Meeting a family in a critical hospital setting following the injury or death of a child is without doubt one of the most difficult situations a nurse encounters. It is often not the time, nor the place, to begin a discussion about what actions by the parents might have thwarted this accident, although the parents may actively be saying, "what if I had not allowed her to do that today?" Nurses are often challenged by their own thoughts on parenting and not understanding someone else's decisions.
Children are known to drive many different types of vehicles, including cars, all-terrain vehicles (ATVs), snowmobiles, motorcycles, ride-on lawn mowers, and tractors. In rural communities, it is common for adolescents to be engaged in the work on the family farm and drive tractors and lawn mowers. Recreational use of ATVs, snowmobiles, and motorcycles occurs frequently. Each of these vehicles requires both cognitive and physical abilities that often children younger than 16 do not possess.
In the previous issue of Orthopaedic Nursing, Altizer (2008) discussed the concerns of children operating ATVs and the poignant story of Ben. To continue that discussion, I believe it is appropriate to introduce an organization called Safe Kids USA, whose mission is to prevent accidental childhood injury, a leading killer of children 14 and younger. Part of a global organization, Safe Kids Worldwide, Safe Kids USA continually monitors trends in childhood injuries and has led numerous activities to make change happen. One area that has been addressed is ATV safety.
Levenson (2003) found that between 1982 and 2002, the deaths related to ATV use in children younger than 16 accounted for more than 30% of all deaths. Each year, approximately 100 children younger than 16 die from an ATV-related injury (SafeKids, 2007)
"Compared to a bike crash, an ATV crash is six times as likely to send a child to the hospital and 12 times as likely to kill a child," said Martin R. Eichelberger, M.D., chairman of Safe Kids Worldwide and director of emergency trauma and burn services at Children's National Medical Center in Washington, D.C. "A child riding an ATV is four times as likely to be seriously injured as a rider over age 16." (SafeKids, 2007)
ATV rollovers, collisions and ejections can cause instantly fatal head injuries as well as serious nonfatal injuries to the head, spinal cord and abdomen. "ATVs are inherently difficult to operate, and children do not have the cognitive or physical abilities to drive or ride these vehicles safely," said Eichelberger. "If you're not old enough to drive a car on a paved road with traffic control devices, you're certainly not old enough to drive a powerful open-seat vehicle at speeds up to 70 miles per hour over dirt trails and wild terrain." (SafeKids, 2007)
"After extensive review of the data, we conclude that there is simply no way to make ATV riding a safe activity for children," said Eichelberger. (SafeKids, 2007)
In this issue of Orthopaedic Nursing, Small in her article, "Interventions to Prevent Adolescent Motor Vehicle Crashes: A Literature Review," reviews the literature to help look at ways to prevent motor vehicle crashes in the adolescent population.
For any parent who has handed over a set of automobile keys to his or her over-16 driver, there is always trepidation. This occurs after intense driver's education as required by individual state laws and a parental decision on the "readiness" of the young driver. This should never just occur because a driver's test has been passed but rather after a demonstrated ability to safely drive a car as well as an understanding that good judgment is utilized at all times.
In the case of these other vehicles, however, most of them are considered recreational or work, and it is easy to lose sight of the fact that these vehicles are powerful and dangerous. The same type of assessment as to the "readiness" of the operator must occur. Although formal licensure is not mandated for their use, parents and/or legal guardians must impose their own requirements of education, demonstration of ability to operate the equipment, and that the understanding of the safe use of such a vehicle exists. Just because the vehicle appears to be fun and offers a wonderful experience, the danger associated with these vehicles can never be underestimated as the literature so clearly states.
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