Gerene Denning, of the University of Iowa Department of Emergency Services, presented this at CPSC's ATV Safety Summit Oct. 12, 2012. High Proportions of Roadway Deaths and Injuries on ATVs Suggest Poor Knowledge and Compliance with Road Use Laws. Objectives: To compare fatal and non-fatal ATV crashes on and off the road. Methods: Retrospective studies were performed using national fatality data (CPSC) and statewide injury data. Results: From 1985-2009, 62% of U.S. ATV deaths resulted from roadway crashes, and roadway deaths since 1998 have increased at a greater rate than off-road deaths. Fatal roadway crashes were more likely than off-road crashes to result in multiple deaths and to involve multiple riders, higher alcohol use, more collisions, and more head injuries. Similarly, non-fatal Iowa roadway crashes (2002-2009) involved more passengers, alcohol use, and collisions as compared to off-road crashes. Helmet use was significantly lower in roadway crashes relative to off-road; and more severe injuries overall, including head injuries, characterized roadway crashes. Both studies showed helmets reduced the likelihood of head injury. Conclusion: Despite road use laws, over half of U.S. ATV-related deaths and one-third of serious injuries in Iowa resulted from roadway crashes. We hypothesize that multiple risk factors exacerbate the inherent difficulty of safely operating ATVs on roads, and that speed and lack of protective equipment increase injury severity. Improving knowledge and enforcement of road use laws may be an effective way to reduce ATV-related deaths and injuries.

1. High Proportions of Roadway Deaths
and Injuries on ATVs Suggest Poor
Knowledge and Compliance with
Road Use Laws
Gerene Denning, PhD
Charles Jennissen, MD
Karisa Harland, PhD
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2. Background
22 states, including Iowa, have road use laws restricting use to work-
related purposes.
However, survey studies suggest that riding on the road is a
widespread practice, including among Iowa youth:
• 81% of Future Farmer’s of America (FFA) members (Burgus et al. 2009)
• 82% of 4 H Clubs of America members (Hafner et al 2010)
• 81% Iowa school students (11-16 yrs old) (Jennissen et al.)
In addition, West Virginia reported that 60% of statewide ATV-related
deaths were due to crashes on the roadway (Helmkamp et al. 2008).
Why and how are ATVs more dangerous on the road?
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3. Not all tires are created equal.
Under-inflated,
knobby ATV tires
are designed to
handle UNEVEN,
ROUGH off-road
surfaces.
They can GRAB
the road surface
Well inflated and throw a rider
automobile tires with off, or cause the
good tread are ATV to ROLL
designed to GRIP and OVER,
RELEASE the ROAD particularly while
surface to help turning.
maintain control of the
vehicle.
Automobile Tires ATV Tires
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4. Many factors contribute to loss of
control on the road.
High center of Need wider
gravity. turning radius
CM
than road is
designed for.
Entering roadway Knobby tires
from ditch has can grab when
visibility problems. accelerating.
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5. Objective of Our Studies
To compare roadway and off-road deaths and injuries to
determine whether there were differences in:
Demographics
Riding practices and risk factors
Injury outcomes, including head injuries
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6. Data Sources Used
Consumer Product Safety
Commission (CPSC) National
Fatality Database
Iowa Statewide ATV Injury
Surveillance Database
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7. Iowa ATV Injury Surveillance Database
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8. Fatal crashes have increased at a greater
rate on the roadway vs. off.
Roadway vs. Off-Road Deaths Per Year
• Dramatic increase 600
followed expiration Roadway
Off-Road
of the 10-Year 500
Consent Decree. 48 + 2.8
More Roadway
400
• Fatal roadway Deaths/yr
crashes increased 300
at more than twice 10-Year Consent Decree
the rate of off-road 200
crashes. 20 + 1.8
More Off-road
100
Deaths/yr
• From 1985-2009,
62% of all fatal ATV 0
crashes were on
the roadway! Year
CPSC Fatality Database
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9. Teens and young adults are over-represented
in roadway deaths.
% of Roadway vs. Off-Road Deaths by Age
35 Roadway > Off-Road
Roadway
30
Off-Road
25
Off-road > Roadway
20
15 Off-road > Roadway
10
5
0
Age Range
CPSC Fatality Database
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10. ATV-related injuries also
disproportionately affect the young.
70% 67%
Approximately 3 out of 10 injuries
in our database were among
30% 33% victims less than 16 years of age.
64%
58%
42%
36%
Twice that number (6 out of 10)
involved victims 25 years of age
and younger.
Iowa Injury Surveillance Database 10

11. Fatal roadway crashes were more likely to
involve multiple deaths than off-road crashes.
Single vs. Multiple Fatalities per Crash
N= 3,658 Crashes (1985-2009)
Fatalities Roadway Off-Road
Single 97% 99%
Multiple 3% 1%
Roadway vs. Off-Road Why were
roadway crashes
aOR 3.15 3X more likely to
95% CI 1.95-5.09 involve multiple
deaths?
P value <0.0001
CPSC Fatality Database
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12. Fatal roadway crashes involved more
multiple riders than off-road crashes.
15% 12%
13%
16%
69% 75%
31% Multiple Riders
> 25% Multiple Riders
CPSC Fatality Database
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13. More than 1 out of 10 non-fatal Iowa crash
victims were passengers.
16% 15%
84% 85%
Iowa Injury Surveillance Database
Over 50% of passenger victims were female and
over 60% were children under the age of 16.
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14. Fatal and non-fatal roadway crashes were more
likely than off-road crashes to involve collisions.
CPSC Fatality Database Over 10 times
Fatality Mechanism Roadway Off-Road Relative risk
ATV-Vehicle Collision 29% 6% Odds Ratio 10.4
ATV-Other Collision 37% 22% 95% CI 8.9-12.2
Rollover 34% 72% P value <0.001
Iowa Injury Surveillance Database Almost 5 times
Injury Mechanism Roadway Off-Road Relative risk
ATV-Vehicle Collision 35% 5% Odds Ratio 4.7
ATV-Other Collision 27% 20% 95% CI 3.51-6.34
Rollover 38% 74% P value <0.001
ATVs on the roadway are a serious traffic safety hazard!
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15. Fatal and non-fatal roadway crashes were more
likely than off-road crashes to involve alcohol.
CPSC Fatality Database Almost twice
Involved Alcohol Roadway Off-Road Relative risk
Yes 45% 30% Odds Ratio 1.96
No 55% 70% 95% CI 1.74-2.21
P value <0.001
Iowa Injury Surveillance Database Almost twice
Involved Alcohol Roadway Off-Road Relative risk
Yes 13% 8% Odds Ratio 1.91
No 87% 92% 95% CI 1.09-3.36
P value <0.001
Better enforcement of laws prohibiting alcohol use are needed!
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16. Vehicles in fatal crashes are getting bigger
and more powerful.
CPSC Fatality Database
100
775-900 cc
90
80 625-750 cc
70
475-600 cc
60
50 375-450 cc
40
225-350 cc
30
20 100-200 cc
10
<90 cc
0
1985-1990 1991-1998 1999-2003 2004-2009
Years
Do higher rates of roadway fatalities reflect the growing popularity
of large vehicles capable of achieving highway speeds?
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17. Roadway vs. Off-Road Outcomes
Head injuries are among the leading
causes of death and disability from ATV
crashes.
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18. Fatal and non-fatal roadway crashes were
associated with more head injuries.
CPSC Fatality Database Iowa State Trauma Registry
90%
66%
74%
50% 50%
34%
17%
9% 5% 5%
Crashes Glasgow Coma Scale
Fatal Roadway vs. Off-road Non-fatal Roadway vs. Off-road
crashes were 2X more likely to crashes were 3X more likely to
involve a head injury. involve a head injury.
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19. Helmets reduced the likelihood of head injuries.
Fatal Non-fatal
Roadway Off-Road Roadway Off-Road
Helmet use 16% 24% 14% 23%
P value p<0.0001 p<0.01
 Helmets reduced the likelihood of head injury:
•77% for Iowa non-fatal crashes.
•46% for national fatal crashes.
All states need ATV helmet laws that are
effectively enforced!
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20. CPSC Fatality Database
 62% of fatal ATV crashes occurred on the roadway.
 ATV-related roadway fatalities were more likely than off-
road fatalities to involve:
• Teens and young adults
• Multiple deaths
• Multiple riders
• Collisions with another vehicle
• Alcohol
• Head injuries
 ATV-related roadway fatalities were less likely than off-
road fatalities to involve:
• Helmet use among riders.
 Helmets reduced the risk of head injury. 20

21. Iowa ATV Injury Surveillance Database
ATV-related roadway injuries were more likely than off-
road injuries to involve:
• Teens and young adults
• Collisions with another vehicle
• Alcohol
• Head injuries
• Severe trauma (ISS >15)
ATV-related roadway injuries were less likely than off-
road injuries to involve:
• Helmet use among riders
Helmets reduced the risk of head injury.
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22. Conclusions
 ATV riders in states with road use laws are not
complying with the law.
 Compliance with laws requires:
• Knowledge of the laws.
• Enforcement of the laws.
• Removal of economic barriers with compliance.
 ATV riders in states with the following laws also appear
to have poor compliance.
• No passenger laws.
• Alcohol prohibition.
• Helmet laws.
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23. To reduce ATV-related deaths and
injuries…
All states need
evidence-based ATV
laws that are effectively
enforced.
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24. Deaths And Injuries From ATV Crashes
Are Preventable!
To prevent deaths and injuries and their accompanying
financial costs, we need:
• EDUCATION and Public Awareness
• ENGINEERING Safer Vehicles
• ENFORCEMENT of Evidence-Based Public Health and
Safety Laws
It takes all stakeholders working together.
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25. THANK YOU
When we have the power to save lives and health,
we have the responsibility to do so.
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