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By T. Lower, I. Ellis, and A. Larson Combined Universities Centre for Rural Health
January 2005
Pub No 04/174 RIRDC Project No CUT-7A
Executive Summary
Introduction
The high incidence of injuries
in the Australian agricultural sector has been the focus of considerable
attention in recent years. One aspect of the injury profile that is unique
to agriculture is the high prevalence of agricultural motorcycle injuries.
Although the focus of this study is four wheel All-terrain vehicles (ATVs),
there is considerable cross over with the use of two wheel ag bikes.
Internationally there is increasing concern regarding the involvement of ATVs in fatal and serious incidents. Although there is little research published in this area, Australian mortality data indicate there were 11 fatalities for children under the age of 15 years between 1989-92, while hospital data suggests that agricultural motorcycles are responsible for between 8-11% of all on-farm injuries. Based on such data, this issue has been identified as a national priority (Fragar 1996).
To date, the only Australian study to document self-reported injury prevalence in adolescents, indicates that 92% of two-wheeled and 50% of ATV riders aged 15-19 years, have incurred an injury while riding in the previous two years. While the overall prevalence of injuries on two-wheeled motorcycles is higher, injuries sustained from ATVs tend to be of a more serious nature.
It has been demonstrated that over 97% of agricultural motorcycle riders in Australia have no formal training. Despite this, the majority of riders believe that a training course would be beneficial.
Importantly however, there has to this point been no formal training available for ATV riders in Australia. Thus this study sought to introduce a competency based rider-training program to determine its impact on subsequent injury rates.
The specific goal of the project was:
The research objectives
were:
Methods
A randomised control study
design involving six Agricultural Colleges in rural WA was employed. An
initial cross-sectional survey of students (Year 11 and 12) was drawn from
the six designated colleges. An existing survey instrument measuring riding
exposure, vehicle type and maintenance, use of protective equipment, training
and injury experience formed the basis of the questions.
Based on data emanating from the pre-intervention questionnaire, colleges were matched on the basis of gender distribution and access to an ATV on the family property. From these figures, the six colleges were assigned to one of two groups (ATV training intervention / controls).
This process allowed for approximately equal numbers of students with access to an ATV in each group and gender variations.
One teacher from each of the three intervention Colleges was trained by a representative of Honda Australia Rider Training (HART) in the delivery of a competency based ATV course. Training for the students consisted of a one-day program with a maximum of six participants and was conducted on the relevant college grounds. In total 31 one-day courses were required (n = 187 subjects). Subjects in the control group received the existing curriculum, which involved no attention to the issue of ATV safety.
Twelve and 24 months following the initial training, all participating subjects in both the intervention and control groups were asked to complete post-intervention questionnaires (1 and 2).
The baseline data were used to access the current prevalence, nature and predictors of agricultural motorcycle injury, with the post-intervention data seeking to examine variations in injury patterns subsequent to the ATV training.
Results
Half of respondents (49%,
n=159) had incurred an injury from riding an agricultural motorcycle, 44%
(n=145) no injury and 7% (n=22) provided no response. Elsewhere, respondents
were asked if they had ever fallen from an agricultural motorcycle but
not been injured; a further 59 students indicated they had such a near
miss but had not reported an injury.
Therefore, 67% (218/326) students, had an injury or near miss.
As this study aimed to assess the current prevalence and nature of self-reported injury, a filter question to identify individuals who have access to an agricultural motorcycle (either 2, 3 or 4 wheel) on the farm where they live or work and the main bike they use, was included.
This question increased the likelihood of subjects using these vehicles more regularly, rather than in a one-off recreational manner, and was felt to be more representative of farm use, rather than purely recreational use and subsequent injury. In total, 74% (n=240) had access to an agricultural motorcycle, of which 53% (n=127) indicated they had incurred an injury. For those whose main motorcycle was a two-wheeler 59% (92/155) reported injuries, while for those subjects with an ATV as their main motorcycle 21% (31/143) reported injuries. This variation in injury rates was statistically significant (X2=43.55, df=1, p=0.001).
To identify the predictors of injury from these baseline data a logistic regression was performed. While just failing to be statistically significant, those who were self taught were more likely to be injured than those taught either by a friend/sibling or adult (OR 2.13, CI 0.99-4.76). A statistically significant increase in risk was observed for those that reported travelling in excess of 101 km/hour as a maximum speed (OR 4.53, OR 1.33-15.40). Similarly, those who only sometimes wore a helmet were significantly more likely to incur an injury than those reporting they always wore one (OR 4.10, CI 1.26-13.36).
Despite significant efforts, post-intervention surveys (1 & 2) failed to obtain adequate sample responses to undertake detailed analyses (53% & 27% response rates respectively). The intervention group reported slightly lower incidence of injury in the year after the training than the control group (23% compared to 25%). The difference was not statistically significant. However, it is important to emphasise the limited sample power resulting from the low response rates.
Discussion
These data suggest that
injuries resulting from agricultural motorcycles may be partially related
to issues of how training is instigated (adult or self taught) and risk
taking behaviour (speed and helmet use). While the relationships are modest,
they are relatively consistent with existing information in the area in
respect to the high prevalence and general patterns of injury. Though just
failing to reach statistical significance, it appears that being taught
to ride by an adult has some protective effect and is a more preferred
option then either being taught by a friend/sibling or being self taught.
The use of helmets by the students was higher at 49% than the previously reported 10% amongst the 15 to 19 year age group. Nevertheless, this result is still concerning. Head injuries are a major contributor to agricultural motorcycle fatalities and participants who were injured were less likely to wear a helmet than those who were not injured. Although helmets cannot prevent injury per se, their benefits in reducing injury severity demonstrate the utility for increasing their use as part of a comprehensive intervention package to reduce injury.
Those who had received an injury reported greater average and maximum speeds (55km/hour and 84km/hour) for ag-bike use on the farm than those that had not (31km/h and 47km/h). The ATV average and maximum speeds were also greater for those who had received an injury (29km/h and 43km/hour) compared to students who had not reported an injury (23km/h and 35km/h). The results also accord with other studies suggesting an increased injury risk as engine size rises and as speed increases. Clearly, methods to limit speeds are worthy of investigation.
The study had a number of limitations that will influence the interpretation of the results, with the major issues being the relatively small sample and inability to track subjects once they had left the Agricultural Colleges, thereby negating the potential to assess the efficacy of the rider-training course in reducing injury. However, despite the limitations of the study, the results provide an important baseline that captures a broader profile of agricultural motorcycle injury for this age cohort than does mortality or hospital data.
Specifically, data on the prevalence and predictors of injury from the initial baseline survey will prove particularly useful in raising the significance of this issue and guiding future research to identify potentially efficacious intervention approaches.
Data emanating from the baseline survey indicates that agricultural motorcycle injuries are a significant issue for the rural community.
Although no attempt to place an economic value on the cost of these injuries has been attempted in this study, it is evident that there are significant medical and social costs associated with injury.
Despite consistent calls for on-going rider training to enhance skills, there have been no reported studies of the efficacy of such courses.
Indeed, whether traditional skill based rider training reduces or increases the injury burden because of a changes in perceived risk and inflated levels of self-confidence in driving skills is currently not known. It has been suggested that what is required is a training system that develops skills while simultaneously highlighting and embedding the risks (including cognitive aspects relating to attitudes-motivation, perceived risk and vulnerability) in the trainee's psyche. Further assessment of the efficacy of this program is warranted with these principles providing potential guidance to further refine any agricultural motorcycle rider training.
A repeated emphasis on introducing and/or enforcing legislation to restrict the use of ATVs is forthcoming from many previous studies.
However, recent data suggest that such an approach in the USA has been largely ineffective. In the Australian context, it is unlikely that enforcement is a stand-alone option given the vast tracts of land and the inability to enforce such legislation. However, legislation is only one tool in an array of approaches that may help to reduce the injury burden. While the issue of what age individuals should learn to undertake specific tasks such as riding an agricultural motorcycle (2 or 4 wheel) is complex, it is clear from existing Occupational Health and Safety legislation that ensuring a safe workplace, adequate skills training and supervision, are necessary regardless of the age of the rider. Clearly then, a blanket ban on the riding of ATVs for individuals under the age of 16 years is likely to have limited impact and further practical approaches are required to address the issue. Steps must be taken to provide guidance on how to best reduce the risks to children and youth in line with OHS requirements and the realities of their involvement in the farm enterprises. The three core elements of the OHS regulations are that the equipment is in sound and safe functional order, that the individual must have the skills and knowledge to safely carry out the designated task, and that adequate supervision is provided given the level of skill. Thus while checklists can be utilised to assess whether equipment is in safe working order, the issue of skills and subsequent levels of supervision (which also relates strongly to skills), is far from transparent.
To facilitate action, a better definition of the specific competencies and methods to assess them are required for agricultural motorcycle riding. While there are existing competencies listed under the Vocational Education Training (VET) program, it is not known whether these have been reviewed in a systematic manner and linked with physiological and/or cognitive (attitudinal-motivational) capacity.
While it is relatively straightforward to measure physical skills, the measurement of attitudinal-motivational capacity will prove more challenging. Once these competencies can be resolved, the current restriction prohibiting the riding of ATVs for those under 16 years of age, should be rescinded and replaced by a competency approach as the benchmark. Given the significant work that has already been undertaken in driver training for on-road motor vehicles (including motorcycles), leads on efficacious approaches from this sector should be monitored for potential applicability to agricultural motorcycle training.
The results of this study suggest some protective effect when adolescents are taught to ride by an adult (frequently a parent), rather than a friend or being self-taught. In an environment where formal rider training programs are rarely available, this is an important and very practical intervention that could be adopted to reduce future injury risk. This approach may be particularly useful in the formative learning stages and provide a high degree of utility and reach into this high-risk target group. Adults (especially parents), are crucial to the implementation of a practical approach to address this issue, as they can supervise learning, assess skills in an on-going manner and increase the complexity of the required skills in an incremental way.
Additionally, it is imperative that adults (parents) take a lead role in prohibiting the use of these vehicles by visitors unless under strict supervision and with some knowledge of the level of skill of the rider, plus enforce a "no passengers" rule. While the use of adults (parents) as trainers in an on-farm context is advocated here, a note of caution must also be expressed to ensure that this approach does not simply transfer the problem from being one of no training, to one of poorly implemented and limited training that may in fact exacerbate the problem.
While awaiting the clarification of these competencies and assessment methods, a starting point should be to maintain promotion campaigns to help farmers, farm employees and farm managers become aware of the health and safety risks associated with the use of agricultural motorcycles. Farmers are presently being encouraged to have a farm safety policy/procedure for their enterprises. Ag bike and ATV use needs to be included in such plans and then implemented into the work place.
A positive aspect of this study was the relatively high use of helmets and some other protective clothing, particularly amongst those using their vehicles for recreational purposes. This may have a flow-on effect to those using agricultural motorcycles for farming duties. To encourage this a program is required to educate riders on the importance of protective clothing and helmets when riding for all activities, not just recreation. The riders should also have further information on and access to the different types of helmets available. It should become practice for those selling the agricultural motorcycles to ensure they provide this information. Potential also exists to make sure new owners get the correct helmet with the purchase of the motorcycle/ATV. In addition, once the efficacy of a training program has been illustrated, retail outlets should offer free to all new buyers and their immediate families such a course. Finance for this scheme could evolve from a levy placed on the sale of all new agricultural motorcycles and would provide a two-tiered approach to training - either through the retail outlet or adult (parent) centred approach discussed earlier.
While further work examining the use of Roll Over Protection Structures (ROPS) for ATVs should continue, their efficacy remains in doubt.
However as noted elsewhere, there are some engineering modifications that are likely to have a considerable influence on reducing injuries.
As speed has been repeatedly illustrated as a predictive factor, the installation of throttle governors (or speed limiters) on the bikes of novice riders would appear to be a useful approach. Similarly, the use of rear wheel and throttle guards may prevent crashes due to the foot being caught by the wheel or being hit on the hand respectively.
Additionally, with many injuries resulting from the carriage of passengers, modifications of the seat design could discourage this practice.
International developments in trade and globalisation have increasingly impacted on the economic viability of rural production in Australia.
Consequently, there is considerable emphasis placed on productivity and economic issues at both a national and individual farm level. Given the interest in minimising costs, this provides an ideal opportunity to assess the economic impact of agricultural motorcycle injury on rural production input costs e.g. lost work time, repair of equipment and workers compensation costs. As economic considerations are likely to have a significant influence on subsequent action, such information may highlight the importance of managing the risks and preventing these injuries wherever practical.
While there remain significant gaps in our knowledge regarding the best way in which to address the issue, it is evident that an array of engineering, educational and enforcement approaches offers the best opportunity to reduce this problem. A comprehensive approach to address this issue is advocated.
Recommendations
Policy recommendations
Many of the strategies to reduce ATV injuries require strong, consistent policies.
1. The point of purchase can be a powerful setting for promoting safety. Policies are required to ensure vehicle retailers are aware of the various types and sizes of vehicles and the activities for which they are suitable. This knowledge should extend to the importance of protective clothing and equipment. Requiring or encouraging the provision of safety products as part of an all-inclusive price of a new agricultural motorcycle should be considered. This could involve a new helmet, information on rider safety and basic training, or conducting courses (once the efficacy of rider training programs is demonstrated). These products could be supplied by the retailer or provided by others through a levy on all new agricultural motorcycles sold.
2. Clear guidelines for the safe use of ATVs need to be promulgated to farms and agricultural training institutions. These include guidelines for the use of agricultural motorcycles, pre-operational checks, the wearing of protective clothing/equipment including helmets, riding under a speed limit, prohibition on carrying passengers, maintenance of vehicles and provision of competency based rider training programs once their efficacy can be demonstrated.
3. The age restriction on under 16's riding ATVs should be rescinded, subject to the re-assessment of the agricultural motorcycle rider competencies.
4. Injury surveillance at hospital emergency departments should be improved and in some cases commenced. Greater detail about the circumstances of the injury and the type of vehicle are needed (e.g., two-wheel, three-wheel or four-wheel motorcycle rather than just motorcycle). All data should be linked to the national database of the Australian Agricultural Health Unit.
Educational recommendations
The study highlighted a number of shortcomings in the current approaches to ATV rider training.
5. Current agricultural motorcycle rider competencies should be re-assessed to take into account both physical and attitudinal-motivational skills. Once complete, these competencies should be the benchmark for the use of agricultural motorcycles.
6. Rider training approaches must be further assessed for their efficacy in reducing the injury burden. Given the preliminary positive results from car driving training that maintain high levels of perceived risk in participants following training, ATV rider courses should incorporate substantial development of attitudinal-motivational skills in addition to fundamental vehicle handling skills.
7. Education materials emphasising the socialization process and influence of role modelling (e.g., riding speed, riding practices and use of helmets) on subsequent behaviour by children and youth should be developed as support materials and widely disseminated to adults (particularly parents) in rural communities.
8. Education materials to enable adults (particularly parents) to train novice riders in basic skills should be developed and evaluated.
Such programs must incorporate substantial development of attitudinal-motivational skills to maintain high levels of perceived risk. This could also include a well-defined sequence of steps similar to the graduated driving licence system for motor vehicles that would make it easier for adults to adequately train and supervise inexperienced riders.
9. Following the development of an efficacious rider training program, the course should be incorporated into the curricula of agricultural training institutions and be made available more broadly in the public domain via retailers and in conjunction with the Managing Farm Safety Program.
Engineering recommendations
10. Speed limiters for agricultural motorcycles should be more widely available and promoted through retail outlets.
11. Options for re-designing the seats of ATVs to reduce carriage of passengers should be examined.
12. Other engineering solutions to reducing the frequency and severity of rider injuries should be sought and continuously assessed.
Enforcement recommendations
Many existing policies are appropriate but under enforced.
13. OHS regulations regarding the safety of equipment should be enforced at the point of purchase. This should include clearing sales and would ensure that no three wheel ATVs are sold-on and that equipment is in safe working order.
Research agenda recommendations
14. There is still a need for prospective studies into the use of ag bikes/ATVs and the resulting injuries for all age groups (but especially those under 16 years of age).
15. Collaboration between the rural industry, vehicle manufacturers/retailers, enforcement agencies and other stakeholders is necessary to define the competencies that individuals must attain to comply with the OHS regulations. Once defined, these competencies and clear methods to assess them should be disseminated widely within the rural community.
16. An economic impact assessment on the cost and social burden of agricultural motorcycle injury should be completed for the major agricultural commodity sectors.
17. Studies of the efficacy of rider training should include a cost-benefit analysis.
18. Research into protective clothing/equipment that is appropriate for various conditions is required. Examples include helmets that do not restrict hearing, lightweight long sleeve shirts that do not restrict arm movement and goggles that are light weight and can double as sunglasses.
19. Improved systems to track students upon graduation from agricultural training institutions should be explored in future studies.
This could include email addresses, mobile phone/SMS numbers and web-based platforms to elicit responses.
20. The potential for a broader study across states/territories in Australia or potentially internationally to obtain adequate sample numbers to assess the utility of any training course should be examined.
 
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