In their paper published in this issue of Trauma Surgery & Acute Care Open, Luceri and colleagues¹ document e-scooter-related traumas that were presented to an Italian Orthopedic Center emergency department during 6 months in 2021. This retrospective case review was paired with a literature review describing the nature and cause of injuries sustained from e-scooter use. Their findings offer insight into the specific mechanisms and injury sites of e-scooter-related traumas and shed light on the epidemiology of the injuries that are sustained. Their retrospective case review cannot capture exposure to e-scooter usage, which is crucial in determining risk. For example, their finding that most injuries occurred during the day may be a function of greater scooter use during those hours rather than daytime riding being riskier. The authors’ findings were largely corroborated by their literature review which found similar injury profiles among e-scooter riders across five countries. The authors conclude that while e-scooters are an inexpensive and climate-friendly mode of transport, mitigation of e-scooter injury risk is necessary through the implementation of effective policy.

E-scooters represent a new source of injury but also an opportunity for new types of interventions. Rider education, training, and laws are necessary but not sufficient to address the injury risks that are associated with e-scooter use. An emerging approach to road safety, known as safe systems, aims to eliminate road injuries through better design of the road system itself,² creating roadways and vehicles that are inherently safe instead of relying on road users to promote safety.³ For e-scooters, a safe systems approach would modify the roadway environment to include dedicated, protected lanes for e-scooter riders. Cities regulating the use of e-scooters could use GPS monitoring systems to limit the speed a scooter can travel in high-risk areas. The National Mall in Washington, DC and Baltimore City’s Inner Harbor in the USA are examples of ‘geo-fenced’ areas where e-scooter speeds are limited to a few miles per hour to protect the safety of both the rider and the pedestrians. Recognizing that access to transportation is a social determinant of health, policymakers can also address gaps in mobility through regulations that require shared e-scooters to be distributed in a way that increases e-scooter access in underserved neighborhoods.⁴

As Luceri et al highlight in their article, e-scooters are here to stay. Ongoing demand for their use indicates that these vehicles are addressing unmet mobility needs, particularly for young people. Through a safe systems approach, policy makers and injury prevention practitioners can balance the goals of maximizing mobility while optimizing safety.