Fatal All-Terrain Vehicle Crashes Injury Types and Alcohol Use Aron J. Hall, DVM, MSPH, Danae Bixler, MD, MPH, James C. Helmkamp, PhD, MS, James C. Kraner, PhD, James A. Kaplan, MD Background: Since the 1990s, West Virginia has led the U.S. in the per-capita death rate from all-terrain vehicle (ATV) crashes, with rates eight times the national average and continually increasing. A comprehensive assessment was conducted of ATV fatalities to provide critical guidance for community interventions and public health policy to prevent further deaths. Methods: In 2007, death certificates for 2004 to 2006 with ICD-10 codes correlating to ATV crashes were used to identify decedents involved in crashes occurring in West Virginia. Data were abstracted from medical examiner records regarding crash circumstances, sustained injuries, and toxicology. Results: During 2004 –2006, a total of 112 fatal ATV crashes were identified. Nearly all (92%) decedents were the ATV operator, and only 15% were known to have worn helmets. Among 54 traffic crashes, collisions (56%) and head injuries (65%) predominated, whereas the majority of 58 nontraffic crashes were rollovers (55%) and were most commonly associated with compression injuries of the thorax and abdomen (36%). Regardless of crash class (i.e., traffic versus nontraffic), alcohol was detected in the blood of 50% of decedents; of those, 88% had blood alcohol concentrations 0.08% (mean=0.17%), West Virginia’s legal limit. Drugs of abuse were identified in 21% of decedents, including marijuana (11%); opioid analgesics (7%); diazepam (6%); cocaine (2%); and methamphetamine (1%). Conclusions: Fatal crash and injury types differ significantly depending on the location of ATV use, although alcohol and drug abuse are frequent risk factors in all types of ATV crashes. In addition to promoting helmet use, interventions are needed to address alcohol use among ATV users. (Am J Prev Med 2009;36(4):311–316) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Introduction H istorically, among all states West Virginia has had the highest population-based mortality rate (0.70 deaths per 100,000 population) resulting from all-terrain vehicle (ATV) incidents, and an overall rate approximately eight times higher than the national rate. 1,2 Age, gender, ethnicity, education, and the rural nature of a state were implicated as important contributors to observed rate differences. 2 To curtail these preventable deaths, West Virginia enacted its first ATV legislation in 2004. 3 The primary provisions of the law prohibit ATV operation on public roads with a center line or more than two lanes except for the purpose of crossing and require helmet use and training for ATV riders aged 18 years. Overall, the law does not yet appear to have had an impact in reducing ATV mortality. In fact, the average number of deaths increased from 24 per year during 2000 –2003 to 41 per year during 2004 –2006. In a recent analysis of West Virginia ATV deaths during 1999 –2006, the mortality rate had more than doubled that of the 1990s, rising to 1.5 deaths per 100,000 population. 4 That study also concluded that adoles- cence, the operation of ATVs in traffic, lower economic status, a lower level of education, and single marital status were associated with significantly higher rates. During that 8-year period, West Virginia accounted for 5% of all ATV-related deaths reported to the U.S. Consumer Product Safety Commission but for 0.5% of the U.S. population. 5 Further evaluation of ATV crash circumstances and risk factors is needed to identify weaknesses in the initial West Virginia ATV legislation and to support future prevention efforts. Objectives of this study were to describe the types From the Epidemic Intelligence Service, CDC (Hall), Atlanta, Geor- gia; the West Virginia Department of Health and Human Resources (Hall, Bixler, Kraner, Kaplan), Charleston; and the Injury Control Research Center, West Virginia University (Helmkamp), Morgan- town, West Virginia Address correspondence and reprint requests to Aron J. Hall, DVM, MSPH, Division of Viral Diseases, CDC, 1600 Clifton Road NE, Mailstop A-47, Atlanta GA 30333. E-mail: ajhall@cdc.gov. 311 Am J Prev Med 2009;36(4) 0749-3797/09/$–see front matter Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine doi:10.1016/j.amepre.2008.11.019