Internationally, there is a growing body of evidence relating to deaths and serious injury associated with the use of quads.1-3 In Australia and New Zealand, these vehicles are widely used within the agriculture sector and for recreational purposes. Quads are four-wheeled vehicles (sometimes colloquially referred to as quad bikes or ATVs - All Terrain Vehicles), with a straddle seat and handlebars.

As early as the 1980s, significant safety concerns for all-terrain vehicles (inclusive of three and four wheeled vehicles), were raised by the United States Consumer Product Safety Commission (CPSC).4 Most recently, the CPSC identified that there were between 500–600 deaths annually on quads in the 2015–17 period, with more than 100,000 Emergency Department presentations each year.3 Furthermore, the CPSC has maintained an ongoing register of deaths since 1982, which contains over 17,000 fatal cases, with over 20% being children.3, 5

Unlike the US context, the predominate pattern of quad use in Australia (and New Zealand), is agricultural work. Safety concerns were first highlighted in the early 2000s when a study of trends in farm deaths illustrated that while deaths from tractor rollovers had decreased by 74% between 1982–84 and 2001–04, quad-related incidents had increased nearly 13-fold.1 Since this study there have been several reports which all identified a significant fatality burden (especially in relation to agricultural work).6-10

Previous Australian data indicated a statistical difference in the nature of work and non-work fatalities, with work incidents significantly more likely to involve rollovers and asphyxiation/crush injuries. In contrast, non-work cases were more likely to involve non-rollover incidents and head injuries.7, 11 This variation in the pattern and nature of injury, has major implications for work health and safety endeavours, with one coroner labelling quads as “prone to rollover”.12

As a result of the ongoing trauma related to quads on farms, work health and safety authorities from each of the Australian states and territories, in conjunction with New Zealand, undertook a major review under the auspices of the Heads of Workplace Health Authorities (HWSA). The development group included representatives from the work health and safety authorities, farming groups, Federal Chamber of Automotive Industries (FCAI), representing manufacturers and other interested parties. The basis of the strategy was to examine options based on the Hierarchy of Effectiveness of Controls, as per the national legislation.13 In summary, this would commence with options to examine elimination (which is not practical given quads are necessary in some situations e.g. flood mustering), substitution (switching to safer alternative vehicles e.g. Side By Side Vehicles), engineering controls (e.g. fitting Operator Protection Devices), administrative controls (e.g. rider training) and personal protective equipment (e.g. helmets). After 18 months of investigation and discussion, the group released an Industry strategy in 2011.14 However, the FCAI walked out of the final meeting and would not endorse the document as it noted “The retrospective fitting of devices designed to reduce the risk to riders from entrapment beneath an overturned vehicle will be supported (but not required) by WHS regulators”.14 These devices are now commonly termed, Operator Protection Devices (OPDs).

Subsequently, a major study (the quad bike performance project), was commissioned through the University of NSW. Given the propensity for rollover of these vehicles (especially in a work context), the aim was to identify the engineering and design features required for improved vehicle stability and rollover crashworthiness, including OPDs.15 A reference group was formed inclusive of interested stakeholders e.g. FCAI, farming groups, vehicle crash experts etc. Again however, the FCAI representative withdrew from the proceedings, with issues regarding stability testing and the effectiveness of OPDs being at the forefront of their decision.

Table 1: Number of quad related deaths by state, year and incident location (n=155).

Location

2010–15

2016–20

Total

%

New South Wales

Northern Territory/ South Australia

Queensland

Tasmania

Victoria

Western Australia

25

∗

28

9

22

8

15

5

19

5

10

5

40

9

47

14

32

13

26

6

31

9

21

8

Total

96

59

155

Farm

Non-farm

72

24

44

15

116

39

75

25

Notes: ∗Denotes case numbers < 5 NT and SA amalgamated due to small numbers

Building on this history, in 2017 the Australian Competition and Consumer Commission (ACCC), which has a specific product safety mandate, instigated a program to investigate whether a safety standard for all new quads entering Australia (noting no quads are manufactured in Australia), was required to reduce the risk of injury from their use. This systematic consultation process resulted in the publication of a final recommendation to the relevant Commonwealth Minister16 and the proclamation of the Consumer Goods (Quad Bikes) Safety Standard 2019 (the Standard).17 The Standard is being introduced in two stages, with the first stage (required by October 2020) including: (a) meeting existing European or USA Standards; (b) having a spark arrestor fitted; (c) having additional safety information on the risk of rollovers affixed to the quad bike and in the owners’ manuals; and, (d) being tested for lateral static stability and displaying the angle at which the quad tips on to two wheels on a hang tag at the point of sale. The second stage requirements due to take effect by October 2021, include: (a) meeting a defined lateral roll stability limit (must not tip on to two wheels on a slope less than 28.81 degrees); (b) front and rear longitudinal pitch stability (must not tip on to two wheels on a slope less than 38.65 degrees); and, (c) fitting of an OPD or having one integrated into the quads design. Yet again the manufacturers and their representative agency the FCAI have objected to this Standard.18

In the safety realm, the hierarchy of risk controls forms the basis of effectively addressing potential hazards and is enshrined in the Australian Work Health and Safety Regulations (2011).19 Although there are a range of available preventive approaches to reduce the injury burden associated with quads, engineering controls (which design out or limit the impacts of the hazard), are more effective than administrative approaches such as rider training and personal protection measures (e.g. helmets). Ideally, elements from all levels of the hierarchy of risk controls should be used in tandem, to achieve the best possible outcomes. However, until the specification of the Standard, there has been no progress on addressing the key concerns of stability (i.e. to reduce the propensity for rollover) and operator protection (i.e. minimising harms in the event of a rollover).

This descriptive study builds on a previous paper that assessed quad-related fatalities within Australia over the 2001–10 period.7 It seeks to outline the nature and scope of fatal quad incidents both in a farm and non-farm setting, from a work and non-work perspective, plus in relation to rollover and non-rollover incidents for the 2011–20 period. Additionally, the study will assess these data in relation to the introduction of the Consumer Goods (Quad Bikes) Safety Standard 2019.17

Method

A register of quad deaths is based on information sourced from the National Coronial Information System (NCIS). The NCIS is an internet-based data storage and retrieval system for Australian and New Zealand coronial cases. It contains information about all deaths reported to an Australian coroner since July 2000 (January 2001 for Queensland) and to a New Zealand coroner from 1 July 2007.20 New cases are added to the register by alerts via a media monitors program, plus coded and key word database searches periodically undertaken using terms including but not limited to: ‘quad bike’, ‘all-terrain’, ‘ATV’, ‘four wheel & bike’ and ‘4 wheel & bike’. Data can include police, toxicology, autopsy and Coroners’ findings reports for each case that has been finalised and ‘closed’ by a coroner. However, even prior to cases being ‘closed’, information pertaining to intent, location, Cause of Death and work-relatedness are often available. Work-relatedness is determined by the relevant work health authority and is also validated by the research team.

Information accessed in the NCIS reports are coded according to the Quad Related Minimum Dataset, developed to assist researchers to accurately describe the injury event.21 Incidents that are determined by the Coroner to be the result of natural causes or intentional, are excluded from the data. This tool allows for detailed analysis of each case with consideration of human, mechanical and environmental risk factors that lead to the injury event. Data on location (farm/non-farm), work-relatedness, location (state), age group (including children <15 years), mechanism, activity being undertaken and primary cause of death were assessed. The amount of detail within the register is limited by the information available on NCIS at the time of data retrieval. With 79% (n=122) of the quad cases formally ‘closed’ by a coroner at the time of data analyses (February 2021), it is expected that there may be additional cases and detail to add to the register over time.

The NCIS contains the Cause of Death Codes as additional fields provided by the Australia Bureau of Statistics (ABS). The ABS utilises the International Classification of Diseases and Health Related Problems (Tenth Revision) (ICD-10) as the classification system to code cause of death.22

Descriptive data were tabulated in SPSSv26, with chi-square analyses to examine variations in farm/non-farm, rollover/non-rollover and primary cause of death.23 Ethical approval was obtained from the Justice Human Research Ethics Committee CF/19/27527.

Results

There were 155 fatal incidents involving quads in the study period, representing a mean of approximately 15 cases annually. In total, 122 (79%) of the cases had been formally closed by a coroner. Males were involved in 126 cases (81%), with 29 female cases. Total numbers fluctuated both on an annual basis (range 8–22 cases) and within states. The majority of cases (n=119: 77%), occurred in the states of New South Wales, Queensland or Victoria. Overall, 116 (75%) of the cases occurred on a farm (inclusive of work and non-work incidents), with the balance (n=39), in non-farm locations.

Table 2 provides detail relating to the nature of the crash event, location of injury event and whether the machine was being used for work at the time of death. Overall, 52% (n=68) of incidents where work/non-work status was known, involved work. However, there were 18 on-farm cases and six off-farm where work status is yet to be determined. Of the 98 farm incidents where the activity being undertaken was known, 65 (66%) occurred when the machine was being used for work. In contrast, 9% of deaths were associated with a work activity off-farm.

Table 2. Mechanism of crash event by location and work-relatedness (n=155).

Mechanism

Farm

Off-Farm

All cases

Work

%

Non- work

%

Unknown

Sub-total

Work

%

Non- work

%

Unknown

Sub-total

Total

%

Rollover

No load or attachment

22

24

12

13

5

39

-

-

5

6

5

44

48

Spray tank

15

16

-

-

15

∗

∗

∗

∗

∗

17

19

Other load including towed

∗

∗

∗

∗

-

∗

∗

∗

∗

∗

∗

5

5

Passenger involvement

∗

∗

6

7

-

7

-

-

∗

∗

∗

∗

9

10

Still enquiring

6

7

∗

∗

6

14

-

∗

∗

∗

∗

16

18

Total

46

21

11

78

∗

9

∗

13

91

Non-Rollover

Collison with other vehicle/ animal/ loss of control

5

8

-

-

-

5

∗

∗

5

8

∗

6

11

17

Collision with stationary object

9

10

9

10

-

18

-

-

11

17

-

12

30

47

Rider or passenger falls off

5

6

∗

5

∗

9

-

-

∗

∗

∗

11

17

Loading/unloading

-

-

-

-

-

-

∗

∗

∗

∗

∗

Still enquiring

-

-

6

6

-

-

∗

∗

∗

∗

8

13

Total

19

12

7

38

∗

21

3

26

64

Note: ∗Denotes <5 cases

Analysis of the nature of the crash event highlights the leading mechanisms of injury as: rollover with no load or attachments (n=44), collision with stationary object (n=30) and rollover with spray tank (n=17). Overall, rollovers were the mechanism in 59% (n=91) of all incidents.

Rollovers occurred predominantly on farms (86%), with 46 of the 48 work-related rollover deaths occurring in this context. While the total number of on-farm incidents for both rollovers and non-rollovers exceeded that for non-farm deaths, the non-farm deaths were proportionally more likely to involve non-rollovers (67%) and not be work related (90%). The variation between incident location (farm/non-farm) and type of mechanism (rollovers/non-rollovers), was statistically significant (X2=11.9, df=2, p=0.01). Presence of a load was also identified as a potential risk factor in rollover deaths, with over one third (34%), involving a load or attachment on the machine such as the carrying of passengers, fitment of a spray tank or unit and the towing of trailers.

For the 65 on-farm cases known to be undertaking work at the time of the incident, a notable portion (32%), involved mustering cattle or sheep (n=21). Other activities of note included weed spraying (17%; n=11) and general transport use (15%; n=10).

Table 3 indicates the peak age group for all deaths is 60–74 years (25%), with those 45–59 years (21%) also prominent. The mean age was 47 years (SD 23.5) and median 52 years. Overall, those over 45 years of age made up 60% of total cases. For rollovers specifically, those over 45 years of age were involved in 67% of all incidents. In contrast, non-rollover deaths were most common in the 15–29 year age group (28%), in both the farm and non-farm setting. Children (<15 years) were also present in the data (13%) and included cases on child sized quads. Differences in the age patterns of farm and non-farm deaths (X2=13.8, df=5, p=0.01) and for rollovers and non-rollovers (X2=16.8, df=5, p<0.01), were statistically significant.

Table 3. Mechanism of injury event by location and age group (n=155).

Age Group (years)

Farm

Non-farm

Sub-Total

Total

Rollover

Non- rollover

Rollover

Non- rollover

Rollover

Non- rollover

n

%

n

%

n

%

n

%

n

%

n

%

n

%

0–14

14

18

∗

11

-

∗

8

14

15

6

9

20

13

15–29

∗

5

8

21

∗

23

10

39

7

8

18

28

25

16

30–44

<10

10