E-bike injuries: 'We're only seeing the tip of the iceberg,' trauma experts warn (2023)

The irony for Meghan Glaser was that she was already looking for a cyclist, the one to her right, stopped at a stop sign in the coastal neighborhood of La Jolla, near San Diego. She never saw the two bicyclists to her left, high school students who had skipped their own stop and were trying to outrun her car at the intersection. The cyclist in front was driving it; the other hit its front bumper with its rear wheel and went flying.

It was just a road rash, luckily, mostly on the knees and elbows. The student showed up right away and seemed otherwise fine, and he was wearing a helmet. But when Glaser later saw video of a car's dashboard that she was standing near her when the incident occurred, she was deeply shaken.

"Honestly, I was going fast enough and they were going fast enough that it could have been fatal," he told me. "I never saw them because they were going so fast."

Meghan Glaser's assessment was not wrong. The boys rode through the intersection at a speed none of them could possibly achieve on a conventional bike. The leading rider sat on an electric bike, while the trailing rider held onto it with one hand and steered his bike with the other. They really were fast enough that something much worse could have happened.

Some trauma specialists are increasingly saying that is exactly what they are seeing. Although the record of serious injuries on e-bikes is patchy, both anecdotal evidence and interviews in emergency departments, trauma, and orthopedics suggest that we are on the cusp of a new order of danger both on the bike lanes and on the highways.

An increase in sales - and the damage

"Honestly, I think we're probably just seeing the tip of the iceberg," says Dr. Marko Bukur, medical director of trauma at Bellevue Hospital in New York and himself an avid cyclist.Many of the injuries coded (on the electronic record) as conventional devices are likely to be electronic devices."

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Although reliable numbers are elusive, pattern is not. According to the US Consumer Product Safety Commission (CPSC) Estimated Emergency Room Visits Due to Micromobility Products (E-Bikes, Electric Skateboards, and Hoverboards)more than doublefrom 2017 to 2021. The National Transportation Safety Board (NTSB), for its part, ruled53 deathsof electric bike accidents from the same period, denouncing the "lack of comprehensive, consistent and reliable data" likely leading to gross underestimations of the actual statistics. NTSBsrapportnoted that "deaths associated with e-bike riders have also increased exponentially."

The data from other countries is also worrying: in the Netherlands, electric bicycles were responsible for27 %of all fatal cycling accidents in 2017; in Israel, electric bicycles and scooters represented3,686 hospitalizationsbetween 2014 and 2019; and a dutchreviewfound that electric bike riders were 1.6 times more likely to end up in the emergency room than regular bike riders.

These statistics are likely to continue to spread. Electric bike sales are increasing as people increasingly flock to the idea of ​​a bike that can be pedaled but with the motor doing the work when you want or need it. Electric bikes can take riders from 20 mph to almost 30 mph. That top speed is faster than average.Rider part of the Tour de Francia– and the kind of speed the average cyclist would never achieve on their own.

In the US alone, nearly 900,000 electric bikes were sold in 2021, aalmost a doublingof sales from just a year earlier. according to onerapportAccording to the National Association of Bicycle Dealers, total sales revenue will exceed $1.3 billion by 2022, an increase of 33% over the previous year.

"It's opened up the world to a wide variety of people," says Tracy Sheffer, co-owner of electric bike retailer Pedego La Jolla. "Kids who used to sit around the house and play video games all day are now riding e-bikes and getting out there and getting active."

Industry analysis suggests that increased interest from baby boomers is also driving demand. But for teens and retirees alike, those driving speeds are on residential streets, and trauma specialists say that's more than enough movement to cause serious injury.

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'We really see the scale'

People injured in electric bike accidents don't look like people in conventional bike accidents, trauma surgeons believe in major urban areas where electric bikes are becoming legion.

"The vehicle is heavier. I think of it as a vehicle," says Dr. Joseph.Patterson, an orthopedic trauma surgeon at USC Keck Medicine in Los Angeles. Generally, electric bikes weigh between 50 and 80 pounds. "Patients are thrown at higher speeds, but unlike most motorcycles, they don't wear protective gear. (Often) there is no helmet law for them."

“Patients have fractures that are more likely to be open, where the bones stick out of the skin. We see a higher incidence of polytrauma, which means that more than one part of your body or more than one organ system is seriously injured. We usually see more serious injuries, patients who have to go to the hospital longer and need more operations."

For Patterson, who says the incidence of such electric bike accidents is "clearly increasing," these injuries are similar to those sustained in motorcycle accidents rather than standard bike collisions or falls. and Dr. Charles DiMaggio, director of trauma research at NYU Langone Department of Surgery and author of a widely circulated articleanalyzefrom 2000-2017 data says that e-bikes “were three times more likely to result in hospitalization compared to traditional pedal cycles, with many e-bike-related hospital discharges coded as internal injuries.”

"We're really seeing the range," Bellevue's Bukur told me. "This, of course, includes head and neck injuries, traumatic brain injuries, spinal fractures, chest injuries, solid organ injuries, and limb fractures. We've had a lot of people who have been on electronic devices and they've certainly been hit very hard... I mean, the level of care from the UCI."

For these specialists, the risks are obvious. Older cyclists may have slower reaction times, are more prone to serious injury, and do not recover as quickly from crashes. Younger riders have likely never been on anything as fast as an electric bike and have limited decision-making abilities in rapidly changing environments, as Meghan Glaser discovered in La Jolla. They're diligent too - there are already plenty of videos out there explaining how to hack electric bike motors to go much faster than 30mph.

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Add in risky and dangerous behaviors like drunk bicycling, "retrograde biking," ignoring stop lights, and using cell phones while bicycling and you have a recipe for disaster. A Chinese study found correlations between thesebehaviorand traffic injuries related to electric bikes.

“I've seen children younger than teenagers ride them. I'm not happy when I see that,” said UC San Diego Health emergency room physician Dr. Gabe Wardi. “This is a motorized vehicle going down the highway. (with cars), which isn't ideal for a 12 or 13 year old, but these kids also take full advantage of the fact that you can get through neighborhoods on roads where you're supposed to walk or be in a non-motorized vehicle. bike They probably don't know the rules of the road."

Electric bikes are not bicycles

In the United States there is an almost total absence of coherent policies or regulations to deal with this reality. This is a product that, administratively at least, doesn't fit neatly into any one category.

In many states, electric bicycles are placed in the same category as conventional bicycles, and therefore riders are required to wear only a bicycle helmet, and even only within certain age ranges in many states. Other states haveoutdated lawswhich does not include a rating for electric bikes at all. The CPSC, for its part, regulates them astraditional Human Powered Bicycles,and the federal government explicitly excludes them from any category of motor vehicle.

It leaves much of the regulatory responsibility to local government bodies, with a resulting maddening blanket of regulation. In some cities or states, electric bikes have access to bike lanes and bike lanes. In others, they drive down the road in front of and behind large cars. In most states they areexemptregistration or license requirements.

Industry group PeopleForBikes wants all threecommon classesof electric bikes that are strictly regulated as bicycles. However, the increasing incidence of injuries and fatalities requires careful examination of other options.

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There is an interest in public safety. In DiMaggio's study, electric bike accidents werethree times more likelyinvolve a collision with a pedestrian than traditional bicycles or electric scooters. (Again, think speed.) And because American infrastructure lags so far behind developments like this, there aren't enough dedicated bike lanes in major cities—a common theme that predates the e-bike movement, of course, by decades.

"You have to put the infrastructure there for people to use," says Elizabeth Bowersox, director of programs for the San Diego Bike Coalition. "The city needs to take that initiative first and put that infrastructure in there, and then people will use it."

It is an area to work on, but it requires a long-term vision. In the meantime, strict helmet laws should be enforced, the use of protective gear encouraged, and authorities should consider licensing/certification requirements or mandatory training, especially for renters.

"There has to be a classification for something between a motor vehicle and a motorcycle and a regular bicycle," says USC's Patterson. "And I know California law; it's based on watts and top speed. But I'm not sure if that protects people... I'm seeing them go at speeds of 30 to 40 or more, sometimes 50 miles per hour." .

This may seem like a big subway problem, but it won't be long before communities across the country are facing the fallout from the electric bike explosion. This isfastest growing segmentof the aftermarket bicycle industry, and the proliferation of bicycles capable of traveling at the speed of automobiles cannot be safely ignored.

"The helmet is absolutely justified and I think there should probably be an age restriction or minimum age on at least some of them," says Dr. Linda Dultz, a trauma surgeon and director of Parkland Health's surgical intensive care unit. in Dallas. “I can't imagine that a 13-year-old could drive something that can travel 25 to 30 kilometers per hour in the middle of a highway. It just doesn't seem safe."

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Carolyn Barber, MD., is an internationally published scientific and medical author and an emergency physician of 25 years. she is the author of the bookFugitive Medicine: What You Don't Know Can Kill Youand co-founder of the California Homeless Work Programchange wheel.

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