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Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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Statement on Bicycle Safety and the Promotion of Bicycle Helmet Use

March 15, 2023

The American College of Surgeons Committee on Trauma through its Subcommittee on Injury Prevention and Control has updated the Statement on Bicycle Safety and the Promotion of Bicycle Helmet Use developed by the COT in 2014. The following statement has been revised to endorse equitable and fair enforcement of helmet laws and provides updated facts and references on bicycle safety and the efficacy of bicycle helmet use. The ACS Board of Regents approved the statement at its February 2023 meeting in Washington, DC.

The American College of Surgeons Committee on Trauma, through its Subcommittee on Injury Prevention and Control, recognizes the importance of injury prevention in its holistic approach to trauma care. Cycling remains an important means of transportation and recreation; however, the bicycle rider has the potential to be at significant risk of serious injury.

The ACS recognizes the following facts:

  • More than 1,000 people die and 350,000 are seen in emergency departments annually due to bicycle injuries in the US. Bicycle crashes accounted for $5.4 billion in medical costs in 2020, and an additional $7.7 billion in lives lost, lost work, and productivity. Bicycling is among the top 5 leading causes of injury in people ages 5-14 years. The highest death rate from bicycling is among those aged 60-64 years.1
  • Helmets reduce the risk of head injury by 48%, traumatic brain injury by 53%, facial injury by 23%, and fatal injury by 34%.2 Pediatric non-helmeted bikers have a 3-fold higher risk of serious head injury compared to helmeted bikers;3 one study suggests that helmet use may reduce the risk of head injury by 83%.4
  • Bicycle-related head injuries and deaths have decreased in states that have enacted bicycle helmet laws.5
  • Larger effects are found when legislation applies to all cyclists than when it applies to children only. 6
  • Non-legislative and legislative educational programs have been shown to improve and sustain increased helmet use by children.7
  • Helmets provide benefits to both adults and children who ride bicycles. As more helmet laws target youth, the proportion of adults comprising bicycle fatalities has risen.8
  • Peer and adult companion helmet use is associated with increased bicycle helmet use by children.9
  • In some geographic locations with bicycle helmet laws, between 40% to 60% of citations were given to homeless individuals. Black cyclists were 4 times as likely to receive a citation for violating the helmet requirement, while Native American cyclists were just over twice as likely. These findings raise concerns about just and equitable enforcement of helmet laws.
  • Infrastructure support for bicycling (e.g., separated bicycle lanes) is associated with decreased severity of injury and should be encouraged.10
  • Future research on the epidemiology of bicycle-related injuries should focus on the prevalence of helmet use, measurement of the effectiveness of interventions to increase helmet use, and ensuring equitable enforcement of helmet laws.11

In addition to head and facial injuries, bicycle crashes can result in significant musculoskeletal, solid organ, hollow viscus injuries related to blunt trauma, and friction with road surfaces.12

Helmet use has been shown to significantly decrease the risk of both fatal and nonfatal head injuries. Based on these data, the ACS supports efforts to promote, enact, and sustain universal bicycle helmet legislation and enforcement. These efforts to promote and enforce bicycle helmet safety laws must be done with safeguards in place to assure enforcement occurs in a fair and equitable manner.


  1. Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system (WISQARS). Available at: Accessed May 7, 2022.
  2. Høye A. Bicycle helmets - To wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries. Accid Anal Prev. 2018 Aug;117:85-97. doi: 10.1016/j.aap.2018.03.026. Epub 2018 Apr 17. PMID: 29677686.
  3. Hasjim BJ, Grigorian A, Schubl SD, Lekawa M, Kim D, Barnal N, Nahmias J.  Helmets protect pediatric bicyclists from head injury and do not increase risk of cervical spine injury. Pediatric Emergency Care 2022 Jan; 38(1): e360-e364
  4. Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev. 2000;1999(2):CD001855. doi: 10.1002/14651858.CD001855. PMID: 10796827; PMCID: PMC7025438.
  5. Merrill-Francis M, Vernick JS, Pollack Porter KM. “Local All-Age Bicycle Helmet Ordinances in the United States: A Review and Analysis.” The Journal of Law, Medicine & Ethics: a journal of the American Society of Law, Medicine & Ethics. 47.2 (2019): 283–291. Web.
  6. Hoye A. Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation. Accid Anal Prev. 2018 Nov;120:239-249. doi: 10.1016/j.aap.2018.08.001. Epub 2018 Aug 30. PMID: 30173006.
  7. Hagel BE, Rizkallah JW, Lamy A, Belton KL, Jhangri GS, Cherry N, Rowe BH. Bicycle helmet prevalence two years after the introduction of mandatory use legislation for under 18 year olds in Alberta, Canada. Inj Prev. 2006 Aug;12(4):262-5. doi: 10.1136/ip.2006.012112. PMID: 16887950; PMCID: PMC2586783.
  8. Wesson DE, Stephens D, Lam K, Parsons D, Spence L, Parkin PC. Trends in pediatric and adult bicycling deaths before and after passage of a bicycle helmet law.  Pediatrics 2008; 122(3): 605-610.
  9. Wymore C, Denning G, Hoogerwerf P, Wetjen K, Jennissen C. Parental attitudes and family helmet use for all-terrain vehicles and bicycles. Inj Epidemiol. 2020 Jun 12;7(Suppl 1):23. doi: 10.1186/s40621-020-00253-2. PMID: 32532340; PMCID: PMC7291627.
  10. Smith A, Zucker S, Lladó-Farrulla M, Friedman J, Guidry C, McGrew P, Schroll R, McGinness C, Duchesne J. Bicycle lanes: Are we running in circles or cycling in the right direction? J Trauma Acute Care Surg. 2019 Jul;87(1):76-81. doi: 10.1097/TA.0000000000002328. PMID: 31033881.
  11. Lois K. Lee, Michael R. Flaherty, Ashley M. Blanchard, Maneesha Agarwal, THE COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION; Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports. Pediatrics August 2022; 150 (3): e2022058877. 10.1542/peds.2022-058877
  12. Cheung R, Shukla M, Akers KG, Farooqi A, Sethuraman U. Bicycle handlebar injuries - a systematic review of pediatric chest and abdominal injuries. Am J Emerg Med. 2022 Jan;51:13-21. doi: 10.1016/j.ajem.2021.09.043. Epub 2021 Sep 28. PMID: 34649007.