Golf-cart-related injuries are on the rise, warn Toronto doctors, and many incidents involve drivers under the influence of alcohol, or children not wearing seatbelts.

In a commentary published Monday in the Canadian Medical Association Journal (CMAJ), health professionals from Unity Health Toronto found that injuries involving golf carts can be severe, and even fatal, urging governments to address this growing concern as a public health issue.

“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,” Dr. Michael Cusimano, co-author and neurosurgeon at St. Michael’s Hospital, Unity Health Toronto, said in a media release.

Golf carts are often exempt from government road safety regulations and typically lack essential restraints such as seat belts, lap bars and side doors, the authors argue. And regulations vary in provinces or territories.

Ontario and British Columbia, for example, have launched pilot studies to regulate golf carts on rural roads, with maximum speed limits, operation requiring a valid driver’s licence and prohibition of passengers younger than eight years old. These pilot projects also allow the use of golf carts on municipal roads in some jurisdictions.

Elsewhere, like Winnipeg and Saskatoon, a valid driver’s license is also needed to operate a golf cart but minors can still ride as passengers.

“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,” the authors said.

Children are especially vulnerable when riding in golf carts, the report states.

For example, a 2021 study published in Pediatrics examined golf-cart-related injuries in children and adolescents in the United States. The study found a steady rise in injuries over recent years, with more than half occurring in children aged 12 and younger, increasing to over 6,500 cases annually in 2017, 2018 and 2019 from 5,490 cases in 2010.

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The study also found that the most common injuries were superficial wounds and fractures or dislocations, with the majority affecting the head and neck. School and sporting events were found to be the most frequent locations for injuries.

There have also been numerous cases highlighting the dangers of golf carts, including an incident in 2022 in Peterborough, Ont., where a four-year-old boy died from a traumatic brain injury after the golf cart he was riding in rolled over on an unpaved public road. The five other occupants of the cart were ejected and all suffered serious but non-fatal injuries.

Public and private golf courses, as well as home and farm properties and university campuses, are common locations for golf cart use and injuries, without governmental road safety regulations, the authors state.

And alcohol is often served at golf courses and other private recreational facilities, increasing the risk of injuries, they added.

A 2011 study published in Otolaryngol Head Neck Surgery found that alcohol was detected in 59 per cent of people older than 16 years with golf-cart-related injuries, among whom the average blood alcohol concentration was more than double the legal limit in many jurisdictions.

Children were also involved 60 per cent of the time, with an average age of 9.2 years; 69 per cent of the time the children were passengers in the golf cart, the study found.

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, the authors said.

In a 2018 study published in the American Journal of Emergency Medicine, the authors looked at pediatric golf cart injuries between 2008 and 2016 in the United States.

The study found that ejection from the vehicle (52 per cent) and the cart overturning (20 per cent) are the most common mechanisms of golf-cart-related injuries. In all the cart injuries reviewed, the authors said only once was a child wearing a seatbelt, and in the vast majority, no safety equipment was used. Children as young as nine were driving golf carts, and child drivers were associated with the cart overturning.

“Golf cart crashes were a source of substantial morbidity at a level-one trauma center. Increased safety measures, such as higher hip restraints, seatbelts, and front-wheel breaks could substantially increase the safety of golf carts,” the authors argued.

The doctors at Unity Health Toronto urge physicians to advocate for change and encourage golf courses and other properties that use golf carts to update their policies.

“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,” they said.

“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,” they said.

“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.”