According to the four seasons of trauma – summer is a motorcycle season. I am “fortunate” enough to live in a state with no mandatory helmet law. It is nice to know that my personal freedom of not protecting myself with a helmet is protected.

I do not ride a bike. I live on the opposite side of this issue – I treat patients in the trauma ICU. Not surprisingly, with the onset of warm weather we have had an influx of motorcycle trauma patients. A very recent encounter made me think about the helmet law, personal safety and the role of society to care for the trauma patients.

19 year old girl was admitted as a trauma patient with multiple orthopedic injuries including pelvic fractures and fractures of her lower extremities. The patient did not sustain any head injury and was neurologically intact. Her boyfriend let her use his helmet when they were getting on the bike. The boyfriend was pronounced “dead on arrival” due to an overwhelming head injury. Is it possible the he gave her a generous “gift of life” by letting her use his helmet?

This is an isolated encounter, though. It has a significant emotional burden, yet, speaking in scientific terms, is not "statistically significant”. One unfortunate death is not a “representative sample”. To find more meaningful data I delved into Ovid database to find the most recent scientific evidence. I was using terms “helmet” and “head injury” to narrow down my search results.

There was no lack of data. Multiple and multiple studies have shown that helmets do save lives and prevent severe head injuries. The evidence is simply overwhelming. One study found that helmets were 37% effective in preventing death and 65% effective in preventing brain injury.

It seems puzzling to me that we have a universal seatbelts law, yet only 21 states in the Union have a mandatory helmet law. You do not need to conduct a study to figure out that riding a motorcycle is far more dangerous than driving a car – there is no metal shell around you body, there are no restraints, either. Indeed, the federal government estimates that motorcycle deaths are about 35 times that for automobiles per mile traveled.

So, if motorcycle helmets save lives, why there is no uniform mandatory helmet law? Like many things in America, this is more a political than a policy question. In 1995 Congress lifted federal sanctions against states with no helmet law. Congress just could not stand the pressure of anti-helmet lobbyists.

One could argue that personal freedom and the freedom of choice prevailed in this case. What about common sense? If wearing a helmet is good for and not wearing one can kill you, we should see more motorcycle related deaths, right? The study conducted in Pennsylvania showed just that.

The Pennsylvania motorcycle helmet law was repealed in 2003. The helmet use among riders in crashes decreased from 82% to 58%. Head injury deaths increased 66%; non-head injury deaths increased by 25%. Motorcycle related head injury hospitalizations increased 78% compared with 28% for non-head injury hospitalizations.

It begs the question – what’s more important – the personal freedom of being stupid or the benefit for society as a whole from the decreased burden of motorcycle related head injuries?

For the purpose of keeping the post short the issue of the socioeconomic burden of the motorcycle related head injuries and helmet law will be explored in Part 2 of this post. Stay tuned.