WUSM pediatricians aim to reduce injuries from ATV accidents

Most parents would never consider letting their 6-year-old child ride on the back of a motorcycle, yet many adults don’t think twice about letting kids ride all-terrain vehicles (ATVs).

Helmets have been shown to reduce non-fatal head injuries by up to 64 percent and the risk of mortality by 42 percent, but many studies reveal that helmet use on ATVs is low.
Helmets have been shown to reduce non-fatal head injuries by up to 64 percent and the risk of mortality by 42 percent, but many studies reveal that helmet use on ATVs is low.

“Parental supervision is a key element to childhood safety,” explains Dee Hodge III, M.D., a pediatric emergency medicine specialist and associate professor of pediatrics at Washington University School of Medicine in St. Louis. “And when it comes to ATVs, parents literally hold the key to their child’s safety.

“Injuries and death caused by ATVs are a serious and increasing problem in the United States, and it is critical that all riders understand the importance of safe and responsible ATV use,” adds Hodge, who is also associate director for clinical affairs for emergency services at St. Louis Children’s Hospital.

There are approximately 6.2 million ATVs in the United States that are operated by more than 15 million Americans, according to the U.S. Consumer Protection Safety Commission (CPSC). The agency reports that the number of ATV-related injuries increased significantly from 1997 to 2001 — with children under 16 years old suffering disproportionately.

In 1997, the CPSC reported that an estimated 54,700 ATV-related injuries were treated in U.S. emergency departments. By 2001, the number of ATV-related injuries requiring emergency treatment increased by 104 percent to 111,700.

Furthermore, the number of injuries in children under 16 increased nearly 57 percent. And almost 90 percent of youth ATV-related injuries occur when a child is operating an adult-sized ATV.

Studies of U.S. emergency department injuries also reveal an estimated 273 people die annually from ATV injuries — and more than a third of those deaths are children, who have a death risk 4 to 12 times higher than adults, according to the CPSC.

Height of ATV season

Summertime marks the height of ATV season, and ATV-related injuries are one of the more common injuries Washington University pediatricians at St. Louis Children’s Hospital treat during the summer months.

Injuries range from head injuries, which often result from collisions or the machines flipping or rolling over onto the rider, to arm and lower extremity fractures.

“People often see ATVs as fun, go-cart like toys and fail to realize the potential dangers — including the traumatic and even fatal injuries that can result from ATV accidents,” Hodge says. “Lack of education — coupled with lack of legislative regulation — are the main reasons why so many people don’t realize the dangers of ATVs.”

In both Missouri and Illinois, for example, laws governing the use of ATVs apply to public property use only. Illinois does not have a helmet law. In Missouri, only ATV riders under 18 years old must wear a helmet and anyone operating an ATV under 16 years old must be supervised. These laws, however, don’t apply on private property.

And because there are no training or licensing requirements, many people lack an understanding about the dangers associated with ATVs.

The American Academy of Pediatrics has long recommended that pediatricians warn parents that riding ATVs requires skills, judgment and experience — and that children under 16 should not ride them.

In an effort to help reduce ATV-related injuries in children and increase awareness about the potential dangers, the academy issued a model bill in 1989 to serve as a legislative template for states to follow for ATV guidelines.

Recommendations include prohibiting kids under 16 from driving; license, insurance and registration requirements; a ban on public roads; requiring motorcycle-style helmets, eye protection and safety clothing; prohibiting riding with passengers; and forbidding ATV use while intoxicated.

In spite of banning three-wheeled ATVs and prescribing numerous safety-related measures, including helmet recommendations, warning labels and safety programs, ATV injuries are on the rise.

Helmet use is low

“One of the key injury prevention measures we recommend is to wear helmets and protective gear,” says Rob Kregenow, M.D., a pediatric emergency medicine specialist at St. Louis Children’s Hospital and an instructor in pediatrics at Washington University School of Medicine.

Helmets have been shown to reduce non-fatal head injuries by up to 64 percent and the risk of mortality by 42 percent, but many studies reveal that helmet use on ATVs is low. Death rates in states without helmet safety laws are about twice that of those with requirements.

Although ATV dealers offer a safety education course at the time of sale, overall participation in these courses is low, estimated at only 11 percent.

“All people — especially children — riding ATVs should wear helmets, and kids require helmets designed for children,” Kregenow explains. “We had a 6-year-old who was brought into the emergency department because she was wearing an adult helmet, which fell in front of her face, blocked her vision and caused her to run into a tree.”

Kregenow adds that all child ATV riders should be supervised. “Riding ATVs allows for an incredible amount of mobility, and if someone riding alone is injured, several hours may pass before someone finds them,” he says.

The CPSC also stresses no one should ride double — especially with a young child on the front or the back of the ATV. If an ATV rolls over on an adult, he or she often has the upper body strength to move it out of the way, whereas it’s often impossible for small children to move the vehicle off their bodies.

Hodge and Kregenow urge parents to think of ATV use in these terms: “If your child is not old enough to ride a motorcycle, than you really should consider whether they should be riding an ATV.”

Guidelines for riding

CPSC studies show that more than 90 percent of all ATV-related fatalities are the result of warned-against behaviors. Washington University emergency medicine specialists and the ATV Safety Institute recommend the following guidelines for riding ATVs:

  • Always wear a helmet and protective gear.
  • Never carry a passenger on a single-rider vehicle.
  • Never ride on public roads because other vehicles could hit you.
  • Supervise riders younger than 16 and never allow them to ride adult-sized ATVs.
  • Ride only on designated trails at a safe speed.
  • Ride an ATV that’s right for your age. The guidelines are:

-Age 6 and older: Under 70 cubic centimeters
-Age 12 and older 70-90 cubic centimeters
-Age 16 and older: Over 90 cubic centimeters.