On the evening of Aug. 11, Tyler Kuhn, 13, took a spill on his skateboard at Pecos Skate Park and hit his head. After peeling himself off the ramp, his friends went home, assuming he was uninjured. Kuhn sat holding his head at a picnic table waiting for a ride. With the current youth's opinion that helmets and protective padding standing strong are "dorky" or "uncool," most children skating at Phoenix skate parks choose not to wear them. And considering the parks remain unsupervised, skate-at-your-own-risk facilities, it has become easier then ever to get away with it. However, Kuhn's accident opened the eyes of many young skaters in Ahwatukee Foothills, and has more parents concerned about park rules and regulations than ever before. When David Kuhn arrived at Pecos Skate Park to pick up his son, he saw Tyler inside the skate park talking. On his way to the car, Tyler fell onto a picnic table holding his head. "When he asked what happened, Tyler said he thought he hit his head but didn't remember," said Kelly Oxford, whose daughter Brittany is a friend of Tyler. "In the car he started slurring his words and acting loopy," David said. "I knew I couldn't just take him home." David took Tyler to Ahwatukee Urgent Care. Doctors immediately airlifted him to St. Joseph's Hospital and Medical Center where he was diagnosed with a fracture called a "bleeder," meaning his brain was hemorrhaging. In order to give him enough morphine to let his brain heal, Tyler was placed under a medical coma. He was released from St. Joseph's on Aug. 15, but told not to return to Centennial Middle School until released by physicians. Tyler returned to school Aug. 31. "They tried lowering the morphine a couple times, but he was in too much pain," Oxford said. "When he first came home he was sick all the time. He is really lucky his brain didn't swell." David said Tyler's skull fracture should heal within six weeks, however, the brain has a longer, more complicated healing process. Helmets have been shown in studies to reduce the risk of head injury by 85 percent and the risk of brain injury by 90 percent. Oxford, a mother of three, is now even more concerned for her 10-year-old son's safety at Arizona skate parks, and has made a commitment to push for stronger helmet regulations. "I plan on doing research, anything I have to do to open the eyes of parents and get the ball rolling," Oxford said. "If I have to get a petition going, I will." Originally from California, Oxford said she had back-up with the state law that requires children under the age of 18 to wear a helmet when they ride skateboards, bikes and scooters. She said she cannot believe how many kids in Phoenix choose not to wear them, oblivious to the danger of a head injury. "It's easy to enforce curfew here because it is a law," Oxford said. "If parents had a leg to stand on, helmets and safety would be easier to enforce." David said he was surprised to see no supervisor from the park walk Tyler out after his accident and inform him what had happened. "He was in so much pain he was wishing he was dead," David said. "It's like the first day they'll wear a helmet, then it's not cool anymore. It would be nice if the parks had a helmet rule, then if the kids want to be cool, they just don't skate there." Current city of Phoenix skate park rules and regulations can be found at www.phoenix.gov/PRL/rules.html. The consequences of injury According to the U.S. Consumer Product Safety Commission, more than 15,600 persons need hospital emergency room treatment each year for injuries related to skateboarding. Fractures are frequent occurrences, and death as a result of collisions with motor vehicles and falls are also reported. Phoenix Children's Hospital pediatric neurosurgeon Dr. David Shafron said skateboard injuries are common among patients he sees annually, with concussions ranking highest among these injuries. "Concussions are by far the most common thing I see, meaning their level of alertness has been altered in any way, they are not necessarily knocked out," he said. "I usually get more involved when there's a loss of consciousness or skull fracture." Shafron said he sees a couple dozen head injuries a year resulting from children engaging in skateboarding activity without wearing a helmet. "I can honestly say I have never taken care of a kid who was wearing a helmet," he said. According to Shafron, most skull fractures heal well without complication in six to eight weeks. However, recovery becomes more complicated when injuries start involving the brain. A hematoma, a collection of blood over the surface of the brain, is not an uncommon injury from skateboarding without a helmet. If the injury is left untreated over time, a subdural hematoma, an "older" collection of blood and blood breakdown products between the surface of the brain and its outermost covering (the dura), can occur. Small hematomas are common in Shafron's office, but patients with larger injuries need to be taken to the emergency room and operated on immediately. However, the brain does not necessarily have to be bleeding for damage to be done, Shafron said. "Testing has shown cognitive abilities can be impaired for days and even weeks beyond what anyone can tell by just talking to someone," he said. "Post-concussion symptoms, such as memory, behavioral problems, headaches and such, last weeks beyond injury even without any bleeding." Proposing a helmet law for skateboards There are two ways to go about making a law requiring skateboarders to wear helmets in Phoenix. One involves asking the Phoenix City Council to enact the law. The second and much more difficult option is to propose an initiative. According to the city of Phoenix Web site, an initiative is a power reserved to the voters to propose legislation, by petition, which would enact, amend or repeal a City Charter or Code provision. If the required number of signatures is obtained on a petition, the City Council must either adopt the proposed measure or refer it to the voters at a special election, or the next regular election if it is within six months. If approved by voters, the measure becomes law. However, Phoenix Councilman Greg Stanton recommends taking the safer route. "Proposing an initiative is very difficult to do, to the point of being virtually impossible," he said. "It involves getting thousands and thousands of signatures. Asking the City Council to enact the law is probably the most effective way." Stanton recommends gathering as many people as possible to form a coalition, including doctors and researchers to provide evidence and facts on the issue. "The city tries to make decisions based on evidence and facts, not just single incidences," he said. "Any research on what incidences have happened in other cities and what they are doing with this issue will be beneficial." Corinne Frayer can be reached at (480) 898-7917 or firstname.lastname@example.org.