Injury characteristics, helmet use and post-crash behavioural intentions among micromobility users: a prospective study from a German metropolitan emergency department

Background Micromobility vehicles, including bicycles, electric bikes/pedelecs and electric scooters, are increasingly popular worldwide. Helmet use remains low; this study investigated post-crash behavioural intentions and reasons for helmet non-use among injured users. Methods Adults (≥18 years) presenting to an urban German level I trauma centre emergency department after a micromobility crash between January and December 2023 were invited to participate. Clinical data were extracted from records, and participants completed a questionnaire covering demographics, crash circumstances, helmet use, alcohol consumption, prior crashes and future intentions. Results Among 291 participants (mean age 42.4 years, 52% male), most crashes involved bicycles (75%), followed by electric bikes (13%) and electric scooters (11%). Overall helmet use was 37%, lowest among electric scooter riders (10%). Non-helmeted riders sustained more head injuries (32% vs 18%; OR 2.12, 95% CI 1.17 to 3.86). Reasons for helmet non-use included lack of ownership (30%), no prior crashes (20%) and forgetting (16%). Nearly half of non-helmeted riders intended to wear a helmet in the future (47%), while self-reported alcohol consumption was associated with lower intentions for future helmet use (p=0.049). Most participants (85%) intended to continue vehicle use, varying by vehicle type and helmet status. Discussion and conclusions Low helmet use across micromobility modes was accompanied by practical and individual barriers to helmet wearing. Post-crash helmet intentions varied substantially, while alcohol use and vehicle type were associated with these responses. Understanding these behavioural patterns may contribute to future injury prevention efforts.