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Living or dying with the decision not to wear a helmet
No Caption - photo by Lois M. Collins
Josh Frost and two friends were enjoying a sunny late-June evening, celebrating his new job. But his decision not to wear a helmet when he stepped onto his longboard means that for the foreseeable future at least, he will have to wear a helmet even to walk across the room or to ride in a car.

No one can predict whether he will be completely restored when his bodys done healing, or if he will live with residual effects of the injuries he suffered on June 29.

Frost, 18 years old and a recent high school graduate, describes the crash that left him with a badly fractured skull and other injuries: I was riding down slowly to make sure it was safe, and woke up in the hospital.

Thats all the detail he recalls.

By the time his friends ran to him, bystanders who watched him lose control and repeatedly bounce his head as he tumbled down a hill in a lower Avenues neighborhood had called an ambulance. He was not breathing; he was revived in the emergency room at University Hospital, his injuries extensive, his prognosis unclear.

His brain swelling was so severe that doctors had to remove a large chunk of his skull. Until surgeons put it back, a medical helmet is a fact of life albeit an uncomfortable one for Frost.

Traumatic brain injury is a major cause of death and disability in the United States. The U.S. Centers for Disease Control and Prevention says TBIs contribute to about a third of all injury deaths, which it numbers at about 138 a day across age groups nationwide.

Falls are the leading cause of traumatic brain injuries (40 percent) resulting in hospitalization, emergency room visits or death. Among kids, 55 percent of TBIs result from falls. Such injuries are more common for males than for females.

In 2010, 2.5 million emergency room visits included a traumatic brain injury and 50,000 of those individuals died. The year before, the CDC said, an estimated 249,000 kids (those under 19) were treated for sports and recreation-related injuries that included a diagnosis of concussion or TBI. Clearly, helmets won't prevent all head injuries, but health experts repeatedly list helmets as a proven tool to save lives. They protect kids playing sports, cycling and climbing, among other pursuits.

Getting over it

Adam Bullough, 31, works with people who have suffered severe brain injury in his job as a resource facilitator at the Brain Injury Alliance of Utah in Salt Lake City. He also knows what its like to lose bits and pieces of yourself to brain injury. Seven years ago, he was riding his bike without a helmet in Orange County, California, where he lived at the time, when he tipped over.

He was in a coma for a couple of months, and his dad, Robert Bullough Jr., chronicled his first year of recovery in the book Adams Fall: Traumatic Brain Injury the First 365 Days.

The CDC says that while millions of Americans ride bikes, fewer than half wear helmets, holding true for both children and adults. In 2010, 800 bicyclists were killed and more than 500,000 required emergency department care, half of them children.

Bullough has completed college and moved on with his life, but recovering is not the same as being the way you were before the injury, he warns.

There are problems that Ill always have: I have problems with vision, problems with balance, problems with language. I dont think theres anything I can do about that except learn to deal with them and just keep going and hope for the best.

He gradually relearned old pursuits, like playing soccer or rock climbing or riding a bike. But theyre different.

I can do all the same things I did before, but I am not as good at them, he said. They were things I had some level of pride in.

Had he worn a helmet, he notes, hed have been scraped and bruised for sure. But thats about all. My life would be very, very different. I dont know what it would be like, but it would be different.

What he misses most, he adds, is singing. Since his injury, hes lost control over his voice and his vocal range has shrunk, which makes him sad. Music was my identifying passion, he said.

A bunch of little things were left behind when his unprotected head hit the pavement. That it was preventable makes it harder.

If only

Helmets are a cause for the American College of Emergency Physicians, whose members struggle to save lives disrupted by such injuries.

One of the college spokesmen, Dr. Howard Mell, who works at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, said just in the past month, three children have been rushed to his emergency department with serious brain injuries that a helmet might have prevented. Two were hospitalized. The third, a skateboarder, died.

Traumatic brain injuries linger after the initial assault on the brain, often conferring long-term challenges. Parents may lose the child that could have been, Mell said, recalling children left with severe developmental and intellectual delays, possible personality shifts, and changes that interfere with learning, personality and judgment. Modern medicine cannot always overcome the change.

Those who survive may struggle with impaired thinking, memory and movement. They may be plagued by disrupted sensory processes like hearing and sight, as well as personality changes, depression and more, the CDC says. The effects spread past individuals into families and communities.

Mell wonders how many people would stay on a plane if, as they boarded, the pilot said he thought hed skip the safety checklist to save time or because he didnt feel like doing it. Thats essentially what parents do when they let kids skip wearing helmets. Some of the planes would be just fine, and so would some of the helmetless kids. For others, the result would be devastating.

Mell often hears this refrain as he talks with distraught parents after a catastrophic injury: Just this one time, I let them do ____. Its followed by explanations like, I didnt think he was going that far.

Helmets need to be an every-time event. It just takes one fall to change someone into a totally different person. Its a really tragic event. You never want to ask yourself what if' over something as silly as a helmet, he said.

Its especially problematic if someone has already suffered a recent brain injury and gets hurt again, Mell noted a problem thats raised considerable concern about youths (and adults) who play football. Repeat concussions provide cascading damage.

Marisa and Jay Frost, Joshs parents, were told a brain injury increases the chance of subsequent brain injury because people with traumatic brain injury often lose self-awareness and inhibitions most people have, which increases their risk of further injury.

Mell's four children arent allowed to get on scooters, bikes or skateboards without helmets.

I have never seen somebody show up to the emergency department with a head injury who was wearing a proper-fitting helmet, said Mell. Ive seen other injuries, but the head was OK. And the head is the toughest thing to fix. Brain surgery is hard to do and not always as successful as wed like.

Just another day

June 29 started as just another day at the Frost house. An ambitious kid, Josh had just completed training for his second job, at Salt Lake City International Airport, and was getting ready for his first real work day. His mom stopped in his room to tell him she loved him and wish him luck and to remind the good-humored, boisterous youth that 7 a.m. is a bit early to be playing his guitar.

"Seriously. 'Cut it out.' I gave him a hug. 'Enjoy your work day. Love you.' And I left. He was gone with his friends when I got home," she said.

The Frost family, which includes Josh's younger siblings Sofia, 17, and Ben, 5, were getting ready for a move to a different house, so the injury came during a time of controlled chaos. They dropped everything and rushed to the intensive care unit, where early medical reports were grim. They were told he might be in a coma for some time. His future hinged on what happened moment to moment.

Word spread quickly among Frost's friends. The waiting room began to fill, and Marisa Frost said the outpouring stunned her. "To see how much people care for the people you love to see his friends coming. I definitely didn't expect the parents to show up, but we had parents come to the hospital a crowd of people."

While his family kept watch over Josh, Jay and Marisa Frost's friends got a moving trailer and packed the family, then moved and unpacked them. "I can't find anything," his mom said with a laugh, "but I am so grateful."

Josh, she noted, would have been the first to show up if someone else had been injured.

Once they knew he would live, friends wondered how much he'd change. Some wondered, especially, about his sense of humor and playfulness. Would it be the same?

He's not sure, he said, what will be easy and what will be hard in the future. But he is getting stronger every day and he is able to articulate his thoughts clearly, which is comforting to all of them. He doubts hell longboard again. He knows hell never do it without a helmet.

He tires easily, hates his medical helmet and is frustrated by progress that seems slow to him, but amazing to everyone around him.

He was released from the hospital recently but will soon go back to have the piece of skull put back. He has occupational speech and physical therapy sessions, and will have to prove he is capable in order to drive again. Hes working on balance and coordination and making sure he can safely do some daily living tasks, like cooking. Returning to work and school may take months.

"I hope hearing what happened to me will help others be sensible," he said. "It could save lives. I wish I'd worn a helmet."