A UCLA study tracked a year of injuries from e-scooter use in two Southern California hospitals. How serious a safety risk are they?
In the year-plus since rentable electric scooters descended en masse on American cities, a lot of people have been falling off of, and over, them. Just how many, however—and to what degree city officials and other regulators should care—remains a topic of some dispute.
Public officials have used safety concerns as a reason to ban the little dockless vehicles (as in Seattle). And in Baltimore, where a scooter pilot began in August 2018, safety was cited as a main driver behind a proposal to jail scooter users who exceed a 15-mph speed limit or ride on the sidewalk (the city quickly amended the legislation after an outcry). But while evidence of scooter-mania is abundant—Bird, one of the major companies, says it did 10 million rides in its first year—crash and injury data has so far been more anecdotal.
A new study out of Southern California, where the things originated, is the first to quantify the damage. According to medical records from two UCLA hospitals in Los Angeles and Santa Monica, standing electric scooters have been associated with 249 emergency room visits between September 1, 2017 and and the end of August 2018. The list of reported injuries includes dislocations, bone fractures, lung contusions, soft-tissue injuries, and a splenic laceration. Most victims (91.6 percent) were riders who’d fallen, collided with an object, or were struck by a vehicle. But 8.4 percent were pedestrians who collided with scooters, tripped over them, or were attempting to lift them. Only 4.4 percent were recorded as wearing a helmet. None of the injures were fatal, but two patients were sent to the intensive care unit.
While scooter-skeptics seized on the news as proof that the disruptive devices indeed represent a public health menace, others noted that figures from two hospitals hardly provide a full picture of the broader scooter-safety issue. After all, as long as people have been driving things with wheels, they’ve been crashing them. Cars kill 40,000 people a year; another 5,000 lose their lives on motorcycles, and 840 people died on bicycles in 2016. Only three e-scooter deaths have yet been reported. The question many micro-mobility advocates are asking is: Are e-scooters markedly more dangerous than the modes they share the streets with?
According to data from the same two emergency departments, they might be. Over the same 12-month period, researchers measured only 195 visits for bicycle injuries and 181 for pedestrian injuries (though they did not include data on fatalities associated with either). The researchers also say they may have underestimated the number of scooter-related visits, because they were dealing with retrospective data and potentially incomplete reporting.
But Tarak K. Trivedi, an author of the study, isn’t ready to say that 249 scooter-related hospital visits constitutes a true public health emergency. “I don’t know,” said Trivedi, who’s also an emergency room physician. To better measure the relative rate of injury per ride or user, he says he’d need accurate and location-specific ridership data from scooter companies.
Bird would not provide the number of miles its users have covered in Southern California, nor how many of the 10 million total U.S. rides were taken there, and that information is not publicly available. But Bird’s director of safety policy and advocacy, Paul Steely White, told CityLab that ”the number of injuries reported would amount to a fraction of one percent of the total number of e-scooter rides,” which has reached the millions in Southern California, their most popular market. (Lime did not respond to comment by press time.)
Another study designed to measure the public health risk posed by e-scooters is now being conducted by the CDC in Austin, Texas, and Bird says it’s working with St. Louis to conduct another health assessment there. Portland, Oregon, just released data on its own scooter pilot, finding that there were 176 scooter-related emergency room visits from July 25 to November 20, 2018—fewer than the number of bicycle injuries over the same period. (They also noted a positive safety-related ripple effect: “With 34 percent of Portland scooter riders stating they replaced car trips with e-scooter trips, an increase in e-scooter use has the potential to contribute to a reduction in serious injuries and fatalities.”) With data like this from more cities, important context could be gained.
Right now, comparing the rate of scooter injury to that of other urban transportation modes is challenging. The Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS), which collects injury data associated with consumer products from a subset of U.S. hospital emergency departments, found that skateboards were responsible for almost 100,000 injuries in 2017, and bicycles and accessories responsible for more than 450,000. Scooters are not yet included in their analysis.
Other counts have more conservative estimates. According to data from the National Highway Traffic Safety Administration, 45,000 “pedalcyclists” were injured due to bicycle crashes nationwide in 2015—making up only 1.8 percent of all the people injured in traffic crashes during the year. In Southern California alone, 62 people died while riding bicycles last year, with 26 fatalities in Los Angeles proper. And across California, bicycle injury rates have risen, leaping 21 percent between 2007 and 2013.
But given their limited geographic range and more recent deployment, L.A.’s scooter injury rate appears to be disturbing, says Lara McKenzie, a principal investigator in the Center for Injury Research and Policy at the Research Institute at Nationwide Children’s Hospital who researches the public health impacts of bicycles on children. She co-authored research on children’s bicycle injuries in a subset of about 100 hospitals across the country from 2005 to 2016 using NEISS data, and found that bicycle crashes were responsible for about 600 emergency department visits a day among kids 5 to 17 years old. “Two-hundred and fifty [injuries] is not one every day,” she said. (It’s more like .68 a day.) “But they’re a newer thing, and they’re not as popular. It’s a trend you want to be looking at.”
Tridek, a scooter rider himself, doesn’t want cities to ban the devices, which have inspired some passionate backlash because of their perceived (and real) safety risks. “I have sort of the opposite opinion,” he said. “I think they’re good.” While the number of scooter-related ER visits is “a drop in the ocean” of UCLA’s total, he did the study to add clarity to a dangerous dynamic he was already observing in his Santa Monica neighborhood. He’s seen parents and children riding tandem, riders skidding onto the sidewalk instead of staying on the street, and people stumbling out of the bar and onto Birds and Limes. (The study found that only 4.8 percent of those injured were intoxicated.)
“I think people need to understand that there is a probability of injuring yourself badly,” Trivedi said. “There is a vast range of injuries that can occur: You can do anything from break your spine and have some degree of paralysis to wrist and ankle fractures that put you out of commission.” Most of the injuries he tracked—80 percent—came from falls, while 8.8 percent of riders were hit by a vehicle or another moving object.
The study also found that 10 percent of the injured riders were under 18 years old, despite the fact that scooter-renters have to prove they’re over 18 with a license to register. But almost a quarter of the injuries occurred in riders between 41 and 64, suggesting that hopping aboard might pose a special peril for the middle-aged rider whose scooter-skills might be rusty. “It’s physically less demanding to ride a scooter than it is to ride a bicycle,” said Trivedi. said. “So you potentially have people who maybe haven’t ridden a bicycle for years … that don’t have the same level of balance, or whatever it may be.” More than half of those injured were men, and the mean age of patients was 33.7 years old.
To make e-scootering safer for all involved, “there are three levels of implication,” Trivedi said. Perhaps unsurprisingly, almost 95 percent of those injured were not recorded as wearing helmets, including the five patients with reported bleeding in the skull. (Not all nurses and doctors took note of helmet use, but that proportion hews closely to field research on helmet use the researchers also conducted.) Helmet use is found to reduce motorcycle fatalities by 22 to 42 percent, and one review and meta-analysis of 83 studies and 64,000 injured bicyclists found that helmet use reduced the risks of serious head injuries by almost 70 percent.
“We always want more effort around promoting use of helmets” for both bikers and scooter riders, says McKenzie. In her neighborhood in Columbus, Ohio, for example, police officers hand out gift cards for free ice cream to kids they see wearing protective gear. But in California, a law that once mandated helmet use for scooter users was overturned this year. (Bird was a sponsor of the new bill, which lets riders over 18 go helmet-free.)
“I think the problem right now is not policy,” said Trivedi. That more stringent helmet law wasn’t abolished until January 2019, so the study was conducted while it still existed. “I bet you if we went out in the street and asked people, if there was an easier way to get you a helmet that you don’t have to carry around all day, would you wear a helmet, I think most people would say yes.” Like so many safety advocates, Trivedi supports building protected bike lanes designed to “give people an option to be not in the same shared space as cars, but also not in the sidewalk.”
He wants to encourage the adoption of a mode that holds potential to reduce pollution, shrink traffic congestion, and increase mobility. “I personally have an interest in seeing lower-income neighborhoods gain access and have the ability to have a sense of community, get around, get more people outside,” Trivedi added. “I think that’s one of the things that can make communities safer.” The challenge is keeping riders and pedestrians safe, too.