The Effect of Massachusetts State Legislation on Off-Road Vehicle Injuries in Children

1. The Effect of Massachusetts State Legislation on Off-Road Vehicle Injuries in Children Michael R. Flaherty, DO MGH Pediatric Critical Care Medicine

2. Who We Are • Mentor: Peter Masiakos, MD • Department Mentor: Sarah Murphy, MD • George Velmahos, MD, PhD • Haytham Kaafarani, MD, MPH • Jarone Lee, MD, MPH • Alice Gervasini, RN, PhD • Toby Raybould, MS • Karen Donelan, Phd • Mark Mandell, MD

3. Trauma and Injury Prevention Outreach Program • Sports-Related Concussions • Graduated Driver Licensing • Off-Road Vehicle Injuries • Falls • Seat Belts/Booster Seats

5. Injuries Are Not Accidents! • Accident: An unexpected occurrence, happening by chance… implies a random and uncontrollable event • Injury: A definable, correctable event, with specific risks for occurrence … implies something amenable to intervention

7. Pediatric Injury Prevention Laws

8. Off-Road Vehicles • Dirt Bikes/Motocross • All-Terrain Vehicles (ATVs) • 3 and 4-wheeled • Higher center of gravity, prone to rolling over • Weigh in excess of 850 pounds • Large engine sizes not matched to age/body size

10. Policy Statement since 1987 Public, patient, and parent education by pediatricians Equipment modifications; the use of safety equipment (helmets) Development and improvement of safer off-road trails and responsive emergency medical systems Ban on the sale of new and used 3-wheeled ATVs, with a recall of all used 3-wheeled ATVs Passage of legislation in all states American Academy of Pediatrics

11. AAP Model Bill (1989) • Prohibit the use of ATVs, on- or off-road, by children and adolescents younger than 16 years; • Requires an automobile drivers' license, and preferably some additional certification in ATV use; • Prohibits the use of ATVs on public streets and highways; • Prohibits passengers from riding on ATVs; • Prohibits operating an ATV under the influence of alcohol; and • Prohibits the use of ATVs between sundown and sunrise

12. Massachusetts ORV Law • “Sean’s Law”: 2010 • Highlights of MA Law: • Prohibits ORV use under age 9 on public and private land • 10-14 year olds only able to operate ATV if for a sanctioned event/official race • Children 14-16 limited to ORVs with engine sizes less than 90 cubic centimeters • Formation of ORV workgroups including parents, environmental and state police, and physicians

13. Methods • Department of Public Health • Emergency Department Visits • Inpatient Hospitalizations • E-Codes: • E821.0, “non-traffic accident involving other off-road motor vehicle (MV); driver of MV other than motorcycle, ” and E821.1, “nontraffic accident involving other off-road motor vehicle; passenger in MV other than motorcycle

14. Methods • Timeframe • January 2002 to December 2013, 9 years before and 3 years after the 2010 ORV law • Pre-law period (2002–2010) and, • Post-law period (2011–2013)

16. 2002-2010 versus 2011-2013 39% 50% 33% MA Inpatient Hospital Discharge Database, MA Observation Stay Database, MA Outpatient Emergency Department Database, Division of Health Care Finance

17. 41%

19. Conclusions • Sustained reductions in ORV-related injuries for children under 18 • Approximately 10% of ED visits still in children 14-16 • MA law may serve as an example for other states, including bans on private land

20. Where Do We Go From Here? • Fatalities still occurring • Stricter Age Restrictions including 16 and under • Continued enforcement • Continued education

21. “Unless someone like you cares a whole awful lot, nothing is going to get better. It's not.” ~ Dr. Seuss

22. Acknowledgements • Massachusetts General Hospital Trauma and Injury Outreach Program • Dr. Peter Masiakos, Mentor • MA Department of Public Health • MGH Pediatric Critical Care Unit • Phoebe Yager, MD – Program Director • Sarah Murphy, MD – Departmental Mentor