Finally – A Step Towards Safe Transport for Kids in Ambulances!

In 2008 the National Highway Traffic Safety Administration (NHTSA) convened a working group of representatives from the American Academy of Pediatrics, Emergency Medical Services for Children, the American Ambulance Association, and other key organizations and started a project called “Solutions to Safely Transport Children in Emergency Vehicles”. Finally a long-standing problem was being recognized and addressed: “there are no Federal standards or standard protocols among EMS and child safety professionals in the U.S. for how best to transport children safely in ground ambulances from the scene of a traffic crash or a medical emergency to a hospital or other facility. The absence of consistent national standards and protocols … complicates the work of EMS professionals and may result in the improper and unsafe restraint of highly vulnerable child passengers.”(1)

In fact a 1998 study regarding the use of child restraints in ambulances revealed that 35 States did not require patients of ANY AGE to be restrained in a ground ambulance. Of those States that did require some sort of child restraint system, requirements for an “acceptable restraint” varied significantly.(2)

It is illegal in the US to travel with an unrestrained child in an automobile. However, when a child is already sick or injured, we have been willing to transport them in a vehicle where the passenger compartment is exempt from most safety requirements, they cannot be properly restrained and they have a higher probability of an accident than an automobile. We might not if we knew the following:

• It is estimated that up to 1,000 ambulance crashes involve pediatric patients each year.(3)
• In a collision at 35mph, an unrestrained 15kg child is exposed to the same forces as in falling from a 4th story window.(4)

Wednesday September 19, 2012, after an intense 2 year research effort, a public meeting in August 2010 to review the findings and gather input (see Pediatric Safety Post by Sandy Schnee “A Public Meeting on Safe Transport for Kids on Ambulances“), and 2 additional years refining the results, NHTSA has released the official:

“BEST PRACTICE RECOMMENDATIONS FOR THE SAFE TRANSPORT OF CHILDREN IN EMERGENCY GROUND AMBULANCES” …Thank you NHTSA!!

The working group outlined 5 potential child transport “Situations” (see chart below) and for each described their “Ideal” solution – the best practice recommendation for safe a safe transport for each situation. They also presented an “If the Ideal is not Practical or Achievable” alternative – basically an “acceptable” backup plan.

They also came up with guidelines to assist EMS providers in selecting a child restraint system – particularly important because due to the lack of regulation and testing requirements specific to ground ambulances, many of the available child restraint devices were not designed for use in ambulances, some were tested to automotive standards and others were not tested at all.

In the end, the ultimate goal of ALL the recommendations: Prevent forward motion/ejection, secure the torso, and protect the head, neck, and spine of all children transported in emergency ground ambulances.

In short – transport these children safely.

We know that since the adoption of “mandatory use laws” in the U.S. for child safety restraints in automobiles, that thousands of children’s lives have been saved. Yet for years we have continued to allow children to be transported unrestrained on ambulances. With this report, we have finally taken a step in the right direction…

“It is hoped that the recommendations provided in this report will address the lack of consistent standards or protocols among EMS and child passenger safety professionals in the United States regarding how to most safely transport children in ground ambulances from the scene of a traffic crash or medical emergency to a hospital or other facility. It should be noted that the expectation is that States, localities, associations, and EMS providers will implement these recommendations to improve the safe transportation of children in emergency ground ambulances when responding to calls encountered in the course of day-to-day operations of EMS providers. In addition, it is hoped that EMS providers will be better prepared to safely transport children in emergency ground ambulances when faced with disaster and mass casualty situations”.

…. Amen to that !!

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Editorial Update: Quite a bit has happened since the original publication of this article. Suffice it to say that while this was a terrific step in the right direction – it was not enough to cause the system-wide level of change hoped for. According to ems.gov… “unanswered questions remain, primarily due to the lack of ambulance crash testing research specific to children.” To address this, in 2017 the National Association of State EMS Officials (NASEMSO) established the Safe Transport of Children Ad Hoc Committee, with the goal of improving the safety of children transported by ambulance through the creation of evidence-based standards. Pediatric Safety will continue to follow their efforts in future articles as they work to improve the national standard of care and establish consistent guidelines for the safe transport of all our children on ambulances. Every ride, every time.

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References:

1. Notice published by NHTSA of Public Meeting on August 5th, 2010 to discuss draft version Recommendations for Safe Transport of Children on Ground Ambulance Vehicles: Federal Register, July 19, 2010,

2 & 3. Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances: NHTSA / USDOT, September 2012

4. “EMS to Your Rescue?” Int’l Forum on Traffic Records & Hwy Safety Info. Systems – Levick N, July, 2008

What You Need to Know About Car Seat Safety? Ask a Fireman

Being a firefighter, I come across a lot of situations that make me shake my head in wonder. The one that my fellow firemen and I continually come across is installing and checking car seats and the many interesting and creative ways people have managed to improperly install a car seat. Whether you are the SUV with a few seats that have been installed for a while, or the new dad sweating on the way to the hospital stopping at the fire station asking the nice firemen to install your brand new seat, there are a few things that need to be taken into account when choosing your car seat and then installing your car seat.

What choice could matter more than that of the one your child is going to be sitting in as you motor around town? Choosing the correct car seat for your new baby or young child requires some homework and label reading.

First there is price. Car seats come in all price ranges, from free at some local fire stations and community organizations to very expensive with extra padding, lights and toys. Just because a seat costs more does not make it a better seat than the one next to it. Check online at places like www.consumerreports.com or www.safekids.org to find out how these seats compare to one another will give you better insight as to the correct choice for you and may even surprise you.

Next is the correct size seat for your child. This is the part about label reading that I mentioned before. Car seats are designed with a specific weight and height in mind for each seat and making sure the seat is the correct size for your specific child maximizes the safety of the seat for your child. Seats that are too big may allow for too much room for movement and seats that are too small may make your child uncomfortable and ultimately unsafe. Car seats should be securely snug but not a tourniquet.

Installation. Having your brand new car seat is wonderful and having it installed correctly is the most important factor of all. Where can I go to have my new car seat installed? There are many places that will correctly install your new car seat by using certified installation experts that have been trained on many different types of vehicles and the important points of each type of vehicle. You may want to call your local fire department or hospital for information on places to go for installation and you can also consult websites like www.safekids.org or the national highway traffic safety administration website http://www.nhtsa.gov to find installation centers in your area and may even find info on installation events going on in your area right now.

If you have any questions about a soon to be purchase of a car seat or the one that is in your car right now, please feel free to stop in at any fire station and ask for a check. We may shake our head but we love knowing your kids are safe.

God Bless!

What You Need to Know About the New AAP Child Seat Guidelines

The American Academy of Pediatrics has dropped the age milestone that children should remain rear-facing until age 2, and replaced it with the new recommendation that children should remain in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat.

The past decade has seen an incredible dramatic evolution in improvements to child passenger safety. Never-the-less, motor vehicle crashes continue to be the leading cause of death for children ages 4 and older.

According to Dr. Benjamin Hoffman, MD, FAAP, lead author of the policy statement and chair of the AAP Council on injury, Violence and Poison Prevention, “Car seats are awesome at protecting children in a crash, and they are the reason deaths and injuries to children in motor vehicles have decreased”. However, according to the AAP, what many parents don’t realize is that each transition – from rear-facing to forward-facing, from forward-facing to booster seat, and from booster seat to seat belt alone – reduces the protection to the child.

Using the right car safety seat or booster seat, says Dr Hoffman, lowers the risk of death or serious injury by more than 70 percent.

When a child rides rear-facing, the head, neck, and spine are all supported by the hard shell of the car safety seat, allowing the car seat to absorb most of the crash forces, and protecting the most vulnerable parts of the body. When children ride forward-facing, their bodies are restrained by the harness straps, but their heads – which for toddlers are disproportionately large and heavy – are thrown forward, possibly resulting in spine and head injuries.

According to Dr. Hoffman: “if you have a choice, keeping your child rear-facing as long as possible is the best way to keep them safe.”

Here is what the American Academy of Pediatrics is recommending:

1. Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more.
2. Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats through at least 4 years of age. Many seats can accommodate children up to 65 pounds or more.
3. When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old.
4. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
5. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

One of the most important things a parent or caregiver should do is to read the manufacturer’s manual and labels for that particular car seat to find the correct weight and height limits. When a child is approaching one of those limits, it is time to think about transitioning to the next stage.

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Reference:

• Child Passenger Safety Policy Statement; Dennis R. Durbin, Benjamin D. Hoffman, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION
• AAP Updates Recommendations on Car Seats for Children: 2018 American Academy of Pediatrics 8/30/18

The WarmMe: The Safe Car Seat Winter Coat Alternative

Just over four and a half years ago (Winter 2012), I found myself as a first time mom of a beautiful 6 month old baby girl and I had a problem. We had moved my daughter out of her infant car seat and into a convertible car seat, she was just too heavy to carry around in the infant seat. The problem was it was winter and I didn’t know how to keep her warm while also keeping her safe in her new seat. I had read many articles and seen many graphics online about the dangers of using a winter coat under the straps of car seat harness.

A winter coat is too bulky to safely and securely use under a car seat harness. We did the quick test suggested in multiple articles, put the child in their coat and secure the harness straps, tightening them until they feel snug, then take the child out of the seat and remove their coat, put them back in and buckle the straps. We were shocked by the results, we were certain the straps had been tight when the coat was one, but once the coat was removed there was so much slack in the straps! In the case of a car accident, the force from the accident would cause the child’s winter coat to compress against the straps and the result would be gaping, loose straps that a child could slip through. More recently (February 25, 2016), Consumer Report issued a report and video on this exact danger. They suggest removing the child’s coat and putting it over them like a blanket once they are secured in the car seat, or using a blanket to cover the child.

So, how would we keep our little girl warm throughout a cold Michigan winter? We tried multiple options including putting her coat or snowsuit on in the house and removing in the car then putting it over her once she was buckled. We tried layering blankets over her once she was buckled. We tried lightweight sweatshirts under the straps. None of these options were convenient or warm, taking the coat on and off was probably the most time consuming, the blankets didn’t stay on, and the sweatshirts just weren’t warm enough. That’s when I knew there had to be a warm and safe alternative to the winter coat. I decided to make something as warm as a blanket that would stay on without the need for removing in the car. I thought that something like a poncho would work the best, and so the first version of the The WarmMe was born.

The first version of The WarmMe was very basic, it kept my daughter warm and safe in the car, so it served it’s purpose but I felt there were improvements that could be made. The WarmMe had a single button on the front to secure it and made opening the front simple and easy for securing the car seat harness underneath. The first WarmMe was made of a fleece lined sherpa material that was cute and cuddly, but pricey plus very limited on color selection. The WarmMe worked well that first winter, so the next winter I made an identical one that was just a bit larger to fit my quickly growing daughter.

This second winter my daughter was becoming more independent and always wanting to walk rather than be carried, even on cold and windy winter days. I noticed that on a windy day her WarmMe would blow open when she was walking around outside. I decided to add something special that sets The WarmMe apart from other ponchos and kept my little girl warm even on windy days-by a special feature, interior pockets. The pockets on the inside allowed my daughter to keep her hands warm and also wrap The WarmMe around herself when she was wearing it outside of the car. Her second winter, my daughter loved her new and improved WarmMe with the added pockets. This was also when I decided to change the material from the sherpa to fleece. Fleece is much easier to work with especially when adding the pockets, has endless color and print combinations available, and is easily washable (a definite bonus when creating something for little kids!).

People stopped us all the time asking where were got The WarmMe and when I said I made it they started encouraging me to sell them. At this point in time I had two young children and was working part time as a school social worker, adding to a small business to my already full and busy life didn’t seem to make sense to me. Plus, my whole goal was to keep my daughters safe in the car, how could I put a price on that?

In October 2015 my life changed. I suffered a traumatic miscarriage. As our dream of adding a 3rd baby to our family was crushed and I was left in the most physical and emotional pain I have ever experienced, I found myself needing something I was passionate about to get me out of the dark place I was stuck in. At this point I had made a couple WarmMes as gifts for friends and family and the feedback was great, they loved how much easier it made everyday life. That’s when I went for it, I decided to take a chance and put them up for sale, as I realized I could reach a lot of parents and caregivers who were looking for a safe way to keep their little ones warm. The business started very small, just a couple postings on my personal Facebook page that were then shared by my family and friends.

Each WarmMe has always been custom made based on the child’s clothing size and the print or color preference, so I just focused on completing each order as it came in. People soon started asking for added features such as an attached hood. After asking around and doing a little experimenting I decided a hood is just too bulky to be comfortable behind a child’s head and neck while riding in the car. I decided to start offering matching hats and they’ve been a hit! The next request was for matching scarves for the mom or dad and that option was quickly added in what I like to call the “Mommy and Me Set.”

In February 2016, The WarmMe was featured on a segment called “Moms a Genius” on WXYZ Detroit and the business picked up from there. I could no longer keep up with orders on my own, so my wonderful and supportive husband stepped in to help. This year The WarmMe made the news again on my local news station WLNS 6 out of Lansing, MI and has been picked up by other stations in states such as South Carolina, North Carolina, Wisconsin, Indiana, Minnesota, Ohio, New York, and Virginia. This holiday season The WarmMe has been sent to cold states all over the map. The best part of the increased business has been the feedback from happy customers. Almost daily I receive messages stating how much parents and children alike love The WarmMe and how it has made life easier by keeping little ones safe and warm! It is amazing knowing that my product is making life a little easier for parents, while keeping their precious little ones safe! I’m very happy to say that both The WarmMe business and our family are growing as we are expecting the newest addition to our family in January 2017!

HEALTHFUL HINTS:

1. While the WarmMe is designed to young children safe and warm in their car seats, there are also products designed to fit safely over infant seats while not interfering with the ability to securely buckle the harness. These products are ones that do not go between the child and the car seat or buckles, but go over the seat similar to a shower cap.
2. If taking a long road trip or traveling far from home when road or weather conditions are really bad (remember, I’m talking Michigan winters!) take along coats, snowpants, or snowsuits. If something were to happen and you ended up stranded these items would definitely help keep your little one warm until help arrived.
3. Remember safe sleep precautions when using The WarmMe, similar products, or blankets to keep your child warm in the car seat. Always be sure the fabric is away from their face allowing for an open airway. If transferring a sleeping child from the car into their bed always remove The WarmMe.
4. Here is the official Consumer Reports recommended “simple way to check if your child’s coat is too big and bulky to wear under their harness”

• Put the coat on your child, sit them in the child seat and fasten the harness. Tighten the harness until you can no longer pinch any of the harness webbing with your thumb and forefinger.
• Without loosening the harness, remove your child from the child seat.
• Take the coat off, and put your child back in the child seat and buckle the harness straps, which are still adjusted as they were when he was wearing the coat.
• If you can now pinch the webbing between your thumb and forefinger, then the coat is too bulky to be worn under the harness.

Child Safety Seats – Take it From a Fireman

Summer is here and if you are like me, you now have a car load of children tagging along with you to do your daily errands that you normally did while they were in school. Summer is prime time for road trips and field trips to all sorts of amazing places around our great country, but the facts are the facts and the facts are still very much pointing towards too many children either not properly secured in vehicles or just not secured at all. There are laws in every state now that deal with seatbelts and car seats and still some of us do not wear our seatbelts and do not properly secure our children. Please take it from someone who sees the results of not wearing seatbelts in many auto accidents: Seatbelts save lives! And as of 2013, auto accidents are still among a leading cause of death in children, and still one of the most preventable. Whether your child is an infant or a teenager, it is still important to make sure everyone is wearing seatbelts and is properly secured.

According to the CDC In the United States, motor vehicle crashes are a leading cause of death among children. In 2013, 638 children ages 12 years and younger died in motor vehicle crashes, and more than 127,250 were injured. But parents and caregivers can make a lifesaving difference.

Whenever you’re on the road, make sure your child passengers are buckled in age- and size-appropriate car seats, booster seats, or seat belts. Buckle all children ages 12 and under in the back seat. Airbags can kill young children riding in the front seat. Never place a rear-facing car seat in the front seat or in front of an airbag. Note: the safest place for children of any age to ride is properly buckled in the back seat.

Data shows that:

• In 2013, restraint use saved the lives of 263 children ages 4 years and younger.
• Car seats reduce the risk of death in car crashes by 71% for infants and 54% for toddlers ages 1 to 4.
• Booster seats reduce the risk for serious injury by 45% for children ages 4 to 8 years.
• Between 1975 and 2013, child restraints saved an estimated 10,421 lives of children ages 4 and younger.

Know the Stages

Make sure children are properly buckled up in a car seat, booster seat, or seat belt, whichever is appropriate for their age, height, and weight.

• Birth up to age 2 – Rear-facing car seat. For the best possible protection, infants and children should be buckled in a rear-facing car seat, in the back seat, until age 2 or when they reach the upper weight or height limits of their particular seat. Check the seat’s owner’s manual and/or labels on the seat for weight and height limits.
• Age 2 up to at least age 5 – Forward-facing car seat. When children outgrow their rear-facing seats they should be buckled in a forward-facing car seat, in the back seat, until at least age 5 or when they reach the upper weight or height limit of their particular seat. Check the seat’s owner’s manual and/or labels on the seat for weight and height limits.
• Age 5 up until seat belts fit properly – Booster seat. Once children outgrow their forward-facing seat (by reaching the upper height or weight limit of their seat), they should be buckled in a belt positioning booster seat until seat belts fit properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). Remember to keep children properly buckled in the back seat for the best possible protection.
• Once seat belts fit properly without a booster seat – Children no longer need to use a booster seat once seat belts fit them properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). The recommended height for proper seat belt fit is 57 inches tall. For the best possible protection keep children properly buckled in the back seat.

Need Advice?

Install and use car seats and booster seats according to the seat’s owner’s manual or get help installing them from a certified Child Passenger Safety Technician. Find a Child Passenger Safety Technician.

September 19 is National Seat Check Saturday, when drivers with child passengers are encouraged to visit a child safety seat inspection station to have a certified technician inspect their car seat and give hands-on advice free of charge…(although no need to wait for September to get help – it’s available year-round). Locate a car seat inspection station in your area.

• Buckle children in the middle of the back seat when possible, because it is the safest spot in the vehicle.
• Buckle children in car seats, booster seats, or seat belts on every trip, no matter how short.
• Set a good example by always using your seat belt.

Summary a.k.a. the highlights (…at the risk of repeating myself)

1. Using the correct car seat or booster seat can be a lifesaver.
2. Make sure your child is always buckled in an age- and size-appropriate car seat or booster seat.
3. Use a rear-facing car seat from birth to age 2.
4. Use a forward-facing car seat from age 2 up to at least 5.
5. Use a booster seat from age 5 up until seat belts fit properly.
6. Use a seat belt once seat belts fit properly without a booster seat.

So if you are not going to take it from the Fireman, please take it from the CDC. SEATBELTS SAVE LIVES. No matter the age!!

As an EMS professional I urge everyone to buckle up and as a father I urge every parent to be the example in the care and buckle up.

I hope everyone has an amazing summer and you go amazing places. But please WEAR YOUR SEATBELT! Thank you!

The Other Gifts We Give Our Kids

There are many traditions at this time of year that involve parents giving their children presents – whether obviously or through Santa subterfuge! But there are many gifts we give our kids throughout the year that have a much more lasting impact than the latest hot video game or toy, even if our little people don’t yet realize it or always appreciate our efforts. Below is a selection of some of these gifts of love.

Vaccinations

The WHO cites a book on the history of vaccination that says only clean water has done more for the health and wellness of mankind. Historical books, movies and TV shows detail just how frightening the diseases we vaccinate against once were. The shots we get for our children are a gift that provides a lifetime of protection – for them and those around us.

Safe Home

Every time parents install a cabinet lock to hide chemical cleaners, secure heavy furniture and TVs against tipping, or reduce the setting of their water heater they are providing invaluable gifts to their children – reduction in the risk of preventable poisoning, injury, burns. The Consumer Product
Safety Commission says that 22,000 kids are seen in Emergency Departments each year due to injuries from furniture and TV tip-overs – and 26 kids die annually from these incidents.

Safe Transport

Around 400-500 child deaths are prevented in the US every year due to use of car seats and other child restraints – and that’s not counting the reduction in severe injuries from use of safety seats for kids. Every time we strap them into a car seat we are giving them a precious gift and teaching them good car safety habits for when they become drivers.

Healthy Eating Appreciation

Obesity is one of the greatest health crises of our age, given its link to diabetes, heart disease, high blood pressure and cholesterol, liver disease, sleep apnea, arthritis, and even several cancers. Helping our children appreciate food for its support of health is a gift that keeps giving over a lifetime.

Active Lifestyle Encouragement

As parents, we all want our children to live a long and happy life. Physical activity is a important contributor to this goal, given how it reduces risk for chronic diseases and even improves mental health, sleep and mood.

According to the US Centers for Disease Control, “only a few lifestyle choices have as large an impact on your health as physical activity. People who are physically active for about 7 hours a week have a 40 percent lower risk of dying early than those who are active for less than 30 minutes a week.”

Getting our kids to be active – and, more importantly, being a role model for physical activity is literally a gift of life.

Protection from Excessive/Inappropriate Online Exposure

Although the American Academy of Pediatrics has updated their guidelines for “screen time” to better reflect how entrenched online usage now is at all ages, they still make recommendations – such as focusing on content and engaging with your kids around screens – to ensure a valuable online experience. Putting limits in place for when our kids can access the internet and what they can see is an important gift for protecting their online reputation and preventing inappropriate connections.

So while you are savoring your kids squeals of delight when they open their presents during the holidays, remember to pat yourself on the back for all the other gifts you labor to give them year-round – gifts that protect them for a lifetime.

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