Legislation in Québec for all-terrain vehicles: are we doing enough?

OBJECTIVES: All-terrain vehicle (ATV) legislation in Québec is among the most restrictive in Canada. The purpose of our study was to characterize the pediatric ATV traumas in our center and determine the impact of legislation. METHODS: Retrospective chart review of all patients seen in the emergency department after an ATV injury was done from 2005 to 2011. RESULTS: Seventy-tree patients (50 boys and 23 girls) with a mean age of 11 years (range, 3-17 years) were identified. Forty-nine percent were drivers, 40% were passengers, and 11% unknown. Forty-five percent did not reach the legal age of 16 years. Helmet use was documented in 36%. Eighty-five percent were admitted to the floor, and 15% were discharged from the emergency department. Intensive care unit stay was necessary in 21%, and 60% were operated on. Most of the surgeries were for orthopedic, either extremities, spine, or pelvic (80%). The most frequent types of trauma were extremities (30%), head (30%), and face (25%). Head trauma was severe in 23%. Hospitalization rates for ATV injuries have remained unchanged in the last years. CONCLUSIONS: Despite implementation of ATV legislation regarding helmet use and minimal legal age, a lot of our patients did not obey these rules. This study demonstrates that strong legislation did not have a real impact on ATV morbidity in children. It is essential to develop strategies to enforce ATV users to respect legislation.

Impact of off-road vehicles (ORVs) on ghost crabs of sandy beaches with traffic restrictions: a case study of Sodwana Bay, South Africa.

Off-road vehicles (ORVs) are popular in coastal recreation, although they have negative impacts on sandy shores. In South Africa, ORVs are banned from most coastal areas, while some areas are designated for restricted ORV use, providing an opportunity to assess whether ORV traffic restrictions translate into biological returns. In Sodwana Bay, the impact of ORVs on ghost crab populations was investigated. During Easter 2012, ghost crab burrows were counted on beach sections open and closed to traffic. Burrow density in the Impact section was less than a third that of the Reference section, and by the end of the study burrow size in the Impact section was half that of the Reference section. ORV traffic caused a shift in burrow distribution to the Lower beach. However, differences in burrow densities between sections were 14 times smaller than differences obtained at a time when ORV use in Sodwana Bay was not controlled. While confirming the well-established detrimental effects of ORV use on sandy beach ecosystems, results demonstrated that traffic restrictions on beaches measurably minimize impacts to the fauna, thus translating into clear-cut biological returns.

Unregulated and unsafe: the impact of motorcycle trauma on Queensland children.

AIM: To describe paediatric (0-15 years) motorcycle incidents in Queensland, inform safety policy and identify opportunities to improve data in this area. METHOD: Population-based study of motorcycle-related child (0-15 years) trauma, resulting in fatality or hospital admission beyond 24 h to any Queensland public hospital (2007-2009). Data compiled by Statewide Trauma Network and Commission for Children and Young People and Child Guardian. RESULTS: Ten child fatalities were recorded (child death rate = 0.36/100,000 population 0-15 years). All were male and primary riders of their motorcycle. Nine fatalities were related to head injury; of these, five wore inadequate head protection. The coroner identified rider factors as contributory (speed, age or substance abuse) in seven cases. Motorcycle-related incidents were the second most common mechanism recorded after bicycles, comprising 6.8% of 9141 paediatric trauma cases (619 motorcycle-related incidents; 1225 injuries; admission rate = 22.2/100,000 population 0-15 years). Compared with the all-trauma population, patients were older (median age = 13 vs. 10 years) and more frequently male (85% vs. 67%). Average admission was 4.4 days (head injuries = 7.0 days; burns = 5.8 days). Most children incurred >1 injury (mean = 2.01 injuries) with fractures (45%) and open wounds (17%) most common. As a proportion of all diagnoses, most injuries were to lower limb (44%), upper limb (26%) or head and neck (16%). CONCLUSIONS: These data emphasise the need for children to use full protective equipment, especially helmets. Children are not currently protected by legislation mandating safety standards. Regulating rider age and safety standards (protective equipment, training and vehicle maintenance) may reduce the rate and severity of injury.

Pediatric "off-road vehicle" trauma: determinants of injury severity and type.

OBJECTIVES: This study aimed to describe the determinants of the severity and type of injuries sustained by children hurt in off-road vehicle (ORV) accidents. METHODS: This was a retrospective clinical study for which data were obtained from the trauma database at the Children's Hospital at Westmead covering the 10-year period between January 1, 1998, and December 31, 2007. Data points collected included age, sex, Injury Severity Score (ISS), body region injured, type of vehicle, accident setting, mechanism of injury, estimated speed, position of the rider, use of a helmet and/or protective clothing, and hospital length of stay. The study end points were determinants of injury severity and type. Statistical analysis of the collected data was done with the standard statistical software package, SPSS. RESULTS: A total of 288 children (242 male [84%] and 46 female [16%] patients) presented for ORV-related trauma. Helmets significantly diminished the chance of sustaining a head injury occasioning a skull fracture. Jumping was associated with increased ISS and a higher chance of sustaining an abdominal and/or thoracic injury. Older children were more likely to sustain pelvic and spinal injures, be injured while traveling at high speed, and be injured while going over a jump. Mean ISS was significantly lower if trauma was sustained while riding a mini motorcyle in any setting and any ORV at home. CONCLUSIONS: Further research (prospective, federal, and multi-institutional) is needed with a view to optimizing training schedules, rules, regulations, and licensing requirements for pediatric ORV riders.

Retrospective review of all-terrain vehicle accidents in Alberta.

BACKGROUND: All-terrain vehicles (ATVs) are frequently associated with injuries and deaths. In spite of this, very few guidelines, let alone legal restrictions, exist to guide users of these machines. METHODS: We conducted a standardized review of prospectively collected data from the Alberta Trauma Registry. All patients who were involved in ATV-related traumas from 2003 to 2008 with an Injury Severity Score (ISS) greater than 12 were included. The variables studied were age, sex, type of vehicle, purpose of use, person injured (driver or passenger), ISS, distribution of injuries, length of hospital stay, helmet use and death. RESULTS: We evaluated 435 patients with ATV-related injuries and ISS greater than 12. The average ISS was 22.8, with an overall mortality of 4.6%; 55% of patients were not wearing helmets, and most of the deaths (85%) occurred among these individuals. Helmet use was associated with a lower risk of mechanical ventilation and of injury to the head and/or cervical spine. Children accounted for 18.9% of all patients and 15% of deaths; 57% of them were wearing helmets at the time of their accidents. CONCLUSION: All-terrain vehicle use in Alberta carries a significant risk of injury and death, and there is an association between death and lack of helmet use. A minimum age for ATV use of at least 16 years and a legal requirement for helmet use may increase public awareness of these risks and decrease morbidity and mortality.

Prognostic framing of stakeholders' subjectivities: a case of all-terrain vehicle management on state public lands.

Management of all-terrain vehicle (ATV) use on Minnesota state forest lands has a contentious history and land managers are caught between ATV riders, non-motorized recreationists, private landowners, and environmental advocates. In this paper, we demonstrate the usefulness of framing distinct perspectives about ATV management on Minnesota state public forests, understand the structure of these management perspectives, identify areas of consensus and disagreement, specify which stakeholders hold the various perspectives, clarify stakeholder perceptions of other stakeholders, and explore the implications for ATV planning and management. Using Q methodology, three distinct perspectives about how we should or should not manage ATVs resulted from our analysis, labeled Expert Management, Multiple Use, and Enforcement and Balance. A surprising degree of unanimity among the three management perspectives was found. Although some of the areas of agreement would be difficult to implement, others would be relatively simple to put into place. We suggest that land managers focus on widely accepted management actions to ameliorate commonly recognized problems, which may ease tensions between stakeholders and make tackling the tougher issues easier.

Reducing farm injury deaths through regulation.

Manufacturers will need to improve quad bike design to meet safety requirements.

Definition and measurement of rider-intrinsic physical attributes influencing all-terrain vehicle safety.

OBJECT: All-terrain vehicle (ATV) usage has grown tremendously over the years, reaching 9.5 million vehicles in use in 2007. Accompanying this growth has been a concomitant increase in rider morbidity (including traumatic brain and spine injuries) and death, especially in children. The purpose of this study was to define and measure, through field testing, those physical attributes intrinsic to riders, such as height, weight, and wingspan, which may have implications for ATV riders' safety. METHODS: Three field tests (J-hook, brake, and bump) were developed and performed to allow direct measurement of the lateral, longitudinal, and vertical dynamics in 5 riders of varying heights, weights, and wingspans. Two ATVs, a utility and a sport model, were tested for further comparisons. Data were acquired using a comprehensive data acquisition system attached to the ATVs. Assignment of individual rider/ATV test safety ratings and a rider/ATV Total Safety Rating were made from the results of these field tests. RESULTS: The J-hook test results demonstrated that larger rider wingspans positively influence ATV rider safety and mitigate against lateral instability. From the brake test it was determined that a 10-in (25.4-cm) longitudinal displacement, such as that experienced during a sharp deceleration, for a rider of any height or weight, breached the level of defined safety. As rider weight increased, displacement decreased. The bump test provided evidence that increased rider weight also mitigates against vertical displacement. CONCLUSIONS: Individuals with light weights and small wingspans, such as those in the pediatric population, are under considerable risk of injury when operating an ATV due to lateral, longitudinal, and vertical operational instability.

Pediatric all-terrain vehicle injuries: does legislation make a dent?

OBJECTIVES: We sought to determine whether North Carolina legislation pertaining to all-terrain vehicles (ATVs) has affected the frequency, distribution, or severity of injury in children. METHODS: This retrospective study reviewed the Wake Forest University Baptist Medical Center Trauma Registry from 2003 to 2008 along with North Carolina Medical Examiner's child fatality data for all children injured on an ATV. Patients were excluded if the accident did not occur in North Carolina, incomplete data, or if the vehicle was not an ATV. We evaluated the use of helmets, the extent of injury, and the mechanism of injury, comparing the patterns before the laws went into effect (2003-2005) with those after the law was enacted (2006-2008). RESULTS: Eighty-eight patients were included for analysis, predominantly white boys with a mean age of 12.1 ± 4.1 years. Children not wearing helmets were 5-fold more likely to have a significant head/neck injury (odds ratio [OR], 5.1; confidence interval [CI], 1.61-15.88; P = 0.01) and 3.7-fold more likely to have a significant chest injury (OR, 3.73; CI, 1.01-13.86; P = 0.05). Passengers were 5-fold more likely to die or require inpatient rehabilitation (OR, 5.0; CI, 1.2-20.8; P = 0.03) and 13.7 times as likely to have a significant injury to their head/neck (OR, 13.7; CI, 3.07-60.93; P = 0.01). CONCLUSIONS: There were no significant changes seen in the children injured without and then with legislation, which may be significant if ATV use indeed is increasing. A child's vehicular position was the most significant predictor of morbidity and mortality. Helmet use was not increased once mandated by law. Further efforts to implement such legislation and educate the public are necessary to make a significant change in injuries.

All-terrain vehicle safety in Florida: is legislation really the answer?

Florida is among the nation's leaders in all-terrain vehicle (ATV)-related injuries and fatalities. We hypothesized that patients sustaining injuries while in compliance with ATV laws would demonstrate less severe injury patterns and improved outcomes when compared with noncompliant patients. We reviewed patients treated for ATV-related injuries over a 36-month period. We grouped patients according to conformity with Florida statutes and compared demographics, admission status, injuries sustained, and outcome measures. Three hundred seventy-seven patients were treated for ATV-related injuries. In 294 cases, sufficient data existed to assess compliance with Florida's statutes regarding ATV rider safety: safety helmet use for persons younger than age 16 years and prohibition of ATV operation on roadways. Forty-three per cent (n = 126) had violated one or both statutes; 57 per cent (n = 168) had violated neither. The group in violation was younger (15 vs 24 years, P < 0.001) and wore helmets less often (6 vs 34%, P < 0.001). Groups required admission at similar rates (62% violators vs 60% nonviolators, P = 0.770), showed similar injury patterns, and had comparable mortality rates (2% violators vs 5% nonviolators, P = 0.451). Current Florida laws are inadequate to prevent ATV-related injuries and their sequelae. This issue should be addressed through an increased focus on safety education for ATV operators.

North Carolina all-terrain vehicle (ATV) safety legislation: an assessment of the short-term impact on ATV-related morbidity and mortality.

OBJECTIVE: All-terrain vehicle (ATV)-related morbidity and mortality has increased in the US, and states have attempted to combat this trend with ATV-specific safety legislation. The objective of this study was to examine the short-term changes in ATV-related injuries and deaths following the enactment of legislation regulating the operation and sale of ATVs in North Carolina. STUDY DESIGN AND DATA COLLECTION: The study is a retrospective analysis comparing ATV collisions during the six month pre and post period of the effective date of legislation. Demographics, medical outcomes, passenger seat position, helmet use, and alcohol use were analyzed. DATA: Subjects were identified through the North Carolina Trauma Registry and data from the Office of the Chief Medical Examiner. FINDINGS: A total of 102 (51 in both pre- and post-legislation) subjects required medical treatment or were declared dead secondary to ATV collisions in North Carolina. Children under the age of eight years, who were forbidden from using ATVs under the new legislation, had significantly fewer total medical evaluations and deaths in the post-legislative time period. There was no association between legislative time period and ATV-related passenger, helmet, or alcohol use. CONCLUSIONS: In the six months following the enactment of North Carolina's ATV bill, children under the age of eight years were seriously injured or died less often due to ATV-related crashes. No other significant changes in ATV riding patterns were seen between the two time periods, and the morbidity and mortality of all ATV riders did not change. LIMITATIONS: The examined data sets do not include data from all North Carolina hospitals.

All-terrain vehicle fatalities--West Virginia, 1999-2006.

An all-terrain vehicle (ATV) is a motorized vehicle designed for off-road use with low-pressure tires, a seat that is straddled by the operator, and handlebars for steering. Currently, only four-wheeled models are produced in the United States; production of three-wheeled ATVs ended in 1987 because of safety concerns. During the 1990s, West Virginia led the United States in per capita deaths from ATV crashes, with rates approximately eight times higher than the national average. In an attempt to curtail this trend, West Virginia enacted legislation in 2004 to regulate ATV use. This law prohibited ATV operation on paved roads with a center line, unless the vehicle was traveling a distance of < or =10 miles and at a speed of < or =25 miles per hour. The statute also required helmet use and training for ATV riders aged <18 years, regardless of where the ATV was ridden. To guide further prevention campaigns and identify appropriate populations for targeted educational interventions, the West Virginia Department of Health and Human Resources used data from death certificates of 1999-2006 ATV fatalities to analyze demographic and socioeconomic trends. Trends by age and crash classification (i.e., traffic versus nontraffic) also were evaluated in the context of the 2004 law. Results of that analysis indicated that, after the ATV law was enacted in West Virginia, the ATV-related death rate in the state among children did not decline, and total ATV-related traffic fatalities increased from 0.72 per 100,000 population in 2004 to 1.32 in 2006. Higher annual ATV death rates occurred among males, persons aged 10-17 years, residents of the most impoverished counties, and persons aged > or =25 years who had not completed high school. Further preventive measures aimed at reducing ATV-related fatalities should be considered, such as targeted educational interventions and more stringent provisions of the law.

Prevention of all-terrain vehicle injuries: A systematic review from The Eastern Association for the Surgery of Trauma.

BACKGROUND: Despite increasing usage since their introduction, there exist no evidence-based guidelines on all-terrain vehicles (ATVs) and injury prevention. While the power and speed of these vehicles has increased over time, advancements in ATV safety have been rare. METHODS: A priori questions about ATV injury pattern and the effect of helmet and safety equipment use and legislation mandating use were developed. A query of MEDLINE, PubMed, Cochrane Library, and Embase for all-terrain vehicle injury was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. Grading of Recommendations Assessment, Development, and Evaluation methodology was used to perform a systematic review and create recommendations. RESULTS: Twenty-eight studies were included. Helmet use reduced traumatic brain injury (TBI). However, studies examining whether legislation mandating helmet use reduced TBI had mixed results. When ATV safety legislation was enforced, overall injury rates and mortality decreased. However, enforcement varied widely and lack of enforcement led to decreased compliance with legislation and mixed results. There was not enough evidence to determine the effectiveness of non-helmet-protective equipment. CONCLUSION: Helmet use when riding an ATV reduced the rate of TBI. ATV safety legislation, when enforced, also reduced morbidity and mortality. Compliance with laws is often low, however, possibly due to poor enforcement. We recommend helmet use when riding on an ATV to reduce TBI. We conditionally recommend implementing ATV safety legislation as a means to reduce ATV injuries, noting that enforcement must go hand in hand with enactment to ensure compliance.

Legal regulations of restrictions of air pollution made by non-road mobile machinery-the case study for Europe: a review.

The high awareness of intensification and frequency of smog phenomenon all over the world in XXI age makes for detailed analyses of the reasons of its formation and prevention. The governments of the developed countries and conscious of real hazards, including many European countries, aim to restrict the emission of harmful gases. In literature, we can find the discussions on the influence of this phenomenon on the health and life of inhabitants of contaminated areas. Some elaborations of prognostic models, descriptions of pollution sources, the manner of their restriction, and the analysis of causal-consecutive correlation are also popular. The influence of pollutions resulting from the operation of vehicles, planes, and the industry are well described. However, every machine and device which is driven with a combustion engine has the effect on the general level of anthropogenic pollutions. These drives are subject of different regulations limiting their emission for service conditions and applications. One of the groups of such machines described in European and American regulations is non-road mobile machinery. The aim of this paper is the presentation of the problem of weak analysis and application of engineering and technological tools for machinery drive emission, despite of many publications on hazards and problems of emission. These machines have the influence on both the increase of global contamination and the machine users. The regulations of the European Union take into consideration the generated hazards and restrict the emission of machine exhaust gases by approval tests-these regulations are continually improved, and the effects of these works are new emission limits in 2019. However, these activities seem to be liberal as opposed to limits of the emission for passenger and goods vehicles where the technological development of the construction is greater and the regulations are the most rigorous. During the analysis of the development of non-road mobile machinery in the correlation with automotive vehicles, we can indicate engineering and technological solutions which are limiting the emission of non-road mobile machinery, but which are not applied. Due to liberal regulations for this group of machinery, the producers do not apply innovative solutions which can be found in road vehicles. The paper presents the synthetic review of existing EU regulations concerning limits of the emission of harmful exhaust gases which are generated by spark-ignition combustion engines of non-road mobile machinery. The authors show the divergences between the limits of the emission of harmful exhaust gases generated by road vehicles and non-road mobile machinery (boats and railway engines are not taken into account). The authors present the directions of the development of the combustion process control and systems limiting the emission of harmful exhaust gases. High innovative automotive industry was indicated as the direction of the development for limiting the influence of the emission on the environment by non-road mobile machinery.

Age Legislation and Off-Road Vehicle Injuries in Children.

BACKGROUND AND OBJECTIVES: In 2010, the Massachusetts Legislature passed a comprehensive law that restricted off-road vehicle (ORV) use by children <14 years old and regulated ORV use by children up to the age of 18 years. We aimed to examine the impact of the 2010 Massachusetts law on the rates of ORV-related injuries. METHODS: A retrospective analysis was performed of Massachusetts emergency department (ED) and inpatient discharges between 2002 and 2013 as found in the Center for Health Information and Analysis database by using external causes of injury codes specific to ORV-related injuries. Yearly population-based rates were compared before and after the implementation of the law (2002-2010 vs 2011-2013) by using Poisson regression analysis and segmented regression. RESULTS: There were 3638 ED discharges and 481 inpatient discharges for ORV-related injuries in children across the 12-year study period. After the implementation of the law, the rate of ED discharges declined by 33% in 0- to 9-year-olds, 50% in 10- to 13-year-olds, and 39% in 14 to 17-year-olds (P < .0001). There was no significant decline in ED discharges for 25- to 34-year-olds. Inpatient hospital discharges were also reduced by 41% in 0- to 17-year-olds after implementation (P < .001). CONCLUSIONS: As compared with adults (ages 25-34 years), the population-based ORV-related injury rate of residents <18 years old significantly declined after the passage of legislation that imposed age restrictions and other safeguards for youth riders.

Injury severity in pediatric all-terrain vehicle-related trauma in Nova Scotia.

BACKGROUND/PURPOSE: In 2004-2005, legislation restricting all-terrain vehicle (ATV) use by children and an extensive social marketing campaign intended to reduce pediatric ATV-related morbidity. The frequency, nature, and severity of pediatric ATV-associated trauma were compared before and after such interventions. METHODS: A retrospective cohort study was performed for all pediatric ATV-related injuries that presented to the provincial level 1 pediatric trauma center from 1998 to 2014. National databases were queried for ATV-related injury hospitalizations (n=258), trauma center emergency department visits (n=342), and admissions (n=136) in Nova Scotia from 2002 to 2014. Admissions between 1998 and 2003 (n=68) and 2006-2014 (n=60) were compared using chi square analysis for age and gender distribution, length of stay, critical care admission, helmet use, mechanism, and severity of injury. RESULTS: Admissions, trauma center emergency room visits and admissions initially decreased following legislative and social marketing interventions and subsequently gradually increased. Interventions resulted in no significant difference in age or gender distribution, length of hospital stay, critical care admission, helmet use, and mechanism of injury. There was a significantly higher proportion of severe injuries post interventions. CONCLUSIONS: Legislation and social marketing interventions had a short-term decrease on the frequency of ATV-related injuries and no sustained effect on the frequency, nature, and severity of ATV-related injuries. LEVEL OF EVIDENCE: Level IV.

All-terrain vehicle fatalities on paved roads, unpaved roads, and off-road: Evidence for informed roadway safety warnings and legislation.

OBJECTIVE: All-terrain vehicles (ATVs) are designed for off-highway use only, and many of their features create increased risk with roadway travel. Over half of all ATV-related fatalities occur on roadways, and nonfatal roadway crashes result in more serious injuries than those off the road. A number of jurisdictions have passed or have considered legislation allowing ATVs on public roadways, sometimes limiting them to those unpaved, arguing that they are safe for ATVs. However, no studies have determined the epidemiology of ATV-related fatalities on different road surface types. The objective of the study was to compare ATV-related deaths on paved versus unpaved roads and to contrast them with off-road fatalities. METHODS: Retrospective descriptive and multivariable analyses were performed using U.S. Consumer Product Safety Commission fatality data from 1982 through 2012. RESULTS: After 1998, ATV-related deaths increased at twice the rate on paved versus unpaved roads. Still, 42% of all roadway deaths during the study period occurred on unpaved surfaces. States varied considerably, ranging from 18% to 79% of their ATV-related roadway deaths occurring on unpaved roads. Paved road crashes were more likely than those on unpaved surfaces to involve males, adolescents and younger adults, passengers, and collisions with other vehicles. Both the pattern of other vehicles involved in collisions and which vehicle hit the other were different for the 2 road types. Alcohol use was higher, helmet use was lower, and head injuries were more likely in paved versus unpaved roadway crashes. However, head injuries still occurred in 76% of fatalities on unpaved roads. Helmets were associated with lower proportions of head injuries among riders, regardless of road surface type. Relative to off-road crashes, both paved and unpaved roads were more likely to involve collisions with another vehicle. The vast majority of roadway crashes, however, did not involve a traffic collision on either paved or unpaved roads. CONCLUSIONS: Although differences were observed between paved and unpaved roads, our results show that riding on either represented significantly greater dangers than riding off the road. Many vehicle warnings specifically mention the risks of paved but not unpaved roads, yet we found 23 states with half or more of their roadway deaths on unpaved surfaces. Safety warnings should explicitly state the dangers of roadway riding regardless of surface type. These data further support laws/ordinances greatly restricting ATV riding on all types of public roadways.