Fewer and fewer states have good helmet laws any more. Part of the problem is political. But the other part, may be… the end user. Here’s a piece written by a doctor and published in the St. Paul Pioneer Press in 1994 about a case he saw in medical school:
“I was working in a rural emergency room one day when the ambulance brought in a 17-year-old who had been in a motorcycle accident. It had just started raining, and the road was slick; he’d tried to take a corner too fast and had laid the bike down and skidded quite a long way.
“Fortunately, all he had were crapes and bruises. he had no head injury.
“Just as I was finishing up with him, a policeman came in and brought the young man his helmet, which they had taken off him at the scene. it was obviously a fancy and expensive helmet. It was a full-face unit – shiny, multicolored, metal-flake.
“One entire side of the helmet was ruined. It was deeply gouged and had obviously scraped along the asphalt with considerable impact for quite a distance. In some places, it appeared that the entire thickness of the hard shell had been penetrated, and you could see the soft inner lining.
“The young man was obviously very lucky.
“He looked at the helmet, groaned and said: ‘Oh, man! I just bought that a week ago! What a waste of $150!’”
Most trauma professionals recognize the value of motorcycle helmets. I’ve written many articles here on the topic (see below). There is high quality evidence that helmets decrease severity of injury in motorcycle crashes (fewer severe brain injuries, higher survival, etc). And we also know from other studies that riders are not protecting their brain at the expense of their spine and torso.
In the 1970s, 47 of US states had enacted universal helmet laws. It wasn’t long after that the federal government lost its authority to penalize noncompliance. So you know what happened. Special interest groups began to weaken and/or repeal these laws, one by one. Now, although some form of helmet law still exists in 47 states, they apply universally to riders in only 19. In the other 26, only young riders, inexperienced ones, or those with insufficient insurance must wear helmets. But how would law enforcement know that when they see the average motorcyclist whizzing by? Which means that the number of riders wearing them has decreased markedly.
The hard part of doing studies to look at the impact of helmets vs no helmets is placing a specific value on a life. A group at the Medical College of Wisconsin in Milwaukee designed a study to use a specific statistical method to attack this problem. They looked at the the value that one places on a marginal change in their likelihood of death. Another way to look at it is the cost of reducing the average number of deaths by one. This is the Value of Statistical Life analysis.
Here are the factoids:
- Cost and population information was obtained from a number of federal databases
- Injury information was obtained from the National Trauma Databank
- 3951 motorcycle fatalities occurred during the one year study period
- 77% died at the scene, 10% in the ED, and 13% as inpatients
- 37% of riders did not wear helmets, but accounted for 69% of deaths
- Helmet use increased survival in a crash by 50%
- Costs for hospitalization and rehab (for survivors, obviously) were $5.5 billion for nonsurvivors vs $3.3 billion for survivors
- The extra cost per fatality was about $800K
- Therefore, (re)implementing universal helmet laws stands to save $2.2 billion per year
Bottom line: Enough numbers here to make your head spin. The $2.2 billion savings, along with a value of statistical life of $2.4 billion equals $4.6 billion in calculated gains. Obviously, the science appears more exact than it really is, but the numbers are large enough to confidently state that lots of money can be saved by simply wearing helmets. The hardest part of this is the human factor. Without legislation, people won’t wear helmets. And there are enough people that haven’t had to wear them, that they will lobby to keep it that way. Catch-22. The solution: prevention, although this will most likely be after the fact, when the patient is already injured and in the hospital. Do your part!
Reference: National mandatory motorcycle helmet laws may save 2.2 billion annually: an inpatient and value of statistical life analysis. J Trauma 78(6):1182-1186, 2015.
It’s well established that motorcycles helmets make a difference during a crash. EAST has developed an evidence based review that provides recommendations regarding helmet use. Click here to see them. Unfortunately, many states don’t have helmet laws, and several have been persuaded to repeal perfectly good ones.
Although there is strong literature support for helmet use, the specific type of helmet (full-face vs all others) has not been prospectively studied. Helmets that are not full-face (FF) do not cover areas that protect lower parts of the brain and the upper brainstem.
A group in Baltimore did a one year prospective study on the effect of helmet type on craniofacial injury. They treated 176 motorcycle crash victims during that time, and were able to identify the helmet type in 151. A total of 84 wore FF helmets, and 67 wore other types. Here are the interesting findings:
- Facial fractures occurred in 16% of patients. Only 7% of FF helmeted patients had these fractures vs 27% wearing other helmets.
- Skull fractures were found in 6%, with only 1% in FF helmet wearers vs 11% in other helmet types
- Mortality decreased from 7.5% to 4.8% (36% reduction) in the FF helmeted patients (not statistically significant)
- Cervical spine fractures decreased 20% from 11.9% to 8.5% in the helmeted group (also not significant)
Bottom line: Choosing a motorcycle helmet carefully is important. Remember, motorcyclists are far less protected than automobile drivers. Improving protection has definitively been shown to decrease injuries of nearly all types. Although it certainly is patient choice as to what they wear and if they ride, it can make a big difference to them (and society) if they ignore these recommendations.
Reference: Choice of motorcycle helmet makes a difference: a prospective observational study. J Trauma 75(1):88-91, 2013.
I’ve written about motorcycle helmet laws in the past, and the research that supports their use. Unfortunately, not everyone buys into others telling them about the safety aspects. This article hit the news wires on Sunday:
ONONDAGA, N.Y. – Police say a motorcyclist participating in a protest ride against helmet laws in upstate New York died after he flipped over the bike’s handlebars and hit his head on the pavement.
The accident happened Saturday afternoon in the town of Onondaga, in central New York near Syracuse.
State troopers tell The Post-Standard of Syracuse that 55-year-old Philip A. Contos of Parish, N.Y., was driving a 1983 Harley Davidson with a group of bikers who were protesting helmet laws by not wearing helmets.
Troopers say Contos hit his brakes and the motorcycle fishtailed. The bike spun out of control, and Contos toppled over the handlebars. He was pronounced dead at a hospital.
Troopers say Contos would have likely survived if he had been wearing a helmet.
The bikers objected to laws that would require them to wear a helmet while riding. This was the organizer’s reaction to the death:
Christinea Rathbun, president of the Syracuse ABATE chapter, said the biker’s death would not affect the group’s stance on helmet laws. "Absolutely not,“ she said. "It’s not going to stop us protesting our right to wear a helmet or not wear a helmet. It’s your own risk.”
I understand that some riders want the ability to choose whether to wear their helmet. However, I have a hard time believing that Mr. Contos woke up that morning and would have chosen to forego wearing his helmet knowing that he would die later that day if he did.
The number of motorcyclists has been increasing over the past decade. At the same time, the number of states repealing their helmet laws is increasing. The evidence is convincing that the number and severity of brain injuries is decreased with helmet use. But what about spine injury?
Many arguments against wearing helmets given by riders are derived from a report in 1986 by Goldstein*. One of the issues cited in this paper is the potential increase in cervical spine injuries due to the weight of the helmet. A recently published study using the National Trauma Data Bank (NTDB) corroborates several smaller studies which show that this just isn’t so.
All motorcycle collisions in the NTDB involving adults were analyzed by logistic regression. Missing data was compensated for using standard statistical techniques. Nearly 41,000 cases had complete records for analysis. About 77% of riders were wearing helmets, and the overall mortality was 4%.
Nonhelmeted riders suffered the following statistically significant differences:
- A higher proportion of severe head injury (19% vs 9% with helmets)
- Higher incidence of shock on admission (6% vs 5% with helmets)
- Higher injury severity score (ISS) (14.7 vs 13.4 with helmets)
- Higher crude mortality (6.2% vs 3.5% with helmets)
- Higher incidence of cervical spine injury (5.4% vs 3.5% with helmets)
Bottom line: Motorcyclists wearing helmets had a 22% reduction in the likelihood they would sustain a cervical spine injury in a crash. This is in addition to decreases in shock, injury severity and death. These data need to be considered when the future of helmet laws is considered in any state looking at repealing them.
- Motorcycle helmets associated with lower risk of cervical spine injury: debunking the myth. J Amer Col Surgeons 212(3):295-300, 2011.
- *The effect of motorcycle helmet use on the probability of fatality and the severity of head and neck injury. Evaluation Rev 10:355-375, 1986.