Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Motorcycle Helmets

The National Highway Traffic Safety Administration reported an analysis of motorcycle helmet use in fatal crashes. What was discovered is not surprising - namely, that in states in which there is not a state helmet law, the odds of a rider in a single-vehicle (e.g., the motorcycle) crash wearing a helmet was 72% less than in states with a helmet law. So, absent a law, people are not particularly inclined to wear a helmet.

One needs to couple this information with the facts about the benefits of wearing motorcycle helmets. First, motorcyle fatalities and fatality rates are increasing at a time when motorcycle riding is becoming more popular. Second, the average age of motorcycle fatalities has moved up to 39 years, from 30 years nearly 20 years ago, probably because the age of motorcycle riders has increased. Third, motorcycles expose the drivers more directly to lethal forces than do enclosed vehicles. Helmets are essential to prevent brain injuries and deaths.

What are the arguments against wearing helmets? Some argue that motorcycle helmets are heavy and therefore increase neck and spinal cord injuries. The opposite has been shown to be true. Some opponents claim that motorcycle helmets impair the driver's ability to hear and see. These senses have been studied in the context of motorcycle activity and do not appear to be impaired, and in certain circumstances, may be improved. The argument that motorcycle helmets are only effective up to a speed of 15 miles per hour is not entirely true. Many head injuries follow glancing blows, not high speed direct impacts. It is true that a helmet can not be effective against a tremendous blow, but it is better than nothing.

Many argue that there is a freedom of choice issue at play. If you knew that you were going to be struck on the head during a particular ride, would you choose to wear a helmet? Probably, you would. The problem is that no one is able to predict the day or moment of their accident and head injury. Few people believe that anything bad will ever happen to them.

Motorcycle helmets are a surrogate for helmets in all situations of risk in which there is a reasonable likelihood of being struck on the head and injuring the scalp, skull, and/or brain. What are those situations? In the water, it is the kayaker who is at risk for being flipped onto a rock or getting caught in a strainer. Knocked unconscious in the water, he is drowned. For the rock climber, it is being struck by falling rocks, swinging into a rock face, or suffering a fall. For the horseback rider, it is coming off the horse. For the motorcycle or ATV rider, or bicyclist, it is crashing and striking one's head. For the skier, it is falling, crashing, or being struck by a ski or snowboard.

One gives up very little (nothing, really) and gains everything by wearing a helmet in the appropriate circumstances. Freedom of choice is a selfish concept when one considers that the head-injured victim forces loved ones or society to provide care and the financial resources to manage the injury and rehabilitation, and sadly, support for the disabled person, who might have avoided most of the injury by wearing a helmet.

There is no excuse for not wearing a helmet approved for high risk (for head injury) situations. It is no different than wearing a seat belt in a car or washing your hands before you eat. Prevention is the name of the game. Having cared for many people with devastating head injuries, most of which would have been trivial or absent if a helmet had been worn, I can only hope that we do what it takes to mandate helmet use in every reasonable situation for which they would be of benefit. That is a necessary and appropriate use of the law.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.