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Invited Commentary
Emergency Medicine
January 25, 2019

Shareable 2-Wheeled Vehicles—A New Public Health Problem?

Author Affiliations
  • 1Harborview Injury Prevention and Research Center, University of Washington, Seattle
  • 2Editor, JAMA Network Open
JAMA Netw Open. 2019;2(1):e187407. doi:10.1001/jamanetworkopen.2018.7407

Injuries are the most common cause of morbidity and mortality in young adults, driven both by risky behavior and exposure to products, devices, and environments that increase the risk of injuries. The article by Trivedi and colleagues1 reports on a new risk to youth, electric scooters. These devices, along with manual and electric bikes, are increasingly available for short-term rental in cities around the world, providing a quick and easy means of transportation for relatively short distances.

These shareable 2-wheeled vehicles represent the confluence of a number of factors. Traffic in many large cities has become increasingly nightmarish, especially at times of commuting to and from work. Many young adults living in cities do not want the expense of owning, maintaining, and parking a car. Ride-hailing companies like Uber and Lyft have grown dramatically and use of them by young adults is an everyday occurrence for many.

Any vehicle, especially those used in traffic, do pose a risk of injury, as shown in the article by Trivedi and colleagues.1 In 2016, 4780 people died from motorcycle crashes in the United States,2 the most common cause of death being traumatic brain injury (TBI). Motorcycles, per mile driven, have about 29 times the rate of death compared with passenger vehicles.3 The most common cause of serious morbidity and mortality in bicycle crashes is TBI, accounting for about two-thirds of hospitalizations and three-quarters of deaths.4 There are a number of means to prevent these serious injuries. Motorcyclists require a separate license in most states, and courses instructing on safe use are common.

Use of helmets are required by motorcycle riders in 19 states and the District of Columbia, and use is associated with a 37% reduction in fatalities.5 Bicycle helmets have been shown to reduce the risk of TBI by as much as 88%6 and are required in many cities and states across the United States. Cities have built bike lanes to separate bicycles from both pedestrians and motor vehicles to decrease the risk of injury.

Shareable 2-wheeled devices turn all of this on its head. None of the companies that rent these vehicles in the increasingly common hubless system provide helmets. Moreover, what types of helmets should riders wear? The American Society for Testing and Materials standards for bicycle helmets do not cover uses on motorized vehicles, whether they be electric scooters, mopeds, or motorcycles.7 It is highly unlikely that an individual using a shareable electric scooter or electric bike would use a motorcycle helmet, even if one were provided. There are no data on whether bicycle helmets would provide adequate protection against serious TBI for these motorized devices, which can attain higher speeds than would be achieved by most bicyclists on flat roads. And where should users of these electric devices ride? In the street with traffic? On sidewalks with pedestrians? In bike lanes with pedal bicycles?

Trivedi et al1 found that only 4.4% of riders treated for injuries and 5.7% of riders observed in the community were helmeted. The presence of so many unhelmeted users of 2-wheeled vehicles may provide an example to bicycle riders to also forgo helmet use, potentially undoing 2 decades of work to increase helmet use by bicyclists.

We are not troglodytes trying to stuff the genie back in the bottle. Use of rental 2-wheeled vehicles, many of which are now electric, is here to stay and will only grow given the forces that have created the phenomena and the companies seeking to promote the model and increase their profits. Action, however, is needed by a number of players. The Consumer Product Safety Commission should test different helmets for these various devices and label them according to the vehicle in which their use is appropriate. Just as helmet manufacturers responded to the increased demand for bicycle helmets with new and attractive products priced very affordably, these manufacturers should develop and promote use of helmets appropriate for electric scooters and bikes. The companies renting both motorized and unmotorized 2-wheeled vehicles should make appropriate helmets available; failure to do so is like a car rental company renting cars without seat belts. Cities can and should require provision of helmets as part of their contracts with the companies (yes, the cities do have contracts with the companies). We as purveyors of health care and public health should partner with these other players to ensure that these companies are not creating a new public health problem.

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Article Information

Published: January 25, 2019. doi:10.1001/jamanetworkopen.2018.7407

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Rivara FP. JAMA Network Open.

Corresponding Author: Frederick P. Rivara, MD, MPH, Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Ave, PO Box 359960, Seattle, WA 98104 (fpr@uw.edu).

Conflict of Interest Disclosures: None reported.

Trivedi  T, Liu  C, Antonio  SLM,  et al.  Injuries associated with standing electric scooter use.  JAMA Netw Open. 2019;2(1): e187381. doi:10.1001/jamanetworkopen.2018.7381Google Scholar
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.  Web-based Injury Statistics Query and Reporting System (WISQARS). http://www.cdc.gov/injury/wisqars. Accessed November 7, 2018.
National Highway Traffic Safety Administration.  Traffic Safety Facts, 2015: Motorcycles. Report No. DOT HS-812-353. Washington, DC: US Department of Transportation; 2017.
Sacks  JJ, Holmgreen  P, Smith  SM, Sosin  DM.  Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable?  JAMA. 1991;266(21):3016-3018. doi:10.1001/jama.1991.03470210084038PubMedGoogle ScholarCrossref
National Highway Traffic Safety Administration.  Traffic Safety Facts, Laws: Motorcycle Helmet Use Laws. Report No. DOT HS-810-887W. Washington, DC: US Department of Transportation; 2008.
Thompson  RS, Rivara  FP, Thompson  DC.  A case-control study of the effectiveness of bicycle safety helmets.  N Engl J Med. 1989;320(21):1361-1367. doi:10.1056/NEJM198905253202101PubMedGoogle ScholarCrossref
American Society for Testing and Materials (ASTM) International.  ASTM F1447-18, Standard specification for helmets used in recreational bicycling or roller skating. https://www.astm.org/Standards/F1447.htm. Accessed December 19, 2018.
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