Electric Scooters: Case Reports Indicate a Growing Public Health Concern

With the introduction of rideshare electric “dockless” scooters in 2017 by Bird Rides, Inc, a new type of affordable transportation became available to the public. Often seen along the sidewalks and street corners of downtown metropolitan areas, these devices are strategically designed for the heavily congested, urban population centers. Patrons download an application on their smartphone, enter billing information, and then link the account to any available electric scooter. Although commercially available models exist with a top speed of 50 miles per hour and a range of 75 miles, electric scooters from Bird and Lime travel at a top speed of 15 miles per hour and have a range between 15 and 20 miles. On completion, the rider leaves the scooter along the sidewalk, where it waits for the next interested patron. Some of the appealing aspects of these devices include low cost, ease of accessibility, and the ability to bypass the often standstill traffic conditions by using the bike lanes, surface street, and sidewalk.

Over the past two years, market demand has grown, with multiple companies (e.g., Bird, Lime, Spin, Uber, and Lyft) entering the industry. Electric scooters and their derivative will become a $42 billion industry by 2030.¹ However, in parallel with their growing popularity has been an awareness of their safety hazards. Reports across the United States cite various types of injuries, from skin abrasions and ankle sprains to major injuries including open fractures, traumatic brain injuries, and even death.^2–4

RECENT CATASTROPHIC INJURIES

Cedars-Sinai serves a large trauma catchment area in west Los Angeles, California, which represents ground zero for the introduction of electric scooters partly because of the high pedestrian traffic, tourist activity, and surrounding universities.⁵ Almost overnight, we experienced a significant rise in trauma activations and hospital admissions attributed to electric scooters. In 2018, the total number of trauma activations related to electric scooters at Cedars-Sinai was 30; in 2019, we will receive approximately 100. By comparison, Los Angeles County General Hospital, the largest trauma center in Los Angeles County, had zero electric scooter–related trauma activations in 2018, whereas the 2019 estimate is 300.

Recently, two patients were admitted to our institution after catastrophic electric scooter– related collisions. One patient was an otherwise healthy 23-year-old man who was riding a scooter when he was struck by a motor vehicle, which sent him flying approximately 20 feet. On arrival to Cedars-Sinai, the patient went into a pulseless rhythm, and we initiated chest compressions. Despite our best efforts, he was declared dead soon after arrival. This patient marks the ninth known death linked with electric scooter use that has been cited across the United States.⁴

Less than a few weeks after this death, another patient experienced a severe traumatic brain injury after being struck by an electric scooter while in a crosswalk. This 75-year-old gentleman had numerous skull fractures with multiple intracranial hemorrhages and large-territory infarcts. After one month in the neurology intensive care unit, he showed little recovery and was eventually transferred to a long-term-care facility, flaccid in all extremities.

Our experience serves as a warning regarding the public health safety ramifications associated with the use of these devices. In particular, our second case shows that not only riders are at risk for severe injury, which constitute most of the emergency department admissions (92%–98%), but also pedestrians.^2,3 The combination of mass and force from an electric scooter rider can be lethal. Pedestrian injuries after collisions with electric scooters will likely increase as the industry continues to expand and the space on sidewalks becomes increasingly congested with scooters.

POLICY AND ACTION

Multiple cities have enacted laws to try to curb the associated dangers. In Atlanta, Georgia, scooters were banned at night; Nashville, Tennessee, weighed banning their use; and Santa Monica, California, filed a lawsuit against one of the companies. In a comprehensive effort, Los Angeles and other cities released a Vision Zero strategic plan to reduce all traffic-related deaths by 2025. The Vision Zero plan includes traffic safety protocols on how to reduce injuries related to emerging mobility devices such as electric scooters. Although no easy solution exists to reduce all hazards associated with electric scooters, safety standards are necessary and feasible to achieve zero deaths related to their use.

A fruitful discussion on this topic must place the use of these devices within the greater context of other transportation devices. In a theoretical sense, no transportation device is without risk. Motor vehicles, which represent the most commonly used means of transit, still constitute the vast majority of emergency department traumas, with an estimated 89 related deaths per day in the United States.⁶ Bicyclists and joggers are the source of numerous hospital admissions and deaths reported each year.⁷ However, these types of travel are far more ingrained in our society and less likely to fall under scrutiny than the recently introduced electric scooters. We must recognize that without an objective comparison of rider miles or ride hours to the number of severe injuries incurred from other types of transportation in urban areas, the attributable relative risk of scooters cannot be fully described. As such, it is important to be cautionary of any major, knee-jerk responses.

With that said, however, our anecdotal experience and the growing concern for the safety of these devices require lawmakers and stakeholders to take policy steps to prevent injuries from occurring. Outright banning electric scooters would represent the most extreme form of action and would be premature until clear evidence exists that these devices represent a greater danger than other types of transportation. A ban would not only deter innovation and ingenuity but also fail to allow new innovations to address these, and future, safety hazards.

FUTURE DIRECTIONS

Our experience suggests that several thoughtful, targeted interventions may be necessary. Because helmet use is limited while riding electric scooters, newer, more portable helmet designs may lead to increased use. Many riders describe injuries during their first electric scooter ride related to their unexpected speed, which suggests that initial rides should have a limit to the acceleration and top speed. Other riders stated that their injuries occurred while holding a bag or phone, which indicates the need for a cage to hold these items. Potholes or other road hazards that led to a crash suggest that improvements in the electric scooter shocks may reduce injuries.

One important characteristic worth stressing is how silent electric scooters are. Additionally, they are typically dark in color and do not have the high-powered lights or reflectors required by cars and motorcycles. This combination makes scooters particularly prone to collisions with pedestrians. Simple interventions such as a noise alerting sound and additional lights or reflectors could lead to a reduction in scooter versus pedestrian injuries. Dedicated paths that separate electric scooters from both pedestrians and automobiles also would provide significant protection to both riders and pedestrians.

Given the projected growth of the electric scooter industry, we predict that the injury burden from these devices will exceed other pedestrian- or bicycle-related trauma and be second only to automobile collisions in related mortality. Targeting zero deaths is an achievable goal, and further discussion on how best to address this growing public health concern is necessary.