All-terrain vehicle-related nonfatal injuries among young riders in the United States, 2001-2010.

OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)-related nonfatal injuries among riders aged ≤ 15 years treated in hospital emergency departments (EDs) in the United States during 2001-2010. METHODS: National Electronic Injury Surveillance System-All Injury Program data for 2001-2010 were analyzed. Numbers and rates of injuries were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: During 2001-2010, an estimated 361,161 ATV riders aged ≤ 15 years were treated in EDs for ATV-related injuries. The injury rate peaked at 67 per 100,000 children in 2004 and then declined to 42 per 100,000 children by 2010. The annualized injury rate for boys was double that of girls (73 vs 37 per 100,000). Children aged 11 to 15 years accounted for two-thirds of all ED visits and hospitalizations. Fractures accounted for 28% of ED visits and 45% of hospitalizations. CONCLUSIONS: The reasons for the decline in ATV-related injuries among young riders are not well understood but might be related to the economic recession of the mid-2000s and decreased sales of new ATVs. Although many states have regulations governing children's use of ATVs, their effectiveness in reducing injuries is unclear. Broader use of known effective safety measures, including prohibiting children aged ≤ 15 years from riding adult-sized ATVs, always wearing a helmet while riding, not riding on paved roads, and not riding as or carrying a passenger could additionally reduce ATV-related injuries among children. Last, more research to better understand ATV crash dynamics might lead to safer designs for ATVs.

Risk factors, health behaviors, and injury among adults employed in the transportation, warehousing, and utilities super sector.

BACKGROUND: The TWU super sector is engaged in the movement of passengers and cargo, warehousing of goods, and the delivery of services. The purpose of this study is to describe employee self-reported personal risk factors, health behaviors and habits, disease and chronic conditions, and employer-reported nonfatal injury experiences of workers in the TWU super sector. METHODS: National Health Interview Survey (NHIS) data for 1997-2007, grouped into six morbidity and disability categories and three age groups, were reviewed. Demographic characteristics and prevalence estimates are reported for workers in the TWU super sector and the entire U.S. workforce, and compared with national adult population data from the NHIS. Bureau of Labor Statistics employer-reported TWU injury data from 2003 to 2007 was also reviewed. RESULTS: An average of 8.3 million workers were employed annually in the TWU super sector. TWU workers 65 or older reported the highest prevalence of hypertension (49%) across all industry sectors, but the 20% prevalence is notable among middle age workers (25-64). TWU workers had the highest prevalence of obesity (28%), compared to workers in all other industry sectors. Female TWU workers experienced the highest number of lost workdays (6.5) in the past year across all TWU demographic groups. CONCLUSIONS: Self-reported high proportions of chronic conditions including hypertension and heart disease combined with elevated levels of being overweight and obese, and lack of physical activity-particularly among TWUs oldest workers-can meaningfully inform wellness strategies and interventions focused on this demographic group. Am. J. Ind. Med. 56:556-568, 2013. © 2012 Wiley Periodicals, Inc.

State-specific ATV-related fatality rates: an update in the new millennium.

OBJECTIVES: We compared state-specific all-terrain vehicle (ATV) fatality rates from 2000-2007 with 1990-1999 data, grouping states according to helmet, training, and licensure requirements. METHODS: We used the CDC WONDER online database to identify ATV cases from 2000-2007 and calculate rates per 100,000 population by state, gender, and age. RESULTS: ATV deaths (n=7,231) occurred at a rate of 0.32 per 100,000 population. Males accounted for 86% of ATV-related deaths at a rate that was six times that for females (0.55 vs. 0.09 per 100,000 population, respectively); 60% of the male deaths occurred in the 15- to 44-year age group. With the exception of the two oldest age categories, rates were consistently higher in the no-helmet-law group. Both the number and rate of ATV-related deaths increased more than threefold between 1990-1999 and 2000-2007. West Virginia and Alaska continue to have the highest ATV fatality rates (1.63 and 2.67 ATV deaths per 100,000 population, respectively). CONCLUSIONS: Helmet-use requirements seem to slightly mitigate ATV-related death, but training requirements do not. For policy to be effective, it must be enforced.

A trial of an all-terrain vehicle safety education video in a community-based hunter education program.

PURPOSE: All-terrain vehicle (ATV) injury is an increasingly serious problem, particularly among rural youth. There have been repeated calls for ATV safety education, but little study regarding optimal methods or content for such education. The purpose of this study was to determine if an ATV safety video was effective in increasing ATV safety knowledge when used in a community-based statewide hunter education program. METHODS: During the baseline phase, surveys focusing on ATV safety were distributed to students in the Arkansas hunter safety program in 2006. In the intervention phase a year later, an ATV safety video on DVD was provided for use in required hunter education courses across Arkansas. The same survey was administered to hunter education students before and after the course. FINDINGS: In the baseline phase, 1,641 precourse and 1,374 postcourse surveys were returned and analyzed. In the intervention phase, 708 precourse and 694 postcourse surveys were completed. Student knowledge of ATV safety after watching the video was higher than in preintervention classes. Knowledge of appropriate helmet usage increased from 95% to 98.8% (P < .0001). Awareness of the importance of not carrying a passenger behind the driver increased from 59.5% to 91.1% (P < .0001). Awareness of importance of hands-on ATV rider training increased from 82.1% to 92.4% (P < .0001). CONCLUSIONS: A brief ATV safety video used in a hunter education course increased ATV safety knowledge on most measures. A statewide hunter education program appears to be a useful venue for ATV safety education.

ATV and bicycle deaths and associated costs in the United States, 2000-2005.

OBJECTIVE: We determined the rate and costs of recent U.S. all-terrain vehicle (ATV) and bicycle deaths. METHODS: Fatalities were identified from the National Center for Health Statistics Multiple Cause-of-Death public-access file. ATV and bicycle deaths were defined by International Classification of Diseases, 10th Revision codes V86.0-V86.9 and V10-V19, respectively. Lifetime costs were estimated using standard methods such as those used by the National Highway Traffic Safety Administration. RESULTS: From 2000 through 2005, 5,204 people died from ATV crashes and 4,924 from bicycle mishaps. A mean of 694 adults and 174 children died annually from ATV injuries, while 666 adults and 155 children died from bicycle injuries. Death rates increased among adult ATV and bike riders and child ATV riders. Males had higher fatality rates for both ATVs and bicycles. Among children, total costs increased 15% for ATV deaths and decreased 23% for bicycle deaths. In adults, ATV costs increased 45% and bike costs increased 39%. CONCLUSIONS: Bicycle- and ATV-related deaths and associated costs are high and, for the most part, increasing. Promotion of proven prevention strategies, including helmet use, is indicated. However, enforcement of helmet laws is problematic, which may contribute to observed trends.

ATV deaths among older adults in West Virginia: evidence suggesting that "60 is the new 40!".

OBJECTIVES: Describe the epidemiology of all-terrain vehicle (ATV) deaths among persons > or =65 years of age in West Virginia from 1999-2007. MATERIAL AND METHODS: We conducted a review of death certificates identifying ATV fatalities from ICD-10 diagnostic codes V86.0, V86.1, V86.3, V86.5, V86.6, and V86.9. RESULTS: ATV deaths increased 155% from 11% during 1985-1998 to 28% during 1999-2007. Injuries to the upper and lower trunk (62%) were the most common injuries, followed by head and neck injuries (28%). Fatality rates increased substantially from 0.37 deaths per 100,000 in 1990 to 2.14 in 2007, with a twofold increase from 1.08 to 2.14 noted from 2005 to 2007. CONCLUSION: An increase in the number of ATV riders and fatality patterns among older adults suggests an increasing propensity for older adults to engage in activities associated most often with younger age groups. Safety and training efforts sensitive to the specific needs of older ATV drivers is warranted.

Fatal all-terrain vehicle crashes: injury types and alcohol use.

BACKGROUND: Since the 1990s, West Virginia has led the U.S. in the per-capita death rate from all-terrain vehicle (ATV) crashes, with rates eight times the national average and continually increasing. A comprehensive assessment was conducted of ATV fatalities to provide critical guidance for community interventions and public health policy to prevent further deaths. METHODS: In 2007, death certificates for 2004 to 2006 with ICD-10 codes correlating to ATV crashes were used to identify decedents involved in crashes occurring in West Virginia. Data were abstracted from medical examiner records regarding crash circumstances, sustained injuries, and toxicology. RESULTS: During 2004-2006, a total of 112 fatal ATV crashes were identified. Nearly all (92%) decedents were the ATV operator, and only 15% were known to have worn helmets. Among 54 traffic crashes, collisions (56%) and head injuries (65%) predominated, whereas the majority of 58 nontraffic crashes were rollovers (55%) and were most commonly associated with compression injuries of the thorax and abdomen (36%). Regardless of crash class (i.e., traffic versus nontraffic), alcohol was detected in the blood of 50% of decedents; of those, 88% had blood alcohol concentrations >OR=0.08% (mean=0.17%), West Virginia's legal limit. Drugs of abuse were identified in 21% of decedents, including marijuana (11%); opioid analgesics (7%); diazepam (6%); cocaine (2%); and methamphetamine (1%). CONCLUSIONS: Fatal crash and injury types differ significantly depending on the location of ATV use, although alcohol and drug abuse are frequent risk factors in all types of ATV crashes. In addition to promoting helmet use, interventions are needed to address alcohol use among ATV users.

All-terrain vehicle-related hospitalizations in the United States, 2000-2004.

OBJECTIVES: To estimate the incidence of all-terrain vehicle (ATV)-related injury hospitalizations in the United States from 2000 through 2004, and to describe the types of injuries and associated hospital costs for the entire population. METHODS: Data for 2000 through 2004 were obtained from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample--a stratified probability sample of 1004 community hospitals from 37 states. ATV injuries were defined by ICD-9-CM external cause of injury codes within E821. Variables included age, gender, primary diagnoses, patient disposition, primary payer, and hospital charges. Data were analyzed in 2007. RESULTS: There were an estimated 58,254 ATV-related hospitalizations, increasing 90% over the 5-year period. Eighty percent were men. Thirty percent of the cases involved youth under age 18, and 8% were over age 60. Passengers accounted for 9% of the hospitalizations. Eighty-five percent were routinely discharged to home while 13% required long-term rehabilitation or home health care. Payers included private insurance (62%), Medicaid/Medicare (19%), and self-pay (12%). Rural hospitals treated 23% of the cases and urban teaching hospitals 47%. Estimated total hospital charges were about $1.1 billion (20% paid from public funds) with an average charge per patient of $19,671. Leading injuries included fractures of lower limbs (22%; mean hospital charges of $19,626), other fractures (15%; $18,873), and intracranial injuries (14%; $26,906). The overall hospital admission rate was 4.4 per 100,000 population with variation by year, gender, and age. CONCLUSIONS: Voluntary industry and government safety efforts have had little impact on the increasing incidence and cost of ATV injuries. Renewed prevention efforts to making ATV riding safer are warranted.

Realities of disaster preparedness in rural hospitals.

Disaster preparedness has always been an area of major concern for the medical community, but recent world events have prompted an increased interest. The health care system must respond to disasters of all types, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. This study examines the experiences of rural hospital emergency departments with threat preparedness. Data were gathered through a nationwide survey to describe emergency department experience with specific incidents, as well as the frequency of occurrence of these events. Expanding surge capacity of hospitals and developing a community-wide response to natural or human-made incidents is crucial in mitigating long-term effects on the health care system. Analysis of preparedness activities will help identify common themes to better prioritize preparedness activities and maximize a hospital's response capabilities.

Realities of rural emergency medical services disaster preparedness.

INTRODUCTION: Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored. PROBLEM: This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness? METHODS: Data were gathered through a multi-region survey of 1801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities. RESULTS: A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention. CONCLUSION: Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.

All-terrain vehicle-related nonfatal injuries among young riders: United States, 2001-2003.

BACKGROUND: All-terrain vehicles (ATVs) have gained in popularity in recent years, and this rise in use has been accompanied by increases in the number of ATV-related injuries. Because children often lack the physical strength, cognitive abilities, and fine motor skills to operate ATVs properly, their risk for injury is greater. Furthermore, most children ride adult-sized ATVs. OBJECTIVES: To estimate the numbers and rates of ATV-related nonfatal injuries to riders aged < or =15 years who were treated in hospital emergency departments (EDs) in the United States from 2001 through 2003. METHODS: Estimates of ATV-related injuries were obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System-All Injury Program. The database is a nationally representative, stratified probability sample of 66 US hospitals with > or =6 beds and a 24-hour ED. ATV-related nonfatal injuries to riders aged < or =15 years who were treated in hospital EDs were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: From 2001 through 2003, an estimated 108724 children aged < or =15 years were treated in hospital EDs for nonfatal injuries sustained while riding ATVs. The number of ATV-related injuries increased by 25% over the 3-year period. Males aged 11 to 15 years accounted for 52% of all ATV-related ED visits and hospitalizations among young riders. Children aged 0 to 5 years were more likely than the older children to have facial injuries, whereas the older children were more likely to sustain lower trunk and leg or foot injuries. Fractures were the most common diagnosis, accounting for 27% of ED visits and 45% of hospitalizations. CONCLUSIONS: Current legal and regulatory standards have been ineffective in reducing injuries among young ATV riders. Renewed efforts by health care providers to counsel parents about the injury risk to children who ride ATVs and advocate for more stringent state-level minimum age requirements may help reduce the escalating rates of ATV-related injuries among young riders.

A brief summary of alcohol intervention research at West Virginia University from 1998-2003.

Injury resulting in death and disability and alcohol-related problems are two major problems in West Virginia, yet few effective preventive strategies are available. A relatively simple and effective preventive strategy, appropriate for all health care providers, can help to alter excessive alcohol consumption and its resulting harm and consequences. Over the past five years, a series of alcohol intervention projects have been conducted in the Emergency Department at West Virginia University Hospital and other medical settings. Short motivational counseling sessions, which are referred to as screening and brief intervention (SBI), were tailored to each patient's needs. SBI is a secondary prevention strategy used to help persons identified with alcohol problems to decrease their drinking and reduce the harm caused by alcohol. To date, 90% of the nearly 8,000 eligible patients have consented to participate in these studies. Follow-up rates have ranged between 45% and 61%. This article describes the methodologies and results of our SBI studies and their relevance to West Virginia health care providers.

Neurological injury and death in all-terrain vehicle crashes in West Virginia: a 10-year retrospective review.

OBJECTIVE: The purpose of this study was to profile all-terrain vehicle crash victims with neurological injuries who were treated at a Level I trauma center. METHODS: We retrospectively reviewed trauma registry data for 238 patients who were admitted to the Jon Michael Moore Trauma Center at the West Virginia University School of Medicine after all-terrain vehicle crashes, between January 1991 and December 2000. Age, helmet status, alcohol and drug use, head injuries, length of stay, disposition, and hospital costs were studied. Death rates, head injuries, age, helmet use, and safety legislation in all 50 states were compared. RESULTS: Eighty percent of victims were male, with an average age of 27.3 years. Only 22% of all patients were wearing helmets. Alcohol and/or drugs were involved in almost one-half of all incidents. Fifty-five of 238 patients sustained spinal axis injuries; only 5 were wearing helmets. One-third of victims (75 of 238 victims) were in the pediatric population, and only 21% were wearing helmets. Only 15% of victims less than 16 years of age were wearing helmets. There were a total of eight deaths; only one patient was wearing a helmet. CONCLUSION: In the United States, all-terrain vehicles caused an estimated 240 deaths/yr between 1990 and 1994, which increased to 357 deaths/yr between 1995 and 2000. Brain and spine injuries occurred in 80% of fatal crashes. West Virginia has a fatality rate approximately eight times the national rate. Helmets reduce the risk of head injury by 64%, but only 21 states have helmet laws. Juvenile passengers on adult-driven vehicles are infrequently helmeted (<20%) and frequently injured (>65%). We conclude that safety legislation would save lives.

Matched analysis of parent's and children's attitudes and practices towards motor vehicle and bicycle safety: an important information gap.

The purpose of this study was to compare parents' and children's attitudes and habits towards use of bicycle helmets and car seat belts. We hypothesized that parental perception of their children's safety practices did not reflect actual behavior and further, that parental practices, rather than their beliefs about a particular safety practice, have a greater affect on their child's risk-taking behavior. The study population consisted of children in grades four and five and their parents/guardians. Participation in the cross-sectional study was voluntary and confidential anonymous questionnaires were used. In separate and independent surveys, children and parents were questioned in parallel about their knowledge, habits and attitudes toward bicycle helmet use and car safety practices. In the study, 731 students participated with 329 matched child-parent pairs. Ninety-five percent of the children own bicycles and 88% have helmets. Seventy percent of parents report their child always wears a helmet, while only 51% of children report always wearing one (p < 0.05). One-fifth of the children never wear a helmet, whereas parents think only 4% of their children never use one (p < 0.05). Parents report their children wear seat belts 92% of the time while 30% of children report not wearing one. Thirty-eight percent of children ride bicycles with their parents and wear their helmets more often than those who do not ride with their parents (p < 0.05). Parents who always wear a seat belt are more likely to have children who sit in the back seat and wear a seat belt (p < 0.05). Parents' perceptions of their children's safety practices may not be accurate and their actions do affect their children's. Injury prevention programs that target both parents and children may have a greater impact on reducing risk-taking behaviors than working with each group in isolation.

Non-fatal injuries in the West Virginia logging industry: using workers' compensation claims to assess risk from 1995 through 2001.

BACKGROUND: The logging industry has a high rate of both fatal and non-fatal injuries in comparison to other industries, and plays a vital role in WV's economy. METHODS: Workers' compensation (WC) injury claims and employment data were summarized to examine patterns and rates of non-fatal logging injuries in WV from 1995 through 2001. RESULTS: The average annual rate of injury claims was 16.0 per 100 workers per year with rates remaining relatively steady over the 7-year study period. The highest rates of injury were a result of being struck by an object, typically trees, snags, or logs. CONCLUSIONS: WV loggers most often file injury claims as a result of being struck by trees and tree parts, snags, and logs. Assessment of risk is a critical component in helping regulators, researchers, and the logging industry develop viable prevention strategies to reduce the incidence and severity of logging-related injuries.

Feasibility of screening and intervention for alcohol problems among young adults in the ED.

This study evaluates the feasibility of screening and brief intervention (SBI) for alcohol problems among young adults (18-39 years) in a rural, university ED. Research staff screened a convenience sample of patients waiting for medical treatment with the Alcohol Use Disorders Identification Test (AUDIT), used motivational interviewing techniques to counsel screen-positive patients (AUDIT >/= 6) during the ED visit, and referred patients to off-site alcohol treatment as appropriate. Patients were interviewed again at 3 months. Eighty-seven percent of age-eligible drinkers (2,067 of 2,371) consented to participate. Forty-three percent (894 of 2,067) screened positive, of which 94% were counseled. Forty percent of those counseled set a goal to decrease or stop drinking and 4% were referred for further treatment. Median times for obtaining consent, screening, and intervention were 4, 4, and 14 minutes, respectively. Project staff reported that 3% of patients screened or counseled were uncooperative. Seventy percent of 519 patients who participated in follow-up interviews agreed the ED is a good place to help patients with alcohol problems. High rates of informed consent and acceptance of counseling confirmed this protocol's acceptability to patients and indicated patients were comfortable divulging alcohol-related risk behavior. The modest times required for the process enhanced acceptability to patients as well as ED staff. The high prevalence of alcohol problems and the broad acceptance of SBI in this sample provide evidence of the ED's promise as a venue for this clinical preventive service.

ATV-related deaths in West Virginia: 1990-2003.

During the 14-year period from 1990-2003, West Virginia experienced 220 deaths related to All Terrain Vehicles (ATVs). Death rates in West Virginia however, were significantly higher than the national rate or those of any of the its five surrounding states. About 25% of the West Virginia deaths occurred in children less than 18 years of age. Ninety-five percent of the victims were not wearing helmets and 15% were passengers. Nearly one-third of the ATV crashes occurred on public roads, streets, and highways--surfaces on which ATVs are not designed nor recommended to be used. The cost of ATV-related deaths is estimated to be over dollar 100 million annually. The number of non-fatal injuries resulting from ATV crashes is difficult to ascertain because of a lack of a centralized and standardized state-based surveillance mechanism. The 44 states that have some level of ATV safety requirements have a collective death rate half that of states, like West Virginia, who do not have ATV safety requirements. Due to the continuing public health burden caused by ATV deaths and injuries, as well as their associated costs, it is important that West Virginia policymakers pass strong ATV safety legislation during the current session.

Screening and brief intervention for alcohol problems among college students treated in a university hospital emergency department.

The authors evaluated a protocol to screen and provide brief interventions for alcohol problems to college students treated at a university hospital emergency department (ED). Of 2,372 drinkers they approached, 87% gave informed consent. Of those, 54% screened positive for alcohol problems (Alcohol Use Disorders Identification Test score < or = 6). One half to two thirds of the students who screened positive drank 2 to 3 times a week, drank 7 or more drinks per typical drinking day, or had experienced alcohol dependence symptoms within the past year. Ninety-six percent of screen-positive students accepted counseling during their ED visit. Three quarters of those questioned at 3-month follow-up reported that counseling had been helpful and that they had decreased their alcohol consumption. The prevalence of alcohol problems, high rates of informed consent and acceptance of counseling, and improved outcomes suggest that the ED is an appropriate venue for engaging students at high risk for alcohol problems.

Alcohol problems among young adult emergency department patients: making predictions using routine sociodemographic information.

OBJECTIVES: The study aims were to explore the process of identifying young adult Emergency Department (ED) patients at risk for alcohol problems, examine the sociodemographic predictors of patient alcohol problems, and determine differences between patients who screened positive and those who screened negative for alcohol problems. Implications for ED practice are discussed. METHOD: As part of a larger study, the Alcohol Use Disorders Identification Test was administered to consenting patients ages 18 to 29. A score of greater than 5 (out of 40) was considered a positive screen for alcohol problems. Sociodemographic information was collected from a generic Individual Information Form. RESULTS: Approximately 48% (1855 of 3890) of patients screened positive for alcohol problems. Among screen-positive patients, 91% (1689) had scores that corresponded to mild to moderate alcohol problems. Compared with screen-negative patients, screen-positive patients were almost 3 times more likely to be men (odds ratio [OR] = 2.70); 2.5 times more likely to use tobacco (OR = 2.43); 2 times more likely to be single (OR = 2.03); and 1.5 times more likely to have some college education (OR = 1.41), be an 18- to 20-year-old adult (OR = 1.61), be a college student (OR = 1.60), be unemployed (OR = 1.39), and cohabitate with friends (OR = 1.19). Screen-positive patients also were more likely to have made at least one past attempt to change their drinking behavior (OR = 3.21). CONCLUSION: Routine patient information presented an accurate risk profile for alcohol problems among patients in this study. If ED-based health care professionals routinely screened patients for alcohol problems or could predict potential alcohol problems by using routinely collected information, then intervention or referral for additional services may increase.