American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

All-Terrain Vehicle Injuries and Their Prevention

Chris Cribari, MD, FACS


  • Use of ATVs has rapidly increased in rural America and so has the number of ATV-related injuries and deaths.
  • U.S. Consumer Product Safety Commission reports up to 90,000 ATV-related injuries per year and 120 deaths.
  • 50 percent of the injuries and fatalities involve children under 16 years old.
  • Risk of injury is 2.5 times greater if the driver is under 16 years old than for drivers ages 16–34, and 4.5 times higher than for drivers ages 35–50.
  • Poor judgment and risk-taking behaviors are often factors related to accidents.
  • Helmets were worn by only 30 percent of patients.
  • Skin and orthopaedic injuries are the most frequent injuries reported.
  • Head and facial injuries are second most common.
  • 61 percent of fractures are classified as open or comminuted.

Mechanisms of injury

  • Loss of control of vehicle and fall from vehicle (most common mechanisms)
  • Collision with stationary or moving objects
  • Rollover
  • Fall from vehicle

Landscape features that influence ATV accidents and injury

  • Fences
  • Cliffs or steep drop-offs
  • Rocks and ditches
  • Frozen lakes, rivers, or streams
  • Wooded areas

Prevention efforts

  • Sale of ATV to children under 16 prohibited in 1988.
  • Consent decree restricting access to children under 16 not effective in reducing incidence of injury in children.
  • Hands-on training programs; some are now linked to manufacturer warranty eligibility.
  • Encourage consumers to dispose of three-wheel ATVs still in use.
  • Future safety efforts must focus on reducing childhood injuries.
  • Health care providers should utilize "teachable moments."
  • Adults must be role models by embracing and teaching practical preventative measures.
  • Parental education concerning:
    • ATV risks for children under 16
    • Use of safety equipment
    • Use of helmet
    • Restriction of use


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