Lynn Gibbs, MPH David Lawrence, MPH, RN, CS Brigg Reilley, MPH

Copyright 1997 Journal of the Louisiana State Medical Society, Inc



All terrain vehicles (ATVs) have been associated with death and serious injury since their introduction into the marketplace. Fifteen cases of ATV-related brain and spinal cord injury reported to the Louisiana Central Nervous System Registry during 1995 were evaluated for severity, etiology, and outcome. Eleven (73%) of these injuries were sustained by persons under 18 years of age. Despite US Consumer Product Safety Commission and ATV manufacturer recommendations for age restrictions, ATVs continue to be popular recreational devices for children.



All-terrain vehicles (ATVs) have been widely used for recreation in the United States since their introduction in the late 1960s. In the mid-1980s, the US Consumer Product Safety Commission (CPSC) and ATV manufacturers responded to high rates of serious injury and death by halting production of 3-wheeled ATVs, recommending age restrictions on ATV sales, and initiating a campaign to increase public awareness of their improper use (1,2). Despite these efforts, ATVs continue to be a source of severe injury, especially among children.



The Louisiana Office of Public Health maintains the Central Nervous System Injury (CNSI) Registry, a statewide population-based surveillance system addressing brain and spinal cord injury incidence, etiology, and outcome. Reporting of spinal cord injuries (SCI) to the Registry was mandated by the Louisiana legislature in 1985, followed by traumatic brain injuries (TBI) in 1990.

We conducted a retrospective analysis of ATV-associated CNSI case reports for 1995. An ATV-related injury case was defined as a case report with an all terrain vehicle, 3-wheeler or 4-wheeler, referenced in the description of the cause and circumstances of the injury. An SCI case is defined as a patient who arrives alive at an acute care hospital with a traumatic lesion of the neural elements in the spinal canal resulting in temporary or permanent sensory deficit, motor deficit, or bladder or bowel dysfunction.3 A TBI case is defined as a patient who arrives alive at an acute care hospital with an occurrence of injury to the head with one or more of the following: decreased level of consciousness, amnesia, skull fracture, objective neurological or neurophysiological abnormality, or diagnosed intracranial lesion.



We received fifteen case reports of ATV-related traumatic brain and spinal cord injuries to Louisiana residents that occurred during 1995. Twelve people suffered ATV-related brain injuries, two had spinal cord injuries, and one person sustained both a brain and spinal cord injury. Eleven (73%) of the injuries were sustained by persons under 18 years of age (range: 4-32 years). Young white males were at greatest risk for ATV-related injuries.

All of the injuries were related to recreational use of an ATV. Fourteen (93%) of the injuries occurred on a weekend or holiday. Three of the four adults who suffered ATV-related injuries were tested for blood alcohol content. Each tested positive (range: 111-299 mg/dL) and in excess of 100 mg/dL, the legal limit for driving. Although ATV manufacturers caution that the vehicles are designed to transport only one occupant at a time, ATV passengers sustained 4 (26%) of the injuries. Of the ten injury reports documenting the use of protective equipment, none of the injured were wearing a helmet. Although the less stable 3-wheeled ATVs are no longer manufactured, existing "3-wheelers" were not recalled but were allowed to operate their serviceable lives. In 1995, 3-wheelers were involved in 6 of the 13 (46.2%) injuries where vehicle type was known.



None of the safety recommendations of the 1980s were enacted into law. Therefore, safety steps, such as age restrictions and consumer education, rely upon manufacturer and dealer compliance. Public awareness of the dangers of improper ATV use may have dropped since the media coverage ATV injuries received in the 1980s. Recklessness and improper recreational usage have been cited as risk factors for ATV-associated injuries.4,5 These CNS injury cases demonstrate that despite a broad range of safety recommendations and education about risk behaviors such as carrying passengers, alcohol use, and nonuse of protective equipment, ATVs continue to be associated with a high number of injuries.

Operation of ATVs requires coordination, dynamic balance, quick reflexes, and a good sense of judgment. These skills and developmental maturity are lacking in young children. Physicians should caution parents about the hazards of ATV use by children under 16 years of age.



Physicians should counsel parents regarding the inherent hazard of motor vehicle use by children and should help parents select other recreational activities that are more developmentally appropriate than operating motorized vehicles.

If children must ride ATVs they should follow these guidelines:
    1. Riders should receive proper instruction from an experienced operator or professional trainer before attempting to operate the vehicle alone. Parents should closely supervise children while they are using the vehicle.
    2. Children should never operate ATVs designed for adult use, ie, those with engines having more than 90 cubic centimeters of displacement.
    3. Passengers should never be carried on vehicles intended for one person.
    4. Risk-taking behavior, such as jumping over ground depressions, dodging other vehicles, and speeding should be forbidden.
    5. Alcohol and other drugs should never be used before operating a motorized vehicle.
    6. Protective clothing should always be worn. This should include a helmet and goggles. Riders should not wear scarves or other clothing that might get caught in machinery.
    7. ATVs should only be ridden during daylight hours.
    8. Parents should be familiar with the areas where their children will ride and should know where the vehicle is being operated at all times.

This project was funded in part by grant #U59 CCU603362 from the Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Disabilities Prevention Program, and with technical support from the CDC, National Center for Injury Prevention and Control, Division of Acute Care, Rehabilitation Research, and Disability Prevention.

Mr Lawrence, Ms Gibbs, and Mr Reilley are epidemiologists with the Louisiana State Office of Public Health, Disability Prevention Program, Injury Research and Prevention Section.

Reprint requests to: David Lawrence, CSN, National Injury Data Technical Asistance Center, P.O. Box 15817, San Diego, CA 92175.

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