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Since all-terrain vehicles (ATVs) were introduced in the mid-1970s, regulatory agencies, injury prevention researchers, and pediatricians have documented their dangers to youth. Major risk factors, crash mechanisms, and injury patterns for children and adolescents have been well characterized. Despite this knowledge, preventing pediatric ATV-related deaths and injuries has proven difficult and has had limited success. This policy statement broadly summarizes key background information and provides detailed recommendations based on best practices. These recommendations are designed to provide all stakeholders with strategies that can be used to reduce the number of pediatric deaths and injuries resulting from youth riding on ATVs.

Background During the past decade, all-terrain vehicle (ATV)-related injuries treated in US emergency departments decreased by 33%, down to approximately 100,000 injuries in 2016. In comparison, the number of children evaluated for ATV injuries in the Children's of Alabama emergency department more than doubled between 2006 and 2016, counter to the national trend. The American Academy of Pediatrics guidelines state that ATV operators should be at least 16 years old; however, children younger than 16 continue to represent almost one-third of all ATV-related injuries nationwide, and nearly all of the injuries to children in Alabama. Methods Using surveillance data from the Children's of Alabama hospital electronic medical record database, several Alabama counties near Birmingham were identified as having an increased number of children with ATV-related injuries in 2016. The Safety Tips for ATV Riders (STARs) program, developed in Iowa, was provided to middle school students in these counties by pediatric residents. Surveys were anonymously administered to children before and after the program and included information about demographics, knowledge of safe ATV practices, and the likelihood of using the education afterward. Results In total, 525 students participated in January 2019; their ages ranged from 11 to 15 years and the proportion of males and females was equivalent. More than 50% of the children reported riding ATVs in the last 12 months, and of these riders, 47% reported never wearing a helmet when riding. Initially, only 20% of the overall participants knew ATVs were not intended for passengers, 20% knew the recommended engine size for their age, and 57% knew that Alabama law prohibits riding on public roads. After education, this increased to 91%, 90%, and 89%, respectively. Before the STARs program, only 6% knew all three correct answers, whereas 80% answered all of the questions correctly on the postprogram survey. After the program, 34% reported they were very likely/likely to use this information in the future. Conclusions The STARs program dramatically improved short-term ATV safety knowledge, and many participants reported they were likely to subsequently use the safe practices presented. School-based programs, such as STARs, may help increase ATV safety awareness and change behaviors in high-risk age groups. This training may be successfully provided by various motivated individuals, including medical residents.

All-terrain vehicles (ATVs) represent a serious and ongoing public health and safety concern for children and adolescents. Survey studies indicate that high proportions of youth ride ATVs in both rural and nonrural populations. The significant human and economic costs of pediatric ATV-related deaths and injuries result from a number of major risk factors that are highly common in pediatric ATV crashes: operating adult-size vehicles, riding with or as passengers, lack of protective equipment, and riding on public roads. Other less well-studied but potentially significant risk factors are speed, riding at night, alcohol use among older teenagers, and lack of training and supervision. Although potentially safer than adult ATVs, youth models present a number of safety concerns that have not been addressed with rigorous study. The most common ATV crash mechanism is a noncollision event—for example, a rollover. Common injury mechanisms include ejection from the vehicle, resulting in extremity and head injuries, and being pinned or crushed by the vehicle with resulting multiorgan trauma and/or compression asphyxia. Traumatic brain injury and multisystem trauma are the 2 most common causes of death and disabling injury. Taken together, a large multidecade body of evidence is the basis for the American Academy of Pediatrics policy statement recommendation that no child younger than 16 years of age ride on an ATV. Because children continue to be allowed to ride these vehicles, however, efforts to prevent pediatric ATV-related deaths and injuries require multipronged strategies, including education of both youth and parents, safety-based engineering, and enforcement of evidence-based safety laws.

Background Helmets prevent head trauma in both all-terrain vehicle (ATV) and bicycle crashes. This pilot study’s objective was to compare family helmet use and participant attitudes regarding helmets for ATVs versus bicycles. Methods A convenience sampling of adults attending a 2017 university-sponsored health fair who had at least one child Results Subjects (N = 98) were 26–57 years old (mean 40 years). Three-quarters (76%) were female. The percentage always wearing a helmet riding bicycles was 63% (subjects), 58% (spouses/partners), and 51% (children), compared to 11, 14 and 37% on ATVs, respectively. Moreover, the percentage never wearing a helmet while on an ATV was 68% for subjects, 71% for spouses, and 47% for children. Despite helmet use differences between bicycles and ATVs, the importance of children wearing a helmet on these vehicles was rated highly and equally important, 9.28 and 9.58 on a 1–10 scale, respectively. Higher proportions of subjects’ oldest children wore a bike helmet 100% of the time if at least one parent always wore a helmet (81%), compared to children whose parents both wore helmets p p = 0.04 and p = 0.004, respectively). Many reported a “strict no helmet, no bike/ATV riding rule” as being most effective in getting their children to always wear a helmet. Conclusions This study is the first to explore family helmet use while riding bicycles vs ATVs. Although parent’s belief in the importance of helmet use was high for both, helmet use was greater when riding bicycles. Further research is needed to better understand the social and environmental influences that shape parental helmet attitudes and practices in order to improve safety interventions for increasing pediatric helmet use.

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.

BackgroundIn the wake of an epidemic in firearm-related deaths and injuries, youth have become leading voices of concern. This study’s objective was to investigate rural youth’s personal experiences with firearm-related violence, and their attitudes towards firearms and gun violence prevention strategies.MethodsAttendees of the 2019 Iowa FFA Leadership Conference were surveyed about personal experiences with firearm-associated deaths and injuries, and their attitudes regarding firearm-related issues. Descriptive (frequencies), bivariate (chi square, Fisher’s exact test) and multivariable logistic regression analyses were performed utilizing Stata 15.1 (StataCorp, College Station, Texas).ResultsResponses from 1382 FFA members 13–18 years of age were analyzed. About 5% had personally seen someone threatened with a firearm. Over one-third (36%) stated they knew someone who had been killed or injured by gunfire. Of these, over two-thirds knew of someone who had died or was injured unintentionally and 30% knew of someone killed or injured intentionally (e.g. suicide). Nearly all agreed or strongly agreed that the right to use firearms for hunting and shooting sports should be legal (94%), that a firearm safety course should be required to get a hunting license (89%), and that there should be a required background check before purchasing a firearm (89%). Over three-fifths (61%) agreed or strongly agreed that there should be laws requiring safe storage of firearms in homes. Although still high, lesser support for firearm safety policies was seen among males, older youth, participants living on farms or in the country, and youth who hunted, had firearms in their homes, and/or were in homes with unsafe firearm storage.ConclusionsThe majority of youth in this study supported firearm safety measures including required training, background checks, and safe firearm storage in homes. These findings are consistent with the national youth-led call for firearm safety. Additionally, over one-third of respondents personally knew someone who was killed or injured by a firearm and 5% had seen someone or been personally threatened with firearm violence. Our study did not investigate the effects of firearm violence on participants’ mental health and wellbeing, but future studies addressing this question seem highly justified.

Background: Off-road vehicles (ORVs), which include all-terrain vehicles (ATVs) and side-by-sides (SxSs), are designed for off-road use only. Iowa law restricts roadway riding to occupational purposes and limits it to daylight hours. A growing number of Iowa counties are opening roadways to recreational ORV use and many counties are choosing not to include a daylight restriction. To better understand this issue, the study objective was to compare and contrast daytime and nighttime ORV crashes …

Background: Few studies have examined rural children’s exposure to firearms despite their frequent presence in homes. The objective of this study was to investigate rural youth’s use of firearms and whether they had received firearm training. Methods: FFA Leadership Conference attendees in a Midwestern state were surveyed at a children’s hospital safety booth in 2019. Participants were asked about their use of rifles/shotguns and handguns including when they first used a firearm. They were also asked whether they had taken a firearm safety course and how old they were when …

There is building evidence that Adverse Childhood Experiences without early and proper intervention leads to subsequent short- and long-term behavioral, social, physical and mental health problems. Practitioners, researchers, and healthcare systems have been implementing trauma-informed care (TIC) in a variety of health and human services settings, resulting in improvements in clinical care and prevention of illness by identifying high risk populations. This has led to positive health outcomes including improved compliance, better access to mental health services and reduced health care costs. A systematic review was conducted of studies that focused on TIC implementation in healthcare settings, statewide TIC implementation, impact of adverse childhood experiences on health outcomes, impact of TIC on health outcomes, and evaluation of TIC implementation. A search was conducted in March 2019 to identify studies in PubMed, Medline, and other online literature. We limited our search to articles published in English after 2000. This article aims to review the components of TIC phases of implementation in healthcare settings, success stories across the nation to help the readers understand the importance of a paradigm shift to improve healthcare delivery and health outcomes and to prevent illness starting from childhood with a family centered care perspective.

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.

Objective The purpose of this study was to compare the relative efficacy of immobilization systems in limiting thoracic-lumbar movements. Methods A dynamic simulation system was used to reproduce transport-related shocks and vibration, and involuntary movements of the thoracic-lumbar region were measured using 3 immobilization configurations. Results The vacuum mattress and the long spine board were generally more effective than the cot alone in reducing thoracic-lumbar rotation and flexion/extension. However, the vacuum mattress reduced these thoracic-lumbar movements to a greater extent than the long spine board. In addition, the vacuum mattress significantly decreased thoracic-lumbar lateral movement relative to the cot alone under all simulated transport conditions. In contrast, the long spine board allowed greater lateral movement than the cot alone in a number of the simulated transport rides. Conclusion Under the study conditions, the vacuum mattress was more effective for limiting involuntary movements of the thoracic-lumbar region than the long spine board. Moreover, the increased lateral bend observed with the long spine board under some conditions suggests it may be inadequate for immobilizing this anatomic region as presently designed. Should emergency medical service providers choose to immobilize patients with suspected injuries of the thoracic-lumbar spine, study results support the use of the vacuum mattress.

All-terrain vehicles (ATVs) remain a significant source of death and injury among youth. The purpose of this review is to provide an overview of the scope of the problem, the risk factors involved, crash-related outcomes and costs, and injury prevention strategies. There are currently more than 100 pediatric ATV-related fatalities each year and over 30,000 emergency department visits, with a potential annual cost for deaths and injuries approaching $1 billion. Major risk factors include lack of training, operating adult-size ATVs, riding as or carrying passengers, riding on the road, and not wearing a helmet. Extremity injuries are highly common, and the leading causes of death include brain injuries and multi-organ trauma. The latter increasingly involves being crushed by or pinned under the ATV. Reducing ATV-related deaths and injuries will require multiple strategies that integrate approaches from education, engineering, and evidence-based safety laws and their enforcement.

Background Pediatric deaths and injuries from access to firearms are a significant public health problem. No studies have examined how experts determine child neglect regarding firearm access in the home. Our study objectives were to identify factors that influenced pediatric experts' finding of firearm-related child neglect and to assess their attitudes toward child access prevention (CAP) laws. Methods A survey was distributed to the American Academy of Pediatrics Section on Child Abuse and Neglect members. Demographics, attitudes regarding CAP laws, and ages (up to 14 years old) at which experts deemed several scenarios as child neglect were determined. Scenarios tested potential versus actual loaded firearm access, presence or absence of a CAP law, and injury versus no injury when the firearm was accessed. Results One hundred ninety-three surveys were completed. Experts agreed (>95%) that CAP laws were important, even for children up to age 15 years. Although a high percentage considered potential access to a loaded firearm as child neglect, a CAP law significantly increased the percentage for each age. In addition, higher percentages of respondents from states with CAP laws than those without deemed potential access as child neglect for 12- and 14-year-olds. In contrast, if the child had accessed a loaded firearm, there were no significant differences in the high percentages that deemed the scenario as child neglect under any conditions, including with and without a CAP law. Conclusions Although almost all child neglect experts considered potential and actual access to loaded firearms as child neglect, CAP laws increased the percentage for cases of potential access. Universal CAP laws may help ensure that determinations of child neglect are more consistent across states. The deterrent effect of potential child neglect findings may increase the number of parents securing firearms in ways that prevent child access and reduce firearm-related deaths and injuries. Level of evidence Epidemiologic study, level III.

OBJECTIVE: Injury, the most common type of pediatric trauma, can lead to a number of adverse psychosocial outcomes, including posttraumatic stress disorder. Currently, few evidence-based parent programs exist to support children hospitalized after a traumatic injury. Using methods in evaluation and intervention research, we completed a formative research study to develop a new program of psychological first aid, Link for Injured Kids, aimed to educate parents in supporting their children after a severe traumatic injury. METHODS: Using qualitative methods, we held focus groups with parents and pediatric trauma providers of children hospitalized at a Level I Children's Hospital because of an injury in 2012. We asked focus group participants to describe reactions to trauma and review drafts of our intervention materials. RESULTS: Health professionals and caregivers reported a broad spectrum of emotional responses by their children or patients; however, difficulties were experienced during recovery at home and upon returning to school. All parents and health professionals recommended that interventions be offered to parents either in the emergency department or close to discharge among admissions. CONCLUSIONS: Results from this study strongly indicate a need for posttrauma interventions, particularly in rural settings, to support families of children to address the psychosocial outcomes in the aftermath of an injury. FINDINGS presented here describe the process of intervention development that responds to the needs of an affected population. Language: en

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...

Study design This was a prospective simulator study with 16 healthy male subjects. Objective The aim of this study was to compare the relative efficacy of immobilization systems in limiting involuntary movements of the cervical spine using a dynamic simulation model. Summary of background data Relatively few studies have tested the efficacy of immobilization methods for limiting involuntary cervical movement, and only one of these studies used a dynamic simulation system to do so. Methods Immobilization configurations tested were cot alone, cot with cervical collar, long spine board (LSB) with cervical collar and head blocks, and vacuum mattress (VM) with cervical collar. A motion platform reproduced shocks and vibrations from ambulance and helicopter field rides, as well as more severe shocks and vibrations that might be encountered on rougher terrain and in inclement weather (designated as an "augmented" ride). Motion capture technology quantitated involuntary cervical rotation, flexion/extension, and lateral bend. The mean and 95% confidence interval of the mean were calculated for the root mean square of angular changes from the starting position and for the maximum range of motion. Results All configurations tested decreased cervical rotation and flexion/extension relative to the cot alone. However, the LSB and VM were significantly more effective in decreasing cervical rotation than the cervical collar, and the LSB decreased rotation more than the VM in augmented rides. The LSB and VM, but not the cervical collar, significantly limited cervical lateral bend relative to the cot alone. Conclusion Under the study conditions, the LSB and the VM were more effective in limiting cervical movement than the cervical collar. Under some conditions, the LSB decreased repetitive and acute movements more than the VM. Further studies using simulation and other approaches will be essential for determining the safest, most effective configuration should providers choose to immobilize patients with suspected spinal injuries. Level of evidence 3.

Background Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone. Methods American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July–August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test. Results One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is

Purpose: Carrying passengers is an independent risk factor for crash and injury on all-terrain vehicles (ATVs). Optimal seat design would allow for safe vehicle operation while decreasing the likelihood of multiple riders and use by underage operators. A previous study of adult-size ATVs found a wide variability in seat length and placement among manufacturers and between sport (mean 31.3 in.) and utility ATVs (mean 26.1 in.). Seat lengths overall ranged from 19.8-37.0 inches. Many models had seats long enough to accommodate multiple riders. …

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.

Introduction: Deaths and injuries from all-terrain vehicle (ATV) crashes result in approximately700 deaths each year and more than 100,000 emergency department (ED) visits. Commonmisconceptions about ATV crashes are a significant barrier to injury prevention efforts, as is the lackof key information about where and how crashes occur. The purpose of this study was to determineATV crash patterns within a state, and to compare and contrast characteristics of these crashes as afunction of crash-site rurality. Methods: We performed descriptive, comparative, and regression analyses using a statewide off-roadvehicle crash and injury database (2002-2013). Comparisons were performed by rurality as defined usingthe Rural Urban Commuting Area (RUCA) coding system, and we used geographic information system(GIS) software to map crash patterns at the zip code and county levels. Results: ATV crashes occurred throughout the state; 46% occurred in urban and 54% in rural zip codeareas. Comparisons of rider and crash characteristics by rurality showed similarities by sex, age, seatingposition, on vs. off the road, and crash mechanism. Conversely, helmet use was significantly loweramong victims of isolated rural crashes as compared to other victims (p=0.004). Crashes in isolatedrural and small rural areas accounted for only 39% of all crashes but resulted in 62% of fatalities. In bothrural and urban areas, less than one-quarter of roadway injuries were traffic related. Relative crash ratesvaried by county, and unique patterns were observed for crashes involving youth and roadway riders.During the study period, 10% and 50% of all crashes occurred in 2% and 20% of the state’s counties,respectively. Conclusion: This study suggests that ATV crashes are a public health concern for both rural and urbancommunities. However, isolated rural ATV crash victims were less likely to be helmeted, and rural victimswere over-represented among fatalities. Traffic was not the major factor in roadway crashes in eitherrural or urban areas. Unique crash patterns for different riding populations suggest that injury preventionexperts and public policy makers should consider the potential impact of geographical location whendeveloping injury prevention interventions. [West J Emerg Med. 2017;18(5)913-922.]