Through the military and my hospital appointments I’ve been able to work in some incredible regions of the US. In both southern Texas and central Pennsylvania the broad expanses of natural terrain are an invitation begging for off road ATV use. In both locations, I’ve been shocked at the severity of child injuries due to ATVs. One particularly tragic incident I recall was an emergency call in the middle of the night. Three teens riding on two ATV’s in an abandoned field were drinking and decided to play chicken. Who knows what they were thinking, the fun they were having, and their shouts of bravery, but it all came to an end when their two vehicles collided at the front left corners. Two died on that field before EMS arrived, the third was injured from head to toe with multiple broken bones and severe head trauma. It was months and multiple operations later before he was well enough to attend school, and it is impossible to know how much potential he lost.
The ATV was introduced in 1970 by Honda to satisfy requests from motorcycle dealers to provide a product that could boost sales in winter. The Honda US90 was a three wheeled motorcycle with big fat tires designed to go over uneven turf and snow.
It was marketed as an off-road recreation vehicle, but dealers were surprised to find it was mostly being used for farm and industrial applications. It had poor stability due to the high center of gravity, the three-wheeled footprint, and non-intuitive steering. Sales skyrocketed, as did an alarming number of injuries, with 239,000 injuries and 600 deaths recorded in the US from 1971-1987. Even worse, 40% of these deaths were children. Suzuki introduced the LT125, the first four-wheel ATV in 1982. Manufacturers were marketing vehicles for farm and ranch use, but by that time most ATV’s were mainly used for recreational uses such as camping, hunting, and racing.
In 1988 the major manufacturers of ATVs signed a voluntary 10-year consent decree with the Consumer Product Safety Commission in which they agreed that three-wheel ATV’s would be banned, safety equipment would be incorporated, user training would occur at the dealer, units would carry warning labels, and sales to children under 13 would be prohibited. This decree expired in 1998 and was not renewed. From 1995-2000, ATV sales continued to increase, and in the same period injuries increased 63%. The size and power of ATVs grew, and the world saw models with 1000cc engine displacement, weights over 1000lb, and speeds up to 79 mph in the Suzuki LT500R, nicknamed “Quadzilla”.
Currently there are 10.5 million ATVs in use in the US. In 2009, there were 131,900 injuries, and a quarter of them were in children. From 1982-2009 10,281 deaths were recorded, also a quarter of them children. The deadliest states for ATV use are California, Pennsylvania, Texas, and West Virginia, but all states are affected.
Certain aspects of ATVs can explain why there are so many injuries. Their off-road design incorporates a flexible suspension that affects steering and large low inflation tires for off-road traction. Steering is a complicated combination of speed modulation, shift in body weight, and handlebar angulations. It requires the rider to push down on the footrest to shift one cheek off the seat to the inside of the turn. Each bump in the terrain requires an immediate complex response in speed, steering position, and lean. In a crash the ATV carries nearly the weight of a car and the rider exposure of a motorcycle, so severe injuries from vehicle rollover and crush are common. These characteristics can be controlled by a trained adult rider with proper safety equipment, but children can quickly be pushed beyond ability to safely pilot an ATV. I repeatedly see a pattern of injury in children that includes limb fractures, head injuries, internal bleeding, and combinations of these wounds.
Children are disadvantaged because of decreased size, strength, and coordination. They can have difficulty reaching controls on full size ATVs. Additionally, children are more prone to crashes because of inexperience, speeding, and poor judgment when it is required in a split second. Forty percent of published reports of ATV injuries are in children.
These dangers have led the American Academy of Pediatrics to state, “Laws should prohibit the use of ATVs, on or off-road, by children and adolescents younger than 16 years.” American Pediatric Surgical Association similarly states, “Children younger than 16 years lack the judgment and physical ability to safely operate motorized vehicles and should not operate ATVs of any size.”
I know this sounds like the usual pessimistic don’t, don’t, don’t of a doctor, but there are actually some useful recommendations I can make to try and keep safe on an ATV.
- - Only one rider to each ATV: the vehicle is meant for one person and the addition of a passenger shifts the center of gravity backwards. This unloads the front axle and hinders steering. I frequently see a pattern of injury where a passenger on the back of the ATV is crushed in a rollover, or a small child in front of the driver is crushed against the handlebars.
- - Use a helmet! In a crash, a helmet can mean the difference between survival and death, or a life spent in a bed or wheelchair. In surgery we can fix nearly any part of the body, but when brain cells are gone, they don’t come back.
- - Match the ATV size to the driver: Children under 16 should use an ATV of 90cc or less.
- - Be sober when driving an ATV. Alcohol and drugs greatly increase the chance of a crash.
- - Provide adult supervision whenever children are riding ATVs: Adults need to know the tenets of safe riding, and ensure children are following them, and know how to disable the vehicle if they are not.
- - Take a rider safety course: it is better not to learn the idiosyncrasies of the vehicle the hard way.
- - Only travel on terrain within your ability: Some of the most severe injuries we see are collisions with trees or falls over cliffs. Walk out your course before you ride it. Give a wide berth to ledges and drop-offs. Adjust your speed to conditions, Space out vehicles on the trail to avoid collisions. Let a rider who knows the trail lead until you are familiar.
- - Never play chicken on ATVs and never pull or drag anyone behind your vehicle: It’s just inviting serious injury or death.
- - Ride in a group: many ATV trails are in remote areas. After an injury, it can take a long time for rescue extraction, and that rescue may never come if no one knows you have crashed.
- - Use gloves, goggles, boots, long pants, and long sleeves: This protective equipment will ensure you can maintain your vehicle right side up and on the trail no matter what obstacles you encounter.
- - Follow local laws and regulations: For example, Pennsylvania law states that it is illegal for anyone under 8 to operate an ATV. Children 8-9 years can only use an ATV of 70cc or less. Children under the age of 16 must take a rider safety course. Riders must wear a helmet. ATVs cannot be used on open roadways. ATVs must be inspected and registered. These laws do not apply to private property, but they are a good minimum safety requirement anywhere.
At our hospital, we have reached out to the community to keep kids healthy. We have visited health fairs to educate children and parents, and even give away helmets. We won a grant to provide free rider safety courses to a cadre of children each month in the spring and summer. We have been involved with a local recreational area to help plan safe trails, safety regulations, and routes of extrication for air and ground ambulance.
ATVs are a wonderful way to experience the beautiful natural resources of our great country. They have become a staple of outdoor recreational activity for many families. Parents must realize the inherent danger in the activity so they can take safety measures and ensure their children will be there for years to come.
(Images via Wikipedia)