Tá fáilte romhaibh go léir. Apologies have been received from Senator Ruane. There is quite an amount of business taking place in the Dáil, Seanad and other committees, so members will be coming and going. I remind those members who are here to please turn off their mobile phones or switch them to flight mode. This meeting will be broken into a couple of sessions, but the purpose of this part of the meeting is to have a follow-up engagement on the topic of the use of scrambler bikes, public safety and related matters.

On behalf of the committee, I extend a warm welcome to Dr. Luke Phillips, who is a consultant in emergency medicine and trauma at the Mater hospital in Dublin, and Dr. Shane Broderick, who is also a consultant in emergency medicine at the Mater.

We will invite Dr. Philips to make an opening statement of around three minutes, and we will then invite members of the committee to ask questions in the order they have indicated. As we have an additional session today and in order to manage the committee's time effectively, I propose an initial five minutes per member to engage with the witnesses and then we can see if time permits for a second round.

Before I invite Dr. Philips to make his opening statement, I want to explain some limitations to parliamentary privilege and the practice of the Houses with regard to references that may be made to other people in any evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege. Members and witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity they will be directed to discontinue their remarks. It is imperative that they comply with such a direction.

I invite Dr. Phillips to deliver his opening statement.

I thank the committee for inviting me to appear today. My colleague, Dr. Shane Broderick, and I are consultants in emergency medicine and on the trauma service at the Mater hospital, which is one of Ireland's designated major trauma centres.

At the last committee meeting, a letter that Martin and Siobhan Lynch provided was quoted. I want to discuss some of the clinical details of patients presenting with these types of injuries from scrambler bikes and also other e-scooters and e-bikes.

The Road Safety Authority's figures given to this committee in July showed that, between January 2021 and June of this year, four road users died and 59 were seriously injured in collisions involving a scrambler. Two of the deaths and 15 of the serious injuries were not scrambler riders at all; they were pedestrians, cyclists, drivers and passengers. Of the scrambler riders killed or injured, all were male, and three quarters were 25 years or younger. These riders are exposed, travelling at high speeds in urban environments. They have little or no protective equipment. The injury profile that we commonly see is fractured limbs, but we are also seeing spinal fractures, solid organ injuries to the liver and spleen, and severe traumatic brain injuries needing neurosurgical referral. Many of these injuries carry significant morbidity and long-term recovery issues.

The picture with e-scooters is similar. In our hospital, these presentations rose steadily over two years; again, significant limb injuries were the most commonly seen, with many requiring trips to theatre and placing an increasing burden on our emergency department, ED, and inpatient units. Worryingly, 8% of our patients were pedestrians struck by someone else's scooter. The burden on the paediatric population has also been well documented recently, with over a third of traumatic brain injury admissions in children being e-scooter related and this is a pattern we are also seeing in the adult population as well.

My medical and nursing colleagues really welcome Grace's Law and other measures that have been introduced and proposed to improve public and personal safety with the use of these vehicles. We think this should be extended to banning the import and sale of non-road legal machines, mandatory vehicle registration and the ongoing enforcement of the rules of the road and existing age limits, along with the use of protective equipment.

We feel that it is important to capture these injuries in our national trauma data. This data is now formally captured in the National Office of Clinical Audit's major trauma audit. Hopefully the audit provides a lot more information and it could be used to monitor the impact of any of these changes and the implications of legislation as well as informing future policy decisions. I thank the committee for its time. We are happy to take questions.

I thank Dr. Phillips. I remind members that questions can be put to Dr. Phillips or Dr. Broderick in the course of the deliberations. I will now open up the contributions. I ask the members to keep the interactions to within five minutes.

I thank the witnesses for their opening statement. I represent Dublin Mid-West, where we have seen users of e-scooters and scramblers terrorising our communities for more than a decade. This was not as prevalent when I was growing up but it has been going on for the past ten years. The vehicles are often used to transport drugs around the area and to intimidate and frighten people. It is not uncommon to see a scrambler being driven down the Neilstown Road on one wheel. It is something I have seen on a regular basis.

An outright ban on scramblers on public roads was introduced recently. We also have new regulations on the use of e-scooters, with the age requirement to be raised soon to 18. Have the witnesses noticed any change in patterns of behaviour or numbers presenting with injury since the ban on scramblers in public places and the new regulations for e-scooters were introduced?

With scramblers, it probably is too early to say. The numbers we are seeing are small. We have had seven cases so far this year, compared with five last year and seven the year before that. This year's number is worse than last year and on par with the previous year.

Similarly, it is probably too early to tell the impact when it comes to e-scooters. The most recent iteration of the major trauma audit will be published at the end of this year. However, as it refers to 2024 data, it will not add to our evidence base in terms of the impact of regulation. We have called for e-scooters and scramblers to be treated separately, with their own data index codes as part of our major trauma audits, to allow us to monitor this as we go forward.

From a data point of view, we do not know the full extent of these injuries. There is a marked discrepancy between the various figures from the Central Statistics Office, CSO, the Road Safety Authority, RSA, An Garda Síochána, the hospital inpatient inquiry, HIPE, system, and the major trauma audit from the national office of clinical audit, NOCA. The latter largely deals with in-hospital trauma; it does not deal with pre-hospital trauma. Injuries and accidents that are not reported to An Garda Síochána are something we are not catching at all. Those incidents are happening in public parks, the bikes are being discarded and the injured parties are perhaps being patched up and taken to St. Elsewhere. They may be coming into our departments but we are not being told they have come off their scooter. Those patients might be coming up with some other reason for their injuries.

We do not know the full extent of the harm. There is a desperate need to join the dots to ensure that from a data point of view, there is collaborative reporting between all the national bodies I mentioned. I would add the Coroner Service to that list. We need joined-up thinking to make sure we have the full data picture.

Reference was made in the opening statement to different age groups. Has any data been collected on what the purpose of their e-scooter or scrambler usage was for those patients who admit to being on those vehicles? Was it for going to work or school, for example, or for another reason? The AGSI and other Garda representatives who appeared before the committee last week were of the view that the only people who will be prosecuted for breaking the law are those who are largely compliant and responsible, namely, people travelling to work but not wearing a high-visibility vest or helmet. The people engaging in the behaviour I spoke about at the start of my contribution are not compliant. They will not stop and gardaí do not have the ability to stop them. Is there any data on what people's purpose was in driving an e-scooter or scrambler?

No, not necessarily, as we would not ask patients what their purpose was in using those vehicles. Trauma presentations typically spike in the evenings and at weekends. From Thursday to Monday, we tend to get a spike in trauma cases, and we could say that is the case for injuries associated with driving e-scooters, e-bikes and scramblers. We see some patients who were injured early in the morning, who may have been on their way to work, but most of our presentations are after hours. Some of the latter could be people going home from work but the presentations are generally later than that. It would be somebody going home from town or using their e-scooter, e-bike or scrambler for some other reason.

Every year, we see a spike at Christmas in the numbers of e-scooters and scramblers purchased. People probably do not want to hear it but the fact is we are coming up to the Christmas period. What would Dr. Broderick's message be to parents who are considering purchasing an e-scooter or scrambler for their child?

I would say e-scooters are illegal for use by those aged under 16, so they absolutely should not buy one for children in that age group. We hope that age requirement will be raised this week to 18 years of age. It is as simple as that. It is illegal for parents to buy an e-scooter for a child and they should not do so. There potentially should be consequences for adults purchasing an e-scooter for an underage person.

I thank Dr. Broderick.

We will forgive the Deputy's mention of Christmas.

I will focus on the impact this issue is having on front-line healthcare services. Reference was made, if I heard correctly, to 59 individuals aged under 25 having been seriously injured. What is the average length of hospital stay for patients injured in incidents involving e-scooters or scramblers, whether they were the perpetrator, that is, the driver, or otherwise?

It really depends on the injuries they acquire. In our e-scooter study, a lot of the harm involved limb injuries and required a lot of ambulatory care, including visits to outpatient services and also to theatres. A fracture will take six to eight weeks to heal. That means somebody not being able to go to work and potentially not being able to participate in caring for children, siblings, etc. A study in the UK that looked at 79 patients presenting across the year found that the cost from a theatre point of view was approximately £200,000 for that group. We can compare that with the numbers we are seeing across this country, with a fairly equivalent health system. I do not think that data has been properly modelled. There does not seem to be a lot of joined-up thinking in terms of looking at the e-scooter-related and scrambler-related data and trying to quantify the cost. In Australia, the cost of someone presenting with an injury severity score, ISS, of less than five, which is a minor-type injury needing theatre and outpatient time, was around 10,000 Australian dollars. For a prolonged ICU stay lasting weeks, followed by rehabilitation and other care, the cost goes up to somewhere between 30,000 and 100,000 Australian dollars.

That is the issue I want to address. It is one thing breaking an arm and having to get a pin put in it or something like that. I am wondering about the patients with spinal cord injuries who will go to the ICU, have a long stint in Dr. Phillips's hospital, followed by a long stint in the National Rehabilitation Hospital, NRH, and a long recovery that possibly will require further intervention. From the statistics Dr. Phillips has seen already, whether relating to e-scooters or scramblers, what number of patients require that level of care? Is it fewer than ten, for instance?

As a spinal centre, we get patients from across the country. They are subsequently repatriated back to their local hospitals but, in the meantime, they are waiting in our H beds. There generally is only one place where spinal rehabilitation happens in the country, and that is the NRH.

How many H beds does the Mater hospital have?

We have a spinal high-dependency unit, HDU, and then a lot of patients end up in our UCU. I would have to clarify the exact numbers for the Senator.

It would be interesting to know the proportions that apply. Dr. Irwin Gill has spoken from a paediatric point of view about the totally disproportionate number of children taking up beds in Crumlin and Temple Street hospitals following injuries arising from e-scooter and scrambler accidents. The numbers coming in as a consequence of those injuries were entirely disproportionate in terms of the total number of children needing access to elective and other forms of surgery. Those children are coming to Dublin from all around the country.

We see the patients with head injuries if they also have other major trauma. The isolated head injury cases tend to go to Beaumont, so we do not have that data officially. This probably reflects how the trauma system is still a bit fragmented. The care of all these patients potentially should be in one place, which is what is being aspired towards in trauma care in Ireland. It is what we are working towards in our centre as well.

At the end of the day, it is the one HSE in your one region that is footing the bill, however we look it, so it is really what is the cost to care in Dr. Phillips's region, which is Dublin and North East. Dublin and North East has a lot of trauma centres, children's hospitals and everything coming out of it, so to speak, so it would be interesting to know the cost to the State, to the public, to the taxpayer, of these injuries and what the use of that funding for this is preventing in terms of other elective surgeries.

I will put some numbers on that. Regarding the study that Dr. Phillips has spoken about, those 380 patients in that two-year period spent 3,000 hours in our department. They spent 300 days as admitted inpatients. That was 14% of them who required admission and 11% of them needed an operation. That is the burden. It is a huge burden and a huge part of our workload they are causing. Ultimately, e-scooters are only one part of that. Scrambler victims tend to be more severely injured because they are travelling at a higher velocity and so they tend to spend longer in hospital.

The Senator mentioned the study from CHI. Those kids spent on average 18 days in hospital, which is multiples of what a child with a non-traumatic injury or non-trauma associated presentation would spend in hospital. If you extrapolate that 18-day period back to our own trauma data, on average, major trauma patients spend five to seven days admitted, and that is the whole breadth of trauma. A figure like 18 days for a brain injury just shows how severely injured these little kids have been.

Thank you.

I have a couple of short questions. The first is on the emergency department run by the witnesses and the knock-on effect there. Any time I have been in emergency departments, whether Beaumont or the Mater, I will have seen lots of elderly people sitting on chairs and trolleys and so on. It is a very uncomfortable place for them to be. Does this type of vehicular accident put a lot more pressure on waiting times for those elderly people in emergency departments?

It puts more pressure on everything. Trauma is big business for us anyway. If I can refer back again to the major trauma audit, since its first publication in 2016 up until 2022, 33,000 patient encounters were documented. The country sees about 1,600 major trauma patients every year, so it is a huge part of our workload. Trauma is the leading cause of death in the first four decades of life, so lots of young people are coming in to us. Younger people tend to have higher velocity injuries and 15% of them end up in critical care. A lot of this is going to have onward sequelae for everybody else who is waiting in the emergency department.

Our presentations have gone up across all these three demographics. From a scrambler point of view, our numbers are higher this year than last year, which we mentioned earlier. Our e-bike presentations have doubled. The study in Drogheda pooled data between e-scooters and e-bikes. Its data shows that their presentations have quadrupled. CHI’s numbers have doubled. We are already stretched and already busy from a trauma point of view. There is no doubt that these numbers are rising at an exponential rate for us and it is stretching an already overstretched system.

To add to that, a major trauma coming into our department will take up a lot of resources. That is an hour or two of a big team's work that is not seeing the patients waiting to be seen. If a person came off their bike with major injuries, that is a team of about three or four doctors. At night-time, that is our whole emergency department in terms of the NCHDs there. It takes about three or four nurses plus radiology and the inpatient teams. Some of them need to go to emergency theatre and that probably cancels out theatre for the next day sometimes because of the surgeons being in in the middle of the night. There are a lot of downstream effects that happen in hospital when these patients come in if they are sick.

Would Dr. Phillips favour a ban of e-scooters, for example?

I would not. They are a really important form of transport for people and I think people have to have autonomy to make that decision themselves, similar to bicycles and other forms of personal transport. What we can change is how we regulate it. What has happened in the past six months in Ireland has been extraordinary in terms of introducing the age limits, putting high-vis and helmets on people, and now we just need to see that being enforced and we need to see what happens with the data in the next six to 12 months now that those regulations have come in.

Grace's Law came in a few months ago. If there is enforcement, do the witnesses think that will affect the numbers in the emergency departments?

We hope so.

We certainly hope so. A law is only as good as it is enforced. Otherwise it is lip service. If it is not enforced and if people do not know that if they flout the law and might be caught and prosecuted for it, then people will carry on regardless. It has to be enforced.

To put the question in a different way, how vital is enforcement?

Vital.

I thank everyone for coming in. Would the medical profession endorse the placing on it of a legal obligation to report any reasonable injuries as a result of e-scooters or scramblers? Do the witnesses think that would be effective? Would they welcome it?

To clarify, is that in relation to kids, adults or-----

In relation to minors. As we are aware, from 2 October, new regulations will say no one under the age of 18 should be able to ride an e-scooter. As such, when a child comes into the hospital with injuries that reasonably seem to be as a result of an e-scooter accident, would the medical profession welcome legislation that puts a legal obligation on them to report that to An Garda Síochána?

We work mainly in an adult hospital, but we do see that 16 to 18 years age group, which is a tricky age group. They are gaining a bit of autonomy. There is still safeguarding issues around them. There would be a patient confidentiality aspect that we would have to think about. “I don't know how” is probably the truthful answer. I think it is a conversation that you need to have with the parents to start with, if they are available. If there is no parent around and you feel like there is a risk to that child, then we are already mandated to actually speak to Tusla and go through that process.

The medical profession has been very clear that it wants to see a ban on e-scooters before the age of 18. We see the trauma that is caused as a result of incidents. As a mother, I would be absolutely terrified if my son was involved in an e-scooter accident and, as a mother, there is no way I am going to give him the money or the means to have an e-scooter. The new legislation is a piece of the puzzle and a piece of the solution, and enforcement is a piece of the puzzle and a piece of the solution. In some respects I am questioning whether another piece of that puzzle and a piece of the solution is that when children present to an emergency department or into hospitals as a result of accidents or severe trauma that could be as a result of an e-scooter, which would effectively be against the law from 2 October, there should be a legal obligation on the hospital and the hospital staff to report that to An Garda Síochána, because effectively a crime will have been committed. Perhaps it is in the best interests of the child to also investigate how that happened and how it came about.

My second question is what the witnesses think is the role of parents in this puzzle that we are trying to solve.

We know teenagers do risky things. That is one of the parts of being a teenager and growing up and it is very hard for us to police that. We have seen that intervention programmes work really well. I worked at The Alfred in Australia for a number of years. We had a programme called the party programme where we would bring school groups through the hospital and show them the pathway of a major trauma patient.

Those types of things, going into schools and having those conversations, are probably more effective than our being the-----

I absolutely agree. Prevention is always better than cure, but the witnesses are another key component, perhaps, of the solution.

I cannot see us being the police or the Garda of-----

It is not a case of policing it. It is simply a case of reporting it where it is obvious that there has been an accident or a child has had injuries-----

In fairness, I think Dr. Phillips has answered the point. Are you happy enough, Deputy? Have you finished?

Yes. That is me.

I thank both witnesses for being here, for their work in this area and for highlighting the problem as they see it first-hand.

Geographically, have we any breakdown of the admissions? In the part of the world I and the Chair hail from, it would be less of an issue than it would be, say, in the cities, so I am just wondering whether we have any breakdown on the geographic aspect of the admissions.

The RSA figures show that 75% of the scrambler collisions are in Dublin, 6% are in Cork and 6% are in Limerick. The rest are probably spread out around the country in small numbers, I imagine. As regards admission rates, I do not have that data.

That is okay. As regards the trend internationally, which the witnesses would know from speaking to their colleagues, is this a similar problem across the globe? What is the witnesses' experience of that?

It is a similar problem across the globe. It is interesting to see the systems evolve to try to deal with this problem. Some cities, like Paris, are now moving towards outright bans. Prague is going to seriously limit e-scooter availability as well. Internationally, they are clamping down. I think Dr. Phillips quoted some figures for the cost to the exchequer in the UK. It is costing £200 million a year to deal with some of these e-scooter cases - enormous figures - so they are trying to clamp down. Both Dr. Phillips and I have trained in Australia. We were seeing it starting to come in. It has got a little worse in Australia and in the United States. Using e-bikes as an example, 200 people a year die while using an e-bike in the United States. It is a global problem. There is probably a piecemeal, country-specific approach being taken to it, but bit by bit I think people are tending to crack down, albeit in an incremental way. Some cities now are just going with all-out bans.

Is there any particular country the witnesses would point to and say that is a model we should follow, that they know of?

From an overall trauma perspective, and we have spoken a little about trauma and trauma systems, we often look towards the UK from a trauma system point of view. It would be nice to think we could get these traumas down to zero. Taking trauma as a whole, I mentioned a figure of 33,000 cases in 2016-2022, with 1,600 major trauma patients a year. To get that down to zero will probably never happen. Even over the weekend - it would be remiss of us not to mention our road trauma figures - there was the sad loss of four lives. Our figures are 12% up on last year's.

If there is something we can learn from an overall trauma point of view, it is the trauma system part. From a road trauma point of view, the vision towards net zero was to try to halve the trauma deaths on our roads by 2030 and to eliminate them completely by 2050. If we want to halve trauma deaths, we can do the same by delivering a trauma system. We have that experience. The international evidence is there. In London they reduced their trauma deaths by 50% in five years. We are eight years into our trauma system. The initial steering document, A Trauma System for Ireland, was published in 2018 and is being delivered, but on a very piecemeal basis and what we feel is probably too slow a basis. If that were implemented and we were fully resourced to do the jobs we want to do, we could see those figures as well. London has the same trauma demographic, more or less, that we have. There is no reason we could not reduce our trauma deaths by 50%, but we would have to deliver a fully implemented, fully resourced trauma system. The blueprint is there but it has to be given more emphasis. An opportunity was missed not to include this as part of the Critical Infrastructure Act 2026. I think the focus was on other areas and not on health. If we get that trauma system right, it will be of strategic importance. It will cause generational improvements and we could halve trauma deaths. That vision of reducing trauma deaths to 50% by 2030 is achievable, but only with a fully resourced, fully implemented trauma system. If we want to look to it, let us just look to our near neighbours. Let us see what London has done. It has done it and done it well. It continues to do it. To give the committee one other figure, in those five years they estimate that they have saved 600 lives. That is massive. Think about the trauma deaths we have seen, with 138 deaths this year. Could we reduce that by half? The trauma system data internationally suggests that we could if the trauma system were fully resourced and fully implemented.

I thank the witnesses for that.

I thank both our witnesses for their testimony and their advocacy in this area. It is vital. Did Dr. Phillips say 75% of e-scooter accidents are happening in Dublin?

Scramblers.

Scramblers, okay. In terms of the calls the witnesses are making, one is just an outright ban on scramblers, which nobody would dispute. In terms of e-scooters, will they clarify the calls they are making? It is not an outright ban for everybody. It is for under-18s.

We agree with the laws that have been proposed with the under-18 ban, the restrictions in power and speed, and appropriate protective clothing. That is what we are asking for. We think those are really reasonable approaches. Like I said earlier, people should have the right, if they choose, to use appropriately regulated vehicles on the roads.

Of course. In terms of e-scooters and the profile of a person finding themselves involved in an accident, are the vast majority of them young people and children?

We see a range of people. They tend to be younger because those are the people who tend to use e-scooters, that is, in their 20s and 30s, because they can afford them, they are a bit more convenient-----

Are these people just on their way to work? The reason I ask is that I feel, particularly representing an inner-city community, that a lot of where I see e-scooters being problematic is through the sale and transportation of drugs and young people engaging recklessly. We have also heard a lot about social media involvement. Some of the videos of young people you will see on Instagram are just outrageous. Is that the profile of a person being hurt, or is it a person on their way to work going down the canal and taking a tumble?

We see a big mix of people. We deal with an inner-city population so we see that group of people. We also see people on their way to work who have hit a pothole or struck a car. It is a real mix. We do not profile people when they come in, so it would not be something I would specifically ask a patient. I ask them how fast they were going, where they were driving the vehicle and what happened to them, but what the purpose of them riding an e-scooter was would not be a question I would specifically ask.

For me, though, and from the perspective of the justice committee, it is really important as to how these vehicles are being used. Would the witnesses say the infrastructure, in terms of the actual road and pavement networks around the cities, is suitable? I look at some places in Dublin city centre where I see e-scooters being driven and they should never be on the pavements and paths. Cycle lanes are damaged. They are not commensurate with any sort of-----

Anytime you can move a small vehicle like a bicycle or an e-scooter away from a heavy car or a fast car, whether that is a separation or otherwise, is really important because it potentially prevents them interacting at any stage. Infrastructure is really important in preventing those types of injuries that we see. You see that in Copenhagen and some of the other European cities. Where there is that separation, it is a lot safer and people take up this type of transport.

Infrastructure is really important, but people may be flouting the laws anyway and travelling grossly in excess of the speed limits, travelling on footpaths and going through red lights. A study in St. James's Hospital showed that 36% of patients involved in e-scooter accidents had alcohol on board when they were travelling. Infrastructure is important if you are travelling within the designated 20 km/h limits, but people may be flouting them and travelling at excess speeds.

E-scooters are not designed for that at all. They have got a higher centre of gravity. They have got small tyres. The tyres are much closer together.

That probably related to the first question I was asking. How many people who were involved in these accidents - either in the accidents themselves or inflicting it on somebody else - are breaking the law? Are they going too fast? Are they underage?

In our study the mean age was 34 and close to 70% of them were male. We do not know the full circumstances. We are hearing a person's account of an accident. We might hear some account from the paramedics but again it is all second hand, third hand and hearsay. Somebody who has got an injury may not fully recall what happened. We have all had cars come out of nowhere and you do not know whether you are in the right or the wrong. Was my light red or green? In that split second you do not know, so we would not be able to ascertain that level of data despite the fact we certainly inquire as to how this accident happened, but often the patients just cannot tell us.

Okay. I thank the witnesses.

I thank the witnesses very much for coming in. I have a question about the National Office of Clinical Audit's major trauma audit. Is there a form in every casualty department which is filled in for this kind of event?

I can answer that.

There obviously is not, if the witnesses do not know about it.

Dr. Broderick has developed the Traumadoc, which is a national document for emergency medicine. Its uptake across the different departments around the country is a little bit sporadic, but if there is a major trauma coming in we use that. We do not use it for all the minor trauma so we would not pick up the data on that.

That is the thing I am driving at. One of my colleagues was mentioning earlier the possibility of making it mandatory to report underage people and all the rest of it. We do not want a situation where doctors are the first step in a criminal investigation or whatever and I fully understand that. However, allowing for anonymised data, this is an epidemiological issue as I see it. There is a case for that. It is a new one and one which can be controlled and demands to be controlled in whatever way is practical, subject to Garda resources and all the rest of it. Should we not be recommending that there be a standard form with tick boxes? It could check whether it was an e-bike or an e-scooter, a single-vehicle collision or a crash and whether it was on a pavement or, insofar as people can remember, on the road.

I have an impression, though it is entirely anecdotal. I do not see the danger in adults driving electric bikes. It is probably healthy that some of them are doing that rather than driving a car to work and therefore a good thing. Likewise, riding bikes is Government policy now. I would like to see a database that really gives us a solid base on which to formulate policy, limits and all the rest of it. It just occurs to me that it is of the essence we know that little Johnny who ended up with a badly injured skull was on an e-scooter rather than an e-bike, was or was not wearing a helmet and all those things so we all know what the basic data is. We are all on the same side; we want to stop injury. Whether the data is being collected is my point.

Having done a lot of audits and data collection, I know it is a massive problem across any sort of healthcare because you are relying on people's recollection and their note-taking. Standardising any form would help with data collection in terms of trying to tease that out.

I mean it would just be a standard procedure. There is a form. When you go into hospital or any emergency department there are people taking notes. On the clipboard there could be a form.

The other part of that is probably the electronic health records a lot of places have these days. In a lot of the hospitals they are way behind what the international standard would be. To collect that type of data to create these sort of forms is much easier with a forward-thinking electronic health system which we do not have. It makes everything very manual. You are relying on trying to interpret someone's handwriting. You can ask anyone who has gone through our trauma data.

I was thinking of tick boxes rather than narrative reports.

Dr. Broderick wanted to add a point there.

The Traumadoc is that. It is based on tick boxes and we collect a lot of that data. The Senator mentioned the major trauma audit at the outset. To even be included in the major trauma audit, you have to be admitted to the hospital for three days, you have to be transferred between hospitals and you have to succumb to your injuries or be admitted to critical care. Thus, patients who attend us in the emergency department who might be admitted for two days are not featured in the major trauma audit. This is why there is a big disparity again data-wise. An Garda Síochána will have one figure and the CSO might have another figure.

Yes, that is the point.

If somebody has died pre-hospital, the coroner will have that figure but we do not because it is not featuring as part of our major trauma audit data, so we have got to have this collaborative data resource that captures all this data that we all feed maybe collectively into the same database to fully know the true picture of trauma.

I will give the committee a mortality statistic. Our major trauma audit would suggest 200-odd patients on average die per year of major trauma but if you look at the figures from the CSO it would put that figure as people who die of traumatic injuries and other causes. It is not strictly trauma, therefore, but it gives you an idea of somewhere close to 1,100 to 1,300. This means we are missing 1,000 traumatic deaths per year that are just not there as they are not part of our database. A lot of the figures we have quoted and the study Dr. Phillips has authored that we have been referring to a lot today are all audit data. We have to go back and audit our own emergency department data because it is being missed from this major trauma audit. When the next iteration of that trauma audit is released at the end of this year for 2024 it again will not count emergency attendances unless they have met the criteria of people being in for three days, being transferred between hospitals, dying or being admitted.

There was mention of UK figures which are frightening. It was £200 million or whatever. The rule of thumb is to divide the UK figure by ten and you get an Irish figure, in all probability. These are vast sums of money, not to mention the suffering and all the rest of it.

That figure we quoted was only for e-scooters, so £200 million divided by ten, if you wish, is £20 million for e-scooters alone, but what is the cost of scramblers, e-bikes and trauma as a whole? This is why it gets back to the system piece and fully funding and fully implementing and fully resourcing us to do our job. Alternatively, we can play catch up and we can pay these vast sums of money in a healthcare system that is already grossly overstretched from a budgetary point of view. If we can invest and load it head on and get the system there to be able to deal with patients - if we can halve the number of presentations - then that will certainly benefit the Exchequer as well.

Yes. I thank the witnesses.

Most of my questions have been asked. It is very important we concentrate on statistics here. There seem to be glaring omissions across the whole range of data collection processes, given how far we are behind when it comes to e-health. I was that soldier before in another committee. E-health, my God, what it would do for outcomes, financial savings and everything if we just invested in it to the level we require. That is the first thing.

The second thing is that obviously there are different impacts depending on the different types of vehicle. I agree with Senator McDowell we do not necessarily want to stop people using some of these vehicles. My wife has an e-bike. If you are living around the mountains of Tipperary you need pedal assist because it is pretty torturous around Portroe to cycle.

I am sure she needs to get out of the house from time to time.

I am never there so I do not know, but nice try.

He uses an exercise bike.

It is obvious we have, from a trauma point of view, different volumes of trauma and different types of trauma depending on which vehicle we are talking about. Obviously there is horsepower to consider and everything. Something I do not think has come up is that quite an amount of those incidents - this would need to be clarified by data - in urban areas involve, I assume, business vehicles.

On the way to the Houses, I was listening to a chap on the radio saying how he and his son nearly got taken out. Now, to be fair, it was not Deliveroo, but a Deliveroo-type of electric vehicle that was doing serious speed. There has to be a role here for some form of regulatory process involving the businesses that use these type of vehicles to distribute their goods or services. That is one side of things that we probably need to say as well and look at. Would the witnesses agree that they have to take responsibility as regards training, insurance and a whole range of other things from a liability point of view? Is it the case that this issue has probably been not dialled up enough?

From an Australian perspective, there has been a big shift in how these delivery vehicles were regulated over the last few years. We used to see a lot of these injuries come in because of fast unregulated speed on those types of e-bikes. They tend to be contract workers, from my understanding. Having a bit more control over the types of vehicles that your staff are using, who is riding them and the speed that they are going, from a medical point of view, makes sense. I cannot answer from a regulation point of view.

My key point here is that a lot of these vehicles are being used by people who are working in the gig economy. Regulation and standards there leave a lot to be desired, to be honest. From a continuation of that, if regulation and standards are not there as regards how these people are being treated as employees versus all the other issues that we know have come up in that area, you can presume that from a standards point of view, vehicles and use of vehicles and driving and standards as regards all of that simply would not be at the races either.

We are very pleased to welcome back the Chair of the Oireachtas Transport Committee, Deputy Michael Murphy. The Deputy is welcome.

I really appreciate it. I have been watching some of the meeting online, but I have been between committees. I acknowledge the work of the justice committee in this area. It is work that is intersecting with the work we are doing in terms of the wider road safety remit within the transport committee. I have listened to the arguments around the use of e-scooters, and I accept there are many people who use e-scooters responsibly, but there comes a point when we have to look at the evidence in front of us. Three key elements have fundamentally changed the debate.

The first is public opinion. Second is the evidence of the Garda Commissioner before the transport committee on 15 July when he absolutely said that he would support an outright ban. Then there was the evidence of CHI. The witnesses have amplified the evidence of CHI here today as well and in their opening statement. I am just worried that we are tying ourselves up in knots with regulation. I think it was acknowledged in a response to a previous question from a member that enforcement is key. We have to acknowledge the ability of An Garda Síochána to enforce these regulations and further regulations, particularly around licensing and registration. I know it was said that we may have to give these new regulations a chance, but would Dr. Broderick at least support the view that an outright ban needs to be kept on the table?

We have a huge crisis in the context of road safety. Until 16 September, I think 134 lives were lost. A small number of those are linked to e-scooters, but we need to look at the extent to which young children are presenting still to CHI. I crossed the city in the last hour before lunch and I was struck by the level of non-compliance in terms of high-vis jackets and helmets. I struggled to see an e-scooter driver or rider. I have seen two on one e-scooter. I saw children under the age of 16. I saw so many without a high-vis jacket. The vast majority were not wearing helmets. Again, is it still Dr. Broderick's view that the regulations should be given a chance? Would he at least acknowledge that an outright ban must be kept as an option on the table? As Chair of the transport committee, I believe that we are tying ourselves up in knots with these new regulations.

That figure that the Deputy quoted of 134 is 138 after this weekend, tragically. Everything needs to be kept firmly still on the table. There is no doubt about that. We need to tackle this in three different ways. The first one is primary prevention, which has three facets: engineering, education and enforcement. Engineering ensures that these bikes cannot go to that speed, that imported illegal vehicles are not available and that they are banned from being imported in the first place.

Education is something we have got to set about getting into people's homes and schools. We have seen it work. Dr. Phillips has quoted this before, but we have seen it work. I know it might be something different from a trauma demographic point of view, but you see it from a penetrating trauma and a knife crime perspective that education works from a peer-to-peer point of view. To give the committee an example of the way they tackle this in Liverpool, they use youth players to go and talk to their peers in the community. They will listen because they are the same age and they aspire to be those persons. Something like that might work.

The third thing is enforcement. I mentioned before that regulations only work if they are enforced. If the existing age limits and existing rules as they currently stand are properly enforced and if people are travelling within speed limits, then a helmet and a high-vis should make a difference. If people are still travelling at excess speed, still having pillion passengers, still using them underage, under 16 or under 18 at the end of this week, still travelling on footpaths and still going through red lights, then a helmet and a high-vis is not going to work. It needs a complete behaviour and attitudes change.

I mentioned three things. We have touched on data loads of times today. We have a problem with the data, and that is something that we need to rectify to understand the true burden, the full burden of trauma. Then, if we really want to get serious about solving this problem, the trauma system has got to be prioritised. It has to be given strategic importance within the legislative House in this Oireachtas in order that it is delivered. It has started, but it needs to be fully implemented, fully resourced and fully delivered because it has been shown to halve trauma deaths.

I apologise; I was in and out. I was attending the health committee as well. I welcome both witnesses this afternoon. A lot of what I wanted to ask has been asked, but if I will go back to the question about where most of these incidents and accidents are happening. Dr. Phillips said that they are mainly Dublin-based, so I take it that this is primarily an urban problem. Down where I live, there is a beautiful brand new greenway worth €13 million. I regularly see these e-scooters on it. Do we have any data on the infrastructure people are using, like those greenways, cycle lanes and stuff? Is there as high a prevalence of accidents on that type of stuff? Is it like what has been said already, namely, cutting red lights and being on pavements in Dublin, getting caught at the wrong side of a bus or whatever it might be?

We do not have those specifics-----

Even anecdotally, from Dr. Phillips's own experience-----

From our experience of patients coming into the emergency department, a lot of it would involve those sharing the use of the road being struck by a bus or pedestrian hit by a scooter. They are the main injuries we are seeing. Where vehicles interact, that tends to be the big thing. It could also be where they hit a pothole or they lose control because they are going too fast. That is what we are seeing. We are not really seeing the greenways and things like that. It is not really something that we would ask specifically.

That data is being collected, but it is not published in major trauma audits from the rest of the country from an e-scooter perspective. As Dr. Phillips said, our demographic around here is mainly urban. It is not just us that have published on this from the Mater, so it is not just a Dublin-centric thing. The figure of 75% in Dublin is a scrambler statistic.

From an e-scooter point of view, loads of hospitals - Cork, Tallaght, Connolly, St. James's and Our Lady of Lourdes in Drogheda - have published on this. This is a national problem. It is very far from a Dublin-centric problem.

I am from the northside of Cork city where we have a problem in certain areas with scramblers in particular. According to one headline not so long ago, a scrambler bike was confiscated from a four-year-old. It was in a local Cork newspaper. What parent thinks it is okay to buy a four-year-old a scrambler bike? We cannot police every purchase that is made online or in whatever other way. The witnesses say it is about information and changing culture. Could the doctors tell us what happens to a four-year-old, physically, at 30 km/h, 40 km/h or 50 km/h if they hit another person? It will give people who are listening an idea of what people are suffering.

With speed that blunt, in the worst-case scenario they will die. It is usually from severe head injuries and solid organ injuries. They usually die from haemorrhagic shock, which is bleeding to death. A four-year-old has no idea how to ride a bike, let alone something travelling at 40 km/h or 50 km/h. I would say that to parents. We sometimes see people having accidents like this on farms in Australia because kids are on mini scramblers. It would not be an uncommon thing. They are devastating injuries. Even if they survive, they could end up with severe traumatic brain injury, needing care for the rest of their lives. That is what we want to prevent.

This is where we look at scramblers versus e-bikes. I spoke a little earlier about the fact that people generally graduate towards an e-bike. They learn to ride a bike when they are four years of age. They have had a balance bike. They graduate up towards it. They do not all of a sudden learn to cycle on an e-bike. From a scrambler perspective, one would kind of think that some people would graduate from a motorbike. Motorcycles and scramblers are so different. Motorcyclists have paid their tax and insurance. They are older riders. They have done their tests. They have done a theory test, so they are informed users. Not alone that, but they have to graduate through the low-powered motorbikes towards higher power. Before they can get a licence for a high-powered vehicle, they have to go through certain tests again, whereas for a scrambler bike, younger users do not tend to have a driving licence of any description. They are too young to have it. Because they are less than 16 years of age, they have no licence for any other vehicle. They have no idea of the rules of the road and they have not graduated from another similar vehicle.

Scramblers are a completely different machine to try to handle. They are much heavier. I checked in advance to see what is the weight of a scrambler because they are huge machines. They weigh up to 200 kg, which is a fifth of the weight of a car. Dr. Phillips and I have been chatting about cases of young people who are coming in to our emergency departments. They may be 16 years of age but they are so small that we wonder if they can even lift the bike.

I do not want to speak about individual patients, but one person who was in possession of a scrambler was so small that Dublin Fire Brigade did not have the relevant equipment sizes to be able to care for that patient. I doubt the person could have lifted the bike but they could still power it and get it going. It means that there is no margin for error. There is no way that they would have the balance, wherewithal or cognition to be able to compensate when somebody pulls out ahead of them, the road is slick, the traffic lights suddenly change or they spot gardaí in the distance. That is when people lose control and come off the bike.

I thank Dr. Broderick for that. I have a question for him. He talked about the broader trauma system and the need to resource it. What precisely is missing? He spoke about perhaps being in a position to halve the number of trauma-related deaths. I take it that it is not necessarily about reducing the number of incidents but a treatment pathway. What precisely is missing in terms of the infrastructure that could be put in place?

The premise, or even the promise, of a trauma system is that the right patient goes to the right hospital at the right time the first time. If you are gravely injured and you are within our catchment – within 45 minutes of our hospital - there should be pre-hospital protocols that mandate that you are brought directly to our trauma centre. The pre-hospital protocols are not in place at the moment, so you will end up being treated at your local centre and then, if necessary, transferred across to us. There are two designated major trauma centres south of the Border – in Cork and our own one at the Mater - but neither of our hospitals can provide the full breadth of services required to deal with a seriously injured polytraumatised patient. Sometimes the trauma centre has to transfer patients out for various surgeries and then they might be transferred back for us to complete their care. That premise, the promise of the right patient in the right hospital at the right time the first time, is not happening. The trauma strategy document was published in 2018. It was endorsed by the Government but we are eight years into it, which is not far enough along. In London, when it was fully resourced and implemented, trauma deaths were halved in five years. We are eight years in, but we are not nearly far enough along towards where we need to be. We need to get it fully funded and resourced.

Could Dr. Broderick list three things as regards what funding and resources would be directed in order to have the meaningful impact he spoke about?

It still needs to follow the patient journey. We need the pre-hospital system built. We need the bypass protocols within the pre-hospital system, which would mean they get to us. Our hospital has to have the capacity to be able to cope with it. We see today in the media that we do not have the capacity to deal with the patients we currently have, let alone having trauma bypass. We do not have the resources in our hospital to be able to deal with it. The after-trauma care – the after-hospital piece - is vitally important so that we are getting patients transferred out of our hospital into the rehabilitation centre, back home, into a care home, if that is where a person needs to go, or into another hospital to continue their onward treatment. The full trauma journey needs to be funded. It needs to be collectively funded, not piecemeal as it might be at the moment.

If it could be considered as part of the critical infrastructure Bill, this is exactly what it was designed for: to stop the fragmented approach to these big projects of strategic importance. Trauma has to be considered as being a project of that level, the same as the metro, energy initiatives or the critical care wing at the Rotunda. Trauma should get that same level of focus. We should stop the piecemeal funding and finally deliver the trauma centre. If we do, we will see a meaningful difference. If we had done that from the start, we would be where London is now and maybe even ahead of it. If we are given the resources, we will do it. I am so confident that we have the ability to do it but we just need to be resourced.

Dr. Broderick talked about the 45-minute catchment. There are parts of my constituency where people are not 45 minutes from an emergency room, never mind a centre of excellence in any one discipline. Is there a difference in outcomes at present depending on geography?

Geography has a huge impact on the care people receive and, ultimately, whether they live or die from their injuries. That 45 minutes can be expedited with helicopters. Our catchment is not 45 minutes by road; it is 45 minutes to get there. The net for the major trauma centres should mean we cover a much bigger geographical spread – not quite to Donegal but 45 minutes by helicopter would get us a considerable way there.

I thank Dr. Broderick. I propose that we publish the opening statement on the committee's website. Is that agreed. Agreed.

We appreciate that Dr. Phillips and Dr. Broderick are very busy people. They are doing very important, often life-saving work. We appreciate them taking time away from that to assist the committee in its deliberations on this matter. I sincerely thank them for their ongoing work and for engaging with us today.

On that note, we will suspend for a few minutes while we wait for our other guests to come in.