Assemblymember Damon Connolly (D-San Rafael) introduced Assembly Bill 1778 to authorize Marin County and its cities to establish a pilot program prohibiting individuals under the age of 16 from operating class 2 electric-assist bicycles.
The proposed legislation enhances street safety by strengthening enforcement and also mandating helmet usage for all class 2 e-bike riders. As trauma surgeons at MarinHealth Medical Center who routinely treat bike crash victims, we strongly support this legislation.
While e-bikes may represent an environmentally friendly mode of transportation, the increasing usage also poses inherent risks without proper education and training, especially for our youth. Recently, we have noticed an increase in serious injuries and deaths in riders of e-bike crashes at a different level of seriousness not seen previously in our pedal-bike crash victims.
Last fall, an active, healthy, intelligent young rider was seriously injured. We are grateful the family has granted permission to share this story.
Our patient was brought into the Trauma Center after crashing on the e-bike traveling approximately 20 mph. A serious life-threatening head injury requiring emergency surgery was diagnosed. The lifesaving operation performed by neurosurgeon Dr. Blake Taylor was successful due to the prompt response of the Trauma Center team.
After six weeks in the Intensive Care Unit and three months in the hospital, the young patient returned home.
This near-fatal crash was a catalyst for the introduction of AB 1778. We thank the Marin IJ editorial board for endorsing AB 1778 (“Assemblyman’s bill for e-bike safety rings true,” Jan. 12), which is sponsored by the American College of Surgeons California Chapters. The support coalition includes the San Francisco Marin Medical Society, the Marin County Bicycle Coalition, the California Medical Association and the American Automobile Association. We also thank MarinHealth Medical Center CEO Dr. David Klein for sending a letter of support on behalf of the Marin Healthcare District Board of Directors.
In our Trauma Center, the injury pattern after e-bike crashes is more similar to motorcycle crash victims than pedal-bike crash victims. Riders in e-bike crashes were more likely to require hospital admission than those injured from a regular bicycle, with an order of magnitude higher risk of death.
Current law allows children under 16 to operate a class 2 e-bike, some of which can reach speeds of 20 mph with a throttle alone (similar to a moped), which helps explain why serious injuries and even deaths are happening. AB 1778 will extend existing laws prohibiting youth under 16 from operating class 3 e-bikes to also include class 2, which played a role in our patient’s accident.
Unfortunately, similar cases have been reported by trauma surgeons across the Bay Area, California and the nation. In February of 2024, researchers at the University of California, San Francisco reported a 49-fold increase in e-bike riders with head trauma nationally over the past five years. They agree with our conclusions, and Marin County Public Health Officer Dr. Matt Willis, that a lack of safety regulations such as mandatory helmets, speed limits for e-bikes and age restrictions contribute to this emerging public health concern.
Similar findings internationally motivated the Netherlands to limit e-bikes to 15 mph (routinely verified by police inspection) and set the minimum age of ownership to 16.
AB 1778 was passed on Monday. Now, it is headed to the state Senate. The Marin County Civil Grand Jury recommends the county government and each of its municipalities adopt rules limiting use of class 2 e-bikes to operators 16 and older, and require all class 2 e-bike operators to wear helmets. The final task will be for Marin County Supervisor Mary Sackett, a safe e-bike rider and advocate of AB 1778, to introduce the legislation in the Marin Civic Center.
We dedicate this to our young patient. We are grateful for the willingness to share this story, which has been the impetus for important safety regulations. We wish all the best.
Dr. John Maa is a surgeon with the MarinHealth Medical Center Division of General and Acute Care Surgery and was the 2018 president of the San Francisco Marin Medical Society. Dr. Edward Alfrey is the MarinHealth Medical Center director of trauma surgery and chair of the Marin Healthcare District Board.
