In the emergency department, the ‘bat phone’ is reserved for urgent referrals of incoming patients. One busy afternoon, the bat phone rang to advise that a four-year-old boy had fallen off a motorbike.* He'd ridden over a river bank and fallen three metres, hitting his head against a log. The ambulance paramedic reported that the boy was wearing a helmet. Active CPR was in progress.
The hospital's trauma team assembled in preparation for the young boy. Questions were raised regarding the reality of a four-year-old riding a motorised bike. Someone explained that it was common for children to ride motorbikes and quad bikes on farms – he was a country kid.
Drawing the line
The disparity between country and city safety standards for children is an interesting phenomenon. The environment in which you are raised affects how you perceive child safety. Many people believe that living in the country is safer than living in the city. Living on a rural property in Australia is an amazing experience, and arguably provides a healthier lifestyle, with livestock farming known to stimulate wellbeing. There are plenty of outdoor activities and opportunities, and often there are higher levels of social cohesiveness compared to urban living.
This privileged lifestyle should not exempt people from general safety awareness and injury mitigation strategies. Almost all injuries (such as broken bones, lacerations, brain damage, poisoning or burns) can be prevented by identifying their causes and removing these, or reducing people’s exposure to them.
Unfortunately, there is more than double the risk of death from major trauma in rural and remote areas than in metropolitan areas. This may be due to delays with discovering the victim and potential delays with accessing the trauma retrieval system.
Structured recreation facilities such as gyms, aquatic centres and racing tracks may be more accessible in urban areas, often with enforced safety features and supervision available, but they are not without risk or financial cost.
Busy urban roads are associated with a higher incidence of pedestrian injuries. One successful initiative to reduce road fatalities has been the implementation of flashing lights and speed restrictions around more than 600 targeted Queensland school zones.
Social media pressure may be more difficult to target. There have been several incidents of vehicle 'surfing’ – where a passenger rides on the roof, bonnet or bumper of a car, bus or train – that have taken teen lives. 'Planking' involves lying face down in unusual and precarious places, whereas the ‘salamander challenge’ is based on the mythical creature that can endure harm, extinguish fire and not suffer injury. Unfortunately, these dares have resulted in many injuries, particularly after falls from significant heights.
Although the more recent extreme urban fitness – parkour – tends to favour older teenagers and young adults, the aim is to overcome physical obstacles by jumping, leaping, climbing or diving while ideally not touching the obstacles. This has the potential for head injuries and fractures in the absence of protective gear.
Safety begins at home
Every home is different. Some homes are so clean that a child’s immune system is not stimulated enough by exposure to bacteria and microbes, predisposing them to allergies, hay fever, asthma and eczema. On the other hand, there are some hazards that both urban gardens and farm properties share, such as soil-borne diseases from decaying seedlings and parasites. Diseases from viruses, bacteria, protozoa, fungi or nematodes may range from Q fever, ringworm, poxvirus, giardia, toxoplasmosis to hydatid (tapeworm) disease.
The simplest advice is to steer clear of mud, contaminated streams or ponds and aerosolised soil, especially if you have any cuts of sores on your skin. Personal hygiene (thoroughly washing and rinsing) and the use of gloves, boots and goggles will minimise the risk, as will vaccinating pets and livestock. All farms with livestock are subject to biosecurity plans to manage their animal and plant health and protect their livestock from pests and disease.
Snakes and spiders are of major concern in Australia, especially in overgrown gardens and paddocks. It is important to be vigilant with checking and insecticide spraying, and reminding children to check their boots for spiders before putting them on. Snakes tend to be timid and reclusive, and will try to avoid people. They generally to use their sense of smell and vibrations to detect people.
Encourage children to make extra noise as they walk though grass and snake-prone areas, as this will give the snake a warning that something large is in its area, and hopefully it will move away.
Ensure children carry and have practised using a snake-bite kit if they go to remote areas on the property.
While snake venom can kill a person in as little as 10 minutes, it is unusual for an envenomated person to die within four hours. However, the fatality risk is higher if the home property is a long distance from first aid, antivenom and medical management.
It is vital to use age-appropriate instructions with children and involve them in discussions and decisions about their safety regardless of their urban or rural dwelling. In the first five years of life, the child’s brain develops faster than at any other time. Everything they see, hear, touch, smell and taste stimulates their brain, creating millions of connections.
Middle childhood sees major cognitive developments with mastery in many basic skills, and this leads to an increase in self-esteem. However, they often overestimate their own abilities and, unfortunately, may be encouraged to perform adult activities (driving vehicles, breaking in cattle) before they are developmentally ready.
The frontal cortex, responsible for reasoning and thinking, continues to change and mature throughout the teenage years and into adulthood. According to Farmsafe Australia, about 20 children younger than 15 are fatally injured on Australian farms every year, and many more are hospitalised or treated by general practitioners across rural Australia. Every week, more than 10 children are admitted to hospitals with farm-related injuries (Kreisfeld, 2007). Younger children are at greater risk. Two-thirds of child fatalities on farms or properties are younger than five years of age.
Waterways and other bodies of water may also be a potential household hazard. Australia boasts 1.2 million households with swimming pools, and in Queensland they must be registered with the Queensland Building and Construction Commission. They must also comply with the current pool safety regulations.
In Queensland, swimming pools must have a continuous safety barrier maintained by the pool owner that restricts access to the pool. Drowning can occur in as little as 5cm of water, therefore it seems questionable that animal troughs, rainwater tanks, wells, pits that fill with water when it rains, septic tanks, dams, effluent ponds, lakes, lagoons and creeks are not subjected to a similar law, and they often remain unfenced. Drowning in dams is the single biggest cause of child injury and death on Australian farms, accounting for 36 per cent of all child deaths on farms (Pollock et al, 2007).
Man vs machine
All-terrain vehicles (ATV) are large, heavy, powerful machines with speeds up to 130km/h. The irony is they may be unstable and unsuitable on some terrain such as rough, steep and uneven surfaces. Significant gruesome injuries and catastrophic head injuries have occurred following ATV rollovers in these conditions.
Some ATVs do not have seatbelts, rollbars or rollcages, and therefore with sudden deceleration upon hitting an obstruction, the rider may be thrown from the vehicle. Some large models have the brakes and throttle on the handlebars, just a few inches from the seat, where even a toddler can reach them.
Tall, narrow ATVs have a high centre of gravity and can be physically challenging to drive, as they usually require the rider to shift position when driving to increase stability during manoeuvring.
Although quad bikes were originally designed for off-road use, riders need a licence to use them in public spaces. Therefore, the minimum age is 16 for light quads (350kg or less with a maximum design speed of 45km/h). For all other quad bikes, it's 17 years.
The use of quad bikes on private property is not subjected to licensing laws. Children under eight years have recently been banned from riding any quad bike, but enforcing this may prove difficult.
The use of protective attire should be promoted, such as jackets, gloves, boots and helmets designed specifically to protect against injury from impact.
Traumatic brain injuries, as well as spine and long bone fractures, usually result with falls from motorised bikes, whereas spleen and liver lacerations tend to occur with handlebars injuries.
Helmet use can reduce the risk of brain injury by 70 per cent and the risk of death by 40 per cent, and recent changes in the law mandate that quad riders and their passengers wear helmets. On average, there are 17 quad-bike-related deaths (adults and children) on farm properties each year in Australia. Between 2011 and 2016 there were 104 quad-bike fatalities, and almost 11 per cent were children under 12 years of age (Safe Work Australia, 2018).
Motorbike riders should invest in high-quality, abrasion-resistant fabric (such as Kevlar-lined gear) to protect against potential injury, pain, hospitalisation, surgery, physiotherapy, occupational therapy and rehabilitation.
Injury carries a high social, economic and individual cost. Investing in motorcycle lessons for your children – which should include throttle control, braking, cornering, posture, weight transfer and so on – will boost their confidence and competence.
Young children require co-ordination and skill to ride and control a motorbike, as well as enough strength to lift the bike should it fall on the rider. Crush injuries and exhaust burns often result when young children are allowed on motorbikes by themselves. Over 32 per cent of all injuries to children aged 0–19 years requiring hospitalisation in Australia are associated with motorbikes (Kreisfeld, 2007).
Machinery incidents are all too frequent in the country, with falls from farm machinery such as tractors and ride-on lawnmowers. Tractors have proven to be one of the deadliest pieces of equipment on Australian farms. Towing attachments and large loads can affect the stability and handling of tractors. Between 1989 and 1992 there were 87 traumatic deaths associated with tractors (Franklin et al, 2000) predominantly during the planting and harvesting months.
It might seem like a fun thing to do with your children, but co-riding on a lawnmower is never a good idea. Significant injuries including deep lacerations, severed tendons and ligaments, as well as amputations, have resulted when children slip or fall. Reaction times to cut the throttle and turn off the power are no match for the speed of the mower's blades.
Ride-on lawnmowers have been responsible for at least eight deaths in Australia. In March 2012, a 12-year-old boy living on a property in Queensland purchased a modified lawnmower for $150 to drive around his family property (similar to a go-kart). When riding the mower down a steep hill, the boy lost control and tumbled into a paddock. The incident was not witnessed. When his family arrived at the paddock, he was unconscious. At the time of the accident, he was not wearing a helmet or any other protective gear. He sustained broken bones in his left arm, a lacerated spleen, fractured nasal bones, collapsed right lower lobe of lung and catastrophic head injuries. Tragically, he died as a result of these head injuries.
Coronial enquiries into fatal adverse events are disseminated to the public to increase knowledge and improve public health and safety. The following recommendations were made in Queensland following the death of the aforementioned 12-year-old boy.
- Quad bikes are not recommended for use by children under 12 years (regardless of engine capacity) as operators or passengers.
- Children aged 12–16 years should not ride adult-sized quad bikes (in engine capacity of greater than 90cc).
- All young people must be formally trained, including specialised training related to task and terrain.
- When riding quad bikes, young people should always be supervised. This means young people should be in the line of sight of a responsible adult able to respond immediately to an incident.
- Co-riding quad bikes increases injury risk and is not recommended for any age.
- Helmets and personal protective equipment should be worn when operating a quad bike.
Under lock and key
Locked sheds or workshops are the best places to store lawnmowers, irrigation pumps, power tools, welders, weed killers, pesticides, solvents, paints and firearms.
Chemical storage and handling varies from home to home, and all too often chemicals are decanted into small receptacles such as soft drink bottles for ease of use. This has proven too tempting for some children and has resulted in oesophageal and gastric burns following the ingestion of such products.
Respect for animals
Respecting the unpredictability of animals, understanding safe distances and approaching animals safely will help prevent bites, kicks, crushing, ramming and trampling incidents.
Teaching children to ride animals such as a pony or horse from a young age requires strict adult supervision. Ensure that children only ride horses that are suited to their age, size and riding ability. Many large animals (bulls, cows, horses) weight around 500kg compared to a 20–50kg child, therefore a kick or trampling by such an animal can have profound consequences.
Equestrian is commonly stereotyped as a feminine sport, and in 2013 the data collected at our major trauma centre in Brisbane supported this. Of the patients who experienced horse-related trauma that required admission to hospital for more than 24 hours, 83 per cent were female and 17 per cent male.
Parents have the primary responsibility for the safe upbringing of their children. Sharing this responsibility with government regulators, community organisations, business and industry, health and education will promote the full and harmonious development of the next generation. Some prevention strategies include:
- Create a safe and contained play area for young children close to the house and away from water, machinery, chemicals and animals that pose a threat. A fenced yard can make supervision easier.
- As children get older, it is advisable for them to take measures to protect their own safety, to use appropriate high-quality equipment, such as machinery guards and shields, gloves, goggles and enclosed footwear, as well as seatbelts and helmets.
- Choose an area for decontaminating following any chemical use or pesticide application, where waste-water runoff will not affect water supplies in or around the property. Rinse any equipment or machinery used thoroughly and store the equipment dry.
- To protect your property from pests and diseases, it is important to adhere to the Biosecurity Act of 2015. Requirements may include strict entry and exit conditions to your property, or closing or restricting access to your premises, and /or restricting movement between specified places on your property.
- Water storage tanks and wells should be covered with lids or mesh, and open water areas should be fenced with child-resistant safety barriers where possible. Close supervision is required near any body of water.
- All machinery, particularly heavy-duty machinery, should be treated with respect and managed in accordance with the manufacturer’s instructions. Most machines are designed for one rider, and co-riding on ride-on lawnmowers is never recommended. Keys for operating machinery should be stored in a safe place away from the machinery.
- Have an emergency plan with appropriately equipped first aid kits, with people trained to provide first aid as well as cardiopulmonary resuscitation and expired air resuscitation. It is prudent to have emergency contact cards beside phones and two-way radios with clear directions and GPS coordinates ready for ambulance, retrieval teams, police or fire brigade.
The real world
Preparing children for the real world while protecting them from danger requires the provision of a safe environment with some commonsense mitigation strategies. Some Australian states have licensing requirements that relate to child safety, but leading, enhancing and advocating for a perpetual national injury prevention campaign that encompasses the welfare of all children will promote a positive safety culture regardless of their country or city address.
Children need a balance between vital life experiences, taking calculated risks in their play, and sporting activities with an adequate level of protection against harm and injury. Developing their skills, exploring their environment and enriching their urban or rural experiences ensures confident, competent and independent young adults. This article does not advocate for a ‘cotton wool’ society where children are overprotected. Knowing the risks and increased dangers of the rural lifestyle compared to urban living will reduce the disparity gap and, with parental responsibility, ensure that all children have the skill and dexterity to perform their activities with a reasonable level of safety.
Tona Gillen is nurse manager, trauma, at Lady Cilento Children’s Hospital in South Brisbane.
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Injury Involving Tractor Run-OverA report for the Rural Industries Research and Development Corporation by J. Miller and L. Fragar Published September 2006
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