ATV Accidents continue to be a major public health issue in West Virginia.

All-terrain vehicle (ATV) riding continues to be a major public health problem in West Virginia because the state leads the nation in the rate of deaths from ATV incidents and has significantly higher death rates than all five of the bordering states. Annually, there are 24 deaths a year in West Virginia due to ATV accidents and thousands of nonfatal injuries. Sporting events using ATVs such as motocross racing have added to the burden of caring for patients who are injured in recreational activities. We report a case study of 10 patients treated over an 18-hour period in a state trauma center for injuries received while riding ATVs casually and in competition. The addition of these 10 patients to the other 108 patients seen in the ED during this period totally disrupted patient flow, caused significant delays in care of the non-trauma patients, and tied up the Radiology Department and operating rooms for an extended period.