Motorcycle helmets provide the best protection from head injury for motorcyclists involved in traffic crashes. The passage of helmet use laws governing all motorcycle riders is the most effective method of increasing helmet use. The National Highway Traffic Safety Administration (NHTSA) encourages States to enact legislation that requires all motorcycle riders to wear helmets. Additionally, NHTSA strongly supports comprehensive motorcycle safety programs that include motorcycle helmet usage, rider education, motorcycle operator licensing, and responsible use of alcohol. Key Facts: In 2002, 3,244 motorcyclists died and approximately 65,000 were injured in highway crashes in the United States. Per mile traveled in 2002, a motorcyclist is approximately 27 times more likely to die in a crash than someone riding in an automobile. Head injury is a leading cause of death in motorcycle crashes. An unhelmeted motorcyclist is 40% more likely to suffer a fatal head injury and 15% more likely to suffer a nonfatal injury than a helmeted motorcyclist when involved in a crash. NHTSA estimates that motorcycle helmets reduce the likelihood of a crash fatality by 37%. The Crash Outcome Data Evaluation System (CODES) study found that motorcycle helmets are 67% effective in preventing brain injuries and that unhelmeted motorcyclists involved in crashes were three times more likely to suffer brain injuries than those wearing helmets. From 1984 through 2002, NHTSA estimates that helmets saved the lives of 13,774 motorcyclists. If all motorcycle operators and passengers had worn helmets during that period, NHTSA estimates that 9,508 additional lives would have been saved. A study conducted at the University of Southern California, which analyzed 3,600 traffic crash reports covering motorcycle crashes, concluded that wearing helmets was the single most important factor in surviving motorcycle crashes. A 1994 study by the National Public Services Research Institute concluded that wearing motorcycle helmets does not restrict a rider"s ability to hear auditory signals or see a vehicle in an adjacent lane. All motorcycle helmets sold in the United States are required to meet Federal Motor Vehicle Safety Standard 218, which established the minimum level of protection helmets must afford each user. Helmet use laws governing all motorcycle riders significantly increase helmet use and are easily enforced because of the riders" high visibility. As States begin to repeal helmet laws fewer riders are wearing helmets. According to the National Occupant Protection Survey, from the Fall 2000 to the Summer of 2002, helmet use dropped from 71% to 58% nationally. Data on crashes in States where only minors are required to wear helmets show that fewer than 40% of the fatally-injured minors wear helmets even though the law requires them to do so. Helmet laws that govern only minors are extremely difficult to enforce. According to NHTSA"s 1998 Motor Vehicle Occupant Safety Survey, public support for motorcycle helmet use laws in the United States is strong, with four out of five people aged 16 and older, supporting such laws. This support has changed little from earlier occupant protection surveys, in 1996 (81%) and in 1994 (82%). Support was more prevalent among women (89%) than men (71%), and among non-motorcyclists (83%) than those who rode motorcycles (47%), with this gap seeming to have widened in the past two years. Support also was higher in States requiring all riders to wear helmets (84%), compared with States having lesser requirements (75%) or no requirement (79%). In 1976, the Highway Safety Act was amended to remove sanctions against States without motorcycle helmet laws. Between 1976 and 1980, motorcycle fatalities increased 61% while motorcycle registrations increased only 15% in comparison with 1975, the year before repeals began. Caution must be exercised when comparing motorcycle crash statistics between States. This is because States differ significantly on a number of factors, such as weather, length of riding season, population density, and urban versus rural roads. The real issue is what happens within a State after a helmet law is adopted or repealed. Reported helmet use rates for fatally injured motorcyclists in 2002 were 53% for operators and 41% for passengers, unchanged from 2001. Legislative Status: Nineteen States, the District of Columbia, and Puerto Rico require helmet use for all motorcycle operators and passengers. In another 28 States, only those under a certain age, usually 18, are required to wear helmets. Three States do not have laws requiring helmet use. Since 1989, six States (Oregon, Nebraska, Texas, Washington, California, and Maryland) have enacted helmet use laws thatgovern all motorcycle occupants.In Oregon, there was a 33% reduction in motorcycle fatalities the year after its helmet law was restored; Nebraska had a 32% reduction in the first year of its law; Texas had a 23% reduction; Washington State had a 15% reduction; California had a 37% reduction; and Maryland had a 20% reduction. Since 1997, six States (Arkansas, Texas, Kentucky, Louisiana, Florida, and Pennsylvania) have weakened universal helmet laws to limit coverage to those under the age of 21. These six States were the first States since 1983 to repeal or weaken a universal helmet law. Helmet use decreased following the changes in helmet laws in Arkansas and Texas. In the first full year following repeal of the law, fatalities in Arkansas increased by 21%, compared with the fatality rate in the last full year under the law that required all riders to wear a helmet. In Texas, operator fatalities increased by 31% compared with the previous year when the helmet law was in place. Arkansas pre-hospital EMS data showed an increase in the number of injured motorcyclists and in the proportion of all injured motorcyclists with head injuries following the change in helmet laws. Texas Trauma Registry data showed that the proportion of motorcyclists treated for traumatic brain injury increased and that treatment costs for traumatic brain injury cases also increased following the law change. Treatment costs for other injury cases did not change to any major extent. Motorcycle crash-related injuries, fatalities, and fatality rates increased in Kentucky (1998) and Louisiana (1999) following the weakening of their helmet laws covering all riders. Kentucky crash data show that in the two full years just prior to the helmet law repeal, there was an average of 573 motorcycle crash related injuries, while in the two post repeal years, there was an average of 785 injury crashes, a 37% increase. Louisiana crash data show injuries increased by more than 48%, from an average of 741 motorcyclist injuries in last two years of the all-rider helmet law to 1,101 in 2000. Fatality numbers increased in Kentucky from an average of 23 per year prior to repeal to an average of 36 following the repeal. In Louisiana, the average number of fatalities jumped from 26 to 55. In Kentucky motorcyclists killed per 10,000 registered motorcycles averaged 6.4 in the two years prior to repeal and jumped to 8.8 in the two years following repeal. Similarly, in Louisiana, the average fatality rate went from 4.5 in the two years before repeal to 7.9 in the year following repeal. Observed helmet use dropped in both Kentucky and Louisiana. In Kentucky, observed helmet use dropped from 96% in 1997 to 56% in 2001. Louisiana"s observed helmet use dropped from 100% in 1997 to 52% in 2001. Cost Savings: Analysis of linked data from the Crash Outcome Data Evaluation System (CODES) in three States with universal helmet laws showed that without the helmet law, the total extra inpatient charges due to brain injury would have almost doubled from $2,325,000 to $4,095,000. A number of studies have compared hospital costs for helmeted and unhelmeted motorcyclists involved in traffic crashes. These studies have revealed that unhelmeted riders involved in crashes are less likely to have insurance and more likely to have higher hospital costs than helmeted riders involved in similar crashes. The CODES study, mentioned earlier, also found that brain injury cases were more than twice as costly as non-brain injury cases for the one-year period studied. Among the un-helmeted motorcycle in-patients, charges for those suffering brain injuries were 2.25 times higher than for those without brain injuries. Long-term costs were not included. NHTSA estimates that motorcycle helmet use saved $1.3 billion in 2002 alone. An additional $853 million would have been saved if all motorcyclists had worn helmets. NHTSA estimates that motorcycle helmet use saved $19.5 billion in economic costs from 1984 through 2002. An additional $14.8 billion would have been saved if all motorcyclists had worn helmets during the same period. Who Supports Universal Motorcycle Helmet Laws? AAA Advocates for Highway and Auto Safety Allstate Insurance Company American Academy of Family Physicians American Academy of Orthopedic Surgeons American Association of State Highway and Transportation Officials American Academy of Pediatrics American Coalition for Traffic Safety, Inc. American College of Emergency Physicians American College of Preventive Medicine American College of Surgeons American Driver and Traffic Safety Education Association American Insurance Association American Medical Association American Nurses Association American Public Health Association American Trauma Society Association of Women"s Health, Obstetrics, and Neonatal Nurses Association for the Advancement of Automotive Medicine Brain Injury Association Center for Rural Emergency Medicine Emergency Nurses Association Emergency Nurses CARE Epilepsy Foundation of America GEICO General Federation of Women"s Clubs Indian Health Service Motorcycle Industry Council National Association of County and City Health Officials National Association of Orthopedic Nurses National Association of Public Hospitals National Association of Emergency Medical Technicians National Association of State EMS Directors National Association of State Head Injury Administrators National Center for Injury Prevention and Control National Conference of Black Mayors National Flight Nurses Association National Safety Council National Sheriffs Association Nationwide Insurance Native American Injury Prevention Coalition Prudential Insurance State and Territorial Injury Prevention Directors Association Students Against Destructive Decisions State Farm Insurance Think First Foundation Wellness Councils of America State Motorcycle Helmet Use Requirements April 2004 19 States, D.C. and P.R. Required Use For All Riders: Alabama California District of Columbia Georgia Maryland Massachusetts Michigan Mississippi Missouri Nebraska Nevada New Jersey New York North Carolina Oregon Puerto Rico Tennessee Vermont Virginia Washington West Virginia Not Required In 3 States: Colorado Illinois Iowa 28 States Require Use For A Specific Segment of Riders (Usually Under 18): Alaska Arizona Arkansas Connecticut Delaware (1) Florida (2) Hawaii Idaho Indiana Kansas Kentucky (3) Louisiana (4) Maine (5) Minnesota Montana New Hampshire New Mexico North Dakota Ohio (6) Oklahoma Pennsylvania (9) Rhode Island (7) South Carolina South Dakota Texas (8) Utah Wisconsin Wyoming Required for riders under age 19 and helmets must be in the possession of other riders, even though use is not required Required for riders under age 21 and for those without $10,000 of medical insurance that will cover injuries resulting from a motorcycle crash. Required for riders under age 21, riders operating a motorcycle with an instruction permit, riders with less than one year"s experience, and/or riders who do not provide proof of health insurance to county clerk. (insurance provision repealed effective July 15, 2000). Required for riders under age18 and those who do not have a health insurance policy with medical benefits of at least $10,000. Proof of policy must be shown to law enforcement officer upon request. Required for riders under age 15 years of age, novices, and holders of learners permits. Required for riders under age 18 and first year operators. Required for riders under 21 and first year operators. Required for riders age 20 and under and those who have not completed a rider training course or who do not have $10,000 medical insurance coverage. Required for riders under 21 and age 21 or older who have had a motorcycle operator"s license for less than two years or who have not completed an approved motorcycle safety course.