A growing number of adults and children die or are injured — sometimes seriously — in all-terrain vehicle (ATV) accidents each year. In Minnesota, where an estimated 1 in 14 people is an ATV rider, deaths rose nearly 20 percent between 2007 and 2010 alone.
Nationwide, children account for about one-third of ATV-related emergency department visits and one-quarter of the deaths. For the first time, more children are likely to require hospitalization or die in ATV mishaps than in bicycle accidents.
"An ATV is basically a chassis with four wheels and a high center of gravity, so it's inherently unstable. And the driver's body movement is an integral part of the handling," says Todd M. Emanuel, R.N., injury prevention coordinator for Mayo Clinic's emergency services in Rochester, Minn. "Most kids don't have the size, physical strength and balance to control these vehicles, especially adult-sized ones. It's just too much machine for small bodies."
Carrying passengers, which is illegal in some states, though not, with certain restrictions, in Minnesota, makes ATVs even more likely to tip or roll over.
Mayo trauma surgeon Beth A. Ballinger, M.D., points out that unsteadiness increases with multiple riders, especially young children. "You drive differently with a child in your lap, but even adult passengers affect maneuverability," she says, adding that people riding behind are likely to get thrown off.
Rollovers are the most common cause of ATV-related injuries, not only because of instability but also because of where and how the machines are driven. "ATVs are meant to be driven on rough terrain, not paved roads," Emanuel notes. "The wheels don't turn or contact the pavement like car wheels do, so (ATVs) are more likely to flip when drivers are crossing a roadway."
Dr. Ballinger points out that alcohol frequently plays a role in ATV accidents. A review of ATV injury data at The University of Iowa from 2002 to 2009 found that 35 percent of patients tested positive for alcohol, and 25 percent tested positive for drugs.
Head trauma is the leading cause of ATV-associated death and disability.
During the 2010-2011 season, doctors at Saint Marys Hospital, one of Mayo Clinic's hospitals in Rochester, Minn., and a Level I adult and pediatric trauma center, treated 115 people for ATV-related injuries. Of these, 36 percent had head injuries; another 18 percent had injuries to the spinal cord or column. Only 66 percent of patients were known to have worn helmets.
Dr. Ballinger says that helmets could have prevented many, but not all, of these injuries. Some studies suggest that helmets reduce the risk of fatal head injury by 42 percent and the risk of nonfatal head injury by as much as 64 percent. But headgear can't protect against spinal cord, thoracic and abdominal injuries or rib and extremity fractures — all common in ATV accidents.
Dr. Ballinger notes, "An ATV is essentially an engine with four wheels. These vehicles can go 80 miles an hour on a flat surface, but there is no harness, seat belt or cab for protection."
Emanuel says that most local hospitals know what they can and can't handle when it comes to ATV-related trauma. But he stresses that head injuries can deteriorate quickly, and providers need to be alert for subtle signs of traumatic brain injury.
Dr. Ballinger adds that knowing the mechanism of injury is important, too.
"A child who runs into a tree riding a Big Wheel is very different from a child who runs into a tree driving an 800-pound ATV," she says. "The latter is much more likely to have a serious injury and to need a battery of tests, including a CT of the head and neck and possibly an MRI. So understanding what these machines do and the associated injuries is critical. If a child needs a thorough evaluation and a hospital isn't capable of providing it or isn't sure what's needed, then the child should be referred to a higher level of care as soon as possible."
To help promote recreational safety and helmet use, Mayo Clinic conducts educational programs in area middle schools. The Department of Natural Resources also offers mandatory ATV safety training classes throughout the state.
Ultimately, though, injury prevention depends on the people behind the wheel.
"I appreciate the wish to be outside and to go fast and be enthusiastic, especially on the part of young people," Dr. Ballinger says. "And I can understand that this can be a great family activity if it's well supervised and takes place at a reasonable pace on planned trails with everyone wearing helmets. But when it deviates ... from that, it can become dangerous. Unfortunately, our ability to create recreational vehicles has outpaced people's ability to make good decisions about them. We can't get any decent, consistent regulation, so it's up to responsible people to make good decisions and use these vehicles appropriately."