Page 15 - Delaware Medical Journal - March 2017

PUBLIC HEALTH
Children lack the cognitive judgment and motor skills to safely operate all-terrain vehicles (ATVs) in all situations. The Trauma Team clinicians at Nemours Children’s Health System/Alfred I. duPont Hospital for Children (N/AIDHC) were concerned about the severity of injuries sustained by children when they were either the driver or a passenger on an ATV. Although this subset of children within the trauma registry did not account for a high volume of trauma patients, these children sustained a higher proportion of severe injuries. In 2012, the Trauma Team at N/AIDHC partnered with Nemours Health & Prevention Services to form a broad-based statewide coalition in order to impact this alarming trend and to improve safety for those who ride ATVs. The coalition worked together to reach consensus and to successfully advocate for the passage of legislation requiring helmets and limiting passengers for recreational ATV riders under the age of 18. This legislation was signed into law in July 2015. Working with both ATV dealers and a national industry association, the coalition also has been successful in bringing to the State of Delaware, an ATV safety training course for riders in 2016. An evaluation of the impact of this new legislation using state trauma data will begin in 2017.
Key words: pediatrics, all-terrain vehicle, trauma, child advocacy, policy, personal protective equipment
Acknowledgements: The authors would like to thank MarySue Jones, state Trauma System Coordinator; the Delaware Trauma System Registry; and trauma system hospitals for providing the data needed to assess the extent of pediatric ATV-related injuries and fatalities in Delaware. Additionally, we are grateful to Zhongcui Gao and Tiho Enev for the countless hours they devoted to analyzing the Delaware Trauma System Registry data and to Nemours Delaware Valley Government Relations for their advocacy on behalf of stronger ATV regulations in Delaware.
Introduction
Clinicians on the Trauma Team at Nemours Children’s Health System/Alfred I. duPont Hospital for Children (N/AIDHC) were concerned with the severity of all-terrain vehicle-related injuries sustained by children seen in the emergency department, some as young as one year old. Although the actual number of children injured while riding all-terrain vehicles (ATVs) is small when compared to the total population of trauma patients, the severity and impact of these injuries on patients and their families
An analysis of local trauma registry data revealed a 1,300 percent increase between 2007 and 2010 in the total number of patients with ATV-related injuries seen
at N/AIDHC. As a result, the Trauma Team requested administrative support via a position paper to develop an injury prevention initiative for addressing these alarming trends. Using the American Academy of Pediatrics’ (AAP) 1987 policy statement on child use of motorized cycles

in 2000, the team made recommendations to address these injuries through education, training, partnerships, and policy change. The AAP advocates passage of state
laws prohibiting children under age 16 from riding ATVs; requiring motorcycle- style helmets for on-road and off-road
use; requiring ATV operators to have an automobile driver’s license and preferably operation between sunset and sunrise; prohibiting ATV operation on public streets and highways; prohibiting ATV operation prohibiting ATV operators from carrying passengers.1
The Trauma Team collaborated with Nemours Health & Prevention Services (NHPS) for the purpose of researching and recommending policy options to address pediatric ATV-related injuries. NHPS, a division within Nemours Children’s Health System focused on population health, has extensive experience in coalition-building around health promotion and disease
prevention and has established relationships with state and local policy-makers and community-based organizations. This collaboration married the clinical expertise injury of the Trauma Team with the policy analysis and evaluation capacity of NHPS. Nemours Delaware Valley Government Relations also was engaged in these efforts to assist with policy strategy, stakeholder outreach, and advocacy.
BACKGROUND
Child and adolescent ATV operators
risk serious injury and in some cases death because they do not possess the cognitive abilities and motor skills necessary to safely maneuver ATVs in
all circumstances. ATVs are large, heavy motorized vehicles that can sustain speeds in excess of 60 mph. According to the AAP, “the safe use of ATVs requires
the same or greater skill, judgment, and experience as needed to operate an automobile.”2 There were 13,617 ATV-
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Abstract