FRANKFORT — The wilderness and terrain of eastern Kentucky, so irresistible to many drivers of all-terrain vehicles, also have become the deadliest.

        At least 97 people — including three Northern Kentucky residents — have died in Kentucky as a result of ATV accidents since 1997. Fifty-eight fatalities occurred in the eastern third of the state. A third of those killed have been 17 or younger. Hundreds of other riders have been injured badly enough to require admission to a hospital, according to figures compiled from hospitals, police, state agencies and news reports.

        There is no central reporting of ATV accidents, in part because the vehicles — machines with large tires and handlebar controls like a motorcycle — are unlicensed and designed for off-road use. Accounts of accidents were available in only a fraction of the cases. But there are indications that many of the deaths occurred when machines went out of control or flipped on embankments.

        There was at least anecdotal evidence, especially in accidents involving children, that ATVs often were being operated in ways that manufacturers specifically warn against: Riding with passengers. Not wearing a helmet. Excessive speed. Venturing onto terrain that overmatched a driver's skill. Kids riding without parental supervision. Recent examples:

        • Marion Miller, 12, killed Aug. 21 when he was thrown from an ATV driven by a 16-year-old in Todd County.

        • Dillon Madden, 2, killed in June when an ATV driven by an adult skidded off a gravel driveway and crashed in Greenup County.

        “They're really not toys. They're motor vehicles. Yet, the perception is, this is a fun toy,” said Dr. Susan Pollack, a University of Kentucky pediatrician who tracks ATV-related injuries at the Kentucky Injury Prevention Research Center.

        “People have 4-year-olds riding them, not uncommonly. You wouldn't give a 4-year-old the keys to the car. So, what makes you think he can handle even a (small) ATV?” Dr. Pollack said.

        Dr. Heinrich Werner, director of the pediatric intensive-care unit at UK Children's Hospital, said he has had about a dozen young patients this year with severe injuries from ATV accidents.

        The worst are head, neck and spinal injuries. “We regularly have a child from an ATV accident,” Dr. Werner said. “The worst are the children who are left severely brain damaged — a very severe, traumatic brain injury that left them in a permanent vegetative state.”

        The American Academy of Pediatrics wants states to prohibit ATV use by anyone younger than 16. Kentucky has not done so. In fact, the state law intended to keep ATVs off-road had a loophole poked into it by the General Assembly last year.

        A clause was added to let ATV drivers onto two-lane roads “in order to cross the highway.” It said the ATV could travel no more than two-tenths of a mile on the highway. But that was immediately followed by another section that allows ATVs to run on two-lane public roads with no mileage restriction, provided the operator is licensed and engaged in farm work, construction, road maintenance or snow removal — none of which is defined.

        Dr. Pollack, though a critic of the law, said she did not know whether it had made any difference, given that most ATV accidents involving children seem to happen on private land. “We haven't seen a single pediatric case — any adolescent cases, even — where they were doing a chore. They were purely recreational,” she said.

        ATV advocates insist that the machines are as safe as their riders, regardless of age.

        “When is too early to start these guys out riding?” said Nathaniel Miller, service manager at Sills Cycle Center in Paducah.

        The dealership sponsors racing at area tracks, including one with a 12-and-under racing class. “We're all for the racing and starting these kids out young,” Mr. Miller said.

        Ray Ochs, an Eastern Kentucky University professor who also teaches a safety course for ATV riders, had a higher opinion of young riders' physical skills than did the pediatricians. “Their judgment and risk taking may be in question, but that's where the training kicks in,” Mr. Ochs said. “Really, you're training and educating the parents, who are required to attend.”

        The half-day rider courses, organized by the ATV Safety Institute in Irvine, Calif., are offered at no extra cost to new ATV purchasers. In Kentucky, about one buyer in four takes the offer, institute spokesman Mike Mount said. Sixteen states require such training, but not Kentucky or any of its neighboring states, Mr. Mount said.

        State Sen. Daniel Mongiardo, a physician in Hazard, said he has seen some horrific injuries, especially to young riders. “Children just don't understand the kind of power they have under them,” Dr. Mongiardo said. “When something 800 to 1,000 pounds flips over on you, it crushes whatever it finds.”

        He does not expect the injuries to abate, since ATV riding is actively promoted for tourism in his area, Dr. Mongiardo said. But the idea of an age limit for ATV riders “just isn't practical,” he said. “The question is: How do you police it? How do you police someone's private property?” If there is to be regulation, it probably should focus on education and mandatory training, he said.

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