Struggling to regain consciousness, I reached back and felt the large bloody gash in my scalp. My son and I had just gotten into Ripstiks. If you haven’t seen one, it looks like a skateboard of sorts but there is only one wheel on each end. We hit a huge patch of algae on the pavement and the sudden loss of friction shot my feet up into the air. The last thing I remember was feeling my body horizontal to the ground and three feet above it. We hustled home and mom turned up just as we were debating whether or not I would have to go to the emergency room or we could get away with superglue. Fortunately, my function was not impaired, my college degrees were not lost and I can still recognize my patients, but I should have worn a helmet.

Several people responded to last week’s column on the dangers of concussions and traumatic brain injuries by pointing out that helmet laws in Hawaii are inadequate. One reader commented: "As a Medicaid worker for the state, I saw so many young adults who applied for welfare medical coverage due to head injuries. Too often, I would hear them say, ‘No one’s going to make me wear a helmet!’ Yet, the taxpayers pick up their medical bills. Freedom with no responsibility for one’s actions is unconscionable."

It costs taxpayers far too much when an uninsured and helmetless rider gets into an accident. The cost of medical attention at the time of the injury is only the beginning. The younger the victim, the more years of productive life lost, and the more support one will need over time from Medicaid and Social Security Disability Insurance or Supplemental Security Income.

The Insurance Institute for Highway Safety gives Hawaii a "Poor" rating for its helmet laws. Currently helmets are required only for motorcyclists age 17 and younger and only for bicyclists age 15 and younger. At this time, there are no laws in force for all-terrain vehicles.

Two state legislators worked to champion new helmet laws for ATVs last session. Sen. Josh Green, (D, Kohala-Kona) chairman of the Senate Health Committee, introduced a bill that would require safety helmets for all minors riding ATVs. He did so after witnessing a tragic accident while working in an emergency room in North Kohala. The accident cost a 16-year-old helmetless rider her life. Rep. Barbara Marumoto (R, Diamond Head-Kahala) introduced a companion bill in the House that would require people of all ages to wear a safety helmet when riding an ATV. Similarly, she was motivated by head injuries suffered by a family member while snowboarding. Unfortunately, both bills stalled in the transportation committees.

Today, when taxpayers and government budgets for health care are all stretched to the max, the people of Hawaii must abide by a minimum standard of personal and civic responsibility. Freedom of speech does not include the right to yell "fire" in a crowded theater where none exists. Similarly, as one reader proclaims, it is "unconscionable" for a helmetless rider to expect the community to pick up the tab in event of head injury. I learned my lesson.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.