Any form of protection afforded to personnel (whether it be to protect the eyes, head, feet, hands, the respiratory system or any other area), falls under the universal principles of Personal Protective Equipment (PPE). As such, PPE is considered the last resort to protect from harm under the ‘Hierarchy of Hazard Control’.

It is worth remembering that in order to reduce the probability of harm resulting from any activity, the following steps should be considered first, in order of the most effective, to least effective:

  • Elimination – to physically remove the hazard itself (where possible)
  • Substitution – by substituting the hazardous element with one which is non-hazardous or less hazardous
  • Engineering – by engineering controls to isolate personnel from the hazard
  • Administrative – by changing the processes, procedures, methods and systems of work
  • PPE – protecting the worker with Personal Protective Equipment (PPE)

Need for head protection

Head protection is required to protect the workforce from potential injury or harm in various environments. The type of protection required is dependent on the activity being undertaken.

In the UK, the Personal Protective Equipment (PPE) Regulations 1992 (as amended in 2013) cover the provision and use of head protection on construction sites. However, the Regulations do not cover specifications for each activity within which ‘head protection’ is required.

It is therefore imperative to undertake a ‘suitable and sufficient’ Risk Assessment of the hazards in any given environment, in order to help select the correct type of head protection.

For example, on a construction site, a typical Risk Assessment should give consideration to the following points when assessing the need and/or type of head protection to be selected:

  • Environment in which the work is taking place
  • Probability of objects falling from height
  • Probability of objects likely to strike the head
  • Likelihood of walking into objects/machinery/equipment at head height
  • Possibility of loads being carried overhead during lifting operations
  • Possibility of swinging loads
  • Possibility of slips, trips and falls
  • Possibility of debris striking the head from other activities

As with any form of Risk Assessment, once the risk (qualitative or quantitative) is calculated, taking into consideration the likelihood and severity of potential harm, and all efforts have been exhausted in order to eliminate or reduce the risks (where possible), the residual risk is then considered in order to take appropriate action and consider preventative measure and selection of appropriate head protection.

Potential consequences of head injuries

Depending on the work activity and type of environment, inadequate protection of the head can result in minor and superficial injuries, to fatalities, from Traumatic Brain Injuries (TBI).

A traumatic brain injury (TBI) is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. The severity of such an injury may range from ‘mild’, i.e. a brief change in mental status or consciousness to ‘severe’, i.e. an extended period of unconsciousness or amnesia after the injury. A TBI can result in short or long-term problems with independent function.

Survivors of TBI often experience long-term behavioural consequences and neuropsychiatric disorders including post-traumatic stress disorder (PTSD), anxiety, depression and dementia.

The condition is also a social, medical and financial burden on sufferers, their families and healthcare systems and there are very few reports assessing the incidence and prevalence of TBI or the standard neurotherapies available to treat it.

There are too few epidemiological studies from the Middle East to have analysed the region’s high casualty rate and injuries from conflict in general, and that of TBI and its consequences in particular within the workplace.

Leading causes of traumatic brain injury

Since the problems experienced by those suffering TBI such as impairments in memory or cognition are often not visible, it has been referred to as the ‘silent epidemic’.

In the US alone, an estimated 1.7 million people sustain a TBI each and every year.

Leading causes include falls, traffic accidents, assault, and being struck by or against an object – such as another person, a wall, or a falling object. The Centers for Disease Control and Prevention (CDC) report that there are:

  • 595,095 fall-related TBIs (35%)
  • 292,202 motor vehicle/traffic related TBIs (17%)
  • 279,882 struck by/against events (16.5%)
  • 169,625 assault-related TBIs (10%)
  • 199,447 unknown causes (12%)
  • 155,255 injuries classified as “other” (9%)

(Source: CDC)

A study titled ‘The impact of traumatic brain injuries: A global perspective’ shows that, according to the World Health Organization (WHO), TBI “will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 million people affected annually by TBI, the burden of mortality and morbidity that this condition imposes on society, makes TBI a pressing public health and medical problem. The burden of TBI is manifest throughout the world, and is especially prominent in Low and Middle Income Countries which face a higher preponderance of risk factors for causes of TBI and have inadequately prepared health systems to address the associated health outcomes. Latin America and Sub Saharan Africa demonstrate a higher TBI-related incidence rate varying from 150–170 per 100,000 respectively due to RTIs compared to a global rate of 106 per 100,000. As highlighted in this global review of TBI, there is a large gap in data on incidence, risk factors, sequelae, financial costs, and social impact of TBI.”

Safety culture

In the realms of health and safety and injuries to the head/TBI, accurate data and statistics are not available for the Middle East region. This is due to a number of reasons, mainly related to the less formal reporting procedures and investigation procedures within the region.

Being based in the United Kingdom, and having worked on one of the world’s largest construction projects in the Middle East, we have first-hand experience of how ‘culture’ plays a significant role in the application of ‘safe working procedures’.

It is no secret that most of the labour force in the Middle East region is brought in from low and middle income countries, such as Pakistan, India and Bangladesh etc., where skilled labour can be sourced at a comparatively low cost.

Whilst the ‘skilled labour’ is ‘skilled’ in various aspects of ‘production’, it is seldom skilled in ‘safe production’. The obvious reasons for this being directly and indirectly attributed to the socio-economic conditions and lack of accountability in their countries of origin. A labourer who is accustomed to using bamboo sticks or other materials to construct an unsafe frame as a platform for elevated work, is by default, unlikely to understand the significance of guardrails, toe boards, base plates or appropriate cross bars of a premium scaffolding system.

With this in mind, we need to ‘mind our heads’, particularly in the Middle East, where the construction of complex high rises, commercial and public buildings is rife in comparison to other parts of the world.

Types of head protection

There are many different types of head protection and choices of protective wear available on the market, each made suitable for the type of protection required.

In fact, there are more than 30 British Standards that cover specifications for various types of protection when it comes to helmets. While this can be confusing, it is important to understand the significance of choosing the appropriate form of protection.

In one of their recent publications, the Chartered Institute of Occupational Safety and Health (IOSH) published a summary of the different types of helmets commonly used in the workplace, as follows (right).

Considerations for selection

When selecting the right helmet, the following points should be considered.

Types of risks and parts of body exposed

This is best assessed by carrying out a ‘suitable and sufficient’ Risk Assessment.

Level of protection needed

In light of the aforementioned specifications, the residual risks from the Risk Assessment will help ascertain the level of protection required.

Length of time PPE to be worn

This is an often-overlooked aspect of any form of PPE. No two individuals are the same, and neither are all helmets (as previously discussed). It is therefore imperative that the right choice is made taking into consideration the environment and job activities of the workforce. Helmets which offer maximum protection are relatively heavy in comparison to those which offer least protection. As such, unsupervised wearers can be found removing their helmets to avoid stress and discomfort, thus leaving them with no protection whatsoever. It is therefore imperative, that the workforce is not overburdened with PPE which is simply not required given their duties. E.g. it would be considered over burdensome for a worker undertaking ‘housekeeping’ duties in the construction of a road, to be expected to wear a high-performance helmet under extreme heat and for lengthy periods of time.

Communication with others

The type of helmet to be selected must take into consideration the activities or job description of the worker. Some helmets may restrict the use of communication devices, e.g. a rigger using radio communication with the crane operator may be supplied with a communication device that may not be compatible with the provided helmet. This could potentially result in catastrophic outcomes.

Type and size of the helmet available

Some helmets may require ventilation holes to help keep the worker’s head cool. However, if this is an electrician, who is working in an environment in which small conductors are likely to poke into the ventilation holes, then this needs to be taken into consideration. Again, the specifications of helmets must be consulted before selecting the type of helmet to be commissioned. It is also important to get the workforce involved in the selection process. In case of any physical impairments or special requirements, the helmet should be compatible with the worker and any special needs. It is also noteworthy that when a worker is involved in the selection process, (s)he is more likely to wear the equipment selected.

Correct standard and CE marked?

It is common to find helmets made by different manufacturers, and the market is open to all types of manufacturers of helmets. Caution needs to be observed during the commissioning of helmets so as not to compromise quality over costs; as that cost saving could cost someone their life.

Fit, comfort, compatibility

Whilst it may seem like a simple choice to provide all workers with the same type of helmet on a construction site, consideration should be given to the fact that some workers may require other PPE such as Respiratory Protective equipment (RPE) in dusty environments, and therefore, their helmet should be compatible with other forms of PPE and the workers should be involved in the selection of the helmet.


Once the right type of head protection has been selected, employers are required to provide training to the workforce in the use, maintenance and reporting of any defects of their PPE. All head protection units should be:

  • Inspected – examined before issue and at regular intervals
  • Tested – while giving due consideration to manufacturers’ suggestions, shelf life, and replacement periods
  • Made subject to regular maintenance, which ensures long life and the required protection