The worldwide sales and use of electric bicycles (e-bikes) have grown dramatically in the past decade, particularly among children and adolescents, becoming an increasing source of road traffic-related morbidity and mortality. Surgeons around the world have witnessed a serious pattern of e-bike-related injury and death.
E-bikes are regulated quite differently around the world, and laws governing their use vary by individual states in the US. In some municipalities, they are banned; elsewhere, they are regulated as either bicycles, mopeds, motorcycles, or motorized vehicles.
Historical Context
The first patents for battery-powered bicycles were issued in France and the US in the late 19th century. The major advancement in the 20th century was the introduction of pedal-assisted bicycles, also known as pedelecs. Pedelecs combine the rider’s pedaling with an electric motor, cutting power to the motor when the rider is not pedaling or when a certain speed (approximately 20 mph) is reached. Many jurisdictions classify pedelecs as bicycles rather than mopeds or motorcycles.
Modern Developments
In 2024, there has been a rapid increase in the combination of pedal-assist and throttle-style e-bikes, with a wide range of designs. Some more powerful e-bikes (Class 2) provide assistance regardless of whether the rider is pedaling and can be accelerated by throttle alone, resembling mopeds. Another concern is that some controllers can be deactivated, allowing speeds greater than 37 mph, comparable to motorcycles.
Advantages of E-Bikes
E-bikes make it possible to commute longer distances in shorter times, as they quickly achieve relatively high speeds with minimal physical effort. They represent an economical, environmentally friendly, and more sustainable mode of transportation that reduces greenhouse gas emissions compared to cars. Rising gasoline prices further increase the value of e-bikes.
Disadvantages of E-Bikes
The higher speeds reduce reaction time for riders to avoid potential collisions. The bicycle-like appearance may not convey these risks to younger riders or parents. Special caution should be exercised in traffic and when traveling downhill, as the heavier battery can lead to faster acceleration and loss of control.
Classification and Regulation
E-bikes are part of a growing class of devices known as electric mobility devices, which include e-scooters, e-unicycles, e-skateboards, e-hoverboards, and the balance scooter Segway. The basic components of an e-bike are a battery, controller, and motor. Accessory components include displays, throttles, and sensors.
US federal regulations limit e-bikes to a motor with a power rating of less than 750 watts and require fully operable pedals. Several nations set lower power limits. Conversion kits available online can alter many e-bikes by 1,000 watts or more to high-power models, evading initial sale labeling requirements. These conversion kits are banned in some locations.
Variability in Regulations
The American College of Surgeons (ACS) highlights the lack of consistent classification and regulation around the nation or globe, with US state laws varying widely and sometimes in conflict. In some municipalities and colleges, e-bikes have been banned. Many nations restrict use to those who are 16 years and older.
Helmets and Safety Standards
Regulations for helmet use vary widely, with some states not specifying any helmet requirements for e-bike use. This variation helps explain the observed severity of injury differences across the US. In California, for instance, current law does not impose an age restriction to operate a Class 2 e-bike, contributing to rising serious injuries and deaths.
Increasing Public Health Concerns
According to the ACS, e-bike injuries have become more common. Pediatric populations appear particularly susceptible to serious injury, with studies noting higher rates of accidents involving motorized vehicles and greater incidence of head injuries. For instance, a study of 561 Israeli pediatric patients noted higher rates of head injuries, lower extremity trauma, and the need for orthopedic operations in the e-bike cohort compared to conventional bicycles.
Key Decision Points for Policymakers
The ACS recommends several key actions for policymakers to address the growing public health concerns related to e-bikes:
- Extending Helmet Laws: Helmet mandate legislation is effective, reducing head injuries significantly. Enforcement of existing helmet laws should be supported, and requiring motorcycle helmets for faster e-bikes should be considered.
- Enforcing Speed and Rider Limits: Strengthen e-bike manufacturing and product safety standards to prevent speed limiter deactivation, with fines for removing speed regulators.
- Changing Nomenclature: Using terms like “e-moped” or “e-motorcycle” could provide greater clarity to purchasers about the risks of these vehicles.
- Requiring Licenses for E-Bike Operation: Consider licensing and registration requirements for e-bike users under the age of 18 (or for all ages).
- Improving Road Safety Design: Promote urban design that supports bicycle lanes and safe routes for e-bikes.
- Increasing Education and Awareness: Implement greater public education efforts about e-bike risks and safety.
- Standardizing Laws: Address the wide variability in international and state laws to promote rider safety and assist law enforcement.
ACS Advocacy and Legislative Actions
In 2021, the death of a 12-year-old after a Class 2 e-bike crash catalyzed a statewide discussion of e-bike hazards in California. This led to the introduction of AB 1778, which creates an e-bike enforcement pilot program in Marin County and prohibits individuals under the age of 16 from operating a Class 2 e-bike.
Conclusion
The rise in e-bike use, especially among children and adolescents, presents a significant public health challenge due to the associated increase in injuries and fatalities. The ACS emphasizes that while e-bikes offer economic and environmental benefits, their higher speeds and potential for severe injuries necessitate urgent action. Policymakers must address key issues such as helmet mandates, speed regulations, and public education to enhance safety. Surgeons and public health officials play a crucial role in advocating for these changes to mitigate risks and ensure safer e-bike use globally.