Page 17 - Delaware Medical Journal - March 2017
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PUBLIC HEALTH
consumer products that come under the agency’s jurisdiction, including ATVs. The CPSC develops voluntary standards with industry, issues and enforces mandatory standards, obtains the recall of products, researches potential product hazards, and informs and educates consumers. However, CPSC has limited authority to affect the behavior of ATV operators.
From 1988 to 1998, the CPSC had in place a consent decree with ATV manufacturers that banned the sale of three-wheel
ATVs; prohibited the sale of large ATVs to children under age 16; and required warning labels on vehicles and a safety awareness campaign. Upon its expiration in 1998, the decree was replaced with voluntary standards. A study on ATV- related accidents during and after the consent decree showed that deaths among children under age 16 during the consent decree remained stable, but then began to increase after its expiration.14
Current Standards
The current ATV industry standard
labels with the manufacturer’s minimum age recommendation and warnings about safe helmet use, riding on public roads, carrying passengers, and riding while shows that the unsafe riding behaviors discouraged by these labels persist.
In addition to the AAP, several other national organizations, including
Safe Kids USA, American College of Emergency Physicians, American College of Surgeons, and Consumer Federation
of America, have issued position statements calling for stricter regulations on ATV use, particularly by children. These recommendations encompass age restrictions for ATV operators, licensing and/or additional education and training requirements, helmet requirements, and
passenger restrictions. Research underpins the effectiveness of the additional safeguards recommended by these organizations. For instance, several studies have found that helmet use contributes to better health outcomes following ATV- related accidents, including reduced injury severity, lower incidence of traumatic brain injuries (TBIs), shorter length of stay in
the intensive care unit and hospital, and greater likelihood of survival.12,15-17 In rates,17 Helmkamp et al. found that death rates from ATVs were 23 percent higher in states without helmet laws.18
ACTION PLAN
At the inception of the collaboration between the N/AIDHC Trauma Team
and NHPS, analyses were conducted
to assess the roles of federal, state, and local governments in regulation of ATVs and the industry standards to which the manufacturers are subject. Administrative codes of various states were examined and agencies in other states were contacted
to gain information on ATV regulation enforcement.
Policy Scan and Analysis
of Trauma Registry Data
This investigation revealed that Delaware’s ATV regulations did not compare favorably with the policy positions of the aforementioned national organizations, in particular the AAP policy position endorsed by Nemours clinicians. Delaware’s off-highway vehicle (OHV) regulations, which encompass regulation of ATVs, found in Delaware Code, Title 21 prohibit OHV operation on
of drugs or alcohol, and between sunset and sunrise without headlights and
tail lights.19 State regulations related to operator age requirements, helmet use,
training requirements, and passenger restrictions were either non-existent or
fell short of the AAP’s recommendations. In comparison, several other states have stronger regulations for ATV use that better protect ATV operators, particularly minors. Massachusetts and South Carolina have passed laws to impose stricter regulations for ATV use, which include age restrictions, helmet requirements,
and training requirements for young ATV operators.20, 21
The local policy scan also entailed assessment of the state’s ATV riding culture, availability of local training options, and political climate. Policy change concepts were tested informally with stakeholders and targeted legislators to gauge support and opposition. An analysis of Delaware Trauma System Registry data undertaken to assess the prevalence of ATV-related injuries treated at trauma system hospitals in Delaware further validated the need for stronger ATV regulations. Data on 232 pediatric trauma patients with ATV-related injuries seen from 2000 to 2013 revealed that 52.8 percent were not wearing helmets when injured. Trauma patients unhelmeted
at the time of their accident were more likely to sustain severe injuries when compared to helmeted patients. Among unhelmeted patients, 17.6 percent sustained severe and 7.8 percent sustained critical injuries. Among helmeted patients, 7.9 percent sustained severe and 1.1 percent sustained critical injuries. (See Figure 1). These trauma data are an underestimate
of the number of ATV-related injuries that occur among children in Delaware as they do not include patients treated at the emergency department who did not require hospital admission or transfer to another facility. Based on this analysis, Nemours leadership approved mobilizing a cross-sector coalition for the purpose
of advocating for stronger state ATV
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