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.
