When the Long Beach, Calif., City Council voted this spring to push e-bikes off city sidewalks, the decisive evidence came not from police crash reports but from a hospital trauma registry.
The trauma department at Long Beach Memorial had logged 168 e-bike injuries from 2023 to 2025, according to Long Beach Post News. They included skull fractures, brain damage, broken ribs and lacerations, in patients ranging from age 5 to 92, many of them teenagers. On May 14, the council agreed to draft an ordinance barring Class 3 e-bikes, which can reach 28 mph, from city sidewalks.
That sequence — a system’s injury data, then an ordinance — is repeating across the country this summer. It marks a shift in who supplies the evidence for micromobility regulation: increasingly it is health systems’ trauma surgeons and pediatric hospital leaders making the case.
To describe the Long Beach caseload, Edna Transon, RN, a nurse and program manager at Fountain Valley, Calif.-based MemorialCare, told the Long Beach Post: “They’re not scrapes, they’re not bumps, they’re not bruises, they’re not even a regular fracture, they’re way more serious.”
Last summer, the American College of Surgeons’ Board of Regents cited more than 20,000 e-bike injuries and roughly 3,000 hospitalizations a year, with only one-third of injured riders wearing helmets. The ACS board called on regions to classify e-bikes by speed, set age, helmet, training and registration rules, and build separated bike lanes.
An Omaha, Neb., rehabilitation hospital reported earlier this year that 3 in 10 of its injured children had been hurt on e-bikes.
The national and local figures give clinical leaders a national reference point as cities supply local data to match.
In San Diego, the city council approved e-bike regulations June 23 that set a minimum riding age of 12 for Class 1 and Class 2 e-bikes and require helmets for all riders under 18, according to KSND-NBC San Diego. Matthew Derkrikorian, RN, director of the emergency department at San Diego-based Rady Children’s Hospital, reported 262 e-bike trauma visits in 2024, up from zero five years earlier, and he said e-bikes are now the leading cause of trauma visits, according to the report.
“Children under 12 simply aren’t developmentally ready for the speed, weight and split-second decisions e-bikes demand,” Romeo Ignacio Jr., MD, trauma medical director at Rady Children’s Hospital San Diego, told the NBC outlet.
The pattern reaches beyond the coasts. At University Hospitals Rainbow Babies & Children’s in Cleveland, e-bike injuries tripled in 2025 and now arrive at a rate of five to six a week — head injuries, fractures and damage to the lungs, liver, spleen and intestines. Independence, Ohio, a nearby suburb, passed an ordinance in July barring Class 3 e-bikes from sidewalks and requiring helmets for riders and passengers under 18.
The severity is what separates this from earlier bike-safety debates. A 2025 study of 914 patients at NYC Health + Hospitals/Bellevue found e-bikes and scooters accounted for nearly 7% of trauma admissions from 2018 to mid-2023 — rising from less than 10% of emergency room trauma cases in 2018 to more than half by 2023. One-third of those patients suffered a traumatic brain injury, two-thirds were admitted and roughly 30% needed intensive care.
“Our study shows that micromobility injuries are producing serious brain and spinal trauma that demands neurosurgical care,” said Hannah Weiss, MD, a neurosurgery resident at NYU Grossman School of Medicine.
For health system leaders, the trend carries three implications beyond the emergency department.
1. A new civic role. Trauma medical directors and pediatric surgery chiefs are increasingly the public face of local safety campaigns, presenting registry data at council meetings.
2. Case mix. The registries these leaders cite describe a surgical, pediatric-heavy injury pattern — brain injuries, multiple operations, ICU stays — landing on trauma and children’s services.
3. Timing. The debates are clustering as the school year opens, the season when pediatric ridership climbs.
Jacksonville, Fla., is weighing a proposed ordinance after Wolfson Children’s Hospital treated 97 children for e-bike and e-scooter injuries in the first six months of 2026 — nearly its full-year 2025 total. Denver City Council is expected to vote on new rules in the coming weeks; Everett, Wash., adopted its own in July.
With more reports of e-bikes and e-scooters resulting in ED admissions, the systems treating the injuries are also the ones counting them. And that count is increasingly what tips the vote in city council meetings.
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