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Objective: Few studies have investigated U.S. emergency department (ED) moped-related injuries. Our objective was to determine the characteristics of moped crashes among adult riders and to identify associations between key variables. Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for 2002–2014. Descriptive and comparative analyses of the identified cases were performed. Results: Based on a probability sample of 2,453 cases, an estimated 108,229 U.S. adult moped-related ED visits occurred during the study period. Injuries increased 2.7-fold over time. Summer months and weekdays were the most common crash times. Three-fourths of injured riders were male, two-thirds were ages 23–59 years, and 77% were Caucasian. Among cases documented, one-half were helmeted, and almost two-thirds of crashes occurred at ≤20 mph. The predominant mechanism was a non-collision crash (60%). Skin-related and musculoskeletal diagnoses were most common. Almost one-fifth of patients were admitted or transferred. Regression analyses showed that males were less likely than females to be in crashes with multiple riders, and more likely to have used alcohol/drugs and to be in a crash with another motor vehicle (MVC). Older riders (≥40 years) were more likely than those younger to have used alcohol/drugs and to suffer torso injuries, and less likely to be in an MVC. As compared to other crash mechanisms, MVCs were more likely to involve injuries to the head/neck/face and torso. The likelihood of being admitted/transferred was higher for males, with increasing age, and for collision-related crashes. The higher likelihood of being admitted/transferred was also characterized by alcohol/drug use, by lower limb and torso injuries, and almost 8 times more likely for riders with serious head injuries. Conclusions: Moped injuries increased in all adult age groups during the study period. However, there were significant differences in contributing factors, crash mechanism, and outcomes by sex, race, and age. These findings suggest the need for targeted injury prevention interventions.

All-terrain vehicle (ATV) crashes are one of the leading causes of death and injury in agriculture across the United States. Use of ATVs is highly prevalent in rural areas and has seen an increase in their application for a variety of agricultural work tasks. Empirical research on the use of these vehicles for agricultural tasks and associated injuries is limited, especially in the United States. Moreover, little is known about the risk factors associated with ATV-related injuries while doing farm work. A comprehensive review was conducted to evaluate the current injury burden of ATV use in agriculture, the need for future research, and possible solutions related to agricultural ATV safety. Potential injury prevention approaches are evaluated based on the hierarchy of control, including elimination or substitution (using side-by-side vehicles instead of ATVs or modifying ATV design), engineering control (operator protection devices), administrative authority (regulations and standards in the United States and around the world), training, and use of personal protective equipment. In addition, vehicle nomenclature, risk factors, and crash mechanisms are reviewed. Recommendations to decrease the likelihood of ATV crashes and injuries are provided.

Purpose: All-terrain vehicles (ATVs) are valuable assets on farms and ranches, but are associated with a growing proportion of U.S. agricultural work-related deaths and injuries. The objectives of ...

Purpose: Recreational off-highway vehicles (ROVs) have become increasingly popular, but no studies have examined the safety issues and experiences of rural teens while operating ROVs. Methods: Atte...

Purpose: All-terrain vehicles (ATVs) are a significant source of rural injuries and deaths. Few studies have examined the best methods to improve adolescent ATV safety practices from the target aud...

BackgroundInjuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases.ObjectiveThe objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system.MethodsIn this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System.ResultsOur review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production.ConclusionsWe encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities.

Safety laws are among the most successful means of reducing injuries, but their effectiveness is strongly influenced by the level of enforcement. To characterize enforcement of off-road vehicle (ORV) laws statewide, analyses of citations were performed using Iowa Court Information System data. From 2005&ndash, 2015, 5173 individuals were charged with 5643 citations issued. Citations averaged &lt, 5/county/year, decreased dramatically over time, and varied by county when normalized to registered all-terrain vehicles (ATVs). Over 90% of operators cited were male and Caucasian. One-fifth were &lt, 18 years old. The top five violations were: operation on a highway/snowmobile trail (51%), registration/identification number not documented/displayed (19%), prohibited use in a park/preserve (5.5%), and operation with more persons than the vehicle is designed to carry (4.4%). The Department of Natural Resources issued the highest percentage of citations, followed in decreasing order by Sheriff, Police, State Patrol, and Conservation officers. Significant differences were identified when citations were compared by sex, age, race, enforcement agency, disposition (guilty vs. not guilty), and when comparing counties with or without an ORV park. These characteristics suggest limited and variable enforcement of laws statewide that may reduce their potential to prevent deaths and injuries, and that improved strategies to support ORV law enforcement are needed.

Purpose: Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural areas and agri...

All-terrain vehicle (ATV)-related deaths and injuries continue to be a significant problem. Influential change agents such as agribusinesses could be important partners for improving safety behaviors among rural ATV users. Our objective was to determine how effectively an injury prevention project could engage agribusinesses through the postal service and to assess their willingness to display a safety poster.One thousand two hundred forty-four agribusinesses received an ATV safety poster and a postcard survey by mail. A randomized sampling of these businesses was surveyed by telephone 4-7 weeks later. Telephone survey questions included whether they recalled receiving the poster, and if so, whether, where and how long the poster was displayed.One hundred six postcards were returned. Of the 192 eligible business persons contacted by telephone, 89% agreed to participate. Approximately one-third of telephone survey participants recalled receiving the poster. Among these, 81% with walk-in customers posted it, and 74% still had it displayed 1 month later. Of participants who did not recall receiving the poster, 83% stated they would have displayed the poster. The cost of displaying each poster in a business was 16.6 cents/day during the first month. Final costs/day would be much less because of continued display.A high percentage of agribusinesses displayed or would have displayed an ATV safety poster, and most displayed it beyond 1 month. Unfortunately, participant recruitment via postal delivery alone was challenging. Nevertheless, mass mailing of injury prevention materials to be displayed in the retail setting may be a low cost method for raising safety awareness.

Since 1985, one-third of all US all-terrain vehicle (ATV)-related injuries and one-quarter of deaths involved victims16 years of age. ATV safety education of youth could help reduce these tragedies.To assess the efficacy of the Safety Tips for ATV Riders (STARs) school-based programme targeting adolescents.A survey was anonymously administered before and after the programme to determine demographics, knowledge and reported likelihood of using the information learned.Over 4600 students in 30 Iowa schools participated from November 2010 to April 2013. Initially, 52% knew most ATVs are designed for one rider, 25% knew the recommended vehicle size for their age range and 42% knew riding on Iowa's roads was legal only for agricultural purposes. After the programme, this increased to 92%, 82% and 76%, respectively (p0.0001 in each case), with 61% of students correct on all three. Better preintervention scores were associated with being males, higher riding frequency and being from isolated rural communities. After the programme, 48% and 32% said they were likely/very likely versus unlikely/very unlikely to use the safety information learned, respectively; younger students, females and infrequent riders reported higher likelihoods.STARs increased short-term ATV safety knowledge and almost half the participants reported they would use the safety information presented. Males and frequent riders seemed more resistant, but some groups that may be more vulnerable to potential ATV crash and injury appeared amenable to the training with higher increases in postprogramme scores and greater intention of improving safety behaviours.

Over 100,000 all-terrain vehicle (ATV)-related injuries are evaluated in U.S. emergency departments each year. In this study, we analyzed the time intervals for emergency medical services (EMS) providers responding to ATV crashes in different location types. Data from the Iowa State Trauma Registry and a statewide ATV crash/injury database was matched with Iowa EMS Registry records from 2004&ndash, 2014. Ground ambulance responses to 270 ATV crashes were identified, and response characteristics and time intervals were analyzed. Off-road crashes had a longer median patient access interval (p &lt, 0.001) and total on scene interval (p = 0.002) than roadway crashes. Crashes in remote locations had a longer median patient access interval (p &lt, 0.001) and total on scene interval (p &lt, 0.001), but also a longer median on scene with patient interval (p = 0.004) than crashes in accessible locations. Fifteen percent of remote patient access times were &gt, 6 min as compared to 3% of accessible crashes (p = 0.0004). There were no differences in en route to scene or en route to hospital time. Comparisons by location type showed no differences in injury severity score or number of total procedures performed. We concluded that responding EMS providers had an increased length of time to get to the patient after arriving on scene for off-road and remote ATV crashes relative to roadway and accessible location crashes, respectively.

Background All-terrain vehicle (ATV)-related deaths and injuries are a growing public health concern, particularly in rural and suburban communities. More engineering approaches that address vehicle safety and promote injury prevention are critically needed. Objectives Our study was designed to determine the variability in seat characteristics among 2012 model-year, adult-size ATVs. Methods Measurements of 67 models were performed using an image-based method. Seat characteristics were compared by manufacturer and by ATV type (sport vs utility). Results There were significant differences in seat length and seat placement among manufacturers and between sport and utility ATVs. Seat lengths ranged from 19.8 to 37.0 inches, with sport models significantly longer than utility models. Longer seats resulted from the back of the seat extending further beyond the rear axle and/or the seat front extending closer to the handle grips. Seat front to handle grip distances ranged from 3.25 to 16.5 inches. Combined data showed a strong inverse correlation between seat length and the distance from the seat front to the handle grips, but no significant correlation with wheelbase or engine size. Conclusions We found wide variability in seat length and placement for adult-size ATVs. However, existing seat specifications were identified that may be a good starting point for improved seat design. Optimal design would allow for safe operation while reducing the likelihood of multiple riders and use by underaged operators, both major risk factors for ATV-related deaths and injuries. Ultimately, regulations may be needed to ensure standardised seat design is incorporated throughout the ATV industry.

The number of off-highway vehicle (OHV) parks continues to grow to meet the recreational needs of ATV enthusiasts and the increasing popularity of the vehicle. Little is known about how OHV park regulations and enforcement affect ATV safety among their users. This study was designed to determine whether there were differences in crash mechanisms and/or compliance with ATV safety laws and regulations when comparing off-road ATV crashes inside and outside state OHV parks. Relative to outside the parks, a smaller percentage of park victims were under the age of sixteen, a lower percentage were passengers, and a dramatically higher percentage were helmeted. Mean injury severity scores were not different inside and outside the parks, but 5% of outside victims had severe brain injuries, as compared to no park victims. Overall, park victims exhibited better compliance with ATV safety laws and regulations and suffered less severe brain injury outcomes. However, park crashes involved more jump-related injuries, suggesting that additional approaches are needed to improve park safety. These findings support the hypothesis that riding environments with safety regulations and effective enforcement can promote safe behaviors and may prevent injuries.

Background All-terrain vehicles (ATVs) have steadily increased in popularity, size and speed, characteristics that likely contribute to the alarming rise in ATV-related fatalities. One potentially high-risk activity is riding on the road. Objectives To compare fatal ATV crashes that occur on the roadway and off, to more fully understand factors that contribute to fatalities at each location. Methods Fatality data from the US Consumer Product Safety Commission (CPSC) were used for descriptive and comparative analyses. Multivariate logistic regression analysis was performed to determine relative risk. Results Over 60% of all fatalities (1985–2009) resulted from roadway crashes. After 1998, roadway fatalities increased at over twice the rate of off-road fatalities. Roadway crashes were more likely than off-road crashes to involve multiple fatalities, carrying passengers, alcohol use, collisions and head injuries. Roadway victims were less likely to be helmeted than off-road victims. Passengers and operators with passengers were also less likely to be helmeted than operators riding alone. Helmeted victims were half as likely to suffer a head injury. Conclusions Fatal roadway crashes were more likely than off-road crashes to involve risk-taking behaviours (eg, carrying passengers) that could exacerbate the inherent difficulty of operating ATVs on roadway surfaces. Higher crash forces from greater speed, and lower use of protective equipment, may also have contributed to higher roadway mortality rates. Eliminating non-essential ATV road use may be an effective way to reduce ATV-related fatalities. This will likely require a substantial investment in rider education and better enforcement of ATV road use restriction laws.

All-terrain vehicles (ATVs) continue to be an increasing cause of injuries and deaths in children, especially in rural communities. More children die in the United States each year from ATV-related events than from bicycle crashes. The purpose of this study was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. An electronic survey was administered to primary care providers belonging to state medical societies. More than 60% of respondents (Total N = 218) believed that ATV anticipatory guidance was important to provide to pediatric patients and their families. However, 78% stated they provide ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% stated they do so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice. Providers in the study demonstrated limited knowledge, reported multiple barriers, and provided little or no ATV safety counseling. However, they consider ATV anticipatory guidance important for their patients. Armed with increased knowledge and appropriate resources, providers could play a significant role in promoting ATV safety.

Traditional all-terrain vehicles (ATVs) are designed for single riders. Although carrying passengers is a known risk factor for injury, how passengers contribute to ATV crashes remains poorly understood. To address this question, we performed a retrospective chart review of ATV crash victims at a U.S. trauma center (2002–2013). Of 537 cases, 20% were passengers or drivers with passengers. The odds of backward rollovers, falls/ejections, crashes on sloped terrain, and collisions with motorized vehicles were all significantly greater when passengers were present. In contrast, the odds of self-ejection or falls/ejections over the handlebars were significantly lower than falls/ejections to the side or rear, in crashes with multiple riders. Among all ejections, self-ejections had the lowest head and highest extremity injury scores and being ejected over the handlebars or to the rear resulted in worse head injury scores than being ejected to the side. In summary, our study found that passengers increased the odds of specific crash and injury mechanisms and that head and extremity injury severity varied by ejection type. Safety interventions including seat design changes that prevent carrying passengers, and a strict, well-enforced no-rider rule are needed to effectively prevent passenger–related deaths and injuries.

All-terrain vehicles (ATVs) are designed for off-highway use only, and many of their features create increased risk with roadway travel. Over half of all ATV-related fatalities occur on roadways, and nonfatal roadway crashes result in more serious injuries than those off the road. A number of jurisdictions have passed or have considered legislation allowing ATVs on public roadways, sometimes limiting them to those unpaved, arguing that they are safe for ATVs. However, no studies have determined the epidemiology of ATV-related fatalities on different road surface types. The objective of the study was to compare ATV-related deaths on paved versus unpaved roads and to contrast them with off-road fatalities.Retrospective descriptive and multivariable analyses were performed using U.S. Consumer Product Safety Commission fatality data from 1982 through 2012.After 1998, ATV-related deaths increased at twice the rate on paved versus unpaved roads. Still, 42% of all roadway deaths during the study period occurred on unpaved surfaces. States varied considerably, ranging from 18% to 79% of their ATV-related roadway deaths occurring on unpaved roads. Paved road crashes were more likely than those on unpaved surfaces to involve males, adolescents and younger adults, passengers, and collisions with other vehicles. Both the pattern of other vehicles involved in collisions and which vehicle hit the other were different for the 2 road types. Alcohol use was higher, helmet use was lower, and head injuries were more likely in paved versus unpaved roadway crashes. However, head injuries still occurred in 76% of fatalities on unpaved roads. Helmets were associated with lower proportions of head injuries among riders, regardless of road surface type. Relative to off-road crashes, both paved and unpaved roads were more likely to involve collisions with another vehicle. The vast majority of roadway crashes, however, did not involve a traffic collision on either paved or unpaved roads.Although differences were observed between paved and unpaved roads, our results show that riding on either represented significantly greater dangers than riding off the road. Many vehicle warnings specifically mention the risks of paved but not unpaved roads, yet we found 23 states with half or more of their roadway deaths on unpaved surfaces. Safety warnings should explicitly state the dangers of roadway riding regardless of surface type. These data further support laws/ordinances greatly restricting ATV riding on all types of public roadways.

Background All-terrain vehicle (ATV) crashes are a serious public health and safety concern. Engineering approaches that address ATV injury prevention are critically needed. Avenues to pursue include evidence-based seat design that decreases risky behaviours, such as carrying passengers and operation of adult-size vehicles by children. Objectives The goal of this study was to create and validate an image-based method to measure ATV seat length and placement. Methods Publicly available ATV images were downloaded. Adobe Photoshop was then used to generate a vertical grid through the centre of the vehicle, to define the grid scale using the manufacturer9s reported wheelbase, and to determine seat length and placement relative to the front and rear axles using this scale. Images that yielded a difference greater than 5% between the calculated and the manufacturer9s reported ATV lengths were excluded from further analysis. Results For the 77 images that met inclusion criteria, the mean±SD for the difference in calculated versus reported vehicle length was 1.8%±1.2%. The Pearson correlation coefficient for comparing image-based seat lengths determined by two independent measurers (20 models) and image-based lengths versus lengths measured at dealerships (12 models) were 0.95 and 0.96, respectively. Conclusions The image-based method provides accurate and reproducible results for determining ATV measurements, including seat length and placement. This method greatly expands the number of ATV models that can be studied, and may be generalisable to other motor vehicle types. These measurements can be used to guide engineering approaches that improve ATV safety design.

Background All-terrain vehicle (ATV) crashes have long been recognised as a public health concern, with >800 deaths and more than 400,000 injuries each year in the U.S. alone. Recreational off-highway vehicles (ROVs) have more recently been growing in popularity, but little is currently known about the impact of their use. Our objective was to determine the epidemiology, mechanisms and risk factors for ROV crashes and injuries. Methods Descriptive and comparative analyses were performed using data from the Consumer Product Safety Commission ROV database (2003–2011). Results The database contained 428 crashes (899 occupants). Occupants were 68% male, 31% Conclusions These data provide important insights into ROV use and related crashes. Although likely to be more stable than ATVs, ROV rollovers, including at low speeds, appear to be the major crash mechanism, most often in a turn. Being unrestrained in a rollover with subsequent ejection and pinning by the ROV were the most significant risk factors for severe injury and death.

Background All-terrain vehicle (ATV) crashes are common in agricultural communities, but few studies have reported on who is being exposed and may be at greatest injury risk. This study was performed to determine the epidemiology of ATV exposure and crashes in a rural county. Methods Data was analysed from the Keokuk County Rural Health study which is a prospective population-based, longitudinal study of residents in Keokuk County, Iowa. Descriptive and comparative analyses were performed on 2006 Round 3 survey data which included ATV-related questions. Results Of 1,123 respondents, 38% reported having ridden an ATV in the previous year. Respondents who were male, younger, currently working on a farm, had higher income, or owned/rented more acres had a greater likelihood of recent ATV exposure. Adults with children in the home were more likely to have ridden an ATV in the past year than those with none (53% vs. 28%, p Conclusions Study respondents had a high exposure to ATVs, particularly young people and those who lived or worked on farms. Safety training efforts should be focused on demographic groups identified with higher exposure and greater likelihood of ATV crash, including agricultural workers and their families.

Background Snowmobiling is a popular form of winter recreation, but adverse events can lead to significant injury. Our objective was to determine the demographics and risk factors for snowmobile-related injuries seen in Emergency Departments (EDs). Methods ED visits related to snowmobile operation were identified in the National Electronic Injury Surveillance System (NEISS) database, which collects information from a national probability sample of U.S. hospitals. Descriptive and statistical analyses were performed. Results From 2002–2013, 1,944 snowmobile-related injuries were identified in the NEISS database. This corresponds to a national estimate of 135,032 snowmobile-related ED visits during the study period. There was a trend of decreasing injuries over time with a national estimate of 12,862 in 2002 and 9,270 in 2013 (average decrease of 499 per year, 95% CI: 89.9–907.7). Most commonly injured were 19–29 year olds, accounting for 30% of the total; 19% were paediatric patients. About three-fourths were male. The most common mechanisms of injury involved falling off (22%), striking a stationary object (16%), and rolling the vehicle (13%). Mechanisms that had the greatest admission rates included events involving a drop-off (50%), ejections (25%) and motorised vehicle collisions (22%). Helmets were reported as being used in 11.4%. Patients wearing a helmet had a 63% reduced odds of requiring inpatient admission compared to those without (p = 0.03). Speed was reported in only 7% of cases. A higher proportion of those operating at speeds estimated ≥35 mph were admitted (24%) as compared to those with lower speeds (15%). Conclusions Snowmobilers without helmets were more likely to require hospital admission. Snowmobilers should be especially wary of terrain changes, other vehicles in the area, and being ejected, as these mechanisms had injuries requiring higher rates of inpatient treatment.

Background Previous studies showed that Iowa all-terrain vehicle (ATV) crash victims from off-highway vehicle (OHV) parks practiced safer riding behaviours than off-road crash victims outside the parks. The objective of this study was to determine the effect of regulations and enforcement on the prevalence of safety behaviours among Iowa OHV park users. Methods From May to September of 2014, motion-activated cameras captured photos of users at the entrances of Iowa’s eight OHV parks. Riders were coded by vehicle type, estimated age, sex, and safety behaviours. Descriptive and multivariable logistic regression analyses were performed. Results A total of 6,718 vehicles and 9,083 riders were analysed. Among OHV park users, 44% were on ATVs, 51% on dirt bikes and 5% on side-by-sides (SxSs). Helmet use was 94% overall. Just 6% of single-rider ATVs and 0.8% of dirt bikes had passengers. While only 11% of park users on ATVs were Conclusions Regulated safety behaviours (helmet use and riding without passengers) were highly common among OHV park users. However, unregulated behaviours (SxS restraint use and children driving youth-sized ATVs only) had lower compliance. Moreover, regulated safety behaviours were significantly increased when the parks were patrolled. This study shows that a combination of regulation and enforcement is effective in ensuring safety behaviour compliance in OHV parks. Similar efforts outside parks could have a substantial effect on decreasing off-road vehicle-related deaths and injuries.

Side-by-side (SxS) vehicles have become increasingly popular, but there are few reports on injury epidemiology. Newspaper reports of SxS and all-terrain vehicle (ATV) crashes were analyzed for nine U.S. states from 2009 to 2011, including comparisons between the two vehicle types. Seventy-nine SxS crashes involving 104 injured victims were identified; three-fourths were males. There was a relatively high percentage of injured passengers (37%), and a higher proportion of female victims were passengers as compared to males (p = 0.015). Children

On-road all-terrain vehicle (ATV) crashes are frequent occurrences that disproportionately impact rural communities. These crashes occur despite most states having laws restricting on-road ATV use. A number of overall risk factors for ATV-related injuries have been identified (e.g., lack of helmet, carrying passengers). However, few studies have determined the relative contribution of these and other factors to on-road crashes and injuries. The objective of our study was to determine whether there were differences between on- and off-road ATV crashes in their demographics and/or mechanisms and outcomes of injuries.Data were derived from our statewide ATV injury surveillance database (2002-2009). Crash location and crash and injury mechanisms were coded using a modification of the Department of Transportation (DOT) coding system. Descriptive analyses and statistical comparisons (chi-square test) of variables were performed. Multivariate logistic regression analysis was used to determine relative risk.976 records were included in the final analysis, with 38 percent of the injured individuals from on-road crashes. Demographics were similar for crashes at each location, with approximately 80 percent males, 30 percent under the age of 16, and 15 percent passengers. However, females and youths under 16 were over 4 times more likely to be passengers (P ≤ 0.0001), regardless of crash location. Compared to those off-road, on-road crash victims were approximately 10 times more likely to be involved in a vehicle-vehicle collision (P0.001), 3 times more likely to have a severe brain injury (P0.001), and twice as likely to have suffered major trauma (P0.001). Adult operators in on-road crashes were also twice as likely to test positive for alcohol as those off-road (P0.05). Helmet use significantly reduced the odds of sustaining a brain injury and on-road victims were only half as likely to be helmeted (P0.01).More than 1 in 3 on-road crashes involved a collision with another vehicle, suggesting that ATVs on the road represent a potential traffic safety concern. Of note, helmets were associated with reduced risk for the number and severity of brain injuries, providing further support for the importance of helmet use. Finally, even controlling for helmet use, on-road crash victims suffered more major trauma and severe brain injuries than those off-road. Overall, our data reinforce the importance of laws restricting ATV road use and the need for effective enforcement, as well as the need to increase user education about ATV road-use laws and the dangers of riding on the roads.

Livestock producers and their employees sometimes experience unintentional needlestick injury (NSI) while vaccinating or injecting medications into animals. There is little published regarding the medical complications that can develop from this occupational exposure. The objectives of this study were to (1) perform a retrospective review of animal-related NSIs treated at a tertiary medical center of a rural state; and (2) review the risks of NSI and measures to decrease their occurrence. Medical records of patients with NSI related to animal injection were identified from the University of Iowa Hospitals and Clinics database from 2002 to 2008 and reviewed. Nine patients received medical care for NSI that occurred while vaccinating farm animals. Most common NSI site was the nondominant hand and most occurred while attempting to inject the animal. Soft tissue infection was common and all nine received oral and/or intravenous antibiotics. Two thirds required hospital admission. Three required surgery and one had a bedside incision and drainage procedure. One patient had a serious inflammatory reaction with necrosis in the leg due to the oil adjuvant in the animal vaccine. Another case had a probable mycetoma with osteomyelitis and soft tissue infection due to the bacteria Streptomyces, which is a NSI complication not previously reported. Although medical complications from farm-related NSIs do not appear to be common, this case series illustrates how these injuries can be debilitating, costly, and lead to loss of work time and productivity. Producers and employees who inject livestock need to be aware of the risks and utilize measures to decrease unintentional NSI.

Statement of purpose Traditional all-terrain vehicles (ATVs) are designed for one rider only. The study objective was to better understand the effect passengers have on the mechanisms and injuries seen in ATV crashes. Methods/approach A retrospective chart review and analysis was performed of trauma registry patients with ATV-related injuries at the University of Iowa from 2002–2013. Results 537 cases were included in the analysis of which 20% were passengers or drivers with passengers. Both children and females were more likely to be passengers (p Conclusions Passengers on ATVs may be at greater risk for fall/ejection to the rear which appears to increase the risk of head injury. ATV operators who self-eject receive extremity injuries but may be more able to protect their heads; passengers limit the ability of a driver to self-eject when losing vehicle control. Significance and contributions This study provides insight on how passengers on ATVs may contribute to crash likelihood and injury severity. A strict no rider rule could reduce risk of some ATV crashes.

Statement of purpose Side-by-sides (SxSs), which includes utility task vehicles (UTVs) and recreational off-highway vehicles (ROVs), have become increasingly popular over the past few years. The study objective was to evaluate SxS crashes with respect to demographics, crash mechanisms, and associated risk factors. Methods/approach A retrospective chart review and analysis was performed of SxS vehicle trauma victims at the University of Iowa from 2008–2013. Results Thirty-three patients with SxS-related injuries were identified. Two-thirds were males. Over half (55%) were children Conclusions Although most current SxS models have roll bars, lack of safety belt use is reducing their benefit. Youth suffer a high percentage of the SxS injuries, often while driving. Significance and contributions No previous reports specifically address the epidemiology of SxS crashes. Study results support prohibiting children from operating SxSs. Certain adult populations appear at risk and may require targeted interventions.

Statement of purpose A previous study found that trauma patients from Iowaoff-highway vehicle (OHV) parks were significantly more likely to be in compliance with all-terrain vehicle safety regulations and behaviours than those injured elsewhere. This study’s purpose was to determine the types of enforcement performed by state Department of Natural Resources (DNR) patrol officers in OHV parks, and which specific code regulations they enforce. Methods/approach Patrol officer time logs and enforcement activities were obtained through a cooperative agreement with the DNR. Enforcement activitiesand variables regarding to whomenforcement activities were directed were analysed. Results During 751 enforcement hours over 160 days, patrol officers recorded 359 separate enforcement activities. Of these, 52% were verbal warnings, 31% written warnings, and 17% written citations. About 89% of enforcement activities was directed at males; no significant difference in type of violation was found by offender’s sex (p = 0.11). Individuals 16 to Conclusions Enforcement by patrol officers at OHV parks in this study was primarily through warnings; violators were allowed to correct their regulatory deficiencies. A smaller number received written citations. Significance and contributions This is the first study to examine enforcement activities related to OHVpark regulations. Further study is needed to determine if safety behaviour compliance is better when patrol officers are performing on-site enforcement as compared to when they are not.

Statement of purpose Safety behaviours of off-highway vehicle (OHV) park users may be better than those riding elsewhere, and census data is required to determine if differences among OHV parks in injuries can be explained by higher use or if other factors are involved. This study’s purpose was to ascertain the photographic capture rate of riders entering OHV parks with motion-activated cameras, and to determine study variable concordance between on-site evaluations and photo appraisement. Methods/approach Panoramic motion-activated cameras were placed at the entrances of all eight public OHV parks in Iowa. On-site assessment and photo image analysis was performed for demographic, vehicle, and safety behaviour variables, and then compared. Results On-site data collection was performed for 114 h for 17 cameras during which 493 off-road vehicles entered the OHV parks. A total of 251 vehicles entering the parks were identified on photos for an overall capture rate of 50.9%. For cameras with at least 5 vehicles noted during on-site evaluation, the capture rate ranged from 38–81%. The number of vehicles entering the parks was segmented by 15 min intervals, and there was no significant variance or decrease in photo capture rate until there were more than 15 vehicles entering a park during a quarter hour period. Variable concordance between on-site and photo derived data ranged from 91–100% which included sex of rider, estimated age group of rider, vehicle type, number of wheels, number of vehicle riders, helmet use, and restraint use for side-by-side vehicles. Conclusions About one-half of riders entering Iowa OHV parks were captured by motion-activated cameras. Concordance of study variables was high between that collected on-site and from photo assessment. Significance and contributions The study validated the use of photo-derived data to determine OHV park users and safety behaviours. Results will also assist in park census estimation.

Statement of purpose Head trauma is the leading cause of death and serious injury from all-terrain vehicle (ATV) crashes. The study objective was to better understand the relationship between speed and ATV crash-related brain injuries. Methods/approach A retrospective chart review and analysis was performed of trauma registry patients with ATV-related injuries at the University of Iowa Hospitals and Clinics from 2002–2013. Results 560 cases were identified; 77% were male and 32% were children 20 mph were associated with higher Max Head Abbreviated Injury Scale (AIS) scores than those ≤20 mph (p = 0.05). Crashes with speeds >30 mph had higher Max Head AIS scores than those ≤30 mph (p = 0.014). Higher speeds were also associated with a trend towards lower patient Glasgow Coma Scale (GCS) scores. Only about 20% of victims overall were wearing a helmet. Competitive racers, although helmeted, had more severe head injuries than all other victims. Competitive racers had lower GCS scores than their helmeted non-racing peers (p Conclusions Higher speed appears associated with greater head injury risk in ATV crashes. Although helmets are protective, there may be ATV crash speeds or mechanisms of brain injury at higher speeds that reduce helmet effectiveness. Significance and contributions This study suggests that the present maximum speed limitations for many youth size ATVs (30 mph) is not safe and puts the child at increased risk for head injury. All ATVs should have a code-protected, tamper-proof speed governor. This would particularly assist parents and employers in protecting youth and employees from the serious risks associated with high operating speeds.

Background The increasing popularity of all-terrain vehicles (ATVs) has been accompanied by an alarming rise in ATV-related deaths. Aims/Objectives/Purpose To compare fatal ATV crashes on and off the road in order to more fully understand the contributing factors for deaths at each location. Methods A retrospective study was performed using national fatality data from the Consumer Product Safety Commission. Results/Outcomes Overall, 62% of US deaths from 1985 to 2009 resulted from on-road ATV crashes. After 1998, on-road deaths increased at a greater rate than off-road deaths (48+2.8 vs 20+1.8 deaths/year), and crashes on the road were three times more likely to result in multiple deaths (p Significance/Contribution to the Field The majority of US ATV-related deaths have resulted from on-road crashes. We hypothesise that risk factors, like passengers and alcohol, exacerbate the challenges of safely operating ATVs on road surfaces, and that higher crash forces from greater speed and lack of protective equipment on the road increase head injuries that result in death. Getting ATVs off the roads may be an effective way to reduce ATV-related deaths.

Background Most surveillance sources provide limited data on the sequence of events during ATV crashes. This limitation provides the rationale to investigate less traditional sources such as social media sites where video sharing has become very popular. Aims/Objectives/Purpose To better understand the mechanisms and contributing factors of ATV-related injuries. Methods A review of ATV-related injuries at the University of Iowa from 2002 to 2009 was performed and crash mechanisms were characterised. A retrospective search of ATV crash videos posted on YouTube was performed. Videos were compiled and analysed. Results/Outcome 345 ATV trauma patients were identified. Rollovers (42%), striking an object (20%), and ejection/fall (13%) were the most common mechanisms of injury. The victim was struck by their ATV in 21% and pinned in 9%. Rollovers were more likely when turning or spinning, and on sloped terrain with passengers. Backward rollovers were most likely with passengers. For those ejected, patients falling/ejected to the rear had the lowest Glasgow Coma Scale (GCS) scores. Patients who jumped off or were ejected off the side had the highest extremity injury scores. The greater the ATV speed, the lower were the patient's GCS scores. 183 ATV crash videos have been collected and characterised to date. Although some ATV crash circumstances were over-represented in the videos, most demonstrated mechanisms that were seen in actual trauma patients. Significance/Contribution to the Field Evaluation of crash videos from social media sites may shed light on injury mechanisms. Analysis of these videos yields significant details that are not available through other sources. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background On-road all-terrain vehicle (ATV) crashes are frequent despite most US states having laws restricting road use. Aims/Objectives/Purpose To determine the demographics, and the mechanisms and outcomes of injuries of on-road versus off-road ATV crashes. Methods Data from our Iowa ATV injury surveillance database (2002–2009) was derived and statistically analysed. Results/Outcomes 976 records were studied, with 38% of injured individuals from on-road crashes. Demographics were similar at each location. Females and youths under 16 were over four times more likely to be passengers (p 15 (p Significance/Contribution to the Field On-road crashes were significantly more likely to involve collision with another vehicle, suggesting on-road ATVs represent a traffic safety concern. Even controlling for helmet use, on-road crash victims suffered more severe injuries than those off-road. Our data reinforces the importance of laws restricting ATV road use and their enforcement, and the need to increase ATV user education about the dangers of on-road riding.

Background The presence of extra riders increases the likelihood of an all-terrain vehicle (ATV) crash and injury. However, many ATVs have seats long enough to accommodate passengers. Aims/Objectives/Purpose To determine if ATV seats could be redesigned to limit use to only one rider. Methods A convenience sampling of 14 ATV models were measured and compared, and seat dimension requirements were analysed at a 26 degree incline/decline. Results/Outcomes Seat lengths varied from 22-35 inches. The seat backs ended fairly consistently at 38-45 inches away from the handlebar attachment. Most of the seat length differences were accountable by the distance from the handlebar attachment to the front of the seat, which varied from 9-19 inches. The incline/decline study revealed that when going downhill, a rider needs to fully extend their arms and move their bottom back to the seat edge in order to move their centre of gravity behind the front tires and avoid a front rollover. When going uphill, a forward lean is sufficient to keep the operator's centre of gravity ahead of the rear tires and prevent a backward rollover. Significance/contribution to the field Since a rider can adequately change their centre of gravity on an uphill incline without shifting their bottom forward, the seat is not required to be as close to the handles as many manufacturers design. We suggest that a shorter seat starting further from the handlebar is the preferred ATV seat design. This should discourage multiple passenger use by reducing the space available for additional riders.

Background Since April 2009, the US Consumer Product Safety Improvement Act requires that new ATVs be subject to an action plan prescribing steps makers and sellers must take to ensure safety, such as rider training, distribution of safety information, and appropriate age recommendation. Aims/Objectives/Purpose To determine the practice of dealers and salespersons with regards to promoting safe ATV use. Methods A 'secret buyer' method was utilised to evaluate ATV seller practices. Results/Outcomes 50 ATV dealerships from 4 states were studied. 35 subjects (70%) were willing to show and discuss selling an adult-sized ATV when told that the purchase was for a 12-year-old. Seven (14%) responded with comments that ATVs should have no extra riders when the investigator made statements about the adequacy of a seat being long enough for a child to give a sibling rides. Only one subject informed about the need for a 12-year-old to complete ATV safety training to drive in a public ATV park when prompted. Significance/Contribution to the Field In this study, most ATV sellers did not follow requirements regarding age recommendation or provide other safety information. Those that did often voiced concerns about possible negative repercussions from violations. Dealership regulation compliance may increase with on-going enforcement. However, a 'don't ask, don't tell' relationship between seller and buyer was alluded to during the study in which sellers don't ask and buyers don't tell they are purchasing a larger machine for a child. This practice would limit the impact of regulation enforcement. This abstract is from proceedings of the Safety 2012 World Conference.

Background Equestrian helmets are effective in preventing head injuries, but use remains low. The media can have a great impact on injury prevention both positively and negatively by their portrayal of protective safety equipment or lack thereof. Aims/Objectives/Purpose To determine the equestrian helmet use of individuals pictured in horse organisation promotional materials. Methods Literature was requested from horse organisations. Photographs in the materials received were reviewed for equestrian helmet use and analysed. Results/Outcomes 113 of 335 organisations responded and 95 sent publications. 2004 photos with 2738 people were evaluated. The highest equestrian helmet use was by children, and teen helmet use was generally portrayed more frequently than in adults. The lowest rate was in the elderly (14.6%). Helmet use was highest in photos that depicted competition-jumping (87.9%). Competition-riding and pleasure-riding helmet use was only 30.0% and 34.5%, respectively. No one who was pictured while working on, with or while on a horse was shown with an equestrian helmet; nor was anyone in a parade. Adults riding with children did have a higher rate of wearing an equestrian helmet than adults who were pleasure-riding in general (44.2% vs 23.2%). Significance/Contribution to the Field Photographs in horse organisation literature often show people not wearing helmets during equine-related activities. Horse organszations have the ability to define equestrian helmet use as normative behaviour by always portraying people with helmets in their published materials. Developing an equestrian safety culture of routine helmet use should decrease the number of serious head injuries experienced by horse enthusiasts.