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Nicholas Stange, MD MPH
Charles Jennissen, MD

Off-road vehicles remain a public health concern in the U.S. and are associated with approximately 700 deaths and 100,000 emergency department visits per year. Our study objective was to determine the epidemiology of eye injuries related to off-road vehicles, including all-terrain vehicles (ATVs), dune buggies and utility task vehicles (UTVs), with determination of the mechanisms of injury and associated diagnoses and the trend of injuries over time.

Off-road vehicle-related eye injuries were identified from 2004-2023 using the nationally representative National Electronic Injury Surveillance System which is maintained by the Consumer Product Safety Commission. Periorbital injuries were not included. The database narratives were utilized to code the mechanism of injury. Descriptive and comparative analyses (chi-square and Fisher’s exact test) were performed.

An estimated 20,076 ORV-related eye injuries (yearly average 1,004 cases) occurred, but incidents decreased significantly over time. Greater decreases in eye injuries were seen among youth, males, and those occurring at home or on farms/ranches. Injured victims were 77% males, 76% adults, and 90% non-Hispanic White. Nearly half (46%) occurred at home and 32% at a place of recreation/sports. Primary injury mechanisms included being hit by a foreign body/projectile (52%), hit by a branch (17%), and vehicle collisions/ejections (13%). The most common diagnoses were eye abrasions/contusions (55%) and foreign bodies (19%). Severe injuries included lacerations, hyphemas, traumatic uveitis, retinal detachments and ruptured globes. The vast majority (97%) were able to be discharged. Debris in foreign body/projectile injuries were 70% grass/dirt/dust/rocks, 20% insects and 5% sticks/wood. Only 1.4% of operators/passengers injured were documented as using safety glasses/goggles, with few using helmets. Injury mechanisms varied significantly between adult males and females, p=0.002. Higher proportions of injured youth were females and required admission for their injuries as compared to adults, p=0.002 and p=0.043, respectively.

ORV-related eye injuries are typically due to mechanisms that could have been avoided or have their severity decreased with the use of eye protection. The promotion and use of helmets with face shields or safety googles when riding ORVs are critical for preventing these injuries, especially among youth who had greater proportions of severe eye injuries requiring admission.

Attendees will be able to:
1) Describe the trend in overall and pediatric off-road vehicle-related eye injuries over time.
2) Identify at least three mechanisms for off-road vehicle-related eye injuries.
3) State two comparative differences between off-road vehicle-related youth versus adults and how most of these injuries could be prevented.

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Ahran Washington, MHA, BS, NREMT, CPST, CPSI
ShaRhonda J. Love, MPH
Kristyn Jeffries, MD, MPH

Over the past decade, all-terrain vehicles (ATV) have increased in popularity with children and adolescents, especially those living in rural areas in the United States. Youth have 12 times greater risk of ATV related injuries compared to adults, and the incidence of pediatric emergency department visits for ATV related injuries in Arkansas has similarly increased. To improve the ATV safety education among youth in our state, we developed a school-based educational program called Operation Safe T.R.I.P.S.S. that addressed safe ATV riding behaviors for adolescents.

Operation Safe T.R.I.P.S.S. is a school-based, 50-minute, assembly style ATV program adapted from the hospital-based, day-long ATV Safety initiative “Ride on TN” at Vanderbilt and in collaboration with University of Iowa Children’s Hospital. Utilizing the internal and external partnership injury databases of our hospital’s trauma department and Emergency Medical Services for Children (EMSC), we identified six counties, in rural areas of the state, with higher numbers of ATV injuries, which were subsequently targeted for this program. Participants completed pre- and post-surveys to measure knowledge gained of safe ATV riding behaviors. After completion, participants signed ATV safety pledge cards and had the opportunity to receive ATV safety gear.

Seventeen school presentations were completed between February to May 2025 with a total of 2817 participants. We had 94% pre-survey completion and 74% post-survey completion. Participants had a 21% increase in overall knowledge of ATV safety riding behaviors after the program. The program’s approval was 93% among participants and 63% of participants noted willingness to promote ATV safety with family and friends. Over 90 sets of ATV helmets, goggles and gloves were distributed in addition to 27 Stop the Bleed kits. Participants were referred to our hospital’s Family Resource Center for helmet fittings and further ATV education.

School-based ATV safety education programs, like Operation Safe T.R.I.P.S.S., can have a significant impact by increasing ATV safety knowledge among adolescents in a rural state. The success of this program also led to development of public service announcement that has been displayed across our hospital’s social media platforms to reach a broader audience.

1) Understand the risks of ATV related injuries for youth 2) Describe how ATV safety education can be implemented in a school based program 3) Discuss preliminary outcomes used to assess program effectiveness

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Nicholas Stange, MD MPH (Presenter)
Charles Jennissen, MD

Power lawnmowers pose significant ocular hazards and understanding these injuries can inform prevention strategies. The study objective was to determine the epidemiology, mechanisms, and trends of lawnmower-related eye injuries in the U.S., focusing on national estimates, injury types, and high-risk populations.

A retrospective cross-sectional study of U.S. lawnmower-related eye injuries from 2004-2023 was performed using the Consumer Product Safety Commission’s National Electronic Injury Surveillance System. Periorbital injuries were not included. The mechanism of injury and several other variables were coded using the database narratives. Descriptive and comparative analyses (chi-square and Fisher’s exact test) were performed.

An estimated 120,613 lawnmower-related eye injuries occurred in the U.S. from 2004-2023 (N=2,467 NEISS cases). Those injured were 82% males, 95% adults and 82% non-Hispanic Whites. Ninety-nine percent of injuries occurred at home. Most injuries (77%) were from projectiles (predominately grass, dirt and rocks), 12% non-projectile injuries during mowing, 8% maintenance/repair-related and 2% from chemical exposures (primarily gasoline). Common diagnoses included eye abrasions/contusions (55%) and foreign bodies (27%). Severe injuries included retinal detachment, iris sphincter tear, corneal erosion, lens dislocation and globe rupture. Only 2% of projectile injuries were documented in narratives as using eye protection including eyeglasses. The average annual estimate for lawnmower-related eye injuries was 33% lower when comparing 2018-2023 to 2004-2017 (n=4,502 vs. n=6,686, p<0.001). Injuries decreased more in males than in females, (35% vs. 23%, p<0.001) and in adults aged 18-65 (35%) as compared to youth <18 yrs (26%) and adults >65 yrs (23%), p<0.001. Whereas injuries decreased in non-Hispanic Whites by 41%, they increased in Blacks (18%) and other racial/ethnic groups, including Hispanics (42%), p<0.001. Youth <18 years were a higher proportion of bystander (50%) versus operator (5%) injuries, p<0.001. As compared to adults, a greater proportion of injured children were African American and Hispanic (p=0.003) and were injured somewhere other than at home (p=0.023). Bystanders, as compared to operators, had higher rates of severe injuries requiring hospital admission, p=0.002.

Lawnmower-related eye injuries remain a serious risk, especially from projectiles. The risk could be significantly lessened if proper safety glasses/goggles were utilized both while operating mowers and when performing maintenance/repair. Though less frequent, bystander injuries also occur with half of these being children and with a greater proportion requiring admission. Other individuals should not be in the vicinity of a mower’s operation, especially children.

Attendees will be able to:
1) Describe the trend in overall and pediatric lawnmower-related eye injuries over time.
2) Identify at least three mechanisms for lawnmower-related eye injuries.
3) State at least three comparative differences between lawnmower-related eye injuries in youth versus adults.

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Alejandra Mateos Castanon, BA, CPSTI

Motor vehicle crashes are the leading cause of death and injury for children between 1-17 years. In 2021, 711 child passengers ages 12 and younger died in a motor vehicle crash in the United States. Out of these children, 36% were not properly buckled up (cdc.gov). Parents and caregivers play a crucial role in keeping children safe on the road. The purpose of our car seat loaner program is to help discharging families tailored to their specific car seat needs, whether that’s assisting with installation or providing a car seat if the family doesn’t have one. This program is crucial to our patient families as we ensure children are traveling safely in the car.

Our loaner program is based at a hospital and is available to both inpatient and outpatient families. Families can borrow available car seats or restraints from our program for a 90-day period for a $20 cash-only deposit that is returned once family returns the loaner. A loaner can be issued when a family was in a motor vehicle collision and can’t use their own car seat anymore, lives 20 miles or more from the hospital and don’t have access to their car seat prior to discharge, family does not have a car seat for patient, and if the patient is in a cast or brace and doesn’t fit their own car seat.

The effectiveness and impact of our car seat loaner program can be measured by the number of car seats and restraints distributed to families in need. During the 2023–2024 program year alone, we provided 98 loaner car seats to patient families who otherwise may not have had access to an appropriate child restraint; most of these loaners were for patients that had a brace or cast and did not fit their own car seat. Our program assists multiple departments throughout the hospital including Orthopedics, NICCU, CV Acute, CTICU, and AltaMed. One of our program’s limitations is that restraints don’t always come back after the 90-days. To address this challenge, one effective measure is to call parents with reminders about the upcoming end of the loaning period.

Our car seat loaner program is very beneficial to the community as it offers the opportunity to temporarily borrow a car seat or restraint during times when they may not have immediate access to one, or the one they have is not appropriate. Even if a loaner is not needed/provided to a family, our program staff who are Child Passenger Technician Instructors, provide child passenger safety education and go over installation and proper harnessing of their own car seat.

1. Participants will learn about our car seat loaner program’s efforts to ensure adequate child passenger safety of our patients

2. Participants will learn about the eligibility criteria for the program and process for accessing this program

3. Participants will understand the challenges associated with this program and the approach towards addressing them

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Jens Strand, High School Student (Presenter)
Charles Jennissen, MD

There are federally mandated Specialty Vehicle Institute of America (SVIA)/American National Standards institute (ANSI) standards that apply to all all-terrain vehicles (ATVs) including youth models. Youth models are presently categorized by maximum restricted and unrestricted speeds. The maximum speed for Y6+ models (for youth ?6 years) is 15 mph and for Y10+ and Y12+ models (for youth ?10 years and ?12 years) is 30 mph. Prior to 2009, youth models were based on engine displacement with models for youth ?6 years having engine sizes less than 70cc and those for youth ?12 years being 90cc or less. There are no models approved for children under 6 years. The youth ATV market in recent years has been dominated by less expensive Chinese models. The objective of this study was to examine how Chinese youth ATVs are marketed by on-line dealers and whether they comply with federal standards.

Internet searches were conducted from August 2024-March 2025 with various search terms regarding youth ATVs and Chinese models to identify dealers on-line. The websites were reviewed to determine the youth models available and how they were marketed including the ages for which the model was recommended, the engine displacement and maximum speed, as well as dimension specifications. Descriptive analyses were performed.

201 Chinese youth ATVs advertised by eighteen dealers on-line were identified. There were 23 youth models on two websites that were advertised for children <6 years (22 models for as young as 3 years). Most engine sizes for these vehicles ranged from 107-125cc, except one was 40cc; maximum speeds for the six models where stated were 10-45 mph, average 27 mph. Of the remaining 177 youth ATVs, 76 models at ten on-line sites had age recommendations and/or stated maximum speed such that one could determine whether they followed federal regulations. Fifty-two (68%) did not meet speed standards for age. For models not meeting the standard, speeds ranged from 25-37 mph for Y6+ (6 models), 32-45 mph for Y10+ (4 models), 32-45 mph for Y12+ (7 models), and 31-45 mph for those with no age specified (35 models). All 18 sites advertised youth models for which federal standards were not met or did not provide age recommendations or the maximum speed so that this could be determined. Of models recommended for children ?6 years, 173/177 provided the engine displacement. All of them exceeded previous engine size standards for youth models. Engines ranged from 107-135cc for Y6+ (8 models), 107-125c for Y10+ (25 models), 107-125c for Y12+ (22 models) and 107-250cc for ATVs with no specific age designation (122 models).

Dealers marketing Chinese manufactured youth ATVs are generally not following federally mandated standards and/or not providing the recommended age ranges for the youth ATVs they are selling on-line. This is potentially leading to more children riding ATVs that are not designed for them and potentially leading to increased crashes and injuries.

Attendees will be able:
1. To state how youth ATV models are categorized now and how that differs from the past.
2. To discuss the present marketplace regarding the sale of youth ATVs in the U.S.
3. To identify at least three ways in which on-line dealers of Chinese youth ATVs are not following mandatory federal standards and luring customers to purchase ATVs for younger children.

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Parker Sternhagen, Undergraduate (Presenter)
Brooke Askelsen, Undergraduate
Cole Wymore, MD
Junlin Liao, PhD
Pam Hoogerwerf, BA
Brenda Vergara, AA
Charles Jennissen, MD

Manufacturers warn against the use of utility task vehicles (UTVS) on public roads as they are not designed for roadway use. In fact, most UTV-related deaths occur on public roads with the majority not involving another vehicle. Despite this, legislative bodies across the U.S. are passing laws allowing increased UTV use on public roads. The study objective was to examine rural adolescent’s use, knowledge and attitudes regarding UTVs on public roads.

An anonymous survey was performed of 2024 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees. Descriptive, bivariate (chi-square) and logistic regression analyses were performed using Stata 15.1 (StataCorp, College Station, TX).

1,029 FFA members participated. Respondents were 13-18 years with 67% being 14-17 years. One-half were from a farm, one-fifth lived in the country/not a farm, and 30% were from a town. Almost all (96%) were non-Hispanic White. Over half (53%) of respondents’ families owned a UTV and over two-thirds (69%) had driven/ridden one. Of those who had driven/ridden a UTV, 94% had driven/ridden on an unpaved public road (51% reported doing so at least weekly) and 87% had been on a paved road (41% reported doing so at least weekly). Males and owners of UTVs had greater odds of having driven on both unpaved (2.2x and 30.7x, respectively) and paved (1.7x, 13.4x, respectively) public roads at least weekly as compared to their peers. Overall, 64% and 63% stated it was safe to drive UTVs on unpaved and paved public roads, respectively, while 62% and 54% stated UTVs were designed for unpaved and paved roads, respectively. Males (2.8x), owners of UTVs (2.1x) and those that had ridden on public roads (3.1x) all had greater odds of stating it was safe to drive UTVs on both unpaved and paved roads than their comparative peers. Less than half (44%) agreed that most UTV deaths occur on public roads. Over half agreed to assertions that UTV manufacturers state UTVs are safe on unpaved (54%) and paved (52%) public roads. Generally, males, UTV owners, UTV riders, those who had ridden on public roads and more frequent riders all had greater proportions that held these misconceptions. The vast majority (82%) incorrectly believed one could be under 18 years to legally drive UTVs on Iowa county roads.

A majority of study participants had driven/ridden a UTV and almost all of these had been on public roads. The majority agreed it was safe to drive UTVs on both unpaved and paved public roads and were unaware that most UTV-related deaths occur on roads. They also believed the falsehood that manufacturers state UTVs are safe on unpaved and paved public roads. Targeted education and enforced legislation prohibiting use on public roads may be critical in decreasing UTV-related deaths and injuries.

Attendees will be able to:
Describe present practices of rural adolescents regarding driving UTVs on public roads.
Discuss the attitudes rural adolescents have related to the driving of UTVs on public roads.
State at least three demographic groups that had higher proportions who held misconceptions and falsehoods related to UTVs on public roads.

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Nikita Patil, DO
Andrew Tran, MD
Lee Crawley, MS, RRT-NPS
April Clawson, MD
Kristyn Jeffries, MD
Renita Pushparajah Mak, MD

The use of commercial or recreational all-terrain vehicles (ATVs) has significantly increased, particularly amongst the pediatric population with over 300,000 children requiring Emergency Department evaluation between 2001 and 2010. Similar to national trends, ATV use in Arkansas has also increased over the years. However, little is known regarding specific demographic information of those who sustain ATV injuries in Arkansas in more recent years. We aim to compare frequency and severity of ATV injuries in urban and rural parts of Arkansas.

This is a retrospective demographic study of all patients that sought emergency department (ED) care due to an ATV related injury in Arkansas between 2018 and 2023. Data from hospitals outside of the Arkansas Children’s Hospital system were captured by utilizing the trauma repository from the Arkansas Department of Health. Review of individual patient charts was performed with documentation of various demographics including but not limited to age, race, gender, zip codes, ATV type, transport data, and ED disposition status. Descriptive statistics were used to summarize the data.

In total, 3,356 patients under the age of 21 received ED care due to an ATV related injury during this five-year time frame. Of these patients, 65% were male, 82.2% white, 9.6% black, and 6.9% Hispanic ethnicity. The median age was 13 years, with total ages ranging from 6 months to 21 years. The majority of cases occurred in 2020, with 677 ED encounters, and the least in 2018 with 441 total encounters. The greatest number of cases were in Cabot, AR which overall has a low child opportunity index and area deprivation index of 5 and 8, indicating areas of high socioeconomic disadvantage.

These results show that the rates of ATV related injuries in Arkansas are consistent with national trends. These injuries do occur more frequently in rural areas, especially those that have and lower childhood opportunity indices. We hope to use these results to support community education around safe ATV riding practices in schools and/or recreational areas, particularly in rural regions of Arkansas. Furthermore, these results may support changes within state or local legislation for safer ATV use.

1. Examine demographic characteristics of pediatric ATV injuries in Arkansas
2. Identify geographic distribution of these injuries to target community specific education regarding ATV use
3. Identify socioeconomic status and barriers of communities with high rates of ATV injuries