Only 14 days ago it was "definitely doubtful" says Ethan Wright that he would be alive to celebrate his 13th birthday on Wednesday.
He took off his helmet for a few seconds to record a trick – a "double whip over the box" where the base of the scooter spins midair while the rider grips the handlebars – at a Camden skate park. Instead of catching the deck of the scooter with his foot, he catapulted into concrete.
"I landed with force on top of the ramp," said Ethan of Camden. "I thought I was dying."
He was knocked unconscious. The handlebars caused internal bleeding and tore his spleen, causing him to be rushed from Campbelltown Hospital to Randwick Children's Hospital for emergency surgery. He was immobilised for five days and now has to take four months off before he can ride his scooter again.
Now in a bid to reduce the intractably high rate of child injuries caused by falls, playground injuries and sport, Ethan volunteered to talk at the launch of a new resource, the Child Safety Good Practice Guide, launched at Neuroscience Research Australia (NeuRA) on Wednesday by NSW Health and child safety experts.
It outlines the latest research on preventing injuries of all kinds – such as outlining case studies showing where helmet use worked – and identifies gaps in knowledge.
While Ethan nearly always wears his helmet, it is common for riders at skate parks to take them off while they do tricks and record them on video.
Ethan said many children don't wear helmets because they aren't cool, and they don't like the feel of them.
He disagrees: "It is not cool being a quadriplegic."
Ethan's trick was captured on video by his friends, along with the thud of his head when he fell and his friends cries of "oh my god!" before the video ends suddenly.
It is the sound any parent fears, and his father David Wright said he aged decades in hours.
Even experienced pediatrician Dr Susan Adams who treated Ethan found the video hard to watch, partly because the injury was avoidable.
"It is chilling; he goes out cold," she said. "A helmet would have protected his head," said Dr Adams from the Sydney Children's Hospital.
Unintentional injuries among children over one are the leading cause of death and hospitalisations of Australian children.
Every year about 250 Australian children under 18 die from non-intentional injuries, caused by car crashes, suffocation and drowning.
And every day about 188 kids are rushed to hospital.
And every year in NSW alone about 188,000 injured children visit an emergency room, with boys nearly 1.6 times as likely to be injured. Two of the leading causes of these visits are falls, accounting for 45 per cent, and exposure to inanimate mechanical forces (such as falling from a trampoline onto hard ground), 21 per cent.
Since 1999, injuries resulting in hospital admissions have improved in some areas, including poisonings, transport injuries and fatal drownings.
But injuries from falls, exposure to heat, fire and smoke, and all other unintentional injuries have shown no improvement, says the guide published by NSW Health and compiled by a partnership of health and safety groups.
"We need a call to action about child injuries. The fact that we have this incredibly significant child health problem, that we haven't made inroads into, is concerning," said Dr Julie Brown, a senior research fellow at NeuRA.
"It is clear that to do something we need a nationally coordinated response, and to develop effective partnerships. And we need to make sure that we use limited resources as effectively as we can," she said.
While similar guides exist overseas, the Australian report is the first to include injuries from sport. About 23 per cent of Australian children aged 12 to 17 years have been injured playing sport, requiring medical attention. It includes safety guidelines for children's sport including cricket, soccer, horse riding, cycling, baseball, skateboarding, hockey and snowboarding, as well as quad-bikes, another off-the- road vehicles.
Dr Brown and Dr Adams stressed that they weren't trying to stop children from being active, but trying to help them do so safely.
"It is so important that kids are active," said Dr Brown. "This really isn't about keeping kids in cotton wool, it is about them getting out there doing all these fun things, but what we need to do as a society is to make sure they are participating without the risk. They have the right to be able to participate in these activities, and it is our job to make sure that it is safe for them."
For instance, the guide showed that there was evidence that community-based campaigns and legislation requiring that cyclists wear helmets had been proven to reduce injuries. That could provide a framework for policy makers looking to reduce the number of injuries among children at skate parks like Ethan.
Christine Erskine, executive officer at Kidsafe NSW, said it was extremely difficult for an organisation like hers to get funding for new prevention programs.
"We are constantly begging for funds," she said, and always being asked for evidence. Now she could use the guide to show what worked in other settings. This could make it easier to get support for programs into areas where rates of injury are higher, including among Aboriginal children, and those from non-English speaking and lower socio economic backgrounds.
Each section of the book is backed by case studies and evidence, for example, injuries from burns are much higher among Indigenous children, found one study.
Dr Brown said the guide was designed to get people to stop wasting time on programs that don't work and yet more brochures – often done with the best of intentions – and put that energy into evidence backed programs that worked.
The guide notes that "one-off events such as skills-based bike safety fairs – without program elements designed to have increased access to helmets and build some permanence, [such as helmet giveaways], have been shown to have limited or no signs of effectiveness."