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The purpose of this pilot study was to assess the effectiveness of the Bull Tough helmet (Bull Tough, Seguin, TX) in preventing head injuries to bull riders. The hypothesis was that this helmet is effective in diminishing the incidence of head injuries in bull riders.This study was a retrospective study.Surveys were mailed to 320 purchasers of the Bull Tough helmet. Participants were asked to recall the numbers of rides performed in 1999 while wearing the helmet and the number of rides performed in 1999 while not wearing the helmet. In addition, they were asked to provide the number and severity of head injuries suffered in 1999 both while wearing the helmet and while not wearing the helmet.Participants responding to the survey were bull riders from the United States and Canada.Eighty-one riders responded to the survey.The primary outcome measurements were planned before data collection began and included the incidence of head injuries to bull riders both while wearing the helmet and while not wearing the helmet.While not wearing a helmet, the incidence of head injury was 1.54% per ride (11 head injuries/713 rides). While wearing the helmet, the incidence of head injury was 0.80% per ride (28 head injuries/3,518 rides). Using the X2 test, the p value was 0.0570.This study supports the hypothesis that the Bull Tough helmet diminishes the incidence of head injury in bull riders.