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Why the Need for Speed?

ATVs, Speed, and ATV-related Head Injuries

Charles Jennissen, MD, Curtis Brown, BS, Ali Maamar-Tayeb, MDKari Harding, PhD, Gerene Denning, PhD

Department of Emergency Medicine, University of Iowa Carver College of Medicine

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Increase in ATV-Related Injuries

The incidence of ATV-related deaths and injuries has escalated over the past 15 years.

But what has been particularly striking are the increases among adults.

What might be contributing to these increases?

0

15,000

30,000

45,000

60,000

75,000

90,000

105,000Adult

Pediatric (< 16 years old)

Year

Data from the National Electronic Injury Surveillance System (NEISS)

10-Year Consent Decree

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Canadian Sales Data Provide Some Insights

ATVs engines sizes have dramatically increased.

More recent sales data and US data unavailable.

Models available that have >850 cc engines.

Can weigh over 800 pounds and travel over 80 mph.

Murphy et al. J. Trauma,. 56:1185-1190, 2004.

ATV Engine Sizes Sold(Canadian Sales Data)

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Hypothesis

ATV Engine Sizes Sold(Canadian Sales Data)

0

15,000

30,000

45,000

60,000

75,000

90,000

105,000Adult

Pediatric (< 16 years old)

Year

The growing popularity of larger, faster vehicles may be contributing to the increase.

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Objective of Our Studies

Common types of ATV-related injuries have been described.

However, the circumstances under which they occur are poorly defined in the literature.

The objective of the study was to better understand the mechanisms and contributing factors of ATV-related injuries.

Patient records from a Level 1 trauma center.

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Methods

A retrospective chart analysis of all patients entered into the University of Iowa Hospitals and Clinics Trauma Registry with ATV-related injuries from 2002-2009.

Potential subjects coded as having had an off-road vehicle incident were identified.

Vehicles other than traditional 3 or 4-wheeled ATVs (motorbikes, scooters, utility vehicles, etc.) were excluded.

A systematic review of each medical chart was performed.

Details of injury events, potential contributing factors, and resulting injuries were determined and evaluated.

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Demographic Results

345 ATV-related cases

were identified (2002-

2009).

79% of patients were

males.

32% were children <18

years of age.

Patients with ATV Injuries by Gender

Female21%

Male79%

Patients with ATV Injuries by Age

Adults68%

Children (<18)32%

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0.0%0.0%

0.9%

2.4%7.7%

33.2%35.3%

39.4%50.3%

90.3%92.2%

94.8%97.1%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percent of Medical Records that Featured Documentation

WeatherElectronic Device Use

ATV ModelATV Size

Path(straight/turning)Surface Type

SpeedSlope of Terrain

Road/trail/offroad4 vs. 3 Wheels

Time of DayHelmet Use

Seating Position

Cont

ributi

ng F

acto

rs

Medical Record Documentation of Contributing Factors

Documentation

Vehicle parameters were poorly documented.

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Light Conditions

Light Conditions: Percentage of ATV Injuries

Day61.16%

Dusk3.77%

Dawn0.29%

Unknown4.35%

Night30.43%

More than 30% of crashes occurred in limited light conditions

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Crash Mechanisms

Crash Mechanism

• Rollovers (42%) were the most common mechanism of injury.

• Striking an object (20%) and ejection/fall from the machine (13%) were also common.

• Collision with another ATV occurred in 7% of crashes.The victim was struck by

the ATV in 21% and pinned in 9% of the cases.

Larger vehicles may be associated with more crush injuries.

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Helmet Use

21% of all patients were reportedly wearing helmets.

Younger riders (<16 years old) were more likely to be helmeted than those older (p=0.03).

Helmet Use by ATV Crash Victims

No Helmet74%

Helmet21%

Unknown5%

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Head Injury and Speed

The greater the ATV speed, the worse the patient’s head injury (p=0.09).

Max Head Scores

• <16 vs. 26-40 (p=0.05)

• <16 vs. >40 (p=0.02)

00.5

11.5

2

MAX H

EAD

<16 16--25 26--40 >40 Unknown

Speed (mph)

Injuries Related to Speed

N=27

N=23 N=224N=33

N=38

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Head Injury and SpeedHigher ATV speeds trended toward lower the Glasgow

Coma Scale (GCS) scores.

N=27 N=33

N=38 N=23N=224

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13.5

14

14.5

15

GCS

<16 16--25 26--40 >40 Unknown

Speed (mph)

Injuries Related to Speed

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Helmets and Head Injury

Unlike other studies, helmets did not appear to be very protective.

We noticed a significant number of victims were racers.

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Compared to non-racing helmeted riders, non-racing riders without helmets had significantly lower GCS scores (p=0.01).

Head Injury and Helmet Use

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•Compared to non-racing helmeted riders, helmeted racers had significantly lower GCS scores (p=0.02).

Head Injury and Helmet Use

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Speed Kills…

…and causes greater injuries.

Not a new concept but an important one.

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Speed and the Work Setting

Eleven Australian dairy farmer’s ATVs were fitted with two GPS units and accelerometer for 14 days.

Average Daily Exposure 1 1/2 hrs

Average Speed 5.2 mph (1.5-10.4)

Average Maximum Speed 29.0 mph (16.8-48.0)

95% of the time were travelling 18.6 mph (30 kph) or less

Operators over-estimated their speed

Ave. speed 11.8 mph

Average Max. Speed 36 mph

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Why the Need for Speed?

Why are these vehicles manufactured to go so fast?

They are an off-road vehicle manufactured for off-road use.

Who can safely travel greater than 40 mph on most off-road surfaces?

No one!

So how can you experience the speed your ATV can achieve?

Go on the road!

This is a big reason why the rate of roadway deaths are increasing at a much higher rate than those off-road.

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Consumer Product Safety Improvement Act

In effect since April, 2009

Use vehicle maximum and restricted speed limitations for determining the age appropriateness of ATVs

Rather than engine size.

atvs

cene

.com

Category Age Range Maximum Speed

(Restricted)

Maximum Speed

(Unrestricted)

Y-6+ Age 6 or older 10mph/16kph or Less 15mph/24kph

Y-12+ Age 12 or older 15mph/24kph or Less 30mph/48kph

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Speed Limiters

Most ATVs have a throttle limiting screw as their speed limiter. Often the children know how to adjust better than

their parents with simple use of a screwdriver.

Some vehicles have speed limiters that are plugged into the electrical systems Capacitor Discharged Ignition (CDI). Only needs to be unplugged. Cut the wire that connects the limiter to the CDI to

remove the restriction.

A collar or spacer (which limits pulley travel and reduces higher gear ratios). May be removed from the Continuously Variable

Transmission (CVT) for extra speed in some models.

foru

ms.

atvc

onne

ctio

n.co

mw

ww

.any

thin

gatv

.com

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Speed Limiters…. Should be code-protected and tamper-proof so that they cannot be

changed or bypassed by other operators.

Should be incorporated into both youth- and adult-size machines.

Allow parents to limit speed of their vehicles for children of all ages, family as well as non-family.

Allow employers to limit the speed of their vehicles for their employees.

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Conclusions

The ever increasing and higher speeds of today’s ATVs are likely contributing to more deaths and serious injuries.

Although protective, there may be crash speeds or mechanisms of brain injury at higher speeds that reduce helmet effectiveness.

All ATVs should be equipped with a coded and/or programmable speed limiter that cannot be changed or bypassed by another operator.

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Future Directions

Improve crash and injury surveillance in the emergency department:

• A multicenter ATV research network.

• Prospectively data collection.

• Standardized collection tool.

Educational and training approaches to increase user knowledge about the danger of speed.

Engineering approaches to limit speed for safer operation.

Get ATVs off the road except for work-related purposes!

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Thank You