William Davidson, 3, with his father Scott, sustained severe injuries after being crushed by a quad bike.

The Royal Children’s Hospital (RCH), together with Ambulance Victoria, The Royal Australasian College of Surgeons, KidSafe and the Australian Medical Association, is calling for legislation to restrict the use of quad bikes for children under the age of 16.

Quad bike injuries in children have doubled in the past decade, and tragically 11 children under the age of 15 have died on quad bikes nationwide since 2008.

RCH Trauma Service Manager, Helen Jowett, said the statistics were horrifying.

“In the past ten years, the RCH has seen serious trauma cases from children’s quad bike accidents grow by about 25 per cent each year,” Helen said.

“The injuries to these children are severe: intracranial head and brain; skull and face fractures; chest, abdomen and spinal injuries,” she said.

Just three weeks ago, three-year-old William Davidson was crushed by a quad bike on his family’s farm after the bike continued to move when switched off. William was placed in an induced coma and rushed to the RCH were he spent eight days in intensive care.

Associate Professor Trevor Duke, RCH Intensive Care Unit Deputy Director, says William’s story is no different to those of other children critically injured by quad bikes.

“The circumstances may vary, from one child moving cows, some bikes rolling downhill, some crashing into gates or poles or other motorbikes. Most occur off-road or on private properties. What doesn’t vary is the distress the accidents cause the child, their family, and clinicians who care for them,” A/Professor Duke said.

RCH staff from intensive care, orthopaedics, trauma, and the Safety Centre are all seeking legislation to ban the use of quad bikes by children as well as regulation insisting safety gear, such as helmets, be worn at all times.

“For children on private properties there’s no law. Obviously we would like to see everybody wearing a helmet at all times, but for children under 16 there is no law for them to be on or off quad bikes or even wearing a helmet,” Helen Jowett said.

Helen said change would also need to occur at a community level.

“The problem in the community is that people think quad bikes are safe.

“Currently we see children as young as 18 months up to 16 years coming in injured from quad bikes and it is something that we would like to see changed.

“Our concern is the lack of community awareness. Quad bikes are unstable if not ridden appropriately by the instructions and if not adhered to when carrying people on them, and we don’t believe children have the ability to control such heavy vehicles,” she said.

Also see: RCH Opinion: Quad bikes are unsafe for children

Associate Professor Trevor Duke, RCH Intensive Care Unit Deputy Director

In the past three weeks a teenager in Victoria was tragically killed while riding a motorbike on a farm, and two others were critically injured in separate incidents on quad bikes and motorbikes, both on farms, not wearing helmets. In the years we’ve worked in The Royal Children’s Hospital (RCH) Intensive Care Unit (ICU), motorbike and quad bike injuries have increased.

The injuries are often horrific and have resulted in two deaths in Victoria in the past two years. In the last two years there have been 18 children admitted to the ICU in Melbourne with severe trauma from motorbikes or quad-bikes. Last year the injured victims in Victoria included a toddler as young as two years of age, and there were two quad bike-related deaths in New South Wales and Queensland, and one in South Australia.

The circumstances vary, from one child moving cows, some bikes rolling downhill, some crashing into gates or poles or other motorbikes. Most occur off-road or on private properties. What doesn’t vary is the distress the accidents cause the child, their family, and clinicians who care for them.

These cases highlight several major issues that result in death and injury in Victorian children. First, the use of motorised vehicles (quad bikes, motorbikes, tractors) by children off-road for recreational purposes who are inadequately supervised; second, injuries when children are assisting with farm work; and thirdly the lack of legislative protection for children involved in the inappropriate use of vehicles on private property.

It goes without saying that young children have no place on quad-bikes. But even older children and adolescents using bikes for recreational purposes or work often do not have the strength, coordination or maturity to use such vehicles safely. Some injuries occur from impulsivity and bravado, especially in older children, and many from lack of adult supervision of young children. Many other circumstances are just accidents waiting to happen.

It is too common for children to be injured or killed by farm vehicles or other equipment while working or accompanying their parents. Several children, some of pre-school age, are admitted to the RCH each year after being seriously injured in such circumstances – with head injuries, multiple fractures or internal trauma.

Why is the safety of children assisting on family farms after hours or on weekends given less priority than safety for employees in other workplaces? Children are not permitted to be in other workplaces where there are any physical dangers without appropriate precautions and attention to work-place safety regulations. The same rules should apply on farms.

There is a lack of legislation to protect children from using motorised vehicles off-road and on private properties. Currently there is no requirement for a rider of a quad bike or motorbike on private property to wear a helmet or be of a minimum age. Adults should not allow unlicensed or inappropriate use of motorised vehicles and, when used by children of an appropriate age, the safety precautions used on roads – helmets and protective clothing – should also be observed off-road. Farmsafe Australia has valuable information for parents on child safety on farms.

We should do better at protecting children in Victoria. The laws should be looked at, and adults and communities need to take responsibility so that children are not allowed to be in harm’s way, and to ensure the same safety precautions that are legislated for roads and workplaces should apply to vehicles and equipment on rural properties. Concerns over individual rights and freedoms while on private property should not be allowed to get in the way of our duty to protect children.

Professor Trevor Duke
Deputy Director, RCH Intensive Care Unit

Written in conjunction with: Associate Professor James Tibballs, RCH Intensive Care Unit Deputy Director; Mr Russell Taylor, RCH Trauma Service Director; Professor Kerr Graham and Dr Michael Johnson, RCH Department of Orthopaedic Surgery; and Barbara Minuzzo, RCH Safety Centre.

Also see: RCH lobbies for ban on quad bikes

Stuart and Carrie with baby Tommy. Photo courtesy of the Herald Sun.

Parents Carrie and Stuart Maxwell, learned of their son’s condition after a 20 week scan revealed abnormalities in his heart. Doctors said that Tommy would be unlikely to survive more than a few hours without immediate surgery after birth.

Tommy had his first open heart surgery at The Royal Children’s Hospital (RCH) within the first 48 hours of his life. A few hours later, he suffered a cardiac arrest and on day 15, he endured his second lifesaving operation.

Tommy was born with aortic stenosis, a potentially fatal condition where the aortic valve narrows abnormally. In addition, the left side of he’s heart had failed to develop properly and was perforated with a number of holes.

For first time parents, Carrie and Stuart, Tommy’s condition was devastating and stressful. The couple couldn’t pick up and hold their newborn until four weeks after his birth.

When his condition improved, he was eventually moved to a ward and then transferred to the family’s local hospital.

The family praised the work of the surgeons, doctors and nurses at the RCH for the great outcome.

Click here to read the full story on the Herald Sun website.

ABOUT 50 positions will be lost as The Royal Children’s Hospital (RCH) acts to protect patient care from the impact of a $3.6million Commonwealth funding cut.

CEO Professor Christine Kilpatrick said half the job losses would come from existing vacancies which would not be filled.

The remainder would be a combination of redundancies and redeployment, with 12 staff notified today that their positions would no longer exist, she said.

“We treat the sickest children and those with the most complex medical conditions in the country, and we have a responsibility to keep beds and theatres open and to maintain the capacity of our emergency department,” Professor Kilpatrick said.

“The job losses and other measures we’re taking to save $3.6 million this financial year will be disruptive and in some cases painful, but we are confident that we’re taking the most responsible possible approach to meeting this unexpected budget challenge.”

Professor Kilpatrick said a combination of measures taken since the funding reduction was announced in mid-December would save $2.5million.

In addition to the unfilled vacancies and redundancies, the other measures had included a hospital-wide reduction in the use of agency staff and tighter processes around leave rostering to reduce the hospital’s liability.

A handful of staff had responded to an invitation to voluntarily reduce their working hours, and a number of departments had identified opportunities to reduce operating costs or increase revenue.

A staff-led innovation campaign and an ongoing organisational review would need to find the remaining $1.1 million shortfall in the hospital’s budget.

“The hospital funding environment is increasingly challenging, and further reductions are likely for the 2013-14 financial year,” Professor Kilpatrick said.

“The Royal Children’s Hospital is a great paediatric hospital and we do exceptional work, but to be able to maintain our quality of our care we must now become an exceptionally lean organisation.

“This is a difficult time for our staff, but we don’t have a choice around whether or not to act.”

Professor Kilpatrick said she deeply regretted the impact of the funding cuts on the 12 staff whose positions were made redundant today, and said the hospital would do everything it could to support them.

RCH heart patient Mia Cowley with Howie

An interactive website to shed light on the hospital experience and dispel anxiety for thousands of Australian children living with a heart condition was launched at The Royal Children’s Hospital (RCH) today.

The website, named Howie’s Place, is the first of its kind in Australia and features colourful child-friendly videos for children and families to ensure they are prepared and informed before they enter the hospital environment.

Through a partnership between the RCH and HeartKids, and generous funding from The Honda Foundation, Howie’s Place was developed in response to the anxiety families can feel before they enter the hospital environment. The supportive tool was designed to assist parents in preparing their child for cardiac treatment, tests and hospital admissions.

Lyndall Cowley, mother of seven-year-old cardiac patient Mia Cowley, said preparing a young child for major surgery was challenging.

“It can be a very scary time for the entire family. When Mia was coming to hospital before each of her four cardiac surgeries all we had at home was a basic children’s book about heart conditions, there was nothing to show her what it would be like when she came to hospital,” said Lyndall.

“Howie’s Place would have been a tremendous support. The website makes complicated information child and family friendly and will provide immense comfort for families during what can be a very difficult time,” she said.

RCH Director of Cardiology Dr Michael Cheung said coming to hospital for a simple test or for major cardiac surgery can be equally as daunting for the thousands of children that come to the RCH for cardiac treatment.

“The RCH performs over 10,000 echocardiograms and over 1000 heart operations each year. We are also the Nationally Funded Centre for paediatric heart transplantation and hypoplastic left heart syndrome.”

“Having a tool that allows our patients to gain an understanding about life in hospital when being treated for a cardiac condition, before admission and from the comfort of their own home, is invaluable,” he said.

The RCH is the largest paediatric cardiac centre in Australia, providing comprehensive cardiac surgical services for children from Victoria, Tasmania, South Australia, Western Australia, the Northern Territory and overseas.

HeartKids Victoria CEO Terry Hopkins said Howie’s Place was designed and tailored to ensure families had an interactive tool that was engaging and could educate and prepare both the patient and their family before they go to hospital.

“With generous long-term funding from The Honda Foundation and in partnership with the RCH we have been able to create this wonderful tool for families throughout Australia,” he said.

The website contains videos that feature the voice of the late Bud Tingwell as Howie – a loveable kangaroo character. In the ‘kids’ section of the website Howie guides children on a journey through the RCH, exploring the Koala (Cardiac) Ward and meeting doctors, teachers and educational play therapists. There is also a video that teaches children about their heart condition.

In the ‘families’ section, Howie tours the RCH, follows a patient who is having an echo and ECG test and explains what happens before and during a hospital admission.

For more information on Howie’s Place, visit the website at www.rch.org.au/howie

Click here to read about Howie’s Place on the Herald Sun website.

Three-year-old Nyah Threlfall with Santa

Santa paid an early visit to The Royal Children’s Hospital (RCH) this morning to switch on the lights of the huge nine-metre Christmas tree in the hospital’s atrium, Main Street, officially launching Christmas.

Santa spread festive cheer to visitors and reminded patients he’d be at the RCH with bells on on Christmas Day.

The impressive tree will feature in Main Street for the month of December and was lovingly created, designed and donated by the team at Kmart.

Christmas tree designers Dovecote worked with Kmart to develop a number of beautiful designs before the final magnificent signature tree was selected.

Taking nine hours to set up, the tree is whimsically decorated to complement the hospital’s interior design, which draws upon Australian flora and fauna. The tree bursts into song and movement every hour.

Kmart has been donating toys to patients at the RCH through the hospital’s fundraising arm, the RCH Foundation, for almost five years. This year, Kmart has spread Christmas throughout the hospital by supplying over 60 Christmas trees and decorations for wards and family spaces. A team of 70 volunteers from Kmart and Pied Pipers set up the trees last weekend.

Kmart also ensures every patient in the hospital wakes up to a gift at the end of their bed on Christmas morning, and receives another present from Santa.

RCH CEO Professor Christine Kilpatrick said she couldn’t believe it had already been 12 months since patients and staff celebrated the first Christmas in the new hospital.

“We moved on 30 November last year, just in time for the festive period. No sooner had patients settled into their new wards, than the team from Kmart began filling our hospital with Christmas decorations,” Professor Kilpatrick said.

“We work hard to ensure our patients enjoy the best Christmas they can, despite being in hospital. This is made much easier for us thanks to the wonderful support of organisations such as Kmart, Dovecote and the Pied Pipers,” she said.

In the first 12 months since moving to the new hospital, staff at the RCH have performed:

• Australia’s first paediatric intestinal transplant
• 10 heart transplants
• 11 liver transplants
• 209,893 specialist clinic appointments
• 14,630 surgical procedures

The year has also seen 33,930 inpatient stays and 76,225 Emergency presentations at the RCH.

Five-year-old Joel McLean shows RCH plastic surgeon Associate Professor Bruce Johnstone how lucky he is to have the use of his left arm, after it was nearly severed in a ride-on lawn mower injury.

Surgeons at The Royal Children’s Hospital (RCH) have called for behavioural change and stricter consumer controls to protect children from potentially horrific injuries as a result of ride-on lawn mower misuse.

RCH plastic surgeon Associate Professor Bruce Johnstone said the campaign was a response to a gradual increase in the number of children being critically hurt by ride-on mowers, and fears that injuries would continue to escalate as the machines became a more common and affordable consumer item.

“In the last 12 months we’ve operated on five children who’ve been critically injured after falling from, or falling behind a ride-on mower,” A/Professor Johnstone said.

“These are horrific injuries, often requiring amputations of limbs and extensive skin grafts, and the victims are typically boys aged about four-years who face ongoing surgery and problems into early adulthood.

“People must remember that ride-on mowers are not recreational vehicles and should never be considered a ‘ride’ for children. Ride-on mowers are dangerous pieces of equipment and the blades can cause considerable, life-altering injury.

“We want parents and families to treat any area in which one of these machines is being used as a no-go zone for their kids.”

A/Professor Johnstone and a team from the RCH is also liaising with industry, the ACCC and other regulatory bodies to see if there is room to strengthen consumer controls and standards on ride-on lawn mowers.

A 30-year review of ride-on lawn mower injuries at the RCH published in 2008 confirmed injuries from ride-on mower use were steadily increasing. Surgeons are predicting a further increase to 15 injuries over the next five years – double the injury rate of 1990–1999.

The common scenarios for ride-on mower injury include:

• Small children, commonly four-year-old boys, reversed over by the mower when out of the driver’s line of sight

• Children injured by a sibling, who was driving the mower recreationally

• Children slipping off the lap of a parent, who was driving the mower.

Joel McLean, 4 at the time, was flown to the RCH on 26 June last year after being reversed over by a ride-on mower driven by his father on the family’s seven-acre property. The accident occurred in seconds, and left Joel’s forearm almost completely severed.

Joel required three major operations lasting a total of 14 hours during his first admission over 11 days. The first focused on cleaning the extremely contaminated wounds, removing unsalvageable and dead tissues and pinning his forearm bones. Many important structures including the middle 1/3 of the ulnar bone were missing.

The most complex reconstructive procedure occurred on day four and took nine hours. A large area of muscle and skin was transplanted from his back to fill the massive forearm defect and brought in vascularised nerve. This, plus other nerve grafts, were used to reconstruct the ulnar nerve, which is essential for fine hand function. A month later a rib graft was used to bridge the defect in the ulnar bone.

A/Professor Johnstone said all of these procedures had been remarkably successful; however, due to the violence of the injury, poor blood supply to the centres of the bones prevented healing of fractures. A further bone plating operation occurred in August of this year.

Joel’s father, Daniel McLean, recalled the circumstances that led to the horrible incident.

“As I was mowing up and down the slope I came back and I felt a big bump, and it wasn’t until I looked down that I noticed Joel was under the mower,” Daniel said.

“I shut the mower down straight away. You hear of getting the strength of ten men and you do. I had to pull the mower off and pull him out. There was a lot of blood. It was a very traumatic experience. My other boy Keith saw the whole thing.”

“It was one of those things, I had mowed the lawn hundreds of times and I thought the boys were inside,” he said.

Joel’s mother Tammy McLean remembers the incident all too well, and says she and husband Daniel worked quickly to take Joel to hospital.

“I heard Daniel yelling and ran around the corner of the house to see him holding Joel’s arm together,” Tammy said.

“As there was too much blood, we knew we couldn’t wait for an ambulance and drove straight to Albury Base Hospital.

“I did not think he would still have an arm, but hoped he would still have a leg,” she said.

Joel has had at least six operations at the RCH to repair his arm and continues to have regular physiotherapy, hand therapy and hydrotherapy, either at the RCH or with local health providers.

A/Professor Johnstone attributes the increase in injuries to a number of factors, including a rise in the number of ‘hobby’ farms utilising ride-on mowers and the increasing affordability of ride-on mowers. He also says the behaviour of retail staff at the point of sale of these machines is a concern.

“I’ve heard stories of ride-on mower retailers demonstrating to customers how to disengage safety mechanisms that cause the blades to stop turning when the mower is in reverse,” he said.

Despite these trends, the message is clear.

“If I had to draft legislation, I’d say: ‘Keep children under the age of 10 out of the same paddock or area as a ride-on mower’,” A/Professor Johnstone said.

Tammy McLean says it will be a culture change for some families.

“I grew up on a farm and we’d ride tractors and other machines all the time. We think our children know that mowers are dangerous and not to go near them. Make sure children are inside – kids and mowers don’t mix,” Tammy said.