All-Terrain Vehicle-Related Deaths -- West Virginia, 1985-1997

From 1985 through 1997, the U.S. Consumer Product Safety Commission (CPSC) identified 113 deaths associated with all-terrain vehicles (ATVs) * in West Virginia. This report summarizes data from the CPSC ATV-related death database and on-site and/or follow-up telephone investigations; findings indicate that approximately two thirds of deaths were caused by injury to the head or neck. Consistent use of helmets by riders can substantially reduce ATV-related deaths.

CPSC compiles information on ATV-related deaths from its main injury and death database files; data sources for these files include medical examiner and coroner reports, death certificates, newspaper clippings, referrals, and consumer reports of ATV crashes (1). An ATV-related death was defined as a death caused by injury of a driver or passenger of an ATV that was operated for nonoccupational purposes. To meet the case definition, the cause of death had to be attributed to the ATV incident rather than to a preceding event (e.g., myocardial infarction while riding an ATV).

Of the 113 ATV-related deaths in West Virginia during 1985-1997, 100 (88%) occurred among males (Table_1). Age at death ranged from 18 months to 75 years (mean age: 29 years for males; 17 years for females); 18 (16%) persons were aged less than or equal to 12 years, and 11 (10%) were aged greater than or equal to 55 years.

The immediate cause of two thirds of deaths was trauma to the head or neck. Of the 74 persons who died from head or neck injuries, at least 55 (74%) were not wearing helmets at the time of the crash. Information on helmet use was not available for 17 (23%) deaths. In the remaining two (3%) deaths, one driver's helmet cracked when he hit a tree, and in the other case, the driver collided with a truck, and the impact forced the helmet off of his head. Other factors that may have contributed to ATV-related deaths included alcohol or drug use (20% of cases), carrying passengers (25%), and excessive speed (10%).

Collisions accounted for the largest proportion (42%) of deaths; the most common collisions were with fixed objects (e.g., trees, cable wires, guardrails, and rocks) (32%) and with other vehicles (10%) (Table_1). ATVs that overturned and landed on riders accounted for 38% of deaths; overturns occurred in ditches, ravines, embankments, and on other rough terrain.

Thirty-eight of 55 West Virginia counties reported fatal ATV incidents, with 40% of deaths occurring in four of the most populated counties: Kanawha (17 deaths), Cabell (12), Monongalia (nine), and Wood (seven). Thirty-seven deaths (33%) occurred while ATVs were being operated on paved roadways, and 100 (89%) deaths occurred among drivers. Sixty percent of fatal incidents occurred during May-September.

During 1985-1997, West Virginia averaged nine ATV-related deaths annually. From 1996 to 1997, the number of deaths increased from 15 to 19. Because patterns of ATV use in West Virginia during the study period were not assessed, no conclusions about the risk for death to ATV riders were determined.

Reported by: JC Helmkamp, PhD, Center for Rural Emergency Medicine, West Virginia Univ, Morgantown; FJ O'Hara, MS, Mineral County West Virginia Child Injury Advisory Council, Keyser, West Virginia. J David, Directorate for Epidemiology and Health Sciences, Div of Hazard Analysis, Consumer Product Safety Commission. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: During 1985-1997, CPSC reported 2976 three- and four-wheel ATV-related deaths in the United States and Puerto Rico (CPSC, unpublished data, 1998). Although nationally the number of deaths has declined since 1985, the yearly death toll has remained fairly stable since 1992 (1). West Virginia, however, experienced more ATV-related deaths during 1996-1997 than during any other year of the study period.

Data about the number of ATV riders in the state are needed to determine whether the recent increase in the number of deaths reflects a change in risk for death among ATV riders in West Virginia. In addition, some ATV-related deaths may not have been identified, and information about contributing factors (e.g., alcohol or drug use) was incomplete for some cases.

In 1988, the U.S. Department of Justice and ATV distributors signed a 10-year consent decree that prohibited the sale of any new three-wheel ATVs and prohibited the sale of adult-sized four-wheel ATVs for use by children aged less than 16 years (2). However, greater than 90% of deaths among ATV drivers aged less than 16 years have involved adult-sized ATVs (1). The decree also required that distributors include specific safety warnings with ATVs and offer a free training course to purchasers and their families. Since then, the proportion of all ATV-related deaths involving three-wheel ATVs has declined from 45% to approximately 20% (1).

In the United States, approximately 36% of ATV-related deaths occur among children aged less than 16 years (1). Because young children often lack the physical size and strength, cognitive abilities, and fine motor skills to operate ATVs properly, their risk for injury is greater. In 1997, CPSC estimated that ATV drivers aged less than or equal to 15 years were 2.5 times more likely than drivers aged 16-34 years and 4.5 times more likely than drivers aged 35-54 years to be injured (1).

The presence of a passenger impairs safe operation and maneuverability of the ATV. To steer and control an ATV, the driver must be "rider active," making quick body weight shifts combined with acceleration and braking. Therefore, neither children nor adults should ever ride as passengers.

The American Academy of Pediatrics and researchers have recommended age requirements for ATV riders (e.g., aged 14 or 16 years), licensing of ATV riders, and mandatory helmet use (3-7). Consistent use of helmets by all riders can reduce substantially ATV-related deaths (8). The low rates of helmet use reported in the CPSC ATV rider survey (35% of riders reported always wearing a helmet) and in studies of injured riders (3%-30%) suggest that efforts to encourage helmet use have been inadequate (1,4,5).

As in many states, West Virginia does not require ATV riders to wear helmets or to have licenses to drive ATVs. The state is considering legislation that will address ATV-related safety issues, including helmet and eye protection, age restrictions, a safety education certificate, and prohibiting certain acts by operators (e.g., use of alcohol, carrying of passengers, or driving on paved surfaces). As of September 1998, 21 of 31 states with ATV-specific safety requirements covered safety issues being considered in West Virginia (9).

CPSC recommends that ATV users never operate ATVs without proper training or instruction, never carry passengers, never ride on paved roads, never use alcohol or drugs, and always wear an approved helmet and other protective equipment (10). CPSC will continue surveillance of ATV-related deaths and injuries. ATV-related injury or death should be reported to the CPSC hotline, telephone (800) 638-2772.

References

1. US Consumer Product Safety Commission. All-terrain vehicle exposure,

injury, death, and risk studies. Bethesda, Maryland: US Consumer Product Safety Commission, 1998.

2. US District Court for the District of Columbia. 1988. United States of America v. American Honda Motor Co, Inc., et al. Washington, DC: U.S. District Court for the District of Columbia, 1992; civil action no. 87-3525.

3. Committee on Accident and Poison Prevention. All-terrain vehicles: two-, three-, and four-wheeled unlicensed motorized vehicles. Pediatr 1987;79:306-8.

4. Russell A, Boop FA, Cherny WB, Ligon BL. Neurologic injuries associated with all-terrain vehicles and recommendations for protective measures for the pediatric population. Pediatr Emerg Care 1998;14:31-5.

5. Lynch JM, Gardner MJ, Worsey J. The continuing problem of all-terrain vehicle injuries in children. J Pediatr Surg 1998;33:329-32.

6. Warda L, Klassen TP, Buchan N, Zierler A. All terrain vehicle ownership, use, and self reported safety behaviors in rural children. Inj Prev 1998;4:44-9.

7. Lister DG, Carl J III, Morgan JH III, et al. Pediatric all-terrain vehicle trauma: a 5-year statewide experience. J Pediatr Surg 1998;33:1081-3.

8. Rodgers GB. The effectiveness of helmets in reducing all-terrain vehicle injuries and deaths. Accid Anal Prev 1990;22:47-58.

9. Specialty Vehicle Institute of America. State all-terrain vehicle requirements -- September 1998. Arlington, Virginia: Government Relations Office, 1998. 

10. US Consumer Product Safety Commission. News for CPSC: CPSC announces all-terrain vehicle safety programs. CPSC Release #99-034, Consumer Product Safety Commission, Washington, DC, 1998. Available at http://www.cpsc.gov/cpscpub/prerel/prhtml99/99034.html. Accessed December 10, 1998.

* ATVs are motorized, gasoline-powered vehicles generally weighing 300-600 lbs, with oversized, low-pressure tires, a seat designed to be straddled by the user, and handlebars for steering. They are intended for use by riders on off-road, nonpaved terrain.

TABLE 1. Number and percentage of deaths associated with all-terrain vehicles, by
selected characteristics and age at death -- West Virginia, 1985-1997
===============================================================================================================
                                                             Age at death (yrs)
                             --------------------------------------------------------------------------------
                                  0-12           13-19            20-34           >=35             Total
                                 (n=18)          (n=28)           (n=36)          (n=31)           (n=113)
                             -------------     -----------     ------------     -----------     -------------
Characteristic               No.      (%)      No.     (%)     No.      (%)     No.     (%)     No.       (%)
-------------------------------------------------------------------------------------------------------------
Sex
  Males                      12      ( 67)     24     (86)     34      (94)     30     (97)     100      (88)
  Females                     6      ( 33)      4     (14)      2      ( 6)      1     ( 3)      13      (12)

Trauma site
  Head/Neck                  14      ( 78)     18     (64)     24      (67)     18     (58)      74      (65)
  Thorax                      2      ( 11)      1     ( 4)      3      ( 8)      6     (20)      12      (11)
  Abdomen/Pelvis              2      ( 11)      2     ( 7)      0                1     ( 3)       5      ( 4)
  Extremities                 0                 0               1      ( 3)      1     ( 3)       2      ( 2)
  Other/Unknown               0                 7     (25)      8      (22)      5     (16)      20      (18)

Helmet use
  Yes                         0                 1     ( 4)      0                1     ( 3)       2      ( 2)
  No                         11      ( 61)     17     (60)     24      (67)     16     (52)      68      (60)
  Unknown/
    Not reported              7      ( 39)     10     (36)     12      (33)     14     (45)      43      (38)

Alcohol or drug use
  Yes                         0                 3     (11)     11      (31)      9     (29)      23      (20)
  No/Not reported            18      (100)     25     (89)     25      (69)     22     (71)      90      (80)

Incident event
  Overturn/Rollover           9      ( 50)      8     (29)     10      (28)     16     (52)      43      (38)
  Other vehicle collision     1      (  6)      5     (18)      4      (11)      1     ( 3)      11      (10)
  Fixed object collision      7      ( 38)     11     (39)     12      (33)      6     (19)      36      (32)
  Other                       1      (  6)      4     (14)     10      (28)      8     (26)      23      (20)

Location of incident
  Public paved road           2      ( 11)     10     (36)     16      (44)      9     (29)      37      (33)
  Private property            9      ( 50)      5     (18)      6      (17)     14     (45)      34      (30)
  Unpaved road/Trail          7      ( 38)      8     (29)      9      (25)      5     (16)      29      (26)
  Other                       0                 5     (18)      5      (14)      3     (10)      13      (11)

Position of victim
  Driver                     10      ( 56)     26     (93)     34      (94)     30     (97)     100      (88)
  Passenger                   8      ( 44)      2     ( 7)      2      ( 6)      1     ( 3)      13      (12)

Vehicle type
  Three-wheel                 0                 5     (18)     11      (31)      3     (10)      19      (17)
  Four-wheel                 18      (100)     23     (82)     25      (69)     25     (80)      91      (81)
  Unknown                     0                 0               0                3     (10)       3      ( 2)
-------------------------------------------------------------------------------------------------------------
===============================================================================================================

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