Citation

Green RS. CJEM 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Canadian Association of Emergency Physicians, Publisher Cambridge University Press)

DOI

10.1007/s43678-024-00702-7

PMID

38713357

Abstract

Off-road vehicles (ORVs) such as all-terrain vehicles (ATVs) and snowmobiles are popular among outdoor enthusiasts in Canada. Once used primarily to facilitate agriculture and construction, these vehicles have evolved into a major player in the outdoor recreation industry. There have long been concerns surrounding the lack of regulations and the health risks associated with their use, especially while intoxicated, and there are ongoing concerns the situation may get worse with the recent legalization of cannabis [1]. Each year in Canada, there are on average 100 ATV-related deaths and 73 snowmobile-related deaths, the victims are predominantly male, and half of all deaths involve drugs or alcohol [2, 3]. The most common cause of death is traumatic brain injury (TBI) [4]. While most EM and trauma clinicians are aware of the impact that intoxication has on these types of patients through their daily experience, we need more data to inform and guide meaningful policies and programs to minimize and indeed prevent the occurrence of these tragic events.

In this edition of CJEM, Kureshi and colleagues investigated intoxication among injured ORV drivers in Nova Scotia who sustained a significant traumatic injury [5]. In addition to alcohol and cannabis, they looked for the presence of other drugs including cocaine, amphetamines, opiates, benzodiazepines, and other medications used (antihistamines, antitheocratic, etc.) within 6h of injury. In this cohort, authors found that 85% of injured ORV drivers tested positive for at least one substance and 39% were positive for multiple substances. Alcohol was the most common drug identified (58%), followed by opiates (21%), recreational drugs 18% (cocaine/amphetamines) and cannabis (12%).

These results are remarkable, and unfortunately align with clinical experience. The take home here is that almost all ORV drivers with significant injuries are intoxicated. Coupled with the dramatic rise in their popularity, impaired ORV-driving presents a growing health concern in Canada. In Nova Scotia alone, we have observed a 60% increase in ORV-associated major traumas between 2018 and 2022. So, how did we get here? Unfortunately, if the findings of Kureshi and colleagues are accurate, we need to critically reevaluate the safety and injury prevention programs that are in place for substance use as they intersect with ORVs.

This should be viewed as a tremendous wake up call. Despite our abilities in EM and trauma care to resuscitate and rehabilitate our injured patients, we all wish these life-changing events never happened in the first place. Prevention is a core...

Language: en