We who care for patients in the Neuro ICU each day are sometimes the first to observe how certain recreational practices may lead to an increase in potentially life-changing injuries. This has been the case with the rapid and unregulated rise in the use of electric scooters and other motorized boards and bikes. 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 world. 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. Renting these devices 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 doing so is not without concern, as their escalating use has led to deaths and disabling injuries based on epidemiological studies from the last several years, which underscores the risk of using these devices without a helmet or proper training.

Of great concern to neurocritical care providers is that the growth and accessibility of these devices 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 for commuting—can also be deadly, partly related to the danger they pose to pedestrians, but also due to a lack of riders wearing helmets and padding to protect their bodies. The silent nature of their electric motors can also be a danger to others, as riders often weave in and out of traffic and sidewalks. They are easy targets in congested urban traffic, especially when larger vehicles are making turns.

Medical statistics and injury studies have already substantiated these concerns. Findings from a large study in France reviewed 5,233 patients treated in a major trauma center (1). The injuries evaluated in people using these devices 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% from 2021 to 2022 (2). Meanwhile, the CDC has underscored the magnitude of brain injury and how it affects our society. In 2020, 64,000 head injury-related deaths occurred from more than 223,000 TBIs (3). These data correspond to 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, as we all know through our daily practice.

With this in mind, we in neurocritical care need to strongly advocate for the safe regulated use of these devices. The medical community needs to educate the public and pressure local governments to regulate 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. Yet 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 the increased risk of fatality—should provide motivation for enacting state and even federal legislation to protect people who are operating these devices. How can we stand back and not push for the same regulations for these devices? Cities and towns need to better regulate their use through mandatory use training prior to rental. After all, people do not operate motorcycles without proper training and licenses. We also need to push our government to designate specific lanes on our roads to protect both drivers and pedestrians. Vehicles that go 15 mph do not belong on sidewalks and congested city traffic.

We and our colleagues in emergency medicine can and should advocate for such changes, especially in light of our expertise in TBI and its effects on our patients. Reach out to local media, political leaders, and law enforcement to push for this common sense solution, and maybe together we can make it happen.