Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we are talking about riding e-bikes and scooters, and all of the safety issues that go with that. Joining me is Dr. Rahul Sharma. He's a Barbara and Stephen Friedman Endowed Professor, Chair of the Department of Emergency Medicine, and the Emergency Physician-in-Chief for NewYork-Presbyterian Weill Cornell Medical Center.

Dr. Sharma, thank you so much for joining us today. Can you start by sharing some statistics about e-bike and scooter injuries and what you see every day?

Rahul Sharma, MD, MBA: Sure. Well, thank you for having me. We actually assessed our traumatic injuries coming into our emergency department here over five years, so from the years of 2020 to 2025. And that's when things, you know, using e-scooters, e-bikes became really popular, you know, especially after COVID and during COVID.

And what we found, over this five-year span is that about one in five of our trauma cases are actually from micro-mobility devices, so e-scooters, e-bikes, as well as bicycles. So, we're seeing a significant amount of traumas from these devices. And what we also found was that, in more than half of these cases, most of our patients were not wearing helmets. And the patients that weren't wearing helmets actually had a higher risk of having a head injury and also ending up in the ICU. These studies show that these devices, these micro-mobility devices like e-scooters and they're either crashing into other motor vehicles or people are actually falling off of them, which is resulting in the injury. That's what we have been seeing here, particularly at our site.

Melanie Cole, MS: Dr. Sharma, as we're seeing more of these e-bikes and scooters, and I see them because you can rent them now, right? You can rent those scooters just get yourself around, and I agree with you, I never see anybody wearing helmets on them. What are the most common injuries that you do see? Although I do have an idea of what you're going to say. But also, how is it different, if you've noticed, those injuries between traditional bicycles and the injuries that we've seen for years with those?

Rahul Sharma, MD, MBA: One thing I would emphasize is that this isn't just riding a faster bicycle. It's actually a motorized vehicle, and the physics of the crash have changed entirely. We're no longer just treating scraped knees and broken wrists. We're actually seeing high-velocity trauma, severe concussions, traumatic brain injury, facial fractures, and complicated orthopedic injuries like broken legs, pelvic fractures, hip fractures. And these used to be typical more in car crashes and motorcycle crashes. But now, we're also seeing these in these e-bikes and e-scooters.

And just a reminder, these e-bikes that we see, they can reach speeds up to 25, 30 miles per hour, and they can accelerate instantly. So when you combine that speed with the heavier frame as well as the battery, the force that's transmitted during the crash is dramatically higher than a traditional bike. Now, e-scooters in particular are very vulnerable because of their small wheels. So, something as common as a pothole, for example, or even like an uneven street plate can abruptly stop the wheel, throwing the rider forward, resulting in a significant injury.

Now, the other thing that we've also seen are pedestrians being struck by these devices. Now, the pedestrian, there's two types of injuries. The pedestrian, there's an injury from getting struck by one of these scooters or e-bikes. And then, there's another secondary injury from falling down. So, many times they'll get struck, and then they'll fall down, and then they'll hit their head, break their hip, or fracture their pelvis. So, those are the types of injuries that we're seeing.

Melanie Cole, MS: Wow, you gave me kind of the wiggles when you were talking about hitting potholes and those scooters, they go pretty fast as well. And so, I mean, when we think about these, if you were to give the most important bit of safety information for people riding these e-bikes and these scooters, I'd like you to give it now, but also tell us, do helmets really make that big of a difference?

Rahul Sharma, MD, MBA: As an ER physician, I can tell you that wearing a helmet can be the difference between a person walking out of the ER with a mild concussion or having to go to the ICU. All helmets are not created equal. It's important to also check that you're using the right helmet the device that you're actually using, and also if it's the right size.

Now, we found that there were many people about a third of our injuries had head injuries. Helmets are the baseline. You know, for scooters, you know, I would also say that wrist guards are also critical. So instinctively, if you're on a scooter and people fall, they put their hands out to break the fall, then that results in wrist fractures, other upper extremity fractures. But the data is pretty clear that, if you're not wearing a helmet, your chances of having a serious head injury as well as ending up in the ICU are higher.

Melanie Cole, MS: So, Doctor, I mean, we are seeing both of these things in the cities available to rent, you know, kind of like the Divvy bikes. We're just seeing them. You can just rent these scooters and these e-bikes to, you know, bop around the city. And so, as you say, most people are not wearing helmets. But also, they're becoming something that kids are begging their parents for. Teens are saying, "Well, since I can't drive, can I use this e-bike, a scooter to get around?" We even have some kids that I see going back and forth by the sidewalks by our house. So if you're speaking to parents just now, what advice would you like to give them about buying one of these devices, one of these, you know, pieces of equipment really is what they are for their children or teens?

Rahul Sharma, MD, MBA: One thing I will tell you is age is just a number. What's more important, maturity, judgment, and awareness are what really matter. So as many people are aware, teenagers are developing and learning how to work with their surroundings. Now, pairing a device that's capable of going up to 30 miles an hour in a busy city like New York with traffic is a real concern.

Now, if you looked the average age of injured riders is about in, the mid to late 30s, which tells you that it's just not a kid issue. But the one thing that I will tell you is that there's a checklist that I would recommend before you consider buying any of these devices.

First of all, is your child or is the person that wants to buy one of these, are they comfortable handling a regular bike? Now, if you're not good or comfortable at riding a regular bike, it's probably not a good time for you to then go purchase an e-bike or e-scooter or one of these devices and just go out and ride them. Does your child or, you know, loved one, do they understand the traffic rules? Do they understand the concept of what blind spots Because many drivers that are riding these motor vehicles, cars, have blind spots, and you have to be aware that sometimes you might not be visible, when you're riding one of these devices.

And I always tell people, "You could do everything right. You could follow the rules. You could be wearing a helmet. But how do you anticipate other people's behavior? What is your reaction time, and how are you able to respond to the action of other drivers?" That's really key. And you have to make sure that, you know, the person that is going to be riding one of these devices is capable of anticipating other people's behaviors.

A legal reminder, if you're in New York City, riders must be 16 years old, to either operate an e-bike or an e-scooter. So if you have a teenager, 10, 12, 13, 14 years old, it might not be the right time to get them one of these devices.

Melanie Cole, MS: Yeah, that's really good advice. And you made a good point, which leads well into my next question. So, I mean, obviously, when we're teaching our teens to drive, all of those points that you just made, how do you anticipate? How do you think about what could happen? And that's what makes a good driver.

So when we think of people in their 30s, 20s, 40s, who's ever using these, anticipating what's going on, what do you say about the safety looking around? Because a lot of crashes happen at intersections, maybe cars aren't seeing them. And this is what we've heard, Dr. Sharma, really about motorcycles for all of these years, is these intersection accidents that happen because cars or trucks just don't see them. What would you like to tell the people riding these things about making sure that they are safe by making themselves known, letting the cars, trucks, not coming up around, not skipping lanes, not, you know, riding in lanes that they shouldn't be riding in? What would you like to say?

Rahul Sharma, MD, MBA: Well, the first thing I want to emphasize is that right of way doesn't protect you from physics. What do I mean by that? Well, there's this blind spot threat. Fast-moving e-bikes and scooters are often invisible to car drivers, you know, especially on the right side and at intersections. A lot of the cars that are going, you know, are going straight and you might be in a blind spot, so they might not even see you if you're on one of these devices.

And then, there's this green light trap. Many injuries happen when people on these e-bikes, e-scooters assume that a green light means that you're safe, that it's completely fine to go through. Drivers that are actually making turns are not really looking for e-bikes and e-scooters. They're looking for other cars and they're looking for pedestrians, not these smaller, faster vehicles like an e-bike that's going 30 miles an hour. So, you have to be aware of that as well. And we're also seeing this impact just beyond the riders. You know, in our data that we looked at, we actually see a significant amount of pedestrians also that are actually getting struck by these devices. And these injuries can be severe, both not only for the e-bike, e-scooter rider, but also for the pedestrian.

And the other advice that I would give is that, you know, there has to be pedestrian respect, okay? You shouldn't be riding an e-bike, e-scooter, or any of the things on the sidewalk. It's important. It protects not only the rider, but it also protects the pedestrian.

And, you know, while we're talking about e-bikes, you know, we also have to be aware that as pedestrians, we are at equal risk of getting injured. So as a pedestrian, you know, some things that you could do to protect yourself are if you're crossing the street and it's a one way, don't just look in the one way. Look on both sides, because sometimes one of these scooters or e-bikes might be coming the other way and you don't expect it and you get struck.

Also, when you're stepping off the curb, look in the bike lane These bikes and e-scooters are coming very fast sometimes. And when you don't expect it, that's when you get struck, resulting in a serious injury. Establish eye contact. I always say when you see these riders, both who are in cars as well as on these e-bikes and e-scooters, the chance of you getting hit are less because you could anticipate, they could anticipate, and they could avoid a potential collision.

The other thing that we've seen, and not only for pedestrians, but also people that are on these e-bikes and e-scooters, a lot of them have these headphones on, and then with the noise cancellation. And what that does is it gives you the sense that you can't hear anything else, but that could actually be very concerning because you might actually want the noise so then you could hear the other traffic and other things. So, what I would say is ditch the noise cancellation headphones when you are either walking, crossing intersections, or on these e-bikes, e-scooters.

Stay off your phone. You know, I know it's easier said than done, but you know, when you're on your phone and you're crossing the street, or if you're on a bike looking at your phone, you're distracted, your chances of getting injured are higher and having a serious injury.

And also at night, if you're in the city around the hours of 6:00 to 8:00 PM, that's the busy time. Everyone is ordering food. There's more deliveries. There's more delivery bikes out there. And if you're crossing the street, there is more traffic volume. So, be extra cognizant that there is more traffic and the chance of getting hit.

Melanie Cole, MS: You just gave us one of the best safety lists that I have heard in a very long time, and you made so many great points. It's so important that people hear what you just said, Dr. Sharma, so you can always rewind this and listen to what he just said again. But now, when we think of these injuries and we think of the things that can happen, which again, give me all those intrusive thoughts, how does someone recognize the red flags? If we've wiped out on one of those scooters or on an e-bike, or we've been nicked as a pedestrian. You know, I mean, I think it's different obviously, in a car, you're in a cage, and all those safety points you just made about distracted driving and paying attention and headphones, they apply across the motor vehicle spectrum, really.

But if we do get injured, what are we looking for red flag-wise from an emergency medicine physician that says, "Okay, call 911 or get off to the hospital right away"?

Rahul Sharma, MD, MBA: If you look at our data, nearly one in three of the injuries actually involved the head. Many people, you know, had other, you know, internal organ injuries as well. When you get injured, adrenaline can be very misleading. So whether you're a child, an adult, you may feel fine after a crash, but you might still have a serious injury.

So, it's important to be really cognizant and also aware that if you're having some symptoms, for example, head injury red flags, if you had loss of consciousness, even a brief loss of consciousness, you should seek medical care. If you have vomiting, if you have nausea, If you're confused or if your loved one or your child is confused after one of these accidents, or if you have a worsening headache or if your pupils aren't equal, these are things that could be concerning for head injury and that you should most definitely seek emergency care so you could have someone evaluate you.

Now, also, you know, as I said, sometimes adrenaline masks some symptoms sometimes, right? So if you were on a bike and you fell and then you went straight into the handlebar, there's something called the handlebar sign, which is like a bruising of your abdomen, which sometimes could indicate internal organ injury. So if you have severe abdominal pain or bruising, after you went into the handlebars or something like that, if you have dizziness or fainting, those are some symptoms that should be concerning that way you should seek emergency care to have someone evaluate you for potential internal organ injury.

Melanie Cole, MS: This is really such great information. Dr. Sharma, you're such an expert, and you make this so clear. And, you know, you're so very clear and specific about these safety recommendations. So as we wrap up, I'd like you to offer your best advice. Tell people what you would like them to know about safety of e-bikes and these scooters that we're seeing around the city. And are there any regulations, public education, things that you see or wish to see for the community that would help people to understand just what you're talking about here today, some regulations, what would you like to see happen?

Rahul Sharma, MD, MBA: We need an infrastructure and education that matches the technology. So, these injuries that we're seeing from these micromobility devices like e-scooters and e-bikes are now consistent and growing reason for ER visits in urban centers, not just New York, but everywhere.

And where do we need to go with this? Well, what I would recommend is, number one, we need a point-of-sale education. What do I mean by that? So when you buy one of these devices, there should be an emphasis at the store on safety guidance, on regulations, and other guidelines that might be helpful to the person who's purchasing that device.

We also need better infrastructure. You know, there are bike lanes, but we have to make sure that the bike lanes are protected. Not just painted lines, but really support in a way where both our pedestrians as well as our e-scooters, e-bikes, and regular bicyclist can feel safe. And then, we also need stronger enforcement. You know, obviously, as I've mentioned, some of these bicycles and e-bikes can go 30, 40 miles an hour even sometimes. We need to make sure that those enforcement rules of speed are enforced because the higher the speed, the higher the velocity, the higher chance of either the rider or a pedestrian having a serious injury

One other practical advice that I'd like to just mention is, you know, practice first in a safe space. Your ride on one of these devices should not be on a busy New York street for the first time. Go into an empty parking lot or park path. Practice emergency braking or sharp turns until it really becomes routine.

And, you know, my final perspective is that these devices aren't going away. They're part of our culture, how our cities move on. The goal isn't to eliminate them, but to make sure that our kids and our entire community use them safely. And from what we see every day in the ER, small decisions like wearing a helmet can make a life-changing difference.

Melanie Cole, MS: Thank you so much, Dr. Sharma, for joining us today and sharing your incredible expertise about something that people really are curious about. And they want to try, and they see people whizzing by, and they're like "Ooh, they're getting wherever they need to go in such a fun way." But you're seeing the result of that and those injuries. So, thank you so much for coming on and speaking so very clearly about the risks involved. Thank you again.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, iHeart, and Pandora. And for more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast, so many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.