MOTORCYCLE SAFETY

HOW TO SAVE LIVES AND SAVE MONEY 

National Center for Injury Prevention and Control 

Division of Unintentional Injury Prevention
Public HealtH leadersHiP to KeeP

PeoPle safe on tHe road — every day
“Our role is to identify ways to prevent injury and death 

and rigorously check what works and what does not work. 

For motorcycle safety, the research shows that universal 

helmet laws are the most effective way to reduce the 

number of deaths and traumatic brain injuries that 

result from crashes.”

Dr. Thomas Frieden, CDC Director
Motorcycle deaths and injuries are an important public health 

concern and economic liability in the United States.

In this Guide, you will learn:

•	 the public health significance of motorcycle crashes

•	 the best way to protect motorcycle riders

•	 how your state compares with other states in terms of 

motorcycle-related deaths and economic costs

•	 what you can do to increase motorcycle safety.
DEATHS ON THE RISE

Motorcycle-related deaths have increased by 55% since 2000.1

Motorcycle crashes killed 4,502 people in 2010.2

Preventing debilitating injuries and deaths from motorcycle crashes is a growing 

public health concern.

THE COST

The cost of motorcycle crashes is not just measured in bodies, loss, and grief. Motorcycle crashes create a burden to society, consuming public funds for 

emergency response, emergency room costs, and insurance premiums.3 In 

terms of medical care costs and productivity losses...

The economic burden from crash-related injuries and deaths in one year 

alone totaled $12 billion.4

PREVENTION THAT WORKS

With motorcycle ownership at an all-time high, motorcycle-related deaths and traumatic brain injuries are expected to remain at high levels unless more 

effective protective measures are enacted. Helmets are the only safety measure 

proven to save lives, and the universal helmet law (one that covers all motorcycle 

riders) is demonstrated to be the best way to ensure helmet use.5

OVERVIEW

Photo: Dennis Hook, Hooked on Photography
PEOPLE WHO RIDE, PEOPLE WHO DIE

Today, more people are riding motorcycles than ever before. Motorcycle riders represent almost every demographic group in 

the country. Riders now tend to be more affluent than 30 years ago. 

The average age of riders has increased, and more women are riding 

than ever before.8 The profile of who crashes and who dies has 

changed too:

Age: Young people are not the only ones dying in motorcycle 

crashes. In 2010, more than half the people killed in motorcycle 

crashes were 40 or older, up from 25% in 1995.1,2

Sex: While only 10% of riders killed in motorcycle crashes in 2010 

were women, almost all passengers (89%) killed in motorcycle 

crashes were women.2

Helmets: Forty-one percent of motorcycle operators and 50% 

of motorcycle passengers who died in 2010 were not wearing a 

helmet.2

Location: More people are killed in motorcycle crashes on rural 

roads now than 20 years ago. Roughly half of all crashes take place 

on rural roads.9

Alcohol: When people drink and ride, they are at much greater risk 

of crashing and dying. Twenty-eight percent of motorcycle riders who 

died in 2010 had a blood alcohol concentration that was at or above 

the legal limit of .08 g/dL.10

Motorcycle Type: The majority of people who die in crashes are 

riding sport motorcycles with mid-size engines designed to maximize 

speed and agility.9

REAL PEOPLE DYING EVERY DAY
While studying for ministry, I spent a year as chaplain resident at a Chicago hospital. I was “on call” one evening when the 

emergency room paged me. An ambulance had just brought in a fellow who’d been riding his motorcycle without a helmet when 

an SUV had turned in front of him. Unable to turn or stop, he had hit the vehicle, ramming his head into a door. He was a classic 

“biker dude”: muscular arms, tattoos, and a couple day’s growth of beard. He was unconscious and his face was swollen and 

turning purple. Emergency room staff swarmed around him. 

I spent most of the night with that family. I listened to their stories, I shared their tears. The couple had two teenagers, plus a 

younger girl, age nine. I think about his family every time I see a biker zoom by without a helmet. Helmets and cautious driving 

save lives. If, like this fellow, you have tough biker friends, I suppose they will tease you pretty hard if you do wear a helmet. It 

takes a thick skin and courage to handle teasing. Then again, I wonder how much courage it took for the nine-year-old girl to go 

in and say goodbye to her father?

Reverend Dennis McCarty11

Who Dies?

WHO DIES
“A group of state legislators from across the country heard a presentation from a University of 

New Mexico neurosurgeon. At the end of his talk, one legislator asked, ‘If there was one 

thing we could do in the legislature to make your job easier, what would it be?’ 

They expected to hear, ‘Give us more money’ or ‘Increase our budget!’ 

Instead the surgeon answered, ‘Pass a motorcycle helmet law.’”

“From the moment of injury, society picks the person up off the highway; delivers him to a municipal hospital and 

municipal doctors; provides him with unemployment compensation if, after recovery, he cannot replace his lost job; 

and, if the injury causes permanent disability, may assume responsibility for his and his family’s subsistence. We do 

not understand a state of mind that permits plaintiff to think that only he himself is concerned.”

Opinion of the Federal Court of Massachusetts, 1972

Affirmed by the United States Supreme Court12

Melissa Savage‘‘‘‘ 

National Conference of State Legislatures13

Photo: Bill Lavallie, Fine Line International
THE PUBLIC PAYS

I

t is estimated that the economic burden of injuries and deaths from motorcyclerelated crashes in one year totaled $12 billion.4 Studies have also shown 

that a substantial proportion of costs are paid by the U.S. public due to higher 

insurance premiums and taxes, as well as lost tax revenue.3, 15, 16

A study of 105 motorcyclists hospitalized at a major trauma center determined 

that 63% of their care was paid for by public funds, with Medicaid accounting for 

over half of all charges.16

KEY FACTORS

Two key factors influence the public’s financial burden from motorcycle crashes: helmet use and hospital and rehabilitation costs. 

•	 Unhelmeted motorcycle riders injured in a crash and admitted 

to hospitals face substantially higher healthcare costs than do 

helmeted riders. Unhelmeted riders also use more of a hospital’s 

critical resources.17

•	 Unhelmeted motorcycle riders are twice as likely to suffer traumatic 

brain injuries from crashes.17,18,19,20 The median hospital charges 

for motorcycle riders hospitalized with severe traumatic brain injuries 

were 13 times higher than the charges for those who did not have a 

traumatic brain injury.17

•	 Unhelmeted motorcycle riders are less likely to have health 

insurance and are therefore more likely to have their medical 

expenses paid by government-funded healthcare.15

PAYING THE BILL

“Despite the effectiveness of motorcycle helmet 

legislation, many states have repealed these laws 

during the last decade. Aspects often neglected 

by policymakers are who pays for the care of these 

victims and how much of this cost is subsidized by 

public funds.”

Journal of the American Medical Association.16

Everyone pays when a motorcycle rider is severely injured. You can talk about freedom of choice, but when other people have 

to pay for the consequences of that choice, then it’s not freedom of choice at all.

Lt. Col. James Champagne

Executive Director, Louisiana Highway Safety Commission, Retired14

Who Pays?

WHO PAYS
Motorcycle safety measures include motorcycle operator licensing and training, traffic laws and enforcement, and educational programs and 

campaigns. Considerable emphasis is placed on educating both motorcycle riders and car drivers that share the road with motorcyclists 

about safe driving. Additionally, education and outreach efforts often focus on alcohol. However, there is no consistent evidence that any of 

these measures reduce the number of motorcycle crashes or deaths.

HOW EFFECTIVE ARE THE MEASURES?

A few recent studies have shown that mechanical improvements such as antilock brakes can reduce the severity of crashes, and this may 

affect injuries and deaths.5, 21 Other motorcycle safety efforts include improving road conditions, reducing cultural support for rider-group 

alcohol use, and improving clothing and motorcycle visibility through bright or reflective colors. But again, no consistent evidence shows that 

any of these measures reduce the number of motorcycle crashes or deaths.5

Some traffic departments have reported successes in using cues to identify alcohol-impaired riders, however evaluation data is lacking, and 

while specific evaluation data on the effects of enforcement and sanctions on impaired motorcycle crashes is also lacking, enforcement 

strategies (e.g., sobriety checkpoints) exist, which have proven effective for reducing impaired driving and crashes generally.5

The only safety measure that costs little to initiate and reaches all riders is a state universal motorcycle helmet law. It is also the only 

measure proven to improve motorcycle safety.5

SUMMARY OF MOTORCYCLE SAFETY EFFORTS

Unknown:

Limited or no high-quality evidence.

Likely: 

Likely to be effective based on balance of 

evidence from high-quality evaluations. 

Effective in Certain Situations: 

Demonstrated to be effective in certain 

situations. 

Scientifically 

Proven: 

Demonstrated to be effective in several 

scientific evaluations with consistent results.

Adapted from National Highway Traffic Safety Administration’s Countermeasures That Work, 2011 5

 
WHAT HELMETS DO

Wearing helmets that meet the Department of Transportation (DOT) standard is the single most effective means of reducing the number of people who 

get injured or die from motorcycle crashes.5

Helmets are estimated to reduce the likelihood of death in a motorcycle crash 

by 37%.23 The National Highway Traffic Safety Administration (NHTSA) estimates 

that helmets saved the lives of 1,544 motorcycle riders in 2010 alone.24

Traumatic brain injury is a leading cause of motorcycle crash death.25 Even 

when not fatal, these debilitating head injuries can mean a lifetime of costly 

rehabilitation and severe emotional trauma for family and friends. In fact, treating 

severe traumatic brain injuries costs 13 times more than non-brain injuries.17

Helmets reduce the risk of head injury by 69%.3, 26

There are no negative health effects from helmet use. Helmets do not restrict a 

rider’s ability to hear important sounds, or to see a vehicle in the next lane.27

PREVENTION THAT WORKS

WHEN UNHELMETED RIDERS CRASH

Unhelmeted riders are 40% more likely to die from a head injury than someone wearing a helmet.28

The only proven way to get people to wear helmets is the universal helmet 

law.5

ANATOMY OF A HELMET

Since 1974 all motorcycle helmets are required to meet the DOT standard that establishes the minimum level of protection a helmet must afford each 

helmet user.23 Full-face helmets offer the most protection, protecting the eyes 

and face with a face shield and providing protection to the chin. To illustrate 

the importance 

of full coverage, 

research from 

crashes shows the 

distribution of impact 

locations absorbed 

by motorcycle 

helmets.29

Distribution of impact locations on motorcycle helmets, all 

collisions, based on a study by Dietmar Otte.29

I was commuting to work on my motorcycle and headed onto the freeway exchange at about 45 miles an hour. I lost control and 

laid down my bike, really hit my head, and slid my way to a stop. My motorcycle was scratched, my helmet was banged up, and 

the rest of my gear was pretty shredded. But I walked away.

The thing is, I never used my helmet where I lived before because I wasn’t required to — there was no law. Moving to California 

meant I had to wear one, and I am so glad that I did. My helmet saved my life.

Jonathan Hailstone22

What Works?

SAVE LIVES

There are two types of helmet laws used in the 

United States.

Universal Helmet Law: Requires all 

motorcycle riders and passengers of all 

ages to wear helmets whenever riding.

Partial Helmet Law: Only requires specific 

groups of people, such as those below a 

certain age, to wear helmets.

Each state decides its respective helmet law. 

As of May 2012, 19 states and the District of 

Columbia had universal helmet laws, 28 states 

had a partial helmet law, and 3 states had no 

helmet law. Many states have weakened their 

helmet law over the years, while a few states 

have strengthened their helmet law.37

The research on states that change their helmet 

law is very clear: 

•	 When a state enacts a universal 

helmet law, helmet use increases 

substantially.3,30,31,32,33

•	 When a state repeals a universal 

helmet law, helmet use decreases 

substantially.3,34,35,36

•	 When a state repeals a universal 

helmet law, motorcycle deaths and 

injuries increase.3

UNIVERSAL HELMET LAWS INCREASE HELMET USE

Journal of Public Health Policy3
THE FLORIDA CASE STUDY

DEATHS INCREASE FOR RIDERS COVERED BY 

PARTIAL HELMET LAWS

Florida is one example of the ineffectiveness of partial laws to save lives. In 2000, Florida repealed its universal helmet law, weakening it to mandate 

helmet use only for riders under the age of 21 and those with less than $10,000 

of medical insurance coverage.35,37

Comparing the 30 months after the Florida state legislature repealed its 

universal helmet law with the 30 months before repeal:

•	 Deaths of all riders increased by 55%, substantially higher than what 

was expected from the increased registrations after repeal.28,35

•	 Among riders under the age of 21, deaths of unhelmeted riders 

increased by 188%, even though the helmet law still applied to 

them.28,35

•	 Motorcycle crash-related hospitalizations rose more than 40%. The 

costs of treating head injuries from motorcycle crashes more than 

doubled to $44 million.28,35

Only one in four motorcyclists who were hospitalized had medical costs less than 

$10,000, which is the amount of medical insurance coverage that is required to 

ride without a helmet. Hospital discharge data showed that in the period after 

repeal, approximately $10.5 million of hospitalization costs were billed to public 

sources (e.g., Medicaid) or charitable sources, and an additional $8 million 

in costs were classified as “self pay” because patients were underinsured or 

uninsured.28, 35

National Highway Traffic Safety Administration35

THE NEGATIVE IMPACT OF WEAKENING

HELMET LAWS: FLORIDA

Number of deaths of riders under 21 in 30 months before vs. 

after repeal.
PARTIAL LAWS — WHAT THEY LIMIT

Age: Riders under a specific age, which ranges between 17–20 years, are 

required to wear helmets. Applies in all 28 states with partial laws.37

Passengers: Passengers are required to wear helmets if they are under a certain 

age or riding with drivers that are legally required to wear helmets. Applies in 

Colorado, Maine, Michigan, North Dakota, Ohio, and Pennsylvania. Alaska and 

Rhode Island require all passengers to wear helmets.37

Insurance: Florida, Kentucky, and Michigan require anyone without health 

insurance to wear a helmet. Texas requires either proof of insurance or proof of 

successfully completing a motorcycle operator training course to ride without a 

helmet.37

Licensing: Riders with an instructional or learner’s permit or those who are 

recently licensed are required to wear helmets, regardless of age. 

Applies in Alaska, Kentucky, Maine, Minnesota, Ohio, Rhode Island, and Wisconsin. 

Michigan and Pennsylvania require recently licensed riders to wear a helmet, 

unless they have passed a motorcycle safety course.37

PARTIAL LAWS — WHY THEY DON’T WORK

Research shows that partial helmet laws do not motivate riders to wear helmets.35,39 States with partial laws and states with no helmet law 

experience little difference in helmet use.40 Even though all partial helmet laws 

apply to minors, 60% of fatally injured minors were unhelmeted in partial helmet 

law states, compared to 22% in universal helmet laws states from 2008–2010.1

Among young riders who were hospitalized after a crash, the risk of suffering a 

serious traumatic brain injury was 37% higher in partial law states compared 

to universal law states.41 Only the universal helmet law is proven to increase 

helmet use.5

Compliance is low because partial helmet laws are difficult to enforce. Identifying 

partial law violations is problematic. As a result, partial helmet laws are typically 

only enforced when a police officer has pulled a rider over for another infraction, 

such as speeding.42

MOTORCYCLE DEATHS AND PARTIAL HELMET LAWS

One Florida high school senior was planning to attend college to study business and landscaping on a scholarship. He was 

involved in his high school drama club, played on the basketball team, ran track, and was a member of the Students Against 

Destructive Decisions Club. 

Hours before his high school graduation, while riding his motorcycle without a helmet, this teenager crashed and died. Under 

Florida’s partial helmet law he should have been wearing a helmet — he was, after all, under 21 years of age. 

But like many other motorcyclists in states with partial helmet laws, he didn’t wear a helmet. 

He paid the price with his life.38

A Casualty
HELMET LAWS SAVE LIVES AND MONEY

MOTORCYCLE HELMET LAWS IN THE UNITED STATES, AS OF MAY 2012 HOW DO STATES 

MEASURE UP?

In 2010, 42% of motorcyclists 

who were fatally injured were 

unhelmeted. Helmets saved over 

1,500 riders’ lives, but about 700 

more lives could have been saved 

if all riders had worn helmets in 

2010.24

On average, states with a 

universal helmet law save 8 times 

more riders’ lives per 100,000 

motorcycle registrations each 

year, compared to states without 

a helmet law, and save 3 times 

more riders’ lives per 100,000 

motorcycle registrations each year, 

compared to states with a partial 

helmet law.24

Economic costs saved in states 

with universal helmet laws were, on 

average, nearly four times greater

per registered motorcycle than in 

states without such a law.

Insurance Institute for Highway Safety, Highway Loss Data Institute37

*In April 2012, Michigan changed their helmet law from a universal to a partial helmet law. Please note that the

lives saved and dollars saved analyses use 2010 data and reflect the status of the helmet laws at that time.
Data used24, 44; Methods used43

SAVE MONEY
“...vast majorities of the American people accept and support the idea that on safety issues 

it is desirable and necessary for government to set standards and enforce laws designed to 

protect the public.”

Advocates for Highway and Auto Safety45
STRONG SUPPORT 

SUPPORTERS OF MOTORCYCLE SAFETY HELMET LAWS

These are just some of the organizations that support motorcycle helmet laws:

•	 AAA Foundation

•	 American Association of State Highway and Transportation Officials

•	 American Academy of Orthopedics

•	 American Academy of Pediatrics

•	 American College of Surgeons

•	 American Public Health Association

•	 Brain Injury Association

•	 Emergency Nurses Association

•	 Epilepsy Foundation of America

•	 National Safety Council 

•	 Nationwide Insurance

•	 SADD (Students Against Destructive Decisions)

•	 ThinkFirst National Injury Prevention Foundation 

As a rider and a trauma nurse, I would always recommend that riders wear a helmet. I see so much death, loss, grief, and 

trauma from riders and the loved ones they leave behind because of motorcycle crashes. If laws are what work to get people to 

wear a helmet, then we should have strong laws in place nationally.

Carlen Hudnet, RN46

A Rider, a Nurse

STRONG SUPPORT
Do helmet laws interfere with a person’s freedom to choose whether to wear a helmet? 

Yes. Many laws restrict people’s freedom to perform behaviors judged contrary to the public good. These 

include drunk driving laws, cellphone use laws, and infectious disease quarantine laws, to name a few. 

Courts usually uphold such laws as important to the nation’s well-being. 

Don’t helmets make it harder for riders to see or hear?

No. Helmets that meet the DOT standard do not reduce visibility or impair hearing. By protecting people’s 

heads in crashes, helmets only make riding safer. 

If a motorcyclist chooses not to wear a helmet, does it only affect him?

No, not if the rider crashes. Unhelmeted riders injured in a crash have substantially higher healthcare costs 

than helmeted riders. When the rider is insured, these costs are passed on to others in the form of higher 

health insurance premiums. Unhelmeted riders are more likely to be uninsured than other riders. When the 

riders are uninsured, their medical expenses may be paid for using taxpayers’ funds. 

Can motorcycle safety education substitute for helmet laws?

No. The benefits of motorcycle safety education are unclear. A universal helmet law is the most effective 

way to reduce the number of people who are seriously injured or killed from motorcycle crashes.

Are universal helmet laws really that much better than partial helmet laws?

Yes. There is strong, substantial, and clear evidence that universal helmet laws save lives and save money. 

This is not true for partial laws. When a universal helmet law is enacted, helmet use dramatically increases, 

and states see an across-the-board decrease in deaths. If states repeal the law, they see an increase in 

deaths.

FAQs
QUICK FACTS

•	 The single most effective way for states to save lives and save money is a 

universal helmet law.

•	 Helmets reduce the risk of death by 37%.

•	 Helmets reduce the risk of head injury by 69%.

•	 The United States saved $3 billion due to helmet use in 2010.

•	 The United States could have saved an additional $1.4 billion in 2010 if all 

motorcyclists had worn helmets.

•	 Helmets do not reduce visibility or impair hearing.

TAKING ACTION

AAA Foundation

607 14th Street NW

Suite 201

Washington, D.C. 20005

(202) 638-5944

http://www.aaafoundation.org

Advocates for Highway and Auto Safety

750 First Street NE

Suite 901 

Washington, D.C. 20002 

(202) 408-1711

http://www.saferoads.org

American College of Emergency 

Physicians

1125 Executive Circle

Irving, TX 75038

(972) 550-0911

http://www.acep.org

American College of Surgeons

633 N. Saint Clair Street

Chicago, IL 60611

(312) 202-5000

http://www.facs.org

Brain Injury Association of America

1608 Spring Hill Road

Suite 110

Vienna, VA  22182

(703) 761-0750

http://www.biausa.org

Emergency Nurses Association

915 Lee Street

Des Plaines, IL 60016-6569

(800) 900-9659

http://www.ena.org

Governors Highway Safety Association

444 North Capitol Street NW

Suite 722

Washington, D.C. 20001

(202) 789-0942

http://www.ghsa.org

Head Protection Research Laboratory

6409 Alondra Boulevard

Paramount, CA 90723

(562) 529-3295

http://www.hprl.org 

Insurance Institute for Highway Safety

1005 N. Glebe Road

Suite 800

Arlington, VA 22201

(703) 247-1500

http://www.iihs.org 

Motorcycle Safety Foundation

2 Jenner Street

Suite 150

Irvine, CA 92618

(800) 446-9227

http://www.msf-usa.org

National Center for Injury Control and Prevention

Centers for Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30333

(800) 232-4636

http://www.cdc.gov

National Conference of State Legislatures

7700 East First Place

Denver, CO 80230

(303) 364-7700 

http://www.ncsl.org

MOTORCYCLE SAFETY RESOURCES

RESOURCES
National Highway Traffic Safety Administration

1200 New Jersey Avenue SE

West Building

Washington, D.C. 20590

(888) 327-4236

Hearing Impaired (TTY): (800) 424-9153

http://www.nhtsa.dot.gov

National Transportation Safety Board

490 L’Enfant Plaza SW 

Washington, D.C. 20594 

(202) 314-6000

http://www.ntsb.gov

SMARTER

(Skilled Motorcyclist Association-Responsible, Trained 

and Educated Riders, Inc.)

P.O. Box 121

Scottville, MI 49454-0121

http://www.smarter-usa.org

ThinkFirst National Injury Prevention Foundation

1801 N. Mill Street

Suite F

Naperville, IL 60563

(630) 961-1400

(800) THINK-56 (844-6556)

http://www.thinkfirst.org

Transportation Research Board

The National Academies

500 Fifth Street NW

Washington, D.C. 20001

(202) 334-2934

http://www.trb.org

World Health Organization

Helmet Initiative

http://www.whohelmets.org/mhrc.htm

info@whohelmets.org

Helmets: a road safety manual for decision-makers and 

practitioners. Available at: http://www.who.int/roadsafety/projects/manuals/helmet_manual/en/
ENDNOTES

1. National Highway Traffic Safety Administration. Fatality 

Analysis Reporting System: 1994–2010. Washington 

(DC): National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 1994–2010.

2. National Highway Traffic Safety Administration. Fatality 

Analysis Reporting System: 2010. Washington (DC): 

National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 2012.

3. Derrick AJ, Faucher LD. Motorcycle helmets and 

rider safety: A legislative crisis. J Public Health Pol.

2009;30(2):226–242.

4. Naumann RB, Dellinger AM, Zaloshnja E, Lawrence 

BA, Miller TR. Incidence and total lifetime costs of 

motor vehicle-related fatal and nonfatal injury by 

road user type, United States, 2005. Traffic Inj Prev. 

2010;11(4):353–360.

5. National Highway Traffic Safety Administration. 

Countermeasures that work: A highway safety 

countermeasure guide for state highway safety offices. 

6th ed. Washington (DC): National Highway Traffic Safety 

Administration, U.S. Department of Transportation; 

2011.

6. Newton J. Two weeks after motorcycle crash, still ‘touch 

and go’ for teen, dad ‘We’re looking for thoughts and 

prayers’. News Sun. Published August 7, 2006.

7. Haas-Warren E. Personal Interview; January 24, 2010.

8. Motorcycle Industry Council. Motorcycle and scooter 

sales climb for 14th consecutive year [media release]. 

Irvine: Motorcycle Industry Council; February 16, 2007.

9. Padmanaban J, Eyges V. Characteristics of motorcycle 

crashes in the U.S. Presented at the International Road 

Traffic Accident Database Conference; September 2009. 

http://www.internationaltransportforum.org/irtadpublic/

pdf/seoul/2-Padmanaban.pdf. Accessed April 11, 2012.

10. National Highway Traffic Safety Administration. Traffic 

safety facts, 2010: Alcohol-impared driving. Washington 

(DC): National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 2012.

11. McCarty DD. Why ER’s call them donor-cycles. The 

Republic. Published May 7, 2006. Permission obtained 

from and story confirmed by Rev. Dennis McCarty on 

January 28, 2010.

12. Simon v. Sargent, D.C.Mass. 1972, 346 F.Supp.277, 

affirmed 93 S.Ct. 463, 409 U.S. 1020, 34 L.Ed.2d 312.

13. Savage M. National Conference of State Legislators. 

Personal Interview; October 21, 2009.

14. Champagne Lt. Col. J. Louisiana Highway Safety 

Commission, Retired. Personal Interview; October 8, 

2009.

15. Hundley JC, Kilgo PD, Miller PR, Chang MC, Hensberry 

RA, Meredith JW, Hoth JJ. Non-helmeted motorcyclists: 

A burden to society? A study using the national trauma 

data bank. J Trauma. 2004;57(5):944–949.

16. Rivara FP, Dicker BG, Bergman AB, Dacey R, Herman 

C. The public cost of motorcycle trauma. JAMA. 

1988;260(2):221–223. 

17. Cook LJ, Kerns T, Burch C, Thomas A, Bell E. Motorcycle 

helmet use and head and facial injuries: Crash 

outcomes in CODES-linked data. Washington (DC): 

National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 2009.

18. Shankar BS, Ramzy AI, Soderstrom CA, Dischinger 

PC, Clark CC. Helmet use, patterns of injury, medical 

outcome, and costs among motorcycle drivers in 

Maryland. Accid Anal Prev. 1992;24(4):385–396.

19. Governor’s Traffic Safety Bureau. Motorcycle Fact Sheet. 

Des Moines: Iowa Department of Public Safety; 2008.

20. Mounce N, Brackett Q, Hinshaw W, Lund AK, Wells JK. 

The reinstated comprehensive motorcycle helmet law in 

Texas. Arlington: Insurance Institute for Highway Safety; 

1992.

21. Teoh ER. Effectiveness of antilock braking systems in 

reducing motorcycle fatal crash rates. Traffic Inj Prev

2011;12(2):169–173.

22. Hailstone J. Personal Interview; January 30, 2010.

23. National Highway Traffic Safety Administration. 

Motorcycle helmet effectiveness revisited. Washington 

(DC): National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 2004.

24. National Highway Traffic Safety Administration. Lives and 

costs saved by motorcycle helmets, 2010. Washington 

(DC): National Highway Traffic Safety Administration, US 

Department of Transportation; 2012. Unpublished data.

25. National Highway Traffic Safety Administration. Traffic 

Safety Facts, 2006: Motorcycle Helmet Use Laws. 

Washington (DC): National Highway Traffic Safety 

Administration, U.S. Department of Transportation; 

2007.

26. Liu BC, Ivers R, Norton R, Boufous S, Blows S, Lo SK. 

Helmets for preventing injury in motorcycle riders. 

Cochrane Database Syst Rev. 2008;(1):CD004333. doi: 

10.1002/14651858.CD004333.pub3.

27. McKnight AJ, McKnight AS. The effects of motorcycle 

helmets upon seeing and hearing. Washington (DC): 

National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 1994.

28. National Highway Traffic Safety Administration. Traffic 

Safety Facts, 2008: Motorcycle Helmet Use Laws. 

Washington (DC): National Highway Traffic Safety 

Administration, U.S. Department of Transportation; 

2008.
29. Otte D, Hannover Medical University, Dept. of Traffic 

Accident Research, Germany. In: Hough DL. Proficient 

Motorcycling. Irvine: BowTie Press; 2008.

30. Muelleman RL, Milinek EJ, Collicott PE. Motorcycle crash 

injuries and costs: effect of a reenacted comprehensive 

helmet use law. Ann Emerg Med. 1992;21(3):266–272. 

31. Auman KM, Kufera JA, Ballesteros MF, Smialek JE, 

Dischinger PC. Autopsy study of motorcyclist fatalities: The 

effect of the 1992 Maryland motorcycle helmet use law. 

Am J Public Health. 2002;92(8):1352–1355. 

32. Rowland J, Rivara F, Salzberg P, Soderberg R, Maier R, 

Koepsell T. Motorcycle helmet use and injury outcome and 

hospitalization costs from crashes in Washington State. 

Am J Public Health. 1996;86(1):41–45.

33. National Highway Traffic Safety Administration. Evaluation 

of the reinstatement of the motorcycle helmet law in 

Louisiana. Washington (DC): National Highway Traffic 

Safety Administration, U.S. Department of Transportation; 

2008.

34. Ulmer RG, Preusser DF. Evaluation of the repeal of 

motorcycle helmet laws in Kentucky and Louisiana. 

Washington (DC): National Highway Traffic Safety 

Administration, U.S. Department of Transportation; 2003.

35. Ulmer RG, Northrup VS. Evaluation of the repeal of the 

all-rider motorcycle helmet law in Florida. Washington 

(DC): National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 2005.

36. Mertz KJ, Weiss HB. Changes in motorcycle-related head 

injury deaths, hospitalizations, and hospital charges 

following repeal of Pennsylvania’s mandatory motorcycle 

helmet law. Am J Public Health. 2008;98(8):1464–1467. 

37. Insurance Institute for Highway Safety. History of US 

motorcycle laws and changes in coverage. Arlington: 

Insurance Institute for Highway Safety, Highway Loss 

Data Institute; 2011. http://www.iihs.org/laws/

helmetusecurrent.aspx. Accessed April 12, 2012.

38. McCoy L. South Fork High Students graduate with heavy 

hearts after Friday motorcycle crash kills classmate. 

TCPalm. Published June 7, 2008.

39. National Highway Traffic Safety Administration. Without 

motorcycle helmets, we all pay the price. Washington 

(DC): National Highway Traffic Safety Administration, U.S. 

Department of Transportation; 2005.

40. Brooks E, Naud S, Shapiro S. Are youth-only motorcycle 

helmet laws better than none at all? Am J Foren Med Path. 

2010;31(2):125–129.

41. Weiss H, Agimi Y, Steiner C. Youth motorcycle-related brain 

injury by state helmet law type: United States, 2005–

2007. Pediatrics. 2010;126(6):1149–1155.

42. Houston DJ, Richardson Jr. LE. Motorcycle safety and 

the repeal of universal helmet laws. Am J Public Health. 

2007;97(11):2063–2069.

43. National Highway Traffic Safety Administration. Determining 

lives and costs saved and injuries prevented by motorcycle 

helmets. Washington (DC): National Highway Traffic Safety 

Administration, U.S. Department of Transportation; 2011.

44. Federal Highway Administration. Highway statistics 2010: 

State motor-vehicle registrations (Table MV-1). Washington 

(DC): Federal Highway Administration, U.S. Department of 

Transportation; 2011.

45. Advocates for Highway and Auto Safety. 2004 Louis Harris 

poll: Survey of the attitudes of the American people on 

highway and auto safety. Washington (DC): AAA Foundation 

for Traffic Safety; 2004.

46. Hudnet C. Registered Nurse, Quality Improvement 

Coordinator, San Diego Medical Enterprise Services. 

Personal Interview; December 9, 2009.

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention

National Center for Injury Prevention and Control

Call: 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348

www.cdc.gov/injury

Public Health Leadership To Keep People Safe On The Ro

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