot of the damage that occurred.

That's an example of the types of cases that I deal with on a fairly regular basis. Just to give a perspective, and let's look at some of the statistics. The Canadian Institute of Child Health printed a book recently called The Health of Canadian Children. They've been collecting statistics for Canada. In 1985, 55% of deaths -- we're not talking just injuries, we're talking deaths -- in children between the ages of five and 14 were caused by injuries of some form or another. If you look at the statistics in terms of research, cancer causes only 19% of all children's deaths and yet there's way more research, way more money spent on cancer than there is on preventing injuries and the treatment of injuries. Of the injuries that did cause death in 1985, 54% of those were caused by motor vehicle accidents and 20% of those were motor vehicles hitting cyclists.

They estimated in 1987 that 90 more children were injured for every one child who died in a motor vehicle accident, which works out to 20,000 children who were injured by cars. If 20% of them were car-bicycle injuries, that works out to 4,000 children in 1987 across Canada who were injured by a car-bicycle accident and required hospitalization. Indeed, if you look at the hospitalization statistics, 9% of all injury-related hospitalizations for children between the ages of five and 14 back in 1983 were caused by bicycle accidents. There are some tables that I've included at the end of the handout showing the graphs where these statistics came from. If you note the number where they talk about injury-related hospitalizations, they mention the number of about 37,000 children. So we're still talking of a significant number who would have been hospitalized.

If you look at the cost per day for a child to be on a ward such as the children's hospital in London, it's approximately $2,100 a day. That's what the hospital would charge an out-of-province child. That's obviously not what the parents see. In fact, I was somewhat shocked at that myself. I didn't realize it was that amount of money. If you look at the cost in the PCCU, the intensive care unit, it's in excess of $26,000 a day. So if you consider just children admitted overnight for observation because of a bicycle accident, we're spending $2,100 for that child to be in overnight to be observed.

If you look at a child such as Joey who was in the PCCU for a month and then out on the wards for several months thereafter, his total cost, just the hospital cost, was $960,000. That's a tremendous amount of money. That buys a tremendous number of bicycle helmets. I knew it was expensive, but it floored even me as to how expensive this was.

I'm just talking hospital costs. That does not include the costs of the extra support that Joey now has in the home; it does not include the cost of all the special equipment that Joey needs in order to have some semblance of a normal life. It does not include the cost of his special education and the fact that he needs an aid at school now. If you look at all those as the way things are now, that's $1.5 million.

The American Trauma Society estimated that the lifetime cost for severely injured pedal cyclists in the United States was more than US$4.5 million. I would say that's probably an underestimate, certainly for Joey. That might be appropriate if you look at an 18-year-old or even a 27-year-old, but I think it's considerably low for Joey.

So if you consider how much money we would save by insisting that children wear bicycle helmets, on that factor alone I can't imagine that we wouldn't go that route. Regardless of that, I have a more selfish reason for wanting people to wear bicycle helmets: I'm way too busy and I'd like very much not to be as busy as I am.

I've just talked about major head injuries. If you look at minor head injuries caused by a fall off a bicycle -- and that happens all the time; I'm sure all of you, if you've had children riding bicycles, have had them fall off their bicycles and hit their heads. They've probably been lucky in that they haven't hit their heads really badly, but they have at least fallen and hit their heads. We are learning more and more that those minor types of head injuries in which they might have been knocked out only for a few minutes, or not even necessarily knocked out, have a lot of long-term problems. Those problems include difficulty sleeping at night, having headaches, not being able to concentrate or pay attention, and having problems in school with processing information and integrating information. Those are examples of some of the problems. Their school grades often drop a level, and if they were just passing, they frequently start to fail.

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In an older person, there are problems at work and it can cause a lot of stress to families and can cause marital breakups. So even the minor head injuries have an impact and I haven't even tried to cost the financial impact of those.

I don't know whether you're interested in what causes a head injury or a way of a conceptualizing it. I usually tell my parents, when I'm explaining to them what happened, to think of the brain as being like a bowlful of jelly stuck in a hard box. The brain is actually about the same consistency as a bowlful of jelly. You're falling off and you hit your head. The head, the skull and the brain are travelling at the same speed. The skull hits the cement and the impact of that is transmitted through to the brain that is now hitting the skull. It hits there, it bounces back across to the other side and it oscillates back and forth. At the bottom of this box there are a lot of sharp, little spicules that are sticking up; that's the way the skull is shaped. So you're having your brain dragged back and forth along these sharp little things, ripping the bottom portion of it. Often there's a turning injury to it as well, so that the brain cells are sheared against each other and you get further damage just on the basis of a shearing injury.

A bicycle helmet, although it's not going to totally eliminate an impact such as the one that Joey had, on a fall off a bike or a less extensive injury it would certainly absorb a lot of the injury and prevent a lot of the damage that was caused. It's a lot easier to prevent a head injury than it is to treat a head injury.

Just to finish, in southwestern Ontario since I've been there since August of 1991, we've had five major brain injuries to children riding bicycles. Joey was one of them. Three were hit by cars while riding their bikes. One of them was a young girl who was riding behind her brother and hit one of those little grates they have in the road, slipped off her bike, hit her head on the cement sidewalk and ended up having a big epidural haematoma, or a bleed in her head, by the time she was in hospital and treated. She's left now in a wheelchair, having to communicate using a computer or another type of box and is not as damaged as Joey, but certainly is severely damaged and will be damaged like that for the rest of her life.

If you look at how effective bicycle helmets are and in reality how cheap they are in comparison to the cost of having to look after them, I can't see why anybody wouldn't want his child to wear a bicycle helmet. I can't see why any adult wouldn't wear a bicycle helmet when he is riding his bike. It just is beyond my comprehension as to why anybody would even risk something like that.

In the New England Journal of Medicine back in 1989 a study was done in Seattle that showed that wearing bicycle helmets reduced the risk of head injury by 85%. That's a major, significant change. It's a very cost-effective, very easy type of bill activity, whatever you want to call it. It's so incredibly cost-effective. It's so easy that I think making a law and insisting on it, considering how poor the compliance is right now, is one of the best things this government or any government could possibly do.

The Vice-Chair: Is that the end of your remarks?

Dr Gillett: Yes.

The Vice-Chair: We'll move on to some questions. Don't mind me if I keep an eye on the TV screen, just in case something happens. I'm actually paying attention, but you never know when there's going to be a vote.

Before we go into questions, I would ask, if there is a 30-minute bell, could we please stay to the end and deal with the issue at hand here and then go up at the last minute?

Mr Klopp, I believe you had a question.

Mr Paul Klopp (Huron): A question or a comment. I enjoyed your report. I enjoyed it because you had facts that came out and hit me. One of the things that has really floored me about this whole process -- and we've been on this committee for a number of weeks, not consecutively -- was that we've actually had people come in -- and I know that there are always two sides to every story, but it really floored me that the bicycling groups, people who bicycle, are actually quite against us coming up with a law.

Your report says a lot about a lot of the other reports, but it comes out with some very interesting figures. I support this notion that we should do something and your facts just back it up again for me. In one simple line, can I say to those people -- or is there one simple line -- to just show them the numbers and tell them, "Too bad, so sad and carry on"? I just want your opinion.

Dr Gillett: What you would say to those bicycle groups?

Mr Klopp: Yes.

Dr Gillett: Well, I think they've been lucky so far that they haven't hurt themselves. I would just show them the figures. In actual fact, I considered actually bringing down a couple of photographs of these children and what they look like in the intensive care unit and what they're like now, but I didn't want to totally scare everybody off. I think that will, but there will always be those who will say, "It can't possibly happen to me." Unfortunately, when you're dealing with children and teenagers they are of the philosophy that they're invincible. This is part of what you're fighting against: "Well, it can't possibly happen to me, so why should I have to wear a helmet?" Those who have seen what's happening are the ones who are starting to do it. I think it's just a matter of constant education and time that will eventually persuade them of the need.

If you look at seatbelts, it was recognized for the longest time that seatbelts really helped things, but it took 10 years to get it across. Now most people wear seatbelts. There are those who absolutely refuse and who will cite the odd case in which the person's life was saved because he or she wasn't wearing a seatbelt and ignore the fact that so many more were saved and didn't have serious injuries because they were wearing their seatbelts, but we can't protect absolutely everybody all of time.

Ms Sharon Murdock (Sudbury): I want to thank you very much. Part of our whole discussion has been on the education process and how we can implement education with the implementation of this at the same time. Frankly, the graphic depiction of the bowlful of jelly within a hard box with whatever it is that you called them at the bottom --

Dr Gillett: Spicules.

Ms Murdock: -- I think would probably be a really good video and would graphically and simply explain to the public what happens. You put it in terms that a non-medical person can understand. I thank you for that particularly.

I have two questions. Just in terms of the graphs and the stats you used, why was 1983 Canada's last "Injury Hospitalization by Type"?

Dr Gillett: Those are the last records they have.

Ms Murdock: They aren't keeping them now?

Dr Gillett: Well, I'm sure they are keeping them, but the published ones and the ones I had access to were published in 1983. The book that I referred to was just published last year.

Ms Murdock: I see. Okay. The other thing is one of the comments and concerns on this: enforcement under 12. We can't enforce it. You can charge but you can't convict, in terms of not wearing the helmet. Also, I don't think there are any helmets on the market for under five years of age that are CSA, or are there?

Dr Gillett: Yes, there are.

Mr Klopp: Yes, my daughter is three years old. We got one for her.

Ms Murdock: I don't know. There's some concern for under-fives. I know you didn't address it in your presentation, but given that you deal with this on a daily basis and see the ramifications of not wearing helmets, I wonder if you have any thoughts as to --

Dr Gillett: How to get people to wear them?

Ms Murdock: Yes. As you said, it has to be education, but how do you see enforcement coming about? Is it only through education or massive police mobilization, which we are obviously having problems with in the first place?

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Dr Gillett: I would think that if you immediately made a law and you went around and charged everybody, the police would be doing a lot of charging and you would be following up and chasing, and that in itself would probably be expensive.

I think for most law-abiding citizens, if you were stopped by the policeman and he said: "It is the law now that if you're riding a bicycle," tricycle or whatever, "you have to be wearing a helmet. Where is your helmet? Next time, you'd better be wearing your helmet," most children anyhow probably don't have the sophistication to realize that the policeman is probably not going to remember who they are the next time. I think if you take down their name and address and a notice is then sent to the parents that they should be wearing their bicycle helmets and that if they have a couple of notices the parents will then be charged just like the parents are charged if a child is in the car without the car seat or proper restraint, you're not necessarily charging a child and giving him a record; what you're doing is making the parents be more aware and more responsible.

A lot of parents will just tell their children now, "Okay, if you want to ride your bicycle, you wear your bicycle helmet." The children will say, "Well, it's not cool," and it's like: "Well, I don't care whether it's cool or not; you wear your bicycle helmet if you want to ride your bike. If you don't want to wear your bicycle helmet, I guess you won't ride your bike. We'll put it away for the year," and that's precisely what they do. The children start wearing their bicycle helmets when that kind of enforcement is laid on them.

As well, for any bicycle that gets sold, I think bicycle helmets should be considered part of your bicycle and it's just included in the price of your bicycle. That way, it's going to be a gradual change but you're certainly going to get everybody on their bicycle helmets.

Ms Murdock: Thank you very much.

Mr Len Wood (Cochrane North): Sharon basically asked my question, but first of all, I want to thank you very much for coming forward with an excellent presentation.

Just maybe more a comment than a question: As far as skidoos and motorcycles and cars are concerned, the parents are basically responsible. If a person is riding a skidoo while there's an age limit, after that he's on his own and fines can be imposed. So I'm just curious as to how much responsibility you can put on the parents when the kids take off with the bicycle and get around the corner and take the helmet off and put it on the handlebars, or park it someplace where they pick it up on the way back home. How much of a fine and enforcement and how much police involvement are we going to have to be able to enforce something like that? That's what I'm curious about.

Dr Gillett: If you look at the Toronto Bicycle Coalition and the job it's doing, you can present bicycle helmets to children as a very upbeat and positive thing, and one of the big advantages recently has been the development of bicycle helmet covers that come in different colours and styles and stuff so that you can change it according to what you're wearing and along those lines. That has really helped as well.

Most children, if you present to them what would happen with a bicycle helmet -- and one the Toronto group uses is the ripe, empty pumpkin with a bicycle helmet on that gets dropped versus a pumpkin that gets dropped without one, and how the one without gets his pumpkin smashed and the one with the helmet has an intact pumpkin head. When children see those types of things and realize, they're more likely to wear it.

I know that doesn't quite answer your question, but I think that's one way the responsibility is on the child. But you have to realize that most children don't have the cognitive awareness to really see the long-term implications or the reasoning why you're wearing bicycle helmets, and in that sense it has to be the parents and society's responsibility to ensure that they're safe.

If bicycle helmets continue to become cheaper and if there is some form of subsidy -- if you look at the cost of what we're spending on health care, perhaps we could use some of that to turn around and subsidize bicycle helmets. You would be able to get them to wear their bicycle helmets, and then the parents are fined -- what is it you're fined when you're not wearing your seatbelt? Is it $58 or something? I don't know. I've never been fined.

Mr Wood: It's $78.

I appreciate your comments and I'm pleased that at this point in time my grandson is about three and a half and he's very obedient. They have him wearing a helmet when he goes skating on the ice and they have him wearing a helmet when he's on his tricycle because he has fallen off a few times. I don't know how long that's going to last, but I'm pleased that they have started training him when he's real young because --

Dr Gillett: It's like seatbelts. If you start with the children learning that they go into the car and put their seatbelts on and they do it right from the very beginning, it's something you learn to do as part of your life.

Mr Klopp: They'll tell you.

Dr Gillett: Yes, they will. They will start to tell you.

Mr Dalton McGuinty (Ottawa South): Thanks very much for your presentation, Doctor. We've heard from other medical experts, and the evidence is always very compelling. I want to take advantage of your expertise, though, and ask you about the incidence and gravity of injuries sustained by kids using skateboards and rollerblades. Can you tell us something about those? At least, I know there was an editorial -- it may even have been in the London Free Press -- advocating that we extend the use of helmets beyond cyclists to children using those other things.

Dr Gillett: I would probably agree with that, because all the children I see usually get a little chaffed about whether they are wearing their bicycle helmets and whether they wear them when they go rollerblading or rollerskating or skateboarding plus the necessary other pieces of equipment which include elbow pads and knee pads.

In answer to your question, I can only give you the example right now in our PCCU of a 13-year-old boy who was rollerblading to visit his father and was struck by a car. He is probably going to live but he is probably going to be much like Joey when he finally comes out of his coma. He also suffered a cardiorespiratory arrest at the scene. He has damage on both sides, very extensively. He has damage down in his brain stem and it was uncertain as to whether he would even live. At this point I think he's going to, but his life has been destroyed.

We don't see that many. London is in an interesting situation in that it's the children's hospital for southwestern Ontario, but there's still a proportion of children who would be flown to the Hospital for Sick Children and a proportion of children who stay in Windsor. Until recently, at least down towards Windsor, they would have been transferred across to the States and treated in Detroit. I don't think that's allowed any more and I don't think it's happening, but it was happening at one time. So we don't necessarily catch everybody, despite my dismay at that, because head injuries occur, and I think if you're going to do a good job and give them the best chance of getting back into school and being productive members of society, it's a very time-consuming and, in a sense, very expensive process because it involves so many people.

We've seen two rollerblade injuries, the most recent one I've mentioned. We haven't actually seen any skateboard injuries yet, but I'm just waiting. We've had children who have had their heads stepped on by horses and we've had hockey arena falls and a lot of other things, so I'm just waiting.

Mr McGuinty: Tell me about head injuries generally for toddlers and preschoolers. If they are going to suffer a head injury, what is going to be the cause of that? Do they fall off a chair? In terms of the statistics here, how many are related to the bicycles and tricycles and how many --

Dr Gillett: If you look at children under age two and the most common cause, there are three main causes. One of them, unfortunately, is child abuse; that's probably one of the most common causes of head injury in children younger than two. Of the two others, one would be falling and the other would be when riding as a passenger in a motor vehicle, being strapped in but the car's in an accident.

Among children from age two to about age five, falls are probably the greatest cause of injury; being hit by a car is the other, where the child suddenly darts away from you before you have a chance to grab him and there's a car coming and a child doesn't have the awareness. You start to see bicycle injuries at that time, or tricycle injuries.

It's when you get to older children, five to 10, that bicycle injuries really become one of the top contenders. Partly, I think, it's because of parents. When your children are six or seven you think they're independent and should be able to ride their bikes and you don't have to stand guard, so they're set free and they get into a few more problems. Partly I think by that age most children have a bicycle and are riding their bicycles.

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Mr McGuinty: I wonder if I can stop you there for one second. Someone once said to me that if you're going to pass a law that makes bicycle helmets mandatory, why don't you say that you have to wear them if you're on the streets, but if you're in a parking lot where there are no cars, if you're in some kind of a controlled area where you're not going to have to contend with traffic, then you don't have to worry about the bicycle helmets, because the risk has been reduced significantly.

I'm just wondering, what age group? I don't think your answer for an 18-year-old, for instance, would be the same as it would for a six-year-old.

Dr Gillett: I guess my answer is the same for everybody because, yes, being hit by a car is one of the major reasons, but a tremendous number of the head injuries and the minor ones that have all the long-term impact we're beginning to recognize are caused because they fall off their bicycles, because they skid their bicycles, because they hit a stone, because they're just learning how to ride them and they hit their head on a stone that's on the ground, or cement or whatever. I don't think there is a safe area for riding your bicycle and not wearing a bicycle helmet.

Mr McGuinty: You wouldn't have any statistics, by any chance, which would describe the incidence of bicycle-related accidents, those which involve other vehicles and those which don't?

Dr Gillett: Not off the top of my head. I can tell you at the Children's Hospital of Western Ontario we hospitalize 150 children per year with a head injury, and most of those are falls off bicycles. Of those 150, I would say there are 30 to 35 who are hospitalized into the intensive care unit and 20 of those survive to be needing a lot of therapy. That's still leaving you with 100 children per year who are just hospitalized, and I would say a good 80% of those are falls from bicycles. That's a lot.

Mr McGuinty: Just one further question: One of the things I've often wondered is, why is it that we're not concerned as well with the vital organs in the chest area? This is probably fairly obvious, but the most sensitive area to trauma, to a striking injury, is the head. Are there other injuries that -- for instance, if you're hit by a car at 30 miles an hour and you have a bicycle helmet, will that save you?

Dr Gillett: Probably. That's not to say that they're not going to have other associated injuries. They might have a fractured femur and a fractured pelvis or chest contusion or whatever, but we're very good at treating those, and they regenerate and heal themselves. A bone will regenerate and heal itself, no problem. You rarely see a child who has a long-term problem after fracturing a leg or an arm. If it is the chest wall, they might need some support, but that in itself will regenerate and they will return to normal. The brain is unable to regenerate. Once you've lost those brain cells, they're gone and there's nothing I can do to bring them back, and the recovery is so much longer than recovery of any other aspect that I think that's one of the reasons.

I guess the other is that if you look at a person, your brain is an integral part of every component of your body. That's why we can keep you artificially alive for maybe three, four, even up to six days on a ventilator when you are declared brain-dead, but we cannot keep you alive indefinitely, because without the input of the brain the rest of the organs will die on their own anyhow.

I guess I'm biased because I look after the brains and that's my specialty, but I think it is very important and probably has the longest-term impact in terms of quality of life of any of the other systems.

Mr McGuinty: One of the reasons I asked that is because when you see a police officer get out of his or her car, he's got a flak vest on. It covers them from waist to neck, but they have nothing on their head. It seems to me that, from your perspective, they're missing perhaps the most vital part of the body.

Dr Gillett: I guess the difference is that I don't know that a bicycle helmet or any kind of helmet is going to stop a bullet. The vests will decrease the impact, but to get in the amount of lead, or whatever it is in a police vest that helps prevent bullets, I think would weigh so much that the policeman couldn't keep his head up. But I don't know for sure.

Mrs Joan M. Fawcett (Northumberland): I want to thank you too, Doctor. Your statistics here are very, very shattering; as parents, we all shudder at the thought. I have to take myself back to one child of ours in particular -- you seem to always have one -- and I remember him going over the front of his handlebars. He was lucky: He broke his wrist only; he didn't hit his head. The same one at age 19, I guess, broke his neck and should be a quadriplegic, but he's fine. He does lead a charmed life, but I certainly support everything you are saying.

I don't know whether you know the amount of education that is going on. I know there is some education going on in the schools, but I don't know whether you realize how much there is. Would you recommend more, and should it be part --

Dr Gillett: For bicycle helmets?

Mrs Fawcett: Yes, for any kind of head injury type of thing: the skateboard, the rollerblades now, whatever.

Dr Gillett: You hit a pet peeve of mine. I don't think there's nearly enough education going on about head injuries. From my own personal professional perspective, I think most physicians are woefully undereducated on prevention of injuries, woefully undereducated on the effects and what kind of long-term problems there can be. I think that's probably true for most professionals.

Looking within the school boards and actually teaching children or educating children and parents in each individual community -- it's a very scattered type of thing. I know in Toronto with the bicycle coalition, it has been very successful in targeting East York, and it is now expanding out into some of the other areas. They are planning on having all of Toronto going through their program, I think, by next year or something along those lines.

I've tried to get the bicycling committee for the city of London interested in this issue. They are not. So the child safety committee for the city and I and the hospital and some parents, particularly one parent whose child was involved in a bicycle injury, are mounting our own bicycle coalition. We are going to model it after the Toronto one and we are going to blitz the schools over the next couple of years to try to increase the usage.

I know that in some of the other southwestern Ontario communities there are similar blitzes going on, and quite often it's the parents themselves who are taking on some of this responsibility and getting the parent-teacher associations involved. The public health nurses are becoming more involved, so I think it's an expanding and increasingly recognized role, but there's still a lot of room for --

Mrs Fawcett: You teach health and phys ed right from kindergarten up, certainly in the elementary level. It is part of the curriculum, and I can't see any reason why it can't be a part of the curriculum.

Mrs Dianne Cunningham (London North): Just on that note, that if we were all to put our resources together, I know Mr Dadamo in the committee hearings on May 4 suggested that the members should have videos about cycling and the importance of wearing a helmet when they meet and speak to their local students, because this is becoming fairly high profile. In looking into that and talking to Laura Spence at the Hospital for Sick Children, whom you would know, there is a video called Bicycle Safety Camp. It is put out by Triaminic. It is distributed through the Canadian Medical Association, the Ontario Medical Association and Sandoz Triaminic, and the video is for children ages 6 to 12. So when we start getting excited about the government expense, which will be one of the excuses people might want to use -- although this committee is very open; we're not saying those kinds of things; we're trying to come up with the ammunition for people who say, "You can't do it, because we're going to have to create all this stuff" -- that one could be distributed throughout Ontario, we're told.

There's another one, too: Canadian Tire. The private sector has come up with a video entitled Gearing Up For Cycling. It's more family-oriented and includes the Metropolitan Toronto Police, Dr David Wesson from the Hospital For Sick Children, and the Kiwanis injury prevention program. So we are well on our way, and that's the good news.

1800

Mr Chairman, I just wanted to say a sincere thank you to Dr Gillett. I had the privilege of visiting the doctor at the hospital probably halfway into these hearings, as many of us were trying to find out what was going on in our own communities, and I was tremendously enlightened that day, but I've been enlightened times 20 today with your direct answers to our questions.

We are feeling pretty confident about this piece of legislation at this point, but we are also feeling that the responsibility for making it work is going to be on us in this committee with regard to recommendations we can make about legislation and regulations. Mr Chairman, it might be important for Dr Gillett to listen to the next part, because I think what we ourselves need to do now is decide what we can do next.

I know we have other people coming in, but we're feeling a bit frustrated in making recommendations to the bureaucracy and probably three different ministries, giving them some direction. Certainly my staff and the Ministry of Transportation staff have a number of issues they would like to put on a list, and which I would like them to put on a list that we can look at as members. They're the issues that have come out of the hearings with regard to ourselves; a lot of them came out the other day. I'm not sure what my role should be, Mr Chairman, but I'm prepared to do that, as certainly Andrea has been here making the lists, as have others.

The other thing I just noticed -- it's nice to have people ahead of us -- is that Anne in research here started to put a graph together. She uses the word "sample" at the top, but I think it would be absolutely great if we could maybe use this as a guide or incorporate it in some way. The issue is: who, where, the penalty, exemptions, the date it should come into force, the helmet standards, affordability and issues under that. Then we've got: Does it go into the bill, does it go into the regs or does it go into the report? I think if we could delineate some kind of report like this -- I'll take the direction from you, George -- it might be helpful if we did this hard work ourselves.

It might not take so long. We could maybe take it away, or we could probably work through it in a committee, but I'd look for direction from the members, Mr Chairman. It's just an idea of where we go next. We're quite a far way along. We are quite advanced in our thinking on this so far.

The Vice-Chair: This is a new experience for me, as for most of us. Private members' bills are not well known for going this far. I think anything that makes the process simpler for us is probably an asset.

I would like to ask a question that's been a pet question of mine throughout this. I have a problem with people who ride their bicycles with their children strapped behind them in those seats. I just wondered about your opinion of that particular aspect of cycling. Do you see many injuries at all from that?

Dr Gillett: None that have actually made it into the intensive care unit. There are some children who appear in the emergency department: The parent falls, the bicycle slips and the child hits his head. Fortunately, all those children had been wearing bicycle helmets, so there really hasn't been a serious injury that a child has experienced.

There are little triangular go-carts available -- I'm not really sure what they're called -- which are attached to the back of the bicycle; your child sits in the cart and he's strapped in, and he's maybe 10, 12 inches off the ground, so if you do slip on the bicycle, at least when you fall over the child's not going to hit his head. The problem with those are that they are a little bit more accessible to cars than being on the back seat, so I don't think there's any really safe way. I know a lot of people look at bicycling as the route to go in getting rid of cars, and in that sense, then, the little go-cart things would probably be the best way, the safest way.

The Vice-Chair: Thank you very much.

Ms Murdock: I know it's late, but I just have --

The Vice-Chair: Yes, Ms Murdock. This is that type of committee.

Ms Murdock: This is in relation to the two examples you gave, both of which resulted in cardiorespiratory arrest. I understood from some of your comments that the bicycle helmet would probably have saved that from occurring. Why is that?

Dr Gillett: The brain controls how fast your heart beats and your respiratory drive. If you think in terms of this bowl of jelly and you've suddenly been hit and everything has been twisted, you can suddenly get a marked -- well, let's go back a step again. The brain is stuck in this little box and the box itself will never expand. So you have a bowlful of jelly stuck in this box and you suddenly twist it and you rip off some blood, so all of a sudden there's more stuff going into this box than whatever is supposed to be there. The pressure inside of that box goes up really high very quickly, and when your pressure gets up high enough, you compress that part of your brain that controls your heart rate and your respiratory rate. As soon as it gets compressed, it stops telling the heart and the lungs to do their things, and then they stop and you die.

Ms Murdock: Okay. In music there is the term "contrapuntal," and I know there's -- what is it again?

Dr Gillett: Contracoup.

Ms Murdock: How do you spell the word for those things on the bottom of your brain?

Dr Gillett: Spicules.

The Vice-Chair: Any further questions for the doctor? Hearing none, I wish to thank you very much. I know you're a very busy person, and for you to give up an afternoon to come down and talk to us on this, you must be extremely dedicated to the safety and the wellbeing of our youngsters. I thank you very much for your time. If there's any way we can help you, probably in the London area, I know Dianne will.

Dr Gillett: I might take you up on that.

The Vice-Chair: Just a second -- I said Dianne. I moved it to Dianne immediately, realizing my error, because I happen to have doctors after me over in my area. Thank you very much for your time. I know Dianne will help you in any way, indeed if not on a weekly basis. But I wouldn't mind at all, because it is important for the wellbeing of our children. Thank you again, Dr Gillett.

Ms Cunningham has one more thing she wishes to bring forward.

Mrs Cunningham: I just thought it might be a good idea if we asked Anne from legislative research, David Edgar from the Ministry of Transportation and Andrea Strathdee from my office to come up with a report for Monday, not in depth, but after we hear from the Solicitor General on Monday at 3:30, we could probably deal with this, at least start on it on Monday, with whatever they are able to get together, if everybody agrees that would be a good first step for ourselves.

Mr McGuinty: Yes. If we can get that chart ahead of time, it would also be helpful.

The Vice-Chair: What we can do is ask if we can get something put together for Monday.

Mrs Cunningham: If you can, we would appreciate it. I know it's not a lot of time.

The Vice-Chair: I take it from all the heads nodding around the room that this is unanimous consent by all three parties.

Mrs Cunningham: The best way to do it.

The Vice-Chair: Is there unanimous consent? Yes. Thank you very much.

The committee stands adjourned until 3:30 on Monday, when we will have the Solicitor General's office in.

The committee adjourned at 1809.