Statement on bicycle safety and the promotion of bicycle helmet use

The following statement was developed by the American College of Surgeons (ACS) Committee on Trauma and was approved by the Board of Regents at its June 6–7 meeting.

The ACS and its Committee on Trauma recognize the importance of injury prevention in the spectrum of care of the trauma patient. Cycling remains an important means of transportation and recreation; however, the bicycle rider can be at significant risk of serious injury.

The College recognizes the following facts:

  • Approximately 800 people die and 500,000 people are injured in the U.S. annually due to bicycle-related injuries. Bicycle crashes are the fourth largest contributor to childhood injury costs and quality-of-life losses and the leading cause of injury in school-age children. Adolescents and adults ages 45 years and older have the highest bicycle death rates.1
  • Helmets reduce the risk of head injury by at least 45 percent, brain injury by 33 percent, facial injury by 27 percent, and fatal injury by 29 percent. One study suggests that helmet use may reduce the risk of head injury by 85 percent and severe brain injury by 88 percent.2,3
  • Bicycle-related injuries and deaths have decreased in states that have enacted youth bicycle helmet laws.4
  • Non-legislative educational programs have been proven to increase helmet use by children.5
  • Helmets can benefit adult riders as well as children. As more helmet laws target youth, the proportion of adults comprising bicycle fatalities has risen.6
  • Peer and adult companion helmet use is associated with increased bicycle helmet use by children.7

In addition to head injuries, significant abdominal wall, solid organ, hollow viscus, as well as major vascular injuries are common after abdominal pelvic handlebar injury.8

Therefore, supported by these and other epidemiologic and outcomes data, the ACS supports efforts to promote, enact, and sustain universal bicycle helmet legislation and enforcement.


  1. Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system (WISQARS). Available at: Accessed July 7, 2014.
  2. Dellinger AM, Kresnow M. Bicycle helmet use among children in the United States: The effects of legislation, personal and household factors. J Safe Res. 2010;41(4):375‐380.
  3. Thompson RS, Rivara FP, Thompson DC. A case‐control study of the effectiveness of bicycle safety helmets. N Engl J Med. 1989;320(21):1361‐1367.
  4. Meehan WP, Lee LK. Fischer CM, Mannix RC. Bicycle helmet laws are associated with a lower fatality rate from bicycle-motor vehicle collisions. J Pediatrics. 2013;163(3):726-729.
  5. Ekman DS, Ekman R. Twenty five years of bicycle helmet promotion for children in Skaraborg District, Sweden. Int J Inj Control & Safety Promotion. 2012;19(3):213-217.
  6. Yilmaz P, Gabbe BJ, McDermott FT, et al. Comparison of the serious injury pattern of adult bicyclists between South-West Netherlands and the State of Victoria, Australia 2001–2009. Injury. 2013;44(6):848-854.
  7. Khambalia A, MacArthur C, Parkin PC. Peer and adult companion helmet use is associated with bicycle helmet use by children. Pediatrics. 2005;116(4):939-942.
  8. Nadler EP, Potoka DA, Shultz BL, Morrison KE, Ford HR, Gaines BA. The high morbidity associated with handlebar injuries in children. J Trauma. 2005;58(6):1171-1174.

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