Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States.

BACKGROUND: Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases. OBJECTIVE: The objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system. METHODS: In this study, we examined several national United States-based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System. RESULTS: Our review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production. CONCLUSIONS: We encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities.

Prominent Injury Types in Vehicle Underbody Blast.

BACKGROUND: To fully understand the injury mechanisms during an underbody blast (UBB) event with military vehicles and develop new testing standards specific to military vehicles, one must understand the injuries sustained by the occupants. METHODS: Injury data from Service Members (SM) involved in UBB theater events that occurred from 2010 to 2014 were analyzed. Analysis included the investigation of prominent skeletal and visceral torso injuries. Results were categorized by killed-in-action (n = 132 SM) and wounded-in-action (n = 1,887 SM). RESULTS: Over 90% (553/606 SM) of casualties in UBB events with Abbreviated Injury Scale (AIS) 2+ injury sustained at least one skeletal fracture, when excluding concussion. The most frequent skeletal injuries from UBB were foot fractures (13% of injuries) for wounded-in-action and tibia/fibula fractures (10% of injuries) for killed-in-action. Only 1% (11/1037 SM) of all casualties with AIS 2+ injuries had visceral torso injuries without also sustaining skeletal fractures. In these few casualties, the coded injuries were likely due to trauma from a loading path other than direct UBB loading. CONCLUSION: Skeletal fractures are the most frequent AIS 2+ injury resulting from UBB events. Visceral torso injuries are infrequent in individuals that survive and they generally occur in conjunction with skeletal injuries.

Retrospective Analysis of Injuries in Underbody Blast Events: 2007-2010.

Underbody Blast (UBB) exposure emerged as a substantial cause of morbidity and mortality of Service Members in Iraq and Afghanistan, which was unique to OIF/OEF due to the frequent use of improvised explosive devices. Improvised explosive devices under the vehicle delivered high-rate vertical loading to the vehicle translating energy to the occupant(s) resulting in injuries. Injury mitigating technologies needed to be developed; however, technologies rely on biomechanical human response data for research and development. Widely accepted human response corridors have been developed and established for slower frontal and side impact exposures. Currently, there are no accepted human response data for high-rate vertical exposures, like those experienced during UBB events. To understand the mechanisms and replicate the exposures, analyses of injuries caused by UBB events were required. Medical injury data from UBB events during OIF/OEF were examined. Data were categorized by disposition, body region, injury type, and severity. Data analyses were performed on 555 Service Members receiving a total of 3,844 injuries. The Torso and the Head/face regions were the most injured and sustained predominately fractures/dislocations and internal organ injuries. This work will allow others to prioritize injuries to develop the methodology required to create response metrics to improve energy mitigating technology.

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.

An image-based method to measure all-terrain vehicle dimensions for engineering safety purposes.

BACKGROUND: All-terrain vehicle (ATV) crashes are a serious public health and safety concern. Engineering approaches that address ATV injury prevention are critically needed. Avenues to pursue include evidence-based seat design that decreases risky behaviours, such as carrying passengers and operation of adult-size vehicles by children. OBJECTIVES: The goal of this study was to create and validate an image-based method to measure ATV seat length and placement. METHODS: Publicly available ATV images were downloaded. Adobe Photoshop was then used to generate a vertical grid through the centre of the vehicle, to define the grid scale using the manufacturer's reported wheelbase, and to determine seat length and placement relative to the front and rear axles using this scale. Images that yielded a difference greater than 5% between the calculated and the manufacturer's reported ATV lengths were excluded from further analysis. RESULTS: For the 77 images that met inclusion criteria, the mean±SD for the difference in calculated versus reported vehicle length was 1.8%±1.2%. The Pearson correlation coefficient for comparing image-based seat lengths determined by two independent measurers (20 models) and image-based lengths versus lengths measured at dealerships (12 models) were 0.95 and 0.96, respectively. CONCLUSIONS: The image-based method provides accurate and reproducible results for determining ATV measurements, including seat length and placement. This method greatly expands the number of ATV models that can be studied, and may be generalisable to other motor vehicle types. These measurements can be used to guide engineering approaches that improve ATV safety design.

Ejection of a rear facing, golf cart passenger.

The following report details the findings of a series of experiments and simulations performed on a commercially available, shuttle style golf cart during several maneuvers involving rapid accelerations of the vehicle. It is determined that the current set of passive restraints on these types of golf carts are not adequate in preventing ejection of a rear facing passenger during rapid accelerations in the forward and lateral directions. Experimental data and simulations show that a hip restraint must be a minimum of 13 in. above the seat in order to secure a rear facing passenger during sharp turns, compared to the current restraint height of 5 in. Furthermore, it is determined that a restraint directly in front of the rear facing passenger is necessary to prevent ejection. In addressing these issues, golf cart manufacturers could greatly reduce the likelihood of injury due to ejection of a rear facing, golf cart passenger.

ROPS deficiency of gray-market tractors.

Many used tractors that are imported from Japan are adding to the current national inventory in the U.S. and Canada of farm tractors that lack a rollover protective structure (ROPS). Gray-market tractors are built for use by the manufacturer for a certain country but are imported against the manufacture's wishes to a second country for use there, usually as a used tractor. Gray-market tractors may lack ROPS and seatbelts, depending on the date of manufacturer. The objective of this investigation is to describe the gray market for tractors imported from Japan into the U.S. and the policy implications regarding the hazards associated with these imports. Operator manuals and warning labels are typically not written in English. Foreign manufacturers that market tractors in the U.S. have established a variety of disincentives for the importation of gray-market tractors, including issuing warnings, not servicing or providing parts for these tractors, and banning their importation through actions by the U.S. International Trade Commission. Nonetheless, a U.S. market has developed that imports and provides services and parts for gray-market tractors, and some companies provide certified ROPS on the tractors that they sell. A product safety perspective and related policies are presented as an approach to ensuring that these imports are equipped with ROPS and seatbelts.

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.

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.

A mathematical equation for quantifying control functionality in agricultural tractors.

The overall accessibility of controls is one of the most important issues to consider when designing a control layout. Well-arranged controls, whose operational characteristics are based on both design guidelines and on human factors considerations, allow the operator to efficiently interact with the system in question. The objective of this article is to introduce a numerical index, referred to as the "index of functionality", capable of comparing, on a mathematical basis, different control arrangements in agricultural tractors. The model is based on information that has been gleaned from the published literature, with input from both professional ergonomists and experienced agricultural tractor operators. The numerical index may take any value between 0 and +1, with +1 being defined as an optimum value in terms of the functionality of a workstation. Data were collected from six old (pre-1982) and six modern (post-2003) tractor workstations to determine whether the model would recognize improvements that have occurred in the ergonomic design of tractor control layouts over the past 20 years. An average score of 0.19 +/- 0.07 was calculated for the pre-1982 tractor workstations. By contrast, an average score of 0.63 +/- 0.10 was calculated for the post-2003 tractor workstations. A number of limitations have been identified with the current model; despite these limitations, the index of functionality clearly recognized the ergonomic improvements in tractor workstations that have occurred over the past 20 years.

Evaluation of mechanical tractor pedal extensions.

Many farmers with disabilities choose to modify their work environments to accommodate their personal abilities; however, modified tractors may present greater risk to the operator as they are often one-of-a-kind designs that have not been subjected to rigorous safety testing. The objective of this research was to evaluate mechanical tractor pedal , extensions from a safety perspective. This objective was achieved by identifying potential hazards associated with the introduction of a pedal extension into the cab environment so that both existing and novel designs could be compared using a common methodology. Based on review of the published literature, 19 potential hazards associated with the introduction of a pedal extension into the cab of a tractor were identified. A hazard self-assessment worksheet (HSAW), created based on the 19 hazards, was validated through a pilot study. The overall inter-rater reliability and concurrent criterion validity proved to be acceptable. With the use of the HSAW six pedal extensions (three existing designs and three novel designs) were evaluated by 14 experts. Statistical analysis of the results did not identify a "best" design; however, several important trends were observed. Four of the six designs tended to block access to the exit path. The two designs that did not block access to the exit path might be considered to be the best designs for the tractors used in this study, but other designs likely would have been acceptable if they had been custom-fit for these tractors. The results of this research suggest that custom fabrication of pedal extensions for each specific tractor will likely yield the safest work environment for those who choose to use this assistive technology.

Encouraging the installation of rollover protective structures in New York State: the design of a social marketing intervention.

AIMS: Increasing the percentage of rollover protective structure (ROPS) equipped tractors has been the focus of many agricultural safety campaigns. Traditionally efforts have attempted to persuade farmers through education or community awareness interventions. These efforts have lead to marginal change. In response, a social marketing approach was tested as a means for increasing interest in ROPS retrofitting in New York. METHODS: An initial phone survey was conducted with a random sample of New York farmers to identify a potential target population. Following target selection, in-depth interviews were conducted to isolate barriers and motivators to retrofitting. This information was used to develop message prototypes which were tested in small focus group discussions. Selected and revised messages, as well as various other incentives developed in response to feedback from interviews, were then tested in a prospective, quasi-randomized controlled trial. RESULTS: Small crop and livestock farms were selected as the intervention target since they represent 86% of New York farms with none or only one ROPS protected tractor. Barriers to retrofitting which were identified in interviews were: 1) constant exposures normalize risk, 2) risk is modeled by significant others and 3) safety in general and retrofitting in particular requires too much time and money. The piloting of ROPS incentives led to a marked increase in ROPS sales in New York. CONCLUSIONS: Social Marketing provides a promising framework for the design of agricultural injury prevention programs. The potential implications for other health initiatives seeking to promote behaviour change are also discussed.

National Safe Tractor and Machinery Operation Program: development and content evaluation.

Guidelines in the U.S. Department of Labor's Hazardous Occupations Order in Agriculture (AgHO) regulations state that youth can receive tractor safety certification after participating in a 10-hour course, or receive tractor and machinery safety certification after participating in a 20-hour course. An additional four hours of orientation to on-farm hazards and general safety is required to receive full certification in a 24-hour course. Previous research has shown that traditional safety education certification programs were conducted with non-standardized methods and old curriculum materials. The objective of the National Safe Tractor and Machinery Operation Program (NSTMOP) project was to design an effective, efficient, and accountable youth farm machinery certification program with national uniformity and a single set of economically producible instructional materials with demonstrated content validity. The format for the NSTMOP project was guided by focus groups, a national steering committee, and selected agricultural safety educators. Primary curriculum materials include a task sheet format, and new skills and driving evaluations. Data analysis indicates that the instructional materials, the instructional plan, and the evaluation of student participants satisfactorily met the objectives of the NSTMOP project and the AgHO regulations.

Net monetary benefit of cost-effective rollover protective structures (CROPS): an estimate of the potential benefits of the CROPS research project.

This study builds on an earlier study to examine the net monetary benefit of installing cost-effective rollover protective structures (CROPS) instead of utilizing existing ROPS retrofits for all estimated non-ROPS tractors in the year 2004. With the conservative estimates used in the analyses, results indicate that compared to the baseline option (no protective structure), the Install-ROPS option results in a loss of $310 million to society, while the Install-CROPS option results in a net monetary benefit of $276 million over a 20-year period. A comprehensive sensitivity analysis indicated that, for the extreme values (estimates) used, the estimated net monetary benefit is most sensitive to the probability of tractor overturn. Break-even analysis indicated that the unit cost of intervention for the Install-CROPS option can increase by about 58% and still be able to pay for itself. Even when the minimal unit cost of intervention for ROPS is used, the payback period is reduced substantially for the Install-CROPS option, by almost half the payback period. Finally, compared to existing ROPS retrofits, the net monetary benefit is $586 million, representing an estimate of the potential benefits of the CROPS research.

Encouraging farmers to retrofit tractors: a qualitative analysis of risk perceptions among a group of high-risk farmers in New York.

Tractor rollovers continue to be one of the most frequent causes of agricultural fatalities. Despite knowledge of rollovers and the efficacy of rollover protective structures (ROPS), few New York farmers have considered installing ROPS on their unprotected tractors. Qualitative interviews conducted with an "at-risk" segment of the New York farming community indicate that there are a number of barriers to safety in general and to retrofitting, in particular. The following themes and categories emerged in relation to safety and risk taking: constant exposures to risk with positive outcomes normalizes risk; the modeling of risk by significant others positions risk as part of a farming identity; and the pressure to reduce costs, save time, and accept risk frames risk-taking as the cost-effective option (especially in regard to retrofitting, which farmers believe is both expensive and time-consuming). Recommendations for researchers planning retrofitting interventions would be to focus safety messages on the risk to significant others or on the financial impact of rollovers, and to provide financial incentives and assistance to farmers considering retrofitting.