Motorcycle helmet laws: Balancing freedom and financial impact

Several years ago, I cared for a young man who crashed his motorcycle at highway speeds. He arrived, slightly dazed, with a few broken bones. Because he was wearing a full-face helmet, he had sustained only a concussion. The paramedics brought in his helmet as they often do, this one with the metal side buffed down to the inner plastic cushion from the grinding contact with the asphalt. Had he been without a helmet in this high-speed crash, he would have sustained a devastating brain injury and likely have been declared dead at the scene.

Eleven motorcycle riders died recently at the Sturgis rally in South Dakota. In actuality, what often happens after a motorcycle crash is that people survive but end up in a vegetative state (breathing out of their neck, receiving feeding through a tube). The risk of death for motorcyclists in crashes is thirty times greater than for car drivers and passengers. As a former motorcycle rider, it became clear to me that you must continuously ride as if you are invisible to other motorists (and I always rode in full gear). Three-quarters of all motorcycle deaths occur at low speeds (30 miles per hour or less) in residential areas. That is because the enemy of the motorcycle rider is not so much the ground as it is the car. For automobiles, approximately 31 percent of crashes result in injury, but only 0.3 percent of collisions are fatal. Eighty percent of reported crashes result in injury for motorcycles, and about 44 percent of crashes are fatal. Although traffic-related fatalities have decreased since 2005, deaths associated with motorcycle use have actually increased by 55 percent since 2000.

Of all motorcycle protective gear, the helmet appears to be the most important. Failure to wear helmets while riding a motorcycle leads to an increased incidence of severe brain injury (even with minor crashes) and long-term disability, which unnecessarily costs the U.S. taxpayer billions of dollars each year.

Overall, the National Highway Traffic Safety Administration (NHTSA) estimates that helmets reduce traumatic brain injury by 67 percent and mortality by 35 percent. In addition, helmets reduce the risk of cervical spine injury (breaking your neck) by at least 50 percent.

All but 19 states have repealed their mandatory universal motorcycle helmet laws (which existed in all states in 1975 when legislation severed the link of helmet requirement to receiving federal highway funds). Helmet laws really work, as compliance is quite high (it is hard to pass by an officer of the law without your lack of visible headgear).

The improved outcomes associated with wearing helmets translate into billions of dollars saved for the U.S. taxpayer. Two decades ago, the immense economic burden related to injuries and deaths from motorcycle-related crashes was estimated to total over $12 billion per year. Who pays for the cost of motorcycle injury? About two-thirds of care is paid for by public funds.

It is time to mandate that our motorcycle riders wear helmets and protective gear as this tremendous financial burden of their injuries is carried by society at large. The freedom to “feel the asphalt thru your hair” must be balanced with the prohibitive cost to society. I was in Florida in July 2000 when state legislators slipped a law by the trauma community that eliminated the state motorcycle helmet requirement. These local representatives responded to their constituents who demanded the liberty to ride helmetless. The state’s anti-helmet crusade leader died later that month after a motorcycle crash. She was not wearing a helmet.

Stephen Cohn is a trauma surgeon.


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