Exploring the Rise in Severe Injuries Associated With Electric Scooters

Originally published by our sister publication Anesthesiology News

Over the last five years or so, there has been an explosion in the use of electric scooters (e-scooters), electric bikes (e-bikes) and hoverboards in cities, towns and college campuses throughout the United States.

These micromobility devices have gained widespread support for a number of reasons; chief among them is their low carbon footprint, which is an attractive aspect in urban areas. The electric motors convert electrical energy into motion with much less waste compared with gas-powered engines.

However, their growth and accessibility has been associated with a sharp uptick in deaths, traumatic brain injuries (TBIs), internal organ injuries and extremity fractures. The speed of such devices—while certainly an attractive aspect of commuting—also can be deadly, partly related to danger to pedestrians and a lack of people wearing helmets and padding to protect their bodies. The silent nature of their electric motors also can be a danger to others, as drivers often weave in and out of traffic and sidewalks.

There are a large number of rental companies competing for market share and dominance. Because of exploding industry growth buttressed by political influence, you can ride e-scooters and e-bikes in almost every state for a fraction of the cost of standard methods for commuting.

Renting an e-scooter or e-bike is quite easy; you can access one by using an app on your phone and then zip to your destination at approximately 15 mph. But it’s not without concern; escalating use has led to deaths and disabling injuries based on epidemiological studies underscoring their risks in the last several years.

However, the recent bankruptcy filing by the micromobility company “Bird” may be a sign that the industry’s bet on this alternative approach to commuting may not be the financial windfall that investors once expected. Countless lawsuits related to deaths and personal injuries from faulty parts and equipment have been a major consideration in the viability of this mode of transportation, without other safety considerations such as helmets and other protective gear.

Emergency departments have noted an uptick in TBIs, extremity fractures and internal injuries in the last decade since their use has become more widespread.

Findings from a large study in France reviewed 5,233 patients treated in a major trauma center.¹ The injuries evaluated were as severe as those due to bicycle and motorcycle accidents. The death rate reported with e-scooters in traffic accidents was 9.2% compared with 10% for traditional bikes and 5.2% for motorcycles.

Data from a Consumer Product Safety Commission report released in October 2023 indicated that injuries from e-bikes and e-scooters increased by nearly 21% in 2022 from 2021.²

Nearly half (46%) of all e-scooter injuries from 2017 to 2022 occurred in 2022. The commission is aware of 233 deaths, but reported data are incomplete and may be underreported. Overall, injuries from e-scooters, e-bikes and other micromobility devices were estimated to account for 360,800 ER visits from 2017 to 2022, a major impact on our health system. Black consumers also accounted for 29% of these injuries, a significantly higher proportion than their 13% representation in the general population. This may be due to the widespread availability of these scooters in urban areas.

A major issue that needs to be addressed is the etiology of injury patterns while operating such devices. Key aspects to consider include distraction (using smartphones) or impairment related to use of earbuds/listening to loud music, use of alcohol and mind-altering drugs, lack of training to operate a given device, and poor road conditions (puddles of water, icy roads and potholes).

Operating an e-scooter or e-bike in a busy traffic-choked street where motorists may not hear them approaching due to their “silent nature” is a major concern: Their “silent” profile makes visibility an issue while changing lanes and making turns, a clear safety hazard and concern. Their sheer speed also makes riders feel empowered and nearly invincible. Another major issue is that most cities do not have designated lanes for e-scooters and all micromobility devices to improve safety and protect pedestrians on sidewalks or streets.

Operator issues also play a major part in accidents and injuries. There is no required training to operate e-scooters prior to their use.

One of the most easily identifiable contributors to injury severity is the lack of a helmet requirement while operating e-scooters and e-bikes. Years of experience have shown us how helmets have decreased head injuries in bicycle and motorcycle use.

Helmet laws do not apply to micromobility devices including e-bikes, e-scooters and hoverboards. This increased risk for head injuries, internal injuries and fractures—let alone risk for fatalities—should provide motivation for enacting state and even federal legislation to protect people who are operating these devices.

The CDC has underscored the magnitude of how brain injury affects our society. In 2020, 64,000 head injury–related deaths occurred from more than 223,00 TBIs.³

These data generate a staggering estimate of healthcare-related expenditures exceeding $40 billion. In addition, TBI patients are susceptible to lifetime complications including paralysis, seizures, psychosocial issues and loss of income, to name a few.

We can easily predict that due to increased use in e-scooter use and the rise of reported accidents in this non-helmeted population, there will be a massive increase in head injuries. Medical and economic issues can be catastrophic, with a prevailing increase in death and disability. The medical and economic impact of caring for such individuals will translate to billions of dollars, based on thousands of riders killed and injured.

We believe we can address these issues with widespread education in the proper use of e-scooters and e-bikes. Riders also need to be made aware of the injury risks. Proper and well-fitted bicycle helmets could provide effective protection in the majority of accidents, as they have been shown to do in safe bike use. Cities and states also need to develop regulations and laws regarding safe use and review how traffic infrastructure and flow patterns can be improved to provide for the safe use of these e-scooters.

Ongoing review of accident data can also help epidemiologists identify specific risks to pedestrians, motorists and operators of e-scooters and e-bikes. Such data may also help the industry to work to improve their safety to prevent injury and death. Sensors in vehicles that generate a warning may be one potential solution to help motorists identify scooters before turning.

Through public awareness campaigns and local and state regulations, we believe we can improve the safe use of e-scooters and all micromobility devices that are now so prevalent in our communities throughout the United States.

References

1. James A, Harrois A, Abback P, et al. Comparison of injuries associated with electric scooters, motorbikes, and bicycles in France, 2019-2022. JAMA Netw Open. 2023;6(6):e2320960.
2. U.S. Consumer Product Safety Commission. E-scooter and e-bike injuries soar: 2022 injuries increased nearly 21%. October 17, 2023. Accessed January 29, 2024. www.cpsc.gov/Newsroom/ News-Releases/ 2024/ E-Scooter-and-E-Bike-Injuries-Soar-2022-Injuries-Increased-Nearly-21
3. CDC. Traumatic brain injury & conclusion. Last reviewed September 7, 2023. Accessed January 29, 2024. www.cdc.gov/traumaticbraininjury/ data/ index.html

Papadakos is a member of the Anesthesiology News editorial advisory board.

Editor’s note: The views expressed in this commentary belong to the author and do not necessarily reflect those of the publication.