CHICAGO — New research using a decade of data shows the lifesaving impact of universal motorcycle helmet laws. Researchers from the Carolinas Medical Center in Charlotte, North Carolina — an American College of Surgeons (ACS)-verified Level I trauma center — compared outcomes for motorcycle crash victims from North Carolina, where helmets are mandatory for all riders, and South Carolina, where only riders under 21 must wear them. The findings are published in the Journal of the American College of Surgeons (JACS).
Key Findings:
- Helmet use was 94% in North Carolina vs. 47% in South Carolina during the study period.
- Helmeted patients had less severe injuries, with lower Injury Severity Scores (13.6 vs. 16.0).
- Riders without helmets were more likely to require care in the intensive care unit (ICU) (39% vs. 25%) after an accident.
- Patients who were not wearing a helmet during a crash were uninsured more often, shifting costs to taxpayers.
“The two states’ differing laws created a natural experiment,” said senior author A. Britton Christmas, MD, MBA, FACS, medical director of trauma at Carolinas Medical Center. “The results are clear: helmets save lives, and universal laws ensure they’re used.”
States are Scaling Back Universal Helmet Laws
Despite evidence, only 19 states have universal helmet laws — a sharp decline from 47 states 50 years ago. Efforts from motorcycle groups have driven these repeals, even as trauma surgeons emphasize the consequences.
“I’ve testified against repeals in North Carolina because the data doesn’t lie,” said Dr. Christmas. “When helmets aren’t required, fewer people wear them, and more die or face life-altering injuries.”
These different laws impacted helmet usage in patients. Only 47% of patients with a home state of South Carolina were wearing a helmet at the time of injury, as compared to 94.2% of patients from North Carolina.
The Human Toll of No Helmets
The study also found:
- Patients who weren’t wearing a helmet required longer ICU stays and more ventilator support.
- South Carolina’s under-21 helmet law had low compliance: 33% of young riders were not wearing a helmet during crashes, compared to only 10% in North Carolina.
“Universal laws normalize helmet use,” said lead author Stephanie Jensen, MD, MPH. “When young riders see adults without helmets, they question their necessity, and the results are tragic.”
Surgeons as Advocates
The authors urge surgeons and physicians to advocate for helmet laws, citing their unique credibility. “Policymakers need to hear from those who treat these injuries,” said Dr. Jensen. “This isn’t about limiting freedom, it’s about preventing families from losing loved ones.”
The authors noted a limitation of the study is that the data excludes riders who died at the scene or had minor injuries not requiring trauma care.
Study coauthors with Drs. Jensen and Christmas are Ansley B. Ricker, MD; Ronald F. Sing, DO, FACS; Samuel W. Ross, MD, MPH, FACS; Kyle W. Cunningham, MD, MPH, FACS.
Disclosure: Kyle Cunningham, Atricure; Sam Ross, Atricure, Ethicon; Ronald Sing, Vioptix, Ethicon; A. Britton Christmas, Teleflex LLC
Citation: Jensen S, Ricker A, Sing RF, et al. Examining Geographic Disparity: State Helmet Laws Greatly Increase the Use of Helmets and Protect Motorcycle Crash Victims. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001273
