Electric bikes and motorized or electric scooters have been growing in popularity. With their fast speeds and ease of use, they have become a convenient and desirable mode of transportation. Even with their desirable features, e-bikes and e-scooters can pose significant risks for injury, especially amongst the pediatric population. Electric bikes have become more affordable and easily accessible, leading to a rise in popularity. E-bike sales quadrupled between 2019 and 2022, with over 1 million sold each year.
With a new school year ahead, it is important to understand important safety measures, risks, and injury prevention methods, as well as the types of injuries that can occur and the treatment of e-bike and e-scooter-related injuries.
Types of E-Bikes and E-Scooters Explained
To better understand the risks and safety measures associated with electric or motorized bikes or scooters, it is essential to recognize the various types and their corresponding characteristics.
There are three types of e-bikes.
- Class 1: Pedal assist with a motor, without a throttle, with a maximum speed of 20miles per hour (MPH) (with pedal assist). Helmets are not required.
- Class 2: Equipped with a motor and a throttle, with a maximum speed of 20 MPH. Helmets are not required.
- Class 3: Pedal-assist without a throttle, but can reach maximum speeds of 28 MPH with pedal assist. Helmets are required in certain states.
Two types of scooters differ from a traditional foot scooter:
- Motorized Scooter: A 2-wheeled vehicle that includes a rechargeable battery.
- E-Scooter: A 2-wheeled vehicle that is dockless (this type of scooter is often available for rent using smart apps).
Risks of E-Bike and E-Scooter Accidents
E-bikes and e-scooters have become a popular recreation activity for the pediatric population, as well as a form of transportation. Children and adolescents use them as a means of transportation to school, as well as extracurricular events and social gatherings, which tend to increase with school back in session. Adolescents find them desirable because they dont have to rely on parents or school buses for transportation, they result in quicker commutes compared to regular bikes or scooters, and require less physical effort, especially when riding up hills.
E-bikes and motorized/e-scooters can pose dangers to riders as they are faster than traditional bikes and scooters, and include a motor, which makes them heavier and more difficult to control. These factors pose risks to both riders and pedestrians. They lead to increased chances of crashes occurring when riding through crowded school or drop-off zones. Riders may also experience reduced reaction times to avoid accidents due to high speeds and the heavy battery that causes faster acceleration and potential loss of control, especially downhill.
Common E-Bike and E-Scooter Injuries
With an increase in e-bike and e-scooter popularity, there comes an increase in injuries due to the high-velocity and high-energy impacts that are caused by these types of crashes. Originally, the majority of deaths related to e-bike injuries were seen in older adults who were able to financially obtain e-bikes. E-bikes have since become more affordable, leading to an increase in pediatric operations and, consequently, injuries. Studies have shown that between 2017 and 2022, e-bike injuries more than doubled every year, and e-scooter injuries increased by more than 45% every year.
E-bike and e-scooter-related injuries can vary in severity, ranging from minor abrasions and lacerations to fractures, life-threatening and life-altering injuries, and even death. Healthcare professionals are seeing more complex and severe injuries, involving multiple extremities and organs, rather than more isolated injuries that are seen with traditional bike and scooter injuries.
While abrasions and cuts are minor injuries, major injuries can pose serious harm. More complicated injuries from e-bike and e-scooter crashes can include orthopedic and head injuries. Orthopedic injuries can be common in e-bike accidents, and interestingly, complex patella fractures that were uncommon in adolescents prior to the surge in electric vehicle usage have been seen in accidents associated with e-bikes.
Head Injuries
Head injuries and traumatic brain injuries (TBIs) are among the most serious injuries associated with e-bike and e-scooter accidents. There has been an increase in the number and severity of e-bike head injuries, especially amongst teenagers.
The term TBI includes multiple types of injuries to the brain, with differing severities, prognoses, and treatment. Types of TBIs include:
- Hematoma/Hemorrhage: a collection of blood in the brain or around the brain.
- Contusion: bruising on the brain tissue resulting in bleeding and swelling inside the brain.
- Concussion: mild TBI resulting in functional changes, and does not include structural damage.
- Diffuse Axonal Injury (DAI): caused by the shearing of nerve fibers in the brain when the brain rapidly shifts and rotates within the skull.
- Ischemia: disruption of blood flow to the brain, leading to decreased oxygen supply and potential brain tissue death.
- Skull Fractures: a crack in one or more bones of the skull.
Nurses and other healthcare professionals need to understand the different symptoms of TBIs and to recognize that the symptoms of TBIs vary based on the severity of the injury.
Mild TBI symptoms include:
- Loss of consciousness or altered levels of consciousness
- Seizures
- Headaches
- Nausea or vomiting
- Changes in vision
- Light and noise sensitivity
- Dizziness
- Drowsiness
- Fatigue
- Excessive sleeping or difficulty sleeping
- Local bruising or swelling
- Difficulties balancing
- Mood changes such as nervousness, sadness, depression, or irritability
- Memory issues
- Difficulty concentrating or focusing
- Difficulties processing or responding to information
Moderate to severe TBI symptoms include:
- Loss of consciousness
- Memory loss
- Worsening or persistent headaches
- Extreme confusion
- Agitation or other combative behavior
- Changes in speech
- Nausea or vomiting
- Convulsions or seizures
- Clear fluid draining from the nose or ears (result of a basilar skull fracture)
- Bruising noted around the eyes or behind the ears (also indicative of basilar skull fractures)
- Dilation of one or both pupils
- Difficulty staying awake
- Weakness or numbness, especially of the fingers or toes
- Difficulties with coordination, balance, or walking
- Skin discoloration or pale appearance
E-bike and e-scooter injuries can be acute or they can result in long-term complications that can impact physical and cognitive functioning.
Nursing Assessment and Treatment of E-Bike and Scooter Injuries
Life-threatening injuries will always take precedence over minor abrasions. When caring for injured patients from e-bike or e-scooter accidents, healthcare providers should prioritize the ABCs: airway, breathing, and circulation.
- Airway: Is the individuals airway patent? Is it compromised by vomit, blood, saliva, or another substance, leading to a risk of aspiration? Ensure that the airway is patent, and if not, clear the airway. If needed, rolling the individual on their side can help clear an airway using gravity.
- Breathing: Is the individual breathing? Are their respirations regular with a regular pattern? Do you observe tachypnea or bradypnea?
- Circulation: Proper circulation is required to perfuse vital organs. Does the individual have a pulse? Does the individual require chest compressions? Is there any external bleeding that needs to be addressed?
In addition to assessing airway, breathing, and circulation, it is also important to assess the level of consciousness and head trauma. Important assessments pertaining to e-bike and e-scooter injuries include:
- Vital signs, including heart rate, oxygen saturation, respiratory rate, blood pressure, and temperature, are key in evaluating a patients condition. These should be measured frequently and as ordered. For patients who have had hemorrhaging, pay special attention to blood pressure to prevent rebleeding issues and worsening of cerebral edema.
- The Glasgow Coma Scale is used to assess the level of consciousness.
- Neurological exams can include pupil reactivity, eye movement, cranial nerve functions, motor strength, and sensation awareness. These exams should be repeated frequently according to protocol to help determine neurological status and any worsening conditions.
- Intercranial pressure (ICP) - for those with head injuries, monitoring ICP is crucial. Some individuals may also require the monitoring of cerebral perfusion pressure and other parameters.
- ICP management can include maintaining adequate oxygenation and ventilation, ensuring fluid and electrolyte balance, administering proper medications, and elevating the head of the bed.
- Imaging and laboratory work - repeated testing can help detect changes in condition and patient status.
Children should always be seen by a healthcare provider for injuries to the head. Emergency medical attention should always be sought for head injuries resulting in loss of consciousness, severe headaches with vomiting, seizures, or severe neck pain. Call 911 or seek the nearest emergency room as appropriate.
It is also important to acknowledge the risk of spinal injuries and the importance of spinal immobilization. Patients with potential spinal injuries should be placed in a cervical collar and transported on a backboard. It is best practice to assume potential spinal cord injuries until cleared by assessment and imaging.
Injuries from e-bikes and e-scooters will be diagnosed and assessed using a variety of tests and assessments depending on the specific injuries, and may include: CT scans, neurological exams, medical history, MRI, X-rays, electroencephalogram, physical assessments, and symptom review.
Treatment of e-bike and e-scooter-associated injuries varies depending on the type, location, and severity of the injury. Abrasions or lacerations may require cleaning or suturing, treatment of fractures includes immobilization and potentially casting or surgery, internal injuries and head injuries may require surgical and pharmacological interventions. Therapeutic measures will be performed, as well as pain control and management. Depending on the extent of the injury, individuals may be treated on an outpatient basis or in the emergency room, while others may require inpatient hospitalization or even rehabilitation. Some injuries from e-bikes or e-scooters can prove fatal.
Preventing E-Bike and E-Scooter Injuries: Safety Education for Families
As healthcare professionals, it is imperative to educate the community, patients, and their families regarding e-bike and e-scooter safety. Factors that lead to increased risk of significant injuries amongst adolescents include susceptibility to peer influence, risk-taking behaviors, lack of protective headgear, and limited road safety knowledge and experience.
The American Academy of Pediatrics recommends that children under the age of 16 should not operate or ride on motorized or e-scooters. If an adolescent is too young to have a drivers license, they should not operate such scooters. The US Consumer Product Safety Commission recommends that children under 12 years of age not operate any e-bike faster than 10mph. May states prohibit individuals under the age of 16 from operating a Class 3 e-bike.
Individuals who are eligible to operate an e-bike or e-scooter are encouraged to follow safety measures to limit their risk of injury, such as:
- Wearing protective gear, such as a helmet, elbow pads, and knee pads. Ensure that the helmet fits appropriately and is worn every time an e-bike or scooter is being operated.
- Wear reflective gear at night or in low light.
- Turn on the front or rear bike or scooter lights at night or in low light.
- Wear closed-toe shoes.
- Use both hands to steer.
- Use caution on paths that may put pedestrians at risk, such as sidewalks, beach paths, or in parks.
- Road safety: Be alert, use hand signals, obey traffic rules, and know city or state e-bike use regulations, including age and speed restrictions.
- Avoid distractions; distractions can include anything that impairs vision or hearing, such as headphones, phones, or other individuals.
- Call out when riding so others are aware of where you are.
Helmet Use
Helmets are critical to preventing serious head injuries when riding an e-bike or e-scooter. Unfortunately, parents are less likely to require their children to wear a helmet when riding a scooter than when riding a bike. When surveyed, 57% of parents reported that they do not require their child to wear a helmet while riding a scooter. When analyzing individuals who are injured in accidents, only one-third report wearing a helmet. Not all helmets are appropriate for all speeds. Helmets certified by the Consumer Product Safety Committee are to be used for bicycle speeds of 20 miles per hour or less. Helmets certified by the Department of Transportation are recommended for speeds over 20 miles per hour. Ensure that your child is wearing the appropriate helmet for the bike or scooter they are operating.
Additional Safety Measures
Even with appropriate safety measures in place, there is still a risk of injury and accidents. E-bikes and e-scooters have governors in place to limit the speed of the vehicle, but some adolescents have found ways to bypass these limits or even purchase devices to circumvent speed governors, leading to dangerous speeds being reached. It is also important for parents to be aware that even if their child does not personally own an e-bike or e-scooter, they may still have access to one through friends or associates. E-scooters are available for rent on the streets of many cities and can be unlocked with a smartphone app. Often, such apps lack a means of verifying the user's age; therefore, adolescents and children can access them independently.
Advocacy
Healthcare professionals, including nurses, can be advocates for e-bike and e-scooter safety. Further community education and advocacy can help decrease accidents and serious injuries. Problems associated with e-bikes include a lack of consistent age regulations amongst cities, inconsistent helmet requirements, and a lack of consistent e-bike classifications.
Areas for nurse advocacy include:
- Extending helmet laws and encouraging helmet use; not all states have the same helmet requirements pertaining to e-bike and e-scooter usage.
- Consistent and strict age requirements for operating e-bikes and e-scooters, as well as the requirement of a license.
- Encourage strengthened product safety standards and e-bike manufacture standards to prevent speed governor over-rides.
- Restrictions on the number of riders allowed on a single e-bike or e-scooter.
- It has been suggested that requirements for riders who violate laws or regulations pertaining to e-bike or e-scooter usage should require them to complete a safety course when citations are received. This applies to violations pertaining to traffic laws and riding without a helmet.
- New ICD External Cause of Injury codes - There is a need for further information and studies regarding injuries related to e-bike and e-scooter usage to better understand the associated risks and injuries, and to improve treatment for individuals, including pediatric patients. To further increase understanding of injuries related to e-bikes and e-scooters, nurses should advocate for the development of new ICD External Cause of Injury codes that can accurately capture details of electric bicycle injuries, including device types, speeds involved, and crash circumstances.
Conclusion
While e-bikes and e-scooters are an attractive means of transportation and recreation for the pediatric population, it is important to acknowledge the associated risks and increase education about injury prevention and important safety measures. Injuries from e-bike and e-scooter accidents can vary from minor to fatal. Nurses must be prepared to assess and provide adequate patient care to those who have been injured. In addition to caring for injured children and adolescents, nurses need to be able to educate others about e-bike and e-scooter safety, and should make efforts to advocate for improved community safety regarding electric vehicles.
About the Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely those of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
If you want to learn more about CEUfast's Nursing Blog Program or would like to submit a blog post for consideration, please visit https://ceufast.com/blog/submissions.
