Tag Archives: helmets

What Is The Cost of the “Personal Freedom” Not To Wear A Motorcycle Helmet?

The Highway Safety Act of 1966 led to a mandate that all states adopt universal helmet laws for all motorcycle riders or risk the loss of federal highway funds. By 1975, all but 3 states had enacted these laws. However, Congress then did an about-face and eliminated the helmet law requirement for receiving the funds. Many states then revisited their laws, and some repealed them. As of now, 20 states (and D.C.) have inclusive helmet laws, 27 have conditional laws, and 3 (IL, IA, NH) have no helmet requirements.

Croce and his group in Memphis looked at the impact of helmet use in motorcyclists using the National Trauma Data Bank from 2002-2007. They found:

  • Helmet use was higher in states with helmet laws (90%), vs conditional laws (61%), vs no laws (53%)
  • Helmeted riders had less severe injuries in nearly all brain and skull trauma. Glasgow Coma Scale and Injury Severity Scores were significantly lower.
  • Cervical spine fractures were less frequent in helmeted patients (3.9% vs 5.9%)
  • Hospital and ICU stays were shorter for riders who wore helmets
  • Mortality was significantly lower in helmeted motorcyclists (3.8% vs 6.7%)
  • Significantly more helmeted riders were insured

Advocacy groups continue to try to repeal or weaken helmet laws, generally based on a 1986 report (ref 2) which stated that helmets decrease peripheral vision and hearing, increase the number of cervical injuries, and have no impact on mortality. Frequently, proponents of helmet law repeal also claim that the laws infringe on personal freedom.

Helmets do decrease peripheral vision by 20 degrees, but research and a DOT report have shown that this has no impact on motorcycle safety or impact rates (refs 3,4). Helmets have been shown to have no impact on hearing at low speeds, and all riders (with or without helmets) have decreased hearing at higher speeds. Helmets do not diminish or enhance hearing at any given speed (ref 4). A number of studies, including this one, have shown that cervical injuries are less frequent in riders who survive the crash.

The insurance and hospital utilization information in this paper is most interesting. Unhelmeted riders have more significant injuries, are more likely to stay in the hospital and ICU longer, and are much less likely to have insurance to pay for it. And this is for the survivors! Deaths create an even greater societal burden, with lost lifetime earnings, tax revenues and other adverse economic effects.

Courts have repeatedly upheld mandatory helmet laws under the Constitution when challenged. A federal court once responded to one of these challenges with this quote: 

“From the moment of injury, society picks the person up off the highway, delivers him to a municipal hospital and municipal doctors; provides him with unemployment compensation if, after recovery, he cannot replace his lost job; and, if the injury causes permanent disability, may assume responsibility for his and his family’s subsistence. We do not understand a state of mind that permits plaintiff to think that only he himself is concerned.”

For a list of current helmet law status by state, click here.

References:

  1. Impact of motorcycle helmets and state laws on society’s burden. J Trauma 250(3):390-394, 2009.
  2. The effect of motorcycle helmet use on the probability of fatality and the severity of head and neck injuries: a latent variable framework. Evaluation Review 10:335-375, 1986.
  3. Motorcycle helmets – medical costs and the law. J Trauma 30:1189-1199, 1990.
  4. The effects of motorcycle helmets upon seeing and hearing. NHTSA Report number DOT HS 808-399, 1994.

Motorcycle Helmets and Reduction of Head Injury and Mortality

There are more than 4000 motorcyclist deaths each year. Per mile traveled, there are 27 times more motorcycle deaths that automobile fatalities. This is primarily due to the lack of protection available to motorcyclists, including failure to use a helmet. About 50% of motorcycle deaths are due to head injury.

Helmet use by motorcyclists varies widely across the US. Only 20 states and the District of Columbia have mandatory helmet laws for all motorcyclists. 27 states require helmets on some riders, usually those less than 17 or 18 years old. Three states (Illinois, Iowa and New Hampshire) do not have any helmet law.

Do helmets work? Do helmet laws work? Many studies have been done, and now the evidence is convincing that the answer to both questions is yes! The Eastern Association for the Surgery of Trauma has just released an evidence based review on motorcycle helmet use. They looked at 45 of the best scientific studies available to reach their conclusions. Following is a summary of their findings:

  • The use of motorcycle helmets decreases the overall death rate of motorcycle crashes as compared to non-helmeted riders
  • The use of motorcycle helmets decreases lethal head injuries as compared to non-helmeted riders
  • The use of motorcycle helmets decreases the severity of non-lethal head injuries as compared to non-helmeted riders
  • Mandatory universal helmet laws reduce mortality and head injury in geographical areas with the law as compared to those without it

Based on this data, the EAST document makes the following recommendations:

  • Level I (supported by highest quality research): All motorcyclists should wear helmets to reduce the incidence of head injury after a crash
  • Level II (supported by high quality research): All motorcyclists should wear helmets to improve overall survival and reduce head-injury related mortality after a crash
  • Level II: Mandatory universal motorcycle helmet laws should be introduced or re-enacted to reduce morality and head injury after a crash

The full text of the EAST review can be downloaded by clicking the link below.

Reference: EAST Evidence Based Review on Helmet Efficacy to Reduce Head Injury and Mortality in Motorcycle Crashes