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More bike riders are suffering horrendous injuries in Perth road accidents, often after being dragged under big vehicles such as trucks and four-wheel-drives.
Figures obtained by _The Weekend West _ showed 22 bike riders had life-threatening injuries last year - a record and double the number from 2013.
State Major Trauma Unit director Sudhakar Rao said the severity of the injuries was getting worse. "We are seeing a definite pattern - a growing trend of cyclists suffering very severe injuries as a result of being dragged under trucks and bigger vehicles," Dr Rao said.
"It is resulting in horrendous internal injuries - injuries that can require the victim to lie on their fronts in a hospital bed for several months."
Figures show the trauma unit treated 121 cyclists last year, one more than the previous record high of 120 in 2013. Of those, 25 were not wearing helmets.
"There is a clear message to cyclists - you must wear a helmet for your own protection," Dr Rao said. "Most spinal and brain injuries are with you all your life."
He said all road users had to be more aware of bike riders because "they are incredibly vulnerable and not always visible".
"There are a lot of bike injuries during the peak periods in the morning and afternoon but they are not usually serious injuries, probably because vehicles are travelling slower," Dr Rao said.
"The more serious injuries seem to occur at other times of the day, often with cyclists being hit from behind."
At least three cyclists died on WA roads last year. In June, a woman riding a bike died after she was hit by a bus in Mt Lawley.
In October, a 31-year-old man was killed after a white utility allegedly struck him as he rode along Kewdale Road.
In November, a woman died after she was hit from behind by a Toyota Rav 4 while she was riding on Kings Park Road.
Bicycling WA's Jeremey Murray said all road users had a responsibility to ride and drive with courtesy, patience and care.
"We have seen significant increases in the number of people choosing to cycle and disappointingly a corresponding increase in the number of injuries," he said.
But Mr Murray said riding a bike was "safer than sitting on the sofa".
"You are more likely to die from heart disease because of physical inactivity than you are from riding a bike," he said.
In September, the Barnett Government said it would spend $300,000 on an advertising campaign to urge WA motorists and cyclists to better share the road.