Perspectives in Disease Prevention and Health Promotion Injuries Associated with Three-Wheel All-Terrain Vehicles -- Alaska

From January 1983 through December 1984, at least 20 deaths and 538 injuries, including six persons permanently disabled by neurologic injuries, were associated with three-wheel all-terrain vehicles ("3-wheelers" or ATVs) in Alaska. These preliminary data came from an ongoing statewide study conducted by the Alaska Division of Public Health with the assistance of CDC. Of the 20 fatalities, 11 (55%) occurred among males. Ages at death ranged from 12 years to 53 years; 15 (75%) were in the 15- to 34-year age group. Eleven (55%) deaths occurred during a 3-month period in 1983 (Figure 2). No similar cluster was observed in 1984. All but three fatal incidents occurred in the south-central and southwestern portions of Alaska.

Ten persons (50%) died as a result of direct impact to the head (Table 2); only two wore protective helmets when the incidents occurred. Four others not wearing helmets--two of three persons who drowned and two who died of asphyxiation--died following presumed loss of consciousness. Nineteen persons who died were operating the vehicle; in one instance, both the driver and his passenger were killed.

Blood alcohol was measured in 11 individuals who survived less than 4 hours following injury. In eight individuals, the blood alcohol concentration (BAC) exceeded 0.1 g%, the level of intoxication. Two others had blood alcohol detected at levels below 0.1 g%. Only one person had no blood alcohol detected. Five persons died 4 or more hours following injury, so BAC obtained at autopsy may not reflect accurately the BAC at the time of the incident. Blood alcohol was not measured for four persons.

Hospital admissions for persons with ATV-associated injuries were identified by reviewing inpatient records from the Indian Health Service hospitals and from two of the three major private referral hospitals in Alaska. During the 2-year period, 324 patients were hospitalized for ATV-related injuries. The average duration of stay was 8.5 days. Of the 324 hospitalizations, 113 (35%) occurred as a result of fractures/dislocations of the lower extremity. Six patients (ranging in age from 21 years to 51 years) were hospitalized as a result of severe head or spinal cord injuries; they are now permanently disabled and will require long-term skilled care. In one private hospital, 43 (66%) of 65 inpatients required a surgical procedure under general anesthesia. Although data on outpatients from all hospitals are far less complete, 214 outpatient visits for ATV-associated injuries were documented during the study period.

Based on the current estimates for hospital care in Alaska (average of $578 per inpatient day) (1), ATV-associated injuries accounted for approximately $1.6 million in health-care dollars spent for inpatient care alone during 1983-1984. Using estimated costs of basic care for residents of a large long-term care facility in Anchorage ($4,800 per month*), the six permanently disabled individuals may require additional expenditures of $11.5 million for basic long-term skilled care if each lives to age 65 years.

The Alaska Department of Public Safety and Department of Transportation (DPS/DOT) received police reports of 234 incidents involving 304 injured riders or property damage associated with ATV use during the study period. Reports from DPS/DOT were used to characterize riders, vehicles, and environmental conditions involved in fatal and nonfatal ATV incidents investigated by police. Persons in the 10- to 14-year age group (24%) were most frequently involved in incidents reported to DPS/DOT, and more than twice as many males as females were involved. Incidents were reported more frequently on Saturdays and Sundays than on weekdays. Although ATVs are marketed for off-road use, 63% of incidents occurred on roads. Police reported that vehicles were most frequently moving straight at a constant speed (57%) rather than changing speed or direction before the event. The most frequent contributing factors cited by police were alcohol (20%), speeding (16%), driver inexperience (12%), and driver inattention (11%).** Only 9% of riders wore helmets at the time of the incident. Although all ATV models are designed for use by a single rider, 29% of incidents reported by police involved multiple riders. Reported by S Jenkerson, J Middaugh, MD, State Epidemiologist, Alaska Dept of Health and Social Svcs; Epidemiologic Studies Br, Div of Surveillance and Epidemiolgic Studies, Epidemiology Program Office, Special Studies Br, Chronic Disease Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Injuries are the leading cause of premature mortality in the United States (2). Mortality associated with unintentional injuries is the leading cause of premature mortality in Alaska and probably reflects the age structure of the state (median age is 26.3 years). During 1983-1984, fatal injuries resulting from transportation and recreational vehicle crashes accounted for 353 (9%) of 3,881 deaths in Alaska, including: 285 (7%) automobile and truck collision fatalities, 86 (2%) aircraft crash fatalities, 20 (0.5%) ATV-associated fatalities, and 11 (0.3%) snowmachine-associated fatalities. In addition to the premature mortality associated with ATV use, related nonfatal injuries result in substantial costs for both individuals and society.

Interpretation of transportation and vehicle-related injury studies is often constrained by an absence of denominator data, particularly the number of persons at risk of injury. Information concerning the number of vehicles in use and rider-usage patterns is often difficult, if not impossible, to obtain.

Potential risk factors for injuries associated with ATVs include alcohol use, ineffective helmet use, rider inexperience and inattention, and excessive speed. Of major importance is the finding that 12 (60%) of the 20 fatalities may have been prevented by wearing a helmet. These factors, as well as vehicle-use patterns and vehicle characteristics, must be evaluated as part of a rational approach to plan intervention strategies. Injury investigations, such as this study, can serve as a basis for developing and implementing comprehensive injury surveillance systems to monitor the public health impact of injuries.

References

1. American Hospital Association. Hospital statistics. Chicago: American Hospital Association, 1984:45.

2. CDC. Changes in premature mortality--United States, 1982-1983. MMWR 1985;34:17-8. *This figure does not include costs for physicians' fees, medications or occupational, physical, recreational, or speech therapy. **Only one factor per incident was cited.

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