Background: Road traffic injuries kill nearly 1.3 million people every year and several are left with injuries and disability. Accidents are not often due to ignorance but for various factors such as non-usage of protective gear, carelessness etc. This study is undertaken to evaluate various factors responsible for Road traffic accidents and the mortality and morbidity pattern among two wheeler riders and also difference with usage of helmets. Methodology: A cross sectional study conducted in King George Hospital (KGH), in the months of May and June 2012. A sample of 200 victims (riders and pillions) admitted to casualty and other wards were selected by systemic random sampling method. Patients admitted with delayed complications were not included. Data was collected using pretested questionnaire, every day in the casualty and in other wards of KGH. Results: Majority of the victims (87.5%) were males, 76.5% were riders and 23.5% pillions. Age of the victims ranged from 18 to 40 yrs. Accidents occurred more during night time (56%) without enough street light (70%). About 61% of the accidents involved two vehicles. In 13 % of cases the cause of the accident was animals and pedestrians on street. Unconditioned vehicles contributed to 65%, whereas alcoholic state of the riders contributed to 40.5% of the accidents. Mortality was found to be more among nonusers of helmets (82.35%), when condition of the roads (64.71%) and vehicles (64.71%) were not satisfactory. Conclusion: Road traffic accidents continue to be a social menace. The segregation of different types of road users is a key step. Encouraging safe behavior is important along with enforcement of road safety regulations.