Paediatri Child Health
2004;9(5):337-40 Revision in progress February 2009 Parent handout: All-terrain vehicles: Safety tips for parents Index of position statements from the Injury Prevention Committee
Contents
All-terrain vehicles (ATVs) are three- or four-wheeled motorized cycles (ATV injury literature pertains only to three- and four-wheeled vehicles but some newer models may have up to six wheels) with large, low-pressure tires, designed for a single operator riding in off-road areas. ATVs are widely used in rural Canada for occupation, recreation, and transportation. These vehicles are especially dangerous when used by children and young adolescents because they lack the knowledge, physical size and strength, and cognitive and motor skills to operate them safely (1-3). The magnitude of the risk to young riders is reflected in industry literature, vehicle manuals and standard labels on current models, which warn of an increased risk of severe injury or death to riders under the age of 16 years (4). However, these warnings are not reflected in current legislation (Table 1) and ATVs are frequently used by children and young teens. Helmet use is infrequent in this population and unsafe riding behaviours, such as riding double and driving on public roads, are common. ATVs are not designed for these activities. Restricting ridership among young operators and passengers, and improving compliance with established safety recommendations are essential for reducing the number and severity of ATV injuries in children. ATV Access and use ATVs are available in a range of sizes, from 50 cc to 700 cc engine displacement, and weigh up to 273 kg (600 lb). As these vehicles require physical strength and mass for proper handling, children should not ride full-size vehicles. The Canadian ATV industry has endorsed a voluntary standard which recommends that children less than 12 years of age should not ride ATVs greater than 70 cc, and children less than 16 years of age should not ride ATVs greater than 90 cc (4). However, few of the smaller “youth” models are available on the market. ATVs are used by many children in rural and remote areas of Canada, including First Nations communities. Of the 335 rural Manitoba grade 6 children surveyed in 1996 (5) and 1997 (unpublished data), 32% reported having a family ATV and 75% reported ATV riding experience, including 96% of those with a family ATV and 65% of those without a family ATV. ATV experience was reported by 74% of children living on a farm and 75% of children living in a town. Although data are unavailable, ATVs are frequently used as transportation for children of all ages in First Nations communities, as well as for family and farm work-related activities in many rural and remote communities. Hauling loads (eg, wood), directly and in trailers, and towing sleds is commonly seen but it is not recommended for young or inexperienced operators. Few studies have documented helmet use and other safety behaviours in young ATV riders. In an observational study of 269 ATV riders of all ages in several American states with and without mandatory helmet use laws in the summers of 1988 and 1989, helmet use was 78.4%, with no significant differences between age groups (6). Those observed wearing helmets were also more likely to be wearing other types of protective equipment. Riders were 4.3 times more likely to wear a helmet if they had received formal ATV training. Self-reported safety behaviours were examined in the 1996/1997 survey of Manitoba grade 6 students (5). Of the students reporting ATV experience, 26% of females and 41% of males reported always wearing a helmet, and 46% of females and 33% of males reported never wearing a helmet. Forty-two per cent reported always or sometimes riding on public roads, contrary to provincial legislation. All new ATVs carry explicit warning labels stating never to carry a passenger and that passengers “affect balance and steering and increase the risk of losing control” (4), yet many children report riding as passengers, and a significant proportion of those injured on ATVs are passengers.
Males are involved in 75% to 85% of ATV crashes leading to injury (7-11). Children less than 16 years of age account for almost one-third of ATV injury-related emergency department visits (12,13), and 30% or more of ATV injury hospitalizations (14-17). Almost half of all deaths occur in children 16 years of age or younger (10,18). Inexperience, inadequate physical size and strength, and immature motor and cognitive development contribute to the increased risk of injury seen in children. The majority of crashes involving children occur during daylight hours (8,9), on weekend days or holidays (19), with a seasonal variation in injury rates by geographic region, as would be expected. Most nonfatal ATV crashes occur in a variety of off-road areas (7,15); however, fatal crashes occur most commonly on paved roadways and involve collisions with another motor vehicle (10,18). Driver error, particularly poor judgment and loss of control, is commonly cited as leading to ATV crashes (7-9,13,20). Three-wheeled vehicles have been shown to increase the risk of injury three-fold, and are not recommended due to their increased instability (21). Passengers are also commonly cited as a risk factor for ATV crashes and injury due to their deleterious effects on the balance and control of the vehicle. In studies of children hospitalized for ATV trauma, the driver was carrying a passenger in 15% to 30% of cases (7,8,13,15,22). In fatal crashes, ‘doubling’ is frequently cited as a potential responsible factor. In a series of 11 paediatric and adult fatalities, five cases involved ‘doubling’. In two cases, the driver was killed, and in three cases, the passenger (18). ATV Injury The number of hospitalizations for ATV injury increased rapidly in the early to mid 1980s in North America, and it continues to climb. Although Canada-wide trends for this time period have not been compiled, in Manitoba, hospitalizations for off-road vehicle trauma increased from 13 cases in 1980 to 62 cases in 1985, with the greatest increase occurring in ATV injury hospitalizations (8). A recent analysis by the Canadian Institute for Health Information of the national trauma registry data documented 2535 hospitalizations in 2000/2001, an increase of 50% compared with 1996/1997. Children between the ages of five and 19 accounted for 36% of these injuries. The majority were fractures and dislocations; however, head injuries continue to occur despite mandatory helmet legislation in most provinces (Table 1) (23,24). For hospitalized children, the average length of stay for ATV injuries ranges from five to 15 days (12,13,15,17,19). ATV injuries often involve multiple body parts and are commonly severe (15,17,20). In a series of 233 Manitoba children admitted with orthopedic injury following off-road vehicle crashes, the average number of musculoskeletal injuries was 1.7 per patient and the average number of associated injuries was an additional 0.8 injuries per patient. Intensive care unit admission was required for eight patients (8). ATV injuries among children presenting to the emergency department are summarized by the Canadian Hospitals Injury Reporting and Prevention Program, which collects emergency department data from 10 paediatric and five general hospitals across Canada. Between 1990 and 1996, 646 children and youth between the ages of one and 19 years old were treated for ATV injuries (25). These were more common in the summer months between 16:00 and 20:00, and on weekends. This series is notable for the young age of the drivers. Three were less than five years of age and in 32 cases the driver was between five and nine years of age. Many of the injured children were not wearing helmets. History of prevention efforts In response to the epidemic of ATV injuries in North America in the 1980s, the Canadian Paediatric Society and the American Academy of Pediatrics issued a number of recommendations, including a ban on ATV use by children and more rigorous legislation, including a minimum age requirement, mandatory helmet use and compulsory licensing and insurance (1,2). Professional and public concern in the United States prompted a ban on the sale of three-wheeled vehicles in 1988, along with a number of other industry actions (development of a voluntary standard, training programs, warnings and age recommendations on vehicles and in advertising). These industry actions were mandated under a “consent decree” in the United States (which expired in 1998) and were followed by a steady decline in injuries in the early 1990’s. However, recent trends demonstrate a resurgence of injuries, including injuries to children (26,27). The United States Consumer Product Safety Commission has documented statistically significant increases in ATV injuries every year for the most recent three-year study period (1998 to 2000). Children younger than 16 years continue to account for 40% to 50% of ATV injuries and more than 35% of ATV deaths, indicating a continuing and urgent need to reissue warnings about ATV use by children (3). In Canada, children less than 15 years of age continue to account for almost 25% of ATV deaths and more than one-third of serious injuries (24,28). Effectiveness of legislation Between 1990 and 1999, the six states without ATV safety legislation had mortality rates twice that of states with some form of ATV safety legislation, consisting of either helmet or other safety equipment requirements (21 states) or machine-related requirements but no helmet requirements (23 states) (0.17 deaths per 100,000 versus 0.08 and 0.09 per 100,000, respectively) (29). In a subsequent study, the 26 states with the highest paediatric ATV mortality rates were compared with all other states (1982-1998). The states with the highest mortality rates had a two-fold increase in mortality compared with the national average, and 92% had no licensing laws compared with 73% for the comparison group (30). Although these data are crude estimates of the effectiveness of legislation, there is a suggestion that more rigorous laws are associated with reduced mortality. The following recommendations are based on the available research evidence and are consistent with published recommendations of expert authorities (Level II-2, II-3 and III, Grades B and I) (31,32).
Members:
Drs Bich-Hong Nguyen, Ste-Justine Hospital, Outremont, Quebec; Richard
Stanwick, Vancouver Island Health Authority, Victoria, British Columbia;
Lynne Warda, University of Manitoba, Winnipeg, Manitoba (chair and
principal author); Charmaine
van Schaik, Aurora, Ontario; Diane Sacks, University of Toronto, Toronto,
Ontario (board representative); John Philpott, University of Toronto,
Toronto, Ontario.
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