Sure, e-bikes seem fun. Until you're on my operating table. | Opinion

I was the brain surgeon on call in the Marin County, California, hospital one evening when the emergency room paged me. A 15-year-old girl came into the hospital with severe head trauma after falling off a friend's e-bike, within seconds of trying it out.

Immediately, we discovered that her skull was fractured and that the large blood vessels surrounding her brain were torn. The blood was pouring out of the vessels, rapidly pooling inside her brain, pressing and squeezing her brain stem – a vital brain structure that controls breathing.

The pressure inside her skull was rising rapidly and, if not treated immediately, it could have caused irreversible brain damage. I rushed her into my operating room, drilled and removed the entire right side of her skull.

I vacuumed up the blood and stopped the bleeding at its source. It was a matter of life or death. It took most of the night.

In the early morning, she was helicoptered to the children's hospital across the San Francisco Bay. More surgeries, eight weeks in intensive care and a year of recovery awaited her, all because of an impulsive e-bike ride.

Sadly, she wasn't my only young patient who suffered injuries as a result of electric bikes. There have been a succession of patients who have fallen off e-bikes and e-scooters – one patient only 5 years old – who I've treated with these traumatic brain injuries that require emergency surgery.

E-bike injuries aren't getting enough attention

What is missing from the debates surrounding e-bike freedoms and regulation is the focus on the injuries that happen when youths crash their bikes.

If parents, youths, the public and elected officials only knew. If they could see the internal injuries and what happens in my operating room, and in many trauma centers across the country, and what it takes to save these lives or prevent devastating disabilities, maybe they would rethink their priorities.

I, along with a growing number of physicians and legislators nationally, are advocating for e-bike education, training, commonsense regulations and enforcement.

These e-bike injuries are not like those associated with traditional bikes. They are more like motorcycle injuries, and the risk of dying is greater. Those who survive may deal with concussions, comas, skull fractures, tearing of brain tissue, brain swelling and bleeding.

E-bike crashes often lead to brain injuries

Why are these injuries so devastating to the brain? Many people don't realize that blood is toxic to the brain (when outside of normal blood vessel walls) and can damage or kill brain tissue.

Then there's the problem of brain pressure. Because the brain is encased in a hard, inflexible skull, if the brain swells, it cannot expand and thus presses up against the skull.

The pressure builds quickly and damages brain tissue. There are other complications, too.

Often, these brain injuries occur with other bodily injuries: They include broken spinal cords, pelvic bones and facial bones.

We are discovering that e-bike's powerful motors, sudden acceleration, heavy weight, high speeds (some exceeding 30 mph) and momentum can cause riders to lose control.

Young people often don't wear helmets and aren't trained to use electric vehicles. Nor are they educated about traffic rules.

Youths can modify e-bike maximum speeds with software fixes. Add to this mix the rise of illegal bikes, with speeds of 70 mph, that are advertised as e-bikes and, which officials say, are becoming status symbols among teenagers who are too young to legally drive cars.

Riders are not the only ones getting hurt. E-cyclists are also hurting or killing others. Recently, in the suburbs of San Francisco, an e-bike collided with a car, causing a chain reaction accident that left a 4-year-old who was playing on the sidewalk dead.

In Davis, California, a nurse riding her conventional bike collided with an e-bike. She fell, hit her head and died. Pedestrians are being hit, too, as has happened repeatedly in New York City.

Regulations and common sense can reduce risk

E-bikes are gaining popularity even as more variations of them being produced. Meanwhile, states have patchworks of legislation trying to regulate their speeds, power, rider ages, helmet usage, permitted paths, licensing, registration, consumer disclosure requirements and illegal modifications.

In California, for example elected officials have proposed at least nine e-bike bills since January. Not all of them were approved, but some are still under consideration.

Communities like Hillsborough, California, are getting the word out. Holding town halls, education and training sessions for parents and youths, e-bike safety social media contests, and youth commission seminars.

There are steps we can take now. Let's listen to our national medical associations. The American College of Surgeons, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons and the American Academy of Orthopaedic Surgeons have all issued safety recommendations for e-bike and e-scooter injury prevention:

• Promote helmet use.
• Limit top speeds.
• Enforce safe-riding practices.
• Encourage licensure and registration.
• Prohibit riding under the influence.

Parents, don't wait to take precautions. You don't want your child or teen ending up in an operating room like mine.

Blake Taylor, a neurosurgeon, is an assistant clinical professor in the Department of Neurological Surgery at the University of California-San Francisco.

This article originally appeared on USA TODAY: Sure, e-bikes seem fun. Until you're on my operating table. | Opinion

Reporting by Dr. Blake Taylor, Opinion contributor / USA TODAY

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This story was originally published July 13, 2026 at 5:10 AM.