Measures to prevent golf cart–related injuries are urgently needed

KEY POINTS

• Golf cart–related injuries are increasing and can be fatal; children, older people, and those impaired by alcohol or substances are especially vulnerable.

• Most golf cart–related injuries could be prevented with basic safety features such as seat belts and roll cages.

• National standardization of safety features, and regulations similar to on-road vehicles, would likely prevent many golf cart–related injuries, and physicians should advocate for these.

• National, provincial, territorial, and municipal governments, as well as organizations that allow use of golf carts, should introduce and enforce measures to prevent injuries.

Recently, a 4-year-old boy died from a traumatic brain injury sustained while he was in a golf cart that rolled over on an unpaved public road in Peterborough, Ontario.¹ The 5 other occupants of the cart were ejected, and all sustained serious but non-fatal injuries. This was not an isolated event. The American Academy of Pediatrics reported an increase in golf cart–related injuries, from 5490 cases in 2010 to more than 6500 cases annually in 2017, 2018, and 2019.²

This documented increase in frequency of injuries from golf cart use is concerning. Moreover, children, older adults, and people under the influence of alcohol — who are more vulnerable to injury — are frequent golf cart users. One study reported that 50.8% of golf cart–related injuries occurred among children aged 12 and younger. ² Although 43% of golf cart–related injuries are superficial, some are severe or fatal.² Forty-two percent of injuries involve the head and neck region. Many such injuries could be prevented with introduction and enforcement of new regulations and safety standards.

Golf carts are 4-wheel vehicles with lower cost, noise, and emissions than automobiles. Public and private golf courses, home and farm properties, and university campuses — often exempt from governmental road safety regulations — are common locations for their use and the occurrence of injuries.³ Alcohol is often served at golf courses and other private recreational facilities, increasing the risk of injuries. One study found that alcohol was detected in 59% of people older than 16 years with golf cart–related injuries, among whom the average blood alcohol concentration was 182.6 mg/dL, which is more than double the legal limit in many jurisdictions.⁴

Current golf cart designs include emergency brakes, rearview mirrors, and reflectors, but restraints such as seat belts or lap bars, front windshields, side doors, and airbags are uncommon, which means occupants are prone to ejection. Ejection from the vehicle (52%) and the cart overturning (20%) are the most common mechanisms of golf cart–related injuries.⁵

Injuries from golf carts are a public health issue that requires urgent attention from governments and public and private organizations. Implementation of federal regulations that mandate the manufacture and sale of safer vehicles is an important first step. A study found that only 1 in 40 children involved in golf cart accidents wore seatbelts, which likely contributed to the high injury severity (Injury Severity Score > 15 in 25% of the children).⁵ Mandatory seat belts could prevent many injuries, similar to their use in automobiles, and should be standard features of all golf carts. Lap bars are commonly used in roller coasters, given their convenience, rapid application, and design that prevents operation until restraints are secured. Whether they would be better accepted and as effective at preventing ejections as seat belts requires further study. Roll cages to prevent passengers from being pinned by the vehicle should be standard as well.

Regulations regarding the operation of golf carts vary among municipalities in Canada.⁶ Some jurisdictions, such as Ontario and British Columbia, are conducting pilot studies for the regulation of golf cart use on select rural roads.^7,8 Some key requirements in Ontario’s study include allowing use only on roads with a maximum speed limit of 50 km/h, a vehicle maximum speed of 32 km/h, prohibition of drugs or alcohol, operation by a driver with a valid driver’s license, and prohibition of passengers younger than 8 years.⁷ This pilot project started in 2021 and is to last 10 years.⁷ In the United States, the National Highway Traffic Safety Administration classifies a low-speed vehicle as a 4-wheel motor vehicle whose attainable speed (within 1.6 km) is between 32 km/h and 40 km/h.⁹ Golf carts that meet this definition are subject to regulations such as requiring vehicle lights, windshields, and seat belts.¹⁰ Canadian provinces and territories should institute similar regulatory and legal frameworks that apply to all golf carts, and municipalities should enforce bylaws for private and public properties that parallel those for all vehicles.

In Ontario, current impaired driving penalties for automobiles include a 90-day licence suspension, a 7-day vehicle impoundment, and a $550 penalty, imposed after the first offence and followed by stricter penalties and education programs with subsequent offences.¹¹ Similar unambiguous regulations for golf cart users should be implemented across Canada. Insurance incentives and disincentives for companies and drivers with good or poor safety records should be introduced to encourage cities and companies that run golf courses to maintain safe practices and regular safety maintenance of vehicles. In addition, public safety officials should enforce safer environments and document injuries, including near misses. Expanding current surveillance systems, such as the Canadian Hospitals Injury Reporting and Prevention Program, would provide data on injuries that present in emergency departments across Canada and allow better understanding of the extent of these injuries and the effect of new standards and regulations.¹²

Since the frequency of injuries related to golf cart use is increasing, and many of these injuries could be prevented, physicians should advocate for immediate changes to reduce the severity and frequency of golf cart–related injuries. Users and owners of properties where golf carts are driven should be more aware of the hazards of operating a golf cart and modify their behaviour and policies accordingly. Governments, regulatory agencies, and manufacturers should introduce and enforce new safety standards for the manufacture, sale, and use of golf carts to reduce the severity and frequency of golf cart–related injuries.