In early October, all 82 A&E departments in the Netherlands recorded data on bicycle accident victims over a week. They counted more than a thousand victims on regular bicycles and e-bikes – and, perhaps most strikingly, nearly a hundred on fat bikes. Projected over a full year, this equates to about five thousand fat-bike accident victims. “This figure is far higher than the few hundred cases we initially anticipated”, says Marcel Ariës, a neurologist-intensivist at Maastricht University Medical Centre+ (MUMC+) and researcher at the Faculty of Health, Medicine and Life Sciences (FHML). Another alarming finding: almost half of these fat-bike accident victims were children aged 12 to 15, and almost none wore helmets.
It’s concerning, says Ariës. “Fat bikes are often modified to reach high speeds, up to 70 kilometres per hour. They’re basically heavy mopeds, yet they aren’t classified as such. And children are particularly vulnerable, with their proportionately large heads and lower muscle mass. We’re seeing a lot of fractures, brain injuries and abdominal trauma from the impact of the handlebars. It’s shocking, but not surprising. We need to protect children from this.”
Stricter regulations
The hope is that these survey results will prompt politicians to push for stricter regulations “while we have the momentum”, says Ariës. Just last month, the Dutch House of Representatives passed a motion calling for mandatory helmets and a minimum age of 14 for fat-bike riders. “After conducting smaller sample surveys earlier this year, doctors took their findings and a petition to the House of Representatives with a clear message: ‘Please do something about this.’ Apparently, it resonated with politicians.”
But Ariës feels this doesn’t go far enough. “We advocated for a minimum age of 16, not 14, and for all pedal-assisted bicycles, not just fat bikes.” This would include e-bikes and the new “skinny bikes” manufacturers are promoting to circumvent anticipated regulations. “It would discourage them and dissuade children from begging their parents for an e-bike.”
Thanks to the survey, doctors now have national data to support their case. In addition to finding that many fat-bike accident victims were between 14 and 16 years old, the survey showed that a lot of e-bike accident victims were also very young: one in ten were aged 12 to 15. “This figure is lower than for fat bikes, but considering that there are far more e-bikes in the Netherlands, it’s a substantial figure in absolute terms.”
Maastricht’s role
Although most fat-bike accidents (two out of three) occurred in the Randstad region, Maastricht plays an important role in the national debate. “We in the south were the first to sound the alarm and put this issue on the agenda”, says Ariës. In 2020, he himself co-founded “Doctors for Safe Cycling”, a think tank now including over a hundred doctors across the country. They advocated for the national survey, which was carried out by VeiligheidNL.
Alongside age restrictions, Ariës stresses the importance of raising awareness, “particularly about helmet use. We need to take personal responsibility as well. Hospital staff shake their heads every time a tragic case comes in, but at the end of the day I’m usually the only one wearing a helmet while cycling home.”
Christmas gift boxes
To promote helmet use, MUMC+ launched a campaign in 2019 offering discounted bicycle helmets to staff. “We approached UM to see if they wanted to join in, but it never took off. The offer is still available… I think universities, like hospitals, should set a good example, especially if they have health and behavioural scientists among their staff. Once enough people start wearing helmets, we’ll reach a tipping point in society – though it will probably be a slow process.”
Creative solutions can also help. A few years ago, the Mental Health and Neuroscience Research Institute (MHeNs) at FHML included bicycle helmets in employee Christmas gift boxes. “That idea could easily be replicated elsewhere. Personally, I think students should be offered discounted helmets during the introduction week. Many international students come here with little or no cycling experience and suddenly find themselves navigating busy traffic. It only makes sense to offer them head protection.”
After all, accidents can happen in a split second, as Ariës knows all too well. “The danger is that many people think, ‘It won’t happen to me.’ But I see the reality every day in A&E. And you’re not always in control. The survey reflected this as well: in addition to nearly a hundred fat-bike riders, over thirty people ended up in A&E after being hit by a fat bike.”