While the popularity of electric bikes is surging, so are the injuries. An NBC Bay Area investigation offers an exclusive first look at soon-to-be-released data from top transportation experts, which reveals a more than 350% spike in e-bike-related injuries across the country.
Medical officials say the rise in e-bike popularity has resulted in a disturbing phenomenon in emergency rooms throughout America that has left riders with serious and even fatal injuries that far more resemble that of motorcycle crashes than accidents involving conventional bicycles.
While e-bike advocates continue to tout the vehicles as a safe and eco-friendly alternative to cars, top industry voices acknowledge “deceptive” marketing practices by some manufacturers that appear to target the youngest and most vulnerable of riders. As the NBC Bay Area Investigative Unit discovered, products advertised as “e-bikes” are often capable of traveling at speeds far beyond what is legally allowed.
“It’s scary,” said Amelia Stafford, who at just 15 years old was forced to relearn how to walk, talk, and even breathe following a crash on an electric bike. “I look back at photos of myself and it’s like, ‘Oh, my God – that was me.’”
I look back at photos of myself and it’s like, ‘Oh, my God – that was me.’
Amelia Stafford, who miraculously survived an e-bike crash that left her with a serious brain injury
Stafford, who is now 17, said she doesn’t remember much about the accident that left her hospitalized for two months.
“I was pretty much blacked out,” she said.
It was on Sept. 9, 2023, when emergency crews rushed Stafford to the hospital after she was ejected off the back of an electric bike just a few blocks away from her family home in Marin County. She suffered a severe brain injury and spent a week in a medically induced coma. She, ultimately, underwent five surgeries, which included procedures to rebuild her skull after nearly half of it was crushed from the impact of the accident.
“We were very realistically prepared for the worst,” said Scot Stafford, Amelia’s father. “I thought she either could die, was dying, or that if she did come back, it wouldn’t be her.”
Amelia’s skull was so severely damaged, doctors needed to replace nearly half of it with an implant
Amelia described the electric bike she was riding on as feeling more like a motorcycle or moped than a standard bike.
“It’s almost hard to consider that a bicycle,” she said. “It was really fast.”
While pedal assist e-bikes give you a motorized boost while pedaling, throttle e-bikes – like the one Amelia was on – do not require you to pedal. To accelerate, riders on throttle e-bikes need to simply twist the grip or push a button.
Anyone under 18 riding any kind of bike is required to wear a helmet in California. Amelia, however, was not wearing one when a friend invited her to hop on his brand-new e-bike for a “quick ride.”
“I got on un-helmeted because I was just thinking, I’m going to only be on it for about two seconds,” she said.
A sudden jolt of speed immediately threw her onto the street.
“It’s hard to put into words how hard that experience was,” she said. “It was really painful.”
Her skull was fractured so severely doctors needed to replace roughly half of it with an implant.
“Keep in mind, we didn’t buy a bike,” said Amelia’s father, Scot Stafford. “They’re just out there in the ecosystem. If this could happen to us, it could happen to anybody.”
Rules of the road for e-bikes
In California, motorcycles, mopeds, and even motorized scooters require a driver’s license and come with age restrictions, but throttle e-bikes do not have those requirements. The California DMV does mandate that throttle e-bikes possess motors that autonomically shut off once they exceed 20 miles per hour. Similarly, state laws cap motor assistance for pedal assist e-bikes at 28 miles per hour.
The NBC Bay Area Investigative Unit, however, was able to easily find e-bikes advertised online with speeds roughly double that, listed by companies willing to mail those e-bikes to California despite state laws prohibiting such speeds.
“But yet nobody’s enforcing it,” said Monica Stafford, Amelia’s mother. “We have these rules that somehow make us think that we have a system, but it’s the Wild West.”
We have these rules that somehow make us think that we have a system, but it’s the Wild West.
Monica Stafford, Amelia’s mother
The Stafford family is now pushing for new national regulations to standardize what qualifies as an electric bike. They’re also calling for increased restrictions for the youngest of riders.
“I, passionately, believe that we need national standards that will really make kids safer, people safer, and ultimately make biking more sustainable,” Monica Stafford said.
E-bike advocates argue the heightened concern over electric bikes is misguided and should be focused on the high-powered rides “deceptively” labeled as e-bikes.
“You kind of muddy the water and make it nearly impossible to figure out what we need better policy and regulations around,” said Luke Bornheimer, founder of Streets Forward, a San Francisco-based advocacy organization focused on improving safety for pedestrians and cyclists, including those navigating streets on motorized bicycles. “It’s really important to differentiate between electric motorcycles and e-bikes.”
Bornheimer fears the increasing pushback against e-bikes could result in more riders trading in their electric bicycles for cars, which are responsible for far more crashes and injuries on public roadways. In California, more than 287,000 people were injured in automobile-related crashes in 2023 — that’s roughly 60 times more injuries than those involving electric bicycles during the same time period, according to hospital data collected by the Mineta Transportation Institute at San Jose University.
“We are hampering people from shifting trips to bikes, which would help decrease car traffic, decrease noise and air pollution, and decrease carbon emissions,” Bornheimer said in reference to ongoing criticism of e-bikes. “These efforts are well intentioned, but they’re oftentimes not fully thought out and are having unintended consequences.”
It’s really important to differentiate between electric motorcycles and e-bikes.
Luke Bornheimer, founder of Streets Forward
Biking industry acknowledges ‘deceptive’ marketing to youth
The People For Bikes Coalition, which describes itself as the “sole U.S. trade association for manufacturers, suppliers and distributors of bicycle products, including electric bicycles,” acknowledges a growing problem within the industry. According to the organization, products are being “deceptively sold as ‘e-bikes’ that are not lawful electric bicycles” in order “to avoid federal safety standards for motor vehicles and allow users to go faster than legally allowed.”
The trade association, in a statement to the NBC Bay Area Investigative Unit, also noted that “worse, these devices are promoted to youth who are too young to drive, do not have a motor vehicle operator’s license and have not had driver training.”
Attempts to toughen regulations stalled in California
In California, state legislation was pitched earlier this year to crack down on illegal advertising and restrict what actually qualifies as an e-bike. Senate Bill 455, authored by Sen. Catherine Blakespear (D-Carlsbad), set out to create a new category of vehicles called “low-power mopeds” in an effort to better classify products deemed “too powerful” to be considered electric bicycles. The legislation, however, failed to garner enough support from lawmakers.
Meanwhile, e-bike popularity continues to pick up speed. Sales in the U.S. have quadrupled over the past few years, according to the U.S. Department of Energy. This year alone, it’s estimated more than 2 million e-bikes will be sold across America, according to eCycleElectric, a consulting firm specializing in electric vehicles.
Despite the surge, communities have struggled to understand the safety risks, in part, because injury data often lumps e-bikes with other modes of transportation, such as skateboards and scooters, making it difficult to track the prevalence of e-bike injuries.
As a result, California lawmakers approved Senate Bill 381 back in 2023, which formally requested the Mineta Transportation Institute to research e-bike safety issues, in part, by analyzing state and national hospital records. The legislation also required researchers to release a full report on their findings to the state legislature by Jan. 1, 2026.
The NBC Bay Area Investigative Unit got a first look at the data, which reveals 4,757 people in California were injured while using an electric bike in 2023. Conventional bikes, which outnumber e-bikes by the millions in America, produced 44,039 injuries during the same year.
E-bike injuries, however, were generally much worse, according to researchers at the Mineta Transportation Institute – with 17% of e-bike riders going to the hospital, compared to 12% of those who were on standard bicycles.
The Mineta Transportation Institute also examined national statistics from a sample of 96 hospitals across the U.S. by utilizing data from the Consumer Product Safety Commission via its National Electronic Injury Surveillance System (NEISS). According to the analysis, e-bike injuries from 2020 to 2022 spiked 357% across the country, while conventional bicycle injuries decreased 22% over the same time period.
“Using the terminology ‘electric bike’ does not adequately communicate that these are not just bikes,” said. Dr. John Maa, a trauma surgeon of more than a decade. “What we witnessed was this pattern of very serious injury and death.”
What we witnessed was this pattern of very serious injury and death.
Dr. John Maa, trauma surgeon
After witnessing a spike in e-bike riders inside his emergency room, Maa and his colleagues at MarinHealth Medical Center began analyzing their own hospital data and found for the most serious trauma cases, those hurt while on e-bikes were dying at a rate 37 times higher than those hospitalized for crashes involving conventional bikes.
“The severity, the frequency – they were all very alarming,” Maa said. “To have a patient break 23 of their 24 ribs was something I had never seen before with a traditional pedal bicycle.”
Maa, who also serves on the board of governors for the American College of Surgeons, happened to be overseeing care in the emergency room the night Amelia Stafford was rushed in with her brain injury.
“Her case was striking because, for me, it was the first instance of a person under the age of 18 being seriously injured after an e-bike accident,” Maa said. “Amelia’s accident changed the conversation, like turning on a light switch – instantly, everyone recognized the serious risks.”
Amelia’s story pushes lawmakers to take action
Together, Dr. Maa and Amelia Stafford went on to lobby California legislators to pass a new law, that allowed Marin County to institute the state’s first-ever age restriction on throttle-powered e-bikes – requiring riders to be at least 16 years old and mandating helmets for everyone, regardless of age.
“Falls from e-bikes are not like falls from normal bikes,” Stafford told lawmakers during a hearing in May of last year. “I’m here to speak out to protect teenagers like me.”
Ultimately, the measure passed in August 2024 without a single opposing vote, which then allowed Marin County to begin instituting its pilot program of new e-bike restrictions on July 1.
“I’m incredibly proud of the work Amelia has done,” said Monica Stafford, Amelia’s mother. “That’s been a really important first step.”
It has now been more than two years since Amelia’s accident, but the teenager is still dealing with the repercussions of her injuries. As a result of the crash, she has developed epilepsy, a brain disorder that causes reoccurring, unprovoked seizures.
“It’s an upward incline … there’s been ups and downs,” she said. “I’m happy for where I am right now, but it’s been hard.”
In addition to recovering, Stafford is also still advocating – pushing for safety reforms relating to motorized bikes. While she isn’t seeking an outright ban on e-bicycles, she says her accident shows a need for tougher safety measures and said it is time for communities to shift gears.
“I don’t want somebody to go through the same thing that I had to,” she said. “If my voice can make a difference, then that’s all I really hope for.”
Contact The Investigative Unit
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