The last time a patient came through Dr. Josh Green’s Kailua-Kona emergency room after an all-terrain vehicle accident, she died from injuries that could have been prevented, he said.

For Green, the most difficult part was not treating her, but informing the gathered 40 members of her family of the 16-year-old girl’s death.

"Her parents came in and had to be told," said Green, who also is a state senator. "All of her grandparents came. Her siblings had to be told. Her sister in the next room — I had to tell her that her sister had died."

None of the three girls who had been riding that all-terrain vehicle late last year was wearing a helmet. Hawaii is one of six states without helmet laws for ATV riders, but that could soon change.

Last month, Green (D, Kohala-Kona) introduced a bill that would require all minors riding ATVs to use safety helmets. The bill stalled in committee.

It’s a preventable cause of death that Green said he sees far too often.

"I want to make sure that no minor riding an ATV in Hawaii ever dies again from a head injury," said Green.

Almost 800 people a year die nationwide as a result of ATV-related injuries, according to the Consumer Product Safety Commission. In Hawaii, there were 14 deaths from ATV-related injuries from 1982 to 2008, according to the commission.

Another advocate for helmet legislation, Rep. Barbara Marumoto (R, Diamond Head-Kahala), introduced a House version of the ATV helmet bill that would require all vehicle riders to wear helmets regardless of age.

In Hawaii, there were 14 deaths from ATV-related injuries from 1982 to 2008, according to the Consumer Product Safety Commission.

Marumoto has been advocating for tougher helmet and safety laws for most of her 32-year career in the state House. But when one of Marumoto’s own relatives suffered a head injury 15 years ago while snowboarding on Mauna Kea, her push to pass safety helmet legislation became much more personal.

"She had to get 75 staples in her skull," said Marumoto. "She could have become a vegetable."

Marumoto said she became more convinced that helmets were necessary after seeing firsthand the fractured skull of someone so close to her.

"When you see an accident, when you see somebody’s head bashed in, when they get brain trauma, there’s nothing that’s more devastating that (it) could have been prevented," Marumoto said.

Critics of helmet legislation, however, point out that helmets may actually contribute to neck injuries during a high-speed crash.

"A 4-pound helmet can weigh 200 pounds during sudden deceleration," Brian Grayling of Street Bikers United told lawmakers. If a crash victim is traveling fast enough, Grayling said, helmets can actually increase the risk of skull fractures.

Those in the ATV industry, however, are well aware of the safety risks involved, said John Morgan, owner of Kualoa Ranch.

"Accidents happen, but wearing a helmet is the best way to prevent serious injury," Morgan said.

But not all of Morgan’s customers take safety considerations to heart.

"Some people drive unsafely, and if our guide determines that they are a danger to themselves or to other guests, we terminate the ride," said Morgan.

Kualoa Ranch provides between 300 to 400 ATV rides a week on its 4,000-acre facility.

Morgan said new ATV helmet laws would do little to affect his business because Kualoa Ranch already requires its ATV tour customers to wear helmets.

Although Green’s bill stalled in committee, a proposal now before the Senate Judiciary and Labor Committee would require helmet use for riders of not only ATVs, but also for bicycles, mo-peds and motorcycles.

If comprehensive safety legislation is not passed this session, Marumoto said, she is willing to settle for passing one piece at a time.

"Traffic safety is one of those things that would be easy to enact," Marumoto said. "It would save pain and grief and increases in no-fault insurance premiums, health insurance premiums, so it’s a no-brainer to me.

"But you have to wait until the planets are aligned," she said.