ATV ADVOCACY MORNING REPORT

Annie Powers Kate Westmoreland

What is an ATV?
ATV = All terrain vehicle Developed 1971 1-2 passenger 3-4 wheels 50-950cc engine Child size vehicles

The Risk
Inherent instability prone to roll-over High center of gravity Counter-intuitive turning Unrestrained drivers Heavy vehicles (up to 800 lbs) High speeds (up to 95mph) Unstable, uneven, and steep off-road terrain

Pediatric Risk
Inexperienced drivers Less body weight Driving adult sized ATV Lack of helmet use Incompletely developed
o o o

Motor skills Perceptual ability Judgment

Children are 4x more likely than an adult to get injured

Injury Characteristics
20-40% of injuries and death occur in children less than 18 years <1% of injuries occurred during farm/work related activity Increased frequency in summer months

Mechanism of Injury
Roll over Loss of control Separation of vehicle and driver Collisions- ATV, MVC, object

Common ATV Injuries

Head injury
Skull fracture, concussion, intracranial bleed o 5x increased risk if not wearing a helmet o Leading cause of death
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Spinal Trauma Neck / laryngotracheal Long bone fracture Chest and abdomen Facial injury/fracture Abrasions and lacerations

Morbidity and Mortality

Nationwide (2001)
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111,700 ER visits 495 deaths 211% increase in ER visits 159% increase in deaths 175 deaths 64 pediatric deaths (36%) 42% of all ER visits <20 years

Compared to 1993
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Utah (1982-2009)
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The Cost o ~ $3.24 billion in 2003 o > $11,000 hospital cost alone for level I trauma centers in Utah 2001 - 2005

Pediatric Morbidity and Mortality

National (1982-2006) o 2,300 pediatric deaths National (2006) o 111 deaths o 39,300 ER Visits Overall o 20-37% of all ATV deaths o 27-47% of all injuries In the last decade o ~100% increase in deaths and hospitalizations

AAP Recommendations
Prohibition of use in all children under the age of 16 years No child passengers Helmet and eye protection No public street use or night driving Seatbelts and roll over bar Speed governors Automatic headlights Flags and reflectors

ATV Laws In Practice

Ban of 3-wheeled designs in 1988 Engine size limitations for child sized vehicles o Use of 70cc engines for children >12 o Use of adult engines for children >16 Operator training programs Helmet use and eye protection Minimum age requirements (8 years most common) Adult supervision (visual) when under age 16 Restricts passengers from being carried without a passenger seat Prohibits use on public street except to cross

States without safety legislation had a collective death rate twice that of states with safety legislation.

Utah ATV Laws

Prohibits children <8 to operate on public land Riders <18 must wear helmet on pubic land Certification course: Know before you Go o Ages 8-16 or no driver license o Must pass prior to riding public land o Online course ($30) o Receive an operator license o >40,000 youth have taken this class Must have a title and registration with Utah DMV to operate on public land Certain public highways designated for ATV use, must be >18 years or under direct supervision (300 ft) by someone who is >18 years Lighted taillight and headlamp

Helmets and Injury Prevention

Wake Forest University
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Unhelmeted riders were 5-fold more likely to have significant head/neck injuries

The National Trauma Data Bank

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Unhelmeted riders were more likely to sustain TBIs (any and major/severe), to die in the hospital, and sustain significant injuries to the neck and face

Pennsylvania vs. North Carolina

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4.5% of helmeted children had a GCS <8 compared to 11.8% of unhelmeted children

Effectiveness of Helmet Laws

Pennsylvania vs. North Carolina
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Increased helmet use in PA (36% vs. 17%) Children in PA still suffered serious morbidity and mortality

Wake Forest University

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No significant changes seen in children injured with legislation Helmet use did not increase after legislation was passed

Minimum Age Legislation

Nova Scotia banned ATV use in children under the age of 14 in 2004. o Injuries and deaths for that age group decreased 50% in the following year Massachusetts passed Sean's Law on July 31, 2010 bannaing ATV use among children under the age of 14 South Carolina passed Chandler's Law on April 28, 2011, which prohibits:
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A child under age 6 to operate an ATV. A child without a driver's license and under age 16 to carry a passenger while operating an ATV.

Pediatrician Advocacy
Well Child Checks Helmet No passengers! No drivers < 16 years Know before you go!
http://www.atvcourse.com/usa/utah/

References
McBride et al. Pediatric all-terrain vehicle injuries: does legislation make a dent? Pediatr Emerg Care. 2011;27:97-101. Finn et al. A population- based study of all terrain vehicle related head and spinal injuries. Neurosurgery. 2010; 67: 993-997. Bowman et al. Impact of helmets on injuries to riders of all-terrain vehicles. Inj Prev. 2009;15:3-7. Keenan et al. All-terrain vehicle legislation for children: a comparison of a state with and a state without a helmet law. Pediatrics. 2004;113:330334. Helmkamp, JC. A comparison of state-specific all-terrain vehiclerelated death rates, 1990-1999. Amer J of Pub Health. 2001;91:17921795. American Academy of Pediatrics. All-Terrain Vehicle Injury Prevention: Two-, Three-, and Four-Wheeled Unlicensed Motor Vehicles. Pediatrics. 2000;105:1352-1354.