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Medical Students Publish Perspective on Motorcycle Helmet Laws in New England Journal of Medicine

Two medical students at the University of Miami Miller School of Medicine have published a perspective on the relationship between motorcycle helmet laws and public health. Their article, which appeared recently in The New England Journal of Medicine, takes both a statistical and a cultural look at the lives saved by helmet laws and the staggering rise in death, serious injury and public expense that occurs when those laws are repealed.

Motorcycle fatalities account for 14 percent of all U.S. traffic deaths.

Ironically, they write, the inventor of the motorcycle — Sylvester Roper, who fitted a bicycle with a small steam engine two years after the end of the Civil War — became its first fatality. In 1896, during a public demonstration of its 40 mph top speed, he was seen to wobble and fall, and was found dead on the track with a head injury. Serious, often fatal, motorcycle-related brain injuries began to appear in the medical literature in the 1920s. The motorcycle helmet, however, wasn’t patented until 1953.

The U.S. Department of Transportation issued its National Highway Safety Program Standard making helmets mandatory in 1967, and states risked losing federal appropriations if they didn’t enforce it. By 1975, only three states did not have a mandatory helmet law. But in 1976, Congress stopped using that condition for appropriations, and within two years, 27 states had repealed their helmet laws. Florida later followed suit.

The article’s first author, Alexander Busko, a third-year M.D./M.P.H. student who plans to go into emergency medicine, has seen the results of that repeal first-hand.

“Working at Ryder Trauma Center at Jackson Memorial Hospital, I have seen too many young people who were killed or who incurred injuries with lifelong consequences — all because they weren’t wearing a helmet,” he said. “Motorcyclists say this is about their freedom, but when they get into an accident, they are often scooped up and taken to a public hospital by the first responders. The cost can be enormous, so we all end up suffering.”

In fact, write the authors, the nationwide financial burden of motorcycle-related injuries each year — 92,000 in 2014, the most recent year for which there are complete statistics — is in the billions of dollars.

Busko’s co-author, Zachary Hubbard, a third-year M.D./M.P.H. student pursuing neurosurgery, has also witnessed the human cost.

“I began training as an EMT when I was 16,” he said. “One of the first calls I rode on was a single motorcycle crash in which the operator was wearing a cheap helmet that had come off during the accident. It’s not something you forget quickly.”

The two believe reducing financial cost, in addition to physical injuries, may be the way to influence state legislators.

“Florida is kind of a case study,” said Busko. “The state used to have a helmet law, but after its repeal the same thing happened here that we have seen nationwide — overnight, morbidity and mortality rates increased, and with them the financial cost. The cost to Floridians is hundreds of millions of dollars a year, and this could be fixed overnight. All lawmakers have to do is look at the data. It’s easy to save lives.”

Trauma specialist Tanya L. Zakrison, M.D., M.P.H., associate professor of surgery, was the third author, and she helped Busko and Hubbard shape the article for publication. Nonetheless, she gives the students full credit for the final product — and the response it has already generated.

“They conducted thorough historical and statistical research,” she said, “but they also each brought personal observation of the terrible human cost of motorcycle collisions to writing the paper. I hope legislators in Florida and elsewhere will read it and realize how easy it would be to achieve a win-win for public health and public finances.”

Tags: brain injury, Miller School of Medicine, motorcycle helmet laws, The New England Journal of Medicine