Position Statement

Helmet Use by Motorcycle Drivers and Passengers, and Bicyclists

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

The American Academy of Orthopaedic Surgeons (AAOS) endorses laws mandating the use of helmets by motorcycle drivers and passengers, and bicyclists.

Orthopaedic surgeons, the medical specialists most often called upon to treat injuries to cyclists, believe a significant reduction in fatalities and head injuries could be effected through the implementation of laws mandating the use of helmets by all motorcycle and bicycle drivers and passengers. The AAOS strongly endorses such mandatory helmet laws.

Numerous studies in various parts of the United States have shown that helmet use reduces the severity and cost associated with injuries to motorcycle riders. Federal efforts beginning with the Highway Safety Act of 1966 achieved the passage of state laws mandating helmet use and by 1975, 47 states had enacted such laws. With the Highway Safety Act of 1977, however, Section 208 of which relaxed the pressure on states to have helmet laws, the federal government created the opportunity to measure the effectiveness of helmet use when 27 states repealed their helmet laws in the following three years.

Objective analysis of data from the mid 1990s (when helmet laws were widespread) and the late 1990s (when more than half the states had repealed such laws) shows clearly that head injuries and fatalities of motorcycle riders are reduced when motorcyclists wear helmets. Moreover, the costs associated with treating motorcycle riders head injuries have been demonstrated to be significantly reduced-up to 80 percent in one university study - when helmet laws are in effect.

Recent studies again confirmed that the use of helmets reduces the risk of mortality and severe head injury with motorcycle riders who crash, although the former effect may be modified by other crash factors such as speed.

The American Academy of Orthopaedic Surgeons (AAOS) believes that issues of personal freedom should be seen in the context of the fact that the public at large incurs a major part of the cost for injuries to motorcycle riders.

The repeal of helmet laws in many states was based on issues involving some motorcyclists' claims that mandatory use laws infringed on their right to personal freedom. While it can be argued that the states' laws mandating that motorcyclists be licensed to operate the vehicle are a similar infringement, the more important issue is the cost borne by society when a motorcyclist is injured in an accident. Numerous studies have shown that in cases involving motorcyclists who were not wearing helmets, head injuries were more severe, requiring longer, more expensive hospitalization and rehabilitation. Moreover, it has been shown that the public at large bears a major portion of these increased costs, both in the cases where the injured patients' insurance does not cover all the costs associated with care and through the increasing cost of medical insurance premiums. Society must evaluate the claim of infringement on freedom versus the funding of these costs.

The AAOS believes that the current diversity of state helmet laws provides too little protection for motorcycle riders and for society at large.

Currently, 20 states and the District of Columbia have comprehensive motorcycle helmet laws in place requiring helmet use by all riders. Twenty-seven states have a motorcycle helmet law that only require some riders to wear a helmet. Three states (Illinois, Iowa, and New Hampshire) have no helmet requirements at all. With federal statistics showing that a motorcycle driver or passenger is twice as likely to receive a head injury in an accident if he or she is not wearing a helmet, such inconsistencies in state laws seem an egregious lack of responsibility by the legislatures in many states.

The AAOS believes that mandatory helmet laws should be expanded to cover bicyclists as well as motorcycle riders.

There are more than 80 million bicycle riders in the United States.5 Americans of all ages have taken up bicycling for fun, health and fitness benefits, and as a mode of transportation. With this increase in popularity, however, has come an increase in bicycle-related injury and death. Approximately 716 bicycle riders died on U.S. roads in 2008 and 91 percent were not wearing a helmet.

According to the Consumer Product Safety Commission, an annual average of 80 children under 16 years of age died in bicycle-related incidents in recent years. About half of the 500,000 bicycle-related emergency room-treated injuries in 2007 involved children under the age of 16.

There is no federal law in the U.S. requiring bicycle helmets. Currently, a total of 21 states and the District of Columbia have some bicycle helmet laws. Only 13 states have no state or local helmet laws at all.4


  1. Helmet Use Laws as of June 2010, Insurance Institute for Highway Safety. http://www.iihs.org
  2. Bicycle Helmet Safety Institute - Bicycle Helmet Safety Links page, http://www.bhsi.org/links.htm
  3. Liu B, Ivers R, Norton R, Blows S, Lo S: Helmets for preventing injury in motorcycle riders, Cochrane Database Syst Rev. 2004;(2):CD004333.
  4. Bicycle Helmet Safety Institute, 2002 Statistics. http://www.bhsi.org/stats.htm.
  5. Bicycle Helmet Safety Institute, 2010 Update. http://www.helmets.org/stats.htm
  6. Consumer Product Safety Commission. August 2008.
  7. National Highway Traffic Safety Administration. 1996. Report to Congress: benefits of safety belts and motorcycle helmets. Report no. DOT HS-808-347. Washington, DC: US Department of Transportation.

December 1985 American Academy of Orthopaedic Surgeons.
Revised June 2005 and September 2010.

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons.

Position Statement 1110

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