Presentation on theme: "Child Passenger Safety: Update on Maryland CPS Programs AAP Maryland Chapter & Maryland Emergency Medical Services for Children This conference call is."— Presentation transcript:
Child Passenger Safety: Update on Maryland CPS Programs AAP Maryland Chapter & Maryland Emergency Medical Services for Children This conference call is sponsored by the Maryland EMS for Children’s Partnership Grant from the federal EMSC Program USDHHS/HRSA/MCHB Educational Conference Call February 17, 2005
Child Passenger Safety and Occupant Protection Laws and General Overview Meg Miller Maryland Highway Safety Office at State Highway Administration , x4077
Importance of Child Passenger Safety Laws Unintentional injury remains the leading cause of death among children 4-14 years of age 42% of those injury-related deaths are a result of motor vehicle crashes In 2003, 33,471 vehicle occupants were killed in traffic crashes; of those nearly 8% were 0-15 YOA (2,570) 290,000 were injured (28,000 incapacitating injuries) (National Center for Statistics and Analysis)
More Statistics In 2003, 291 children up to age 4 were seriously injured in motor vehicle crashes in Maryland; 35% were totally or improperly unrestrained. In Maryland, only 18% of booster-appropriate children actually are using boosters (according to a 2003 statewide observational study).
Maryland Traffic Law Title Child Safety Seats A child safety seat must be used in accordance with the seat and vehicle manufacturers’ instructions for a child younger than 6 years of age regardless of weight; or who weighs 40 pounds or less; regardless of age A person may not transport a child younger than 16 YOA unless the child is secured in a child safety seat or vehicle’s seat belt in all seating positions in all vehicles
Things to Remember About Current Law Applies to vehicles with MD registration class A, M, and E (trucks under 7000 pounds) Multiple violations in one vehicle at one time are to be considered one violation A child seat or seat belt may only be used by one person If there are more occupants required by this section to be restrained than there are positions for them, there is no violation as long as all positions are in use by someone required to use one.
Applications of the Law In other words, if you have 5 children restrained appropriately in a car with 4 seating positions (driver excluded), there is no violation if the four available seating positions are being used by a child in a restraint system. However, double buckling (two kids in one belt) is a violation. If a seat is used in the US it must meet all US federal safety standards.
CPS Law, Continued Out of State vehicles – A child being transported in a motor vehicle registered in another state, DC, or another country, shall be in an approved child safety seat used in accordance with both the vehicle and the seat manufacturers’ instructions if the child: Is under 4 years of age, regardless of weight; or Weighs 40 pounds or less, regardless of the child’s age
Meaning of the Law Although not specified as a requirement of the law, booster seats are included as one of the child restraint options. Boosters were not specified in the law because some children might need other types of special needs restraints, and we didn’t want to make those technically illegal by saying boosters were the only choice. If child falls into the small % of children that are 6 YOA and less than 40 pounds, by law (and recommendation), s/he still needs to be using a child restraint system.
Exemptions from the Law If a seating position does not allow the proper use of a booster seat (i.e., no shoulder belt available) there is no violation. Also, if only lap belts are available in the back seat, and are being used for children older than 6 and weighing >40 pounds, there is no violation. (It’s not best practice, but it’s not against the law either.) **However, there are restraints available to help in these situations, call KISS for assistance. Also not covered: children who have a written medical certificate from their doctor
Reminders This law was not meant to be punitive—if a family goes to court and proves that they have purchased or rented a safety seat, the fine is waived. Other requirements and applications of the law include: A person may not transport a child younger than 16 years of age unless the child is secured in: a child safety seat or vehicle’s seat belt in all seating positions in all vehicles. A child younger than 16 years may not ride in an unenclosed cargo bed of a pickup truck.
Related Laws The District of Columbia requires all children under 8 to be in a properly installed child safety seat (includes boosters). Their law applies to all vehicles operated in DC. $75 fine and 2 points. Virginia requires use of a child safety seat (including boosters) by children under age 6 with no weight requirements. PA Children up to age 8 must use approved restraint. Secondary law for kids over 4 years of age. DE requires children ages 6 and under and weighing less than 60 pounds to be properly restrained in an appropriate child safety seat in all seating positions.
Changes in the Child Seat Industry LATCH (Lower Anchors and Tethers for Children) Uses a set of bars mounted in the seat bight (where seat cushions meet) to anchor child seat into car Does not use the seat belt anymore All passenger cars have at least two locations Tether anchors are the hooks on the back deck or the back of the seat The top tether on the child seat hooks to them to reduce head excursion
LATCH In most vehicles the lower anchors are only in the outer seating positions and cannot have the two inner most points used together. Meaning if you have a sedan you can not use the LATCH system to anchor the child seat to center rear seat of the vehicle. This system was meant to make the installation of car seats universal and easy. To someone outside looking in, a LATCH-installed seat may not look installed, since seat belts are not being used!
Car Seats with Harnesses for Higher Weight Limits New Car Seats with higher weight limits are now available Until recently there were no car seats made for general use that had weight limits above 40 pounds with the harness system There are several currently available, and more to come! This is good for the kids that still like to move around a lot after 40 pounds and need more protection (i.e., kids who reach 40 pounds very early and who are not developmentally ready to use Belt Positioning Boosters).
Resources There are many resources for you if you have questions or concerns related to transporting children in your vehicles or enforcement/investigative situations. Maryland Kids In Safety Seats (KISS) at MHSO: , MSKC: Various CPS Technicians / Instructors throughout the State
Maryland Kids in Safety Seats (KISS) Maryland Department of Health & Mental Hygiene Tracy A. Whitman Coordinator
What is Kids in Safety Seats? Statewide program dedicated exclusively to child passenger safety issues. KISS: 1.Educates the public (parents and professionals) on all cps issues. 2.Promotes the proper and consistent use of child safety seats. 3.Answers questions/provides technical support/training to the public.
KISS Services Child Safety Seat Loaner Programs Technical Assistance/Referral Service Presentations/Trainings Safety Seat Check-up Events Referral Service Child Passenger Safety Clearinghouse
Loaner Programs Available to Maryland residents Not available in every county Some service county residents only Low cost (sometimes no cost) Education is provided Special needs programs (5) Seats vary per site
Presentations/Trainings One and Two-Hour General CPS Overviews 16-Hour Child Care Providers Training 16-Hour Special Needs Training* 16-Hour RN Training 16-Hour Law Enforcement Training 32-Hour National Standardized Certification Course
Safety Seat Check-up Events Assistance provided to agencies/ organizations conducting events Organized by appointment or open to public SAFE KIDS Van and/or Trailer (fee) KISS holds regularly scheduled check-ups once a month No charge but appointments are necessary
Referral Service KISS maintains a current list of Permanent Fitting Stations (PFS) PFS are sites where child transporters may take their vehicle and seat to have certified child passenger safety technician check the seat for correct use and installation Most locations are free but appointments are necessary Many locations run on a wait list
Clearinghouse Requests for materials Answers “best practice” and other technical inquiries Presentation/training and health fair display requests
Contact KISS Helpline SEAT or Web site
Child Passenger Safety Donna J. Perlin, MD Allen Walker, MD Jean Ogborn, MD Ann Duggan
Statement of Problem Motor vehicle collisions are the major cause of death for children ages 5-9 years Ramsey, A Among 5-9 year olds in fatal crashes, 48% were unrestrained CDC
Statement of Problem Parents reliably restrain their infants and toddlers in appropriate child safety seats secondary to a public awareness of their significant protective records in motor vehicle crashes
Statement of Problem The prevailing belief among parents of children ages 4-8 years is that a lap/shoulder belt is the appropriate form of restraint once the child has outgrown their toddler seat. Unfortunately, the studies show this belief to be false
Booster Seats Decrease the risk of significant injury in a motor vehicle accident by a factor of 3.5 Provide a relative risk reduction of 4.2 for significant head injury Used in only 6-10% of children in the 4-8 year old age range Decreased the risk of both lumbar and hollow viscus injuries Winston, FK, Ramsey, A
Maryland Statistics In 2003, motor vehicle crashes involving Maryland children resulted in fatalities and serious injuries to: 282 children <5 years old 546 children 5-10 years old 923 children years old Car safety seat misuse in Maryland, as of May, 2004, is 88%
Crash Dynamics An object in motion remains in motion at the original speed until acted upon by an outside force Approximate: Weight X Speed = Restraining Force Example: 40 lb. Child in a car going 40 mph has 1600 lbs of crash weight
Three Collisions 1. Vehicle 2. Human 3. Internal
Children in Crashes Children are more vulnerable to injury in crashes because: Immature musculoskeletal system Cars are designed to protect the ADULTS
Child Safety Seats Prevent Injury Prevent ejection Spread out crash forces Contact strongest parts of the child’s body Allow the child to “ride down” the crash Protect head, neck, and spinal column
Local News Paper Articles
Statement of Problem Various studies have shown that only 6- 10% of children who are 4-8 years old are actually being appropriately restrained in booster seats Ramsey, A Decina, LA Karp,H
Statement of Problem Lack of awareness of their need by parents is the most commonly cited barrier to their usage Ramsey, A Rivera, FP Kunkel, NC
Statement of Problem Other barriers to booster seat usage are the cost of the seats, child resistance, peer pressure and the difficulty of fitting multiple seats into the car Rivera, FP Ramsey, A
Statement of Problem Many parents are not aware that the seatbelts required by law in most states for their children ages 4-9 are not sufficient protection for their children in a crash Their perception is that the laws support the current safety recommendations
Statement of Problem “The state law usually ends with three or four year olds. The law of physics lasts a lifetime.” (Bob Wall, Child-Passenger Safety Instructor) 5.
Statement of Problem Many states, including Maryland, have recently or are in the process of enacting legislation mandating booster seat usage for children over age 4
Goals of This Study Our long-term goal is to design an effective intervention to optimize the transportation safety of children ages 4- 8 through a multifaceted attack on the previously reported barriers to booster seat usage
Goals of This Study In order to achieve this goal, we must determine the factors that directly influence the most commonly cited barrier to their usage, parental knowledge of their efficacy
Hypothesis Pediatricians can play an important role in advocating their usage by educating families
Hypothesis We hypothesize that the frequency of booster seat counseling is low among primary care pediatricians
Hypothesis In the first part of our study we hope to assess the frequency of Pediatrician counseling regarding booster seats to delineate those factors that are associated with a poor rate of booster seat counseling.
Hypothesis In the second part of our study we will evaluate the effectiveness of booster seat legislation on Pediatrician counseling practices by assessing the change counseling practices
We acknowledge the role of the pediatrician in the movement towards widespread booster seat utilization
Long Term Goal This study hoped to delineate those factors that are associated with a poor rate of booster seat counseling. Our long-term goal is to devise an intervention directed at those predictive variables.
Study Design/Methods A cross sectional descriptive study Our sample of 992 Maryland pediatricians was obtained from the membership list of the Maryland Chapter of the American Academy of Pediatrics
Study Design/Methods Data was collected via self-administered questionnaires distributed through the mail with two subsequent r ings for non-responders
Study Design/Methods The survey included questions regarding the practitioner’s knowledge of current percentages of booster seat usage, practice experience with patients injured in motor vehicle collisions, awareness of AAP recommendations regarding booster seat counseling, and personal counseling practices
Study Design/Methods Data was gathered regarding variables in our conceptual framework hypothesized to influence pediatrician counseling practices
Study Design/Methods We opted to utilize the enactment of Maryland booster seat legislation on October 1, 2003 as the potential impetus for change in subsequent booster seat counseling practices among Maryland pediatricians
Study Design/Methods Primary Care Pediatricians who responded to the first survey were re- sampled following the legislation change and we are currently in the process of collecting this comparison data
Study Design/Methods A total of 992 surveys were mailed between July 2003 and September 2003, prior to the enactment of Maryland legislation mandating booster seat usage, with a response rate of 45% 104 were excluded due to non-primary care practice or retirement
Results Only 55% of surveyed pediatricians were aware of the AAP recommendation to counsel families of children ages 4-6 about booster seats and were consistently counseling
Results This translates into 45% of pediatricians who were not aware of the recommendation and not counseling
Results Only 30% of the participants were aware of the then upcoming change in the Maryland legislation requiring booster seats
Results Only 17 (5%) were aware of the change and were able to correctly identify the preceding legal restraint requirement for infant/toddlers, children ages 4-6, and children greater than 6 yrs of age Of these 17, 88% were parents themselves
Results Ninety percent of participants reported that they usually or always counsel families regarding infant/toddler seats Only 72% report the same for booster seat counseling
Significance The current usage of booster seats for children ages 4-8 years is only about 6- 10% Multiple barriers to their use have been cited with the most common barrier being parental knowledge A multifaceted approach to public education is needed
Significance Pediatricians must be on the forefront of this process to increase the public’s awareness of this important issue Failure to counsel parents about booster seats implies a lack of acknowledgement of their significance
Best Practice Recommendations for Practitioners/Providers Maryland Child Passenger Safety Advisory Board recommends that written guidelines on the dissemination of CPS information be developed by: public and private hospitals pediatric and family clinics physician offices birthing centers
Best Practice Recommendations for Practitioners/Providers 1. Distribute a current summary of Maryland restraint laws pertaining to children under age Distribute a listing of Maryland Child Passenger Safety (CPS) programs located within the state including the Maryland Kids in Safety Seats program at SEAT
Best Practice Recommendations for Practitioners/Providers 3.Distribute CPS written materials that are current and contain accurate information 4.Encourage proper seat fit by using the 5-STEP test for those that are at least 6 years of age and weigh greater then 40 pounds
The Five Step Test Used to determine if a child is ready for the adult seat belt 1. Does the child sit all the way back against the auto seat? 2. Do the child's knees bend comfortably at the edge of the auto seat? 3. Does the belt cross the shoulder between the neck and arm? 4. Is the lap belt as low as possible, touching the thighs? 5. Can the child stay seated like this for the whole trip?
Best Practice Recommendations for Practitioner/Provider 5.Educate patients about the risks of death or serious injury associated with failure to use a child safety seat or seat belt system appropriate for size
KISS - Maryland Kids In Safety Seats What is the Appropriate Seat for Your Child? Guide to Using Rear-Facing Restraints What are Maryland Safety Laws? When are Upcoming Seat Safety Checks? When are Upcoming Seat Safety Trainings? KISS Newsletter – New notes
Hospital Resource Information Kits CPS Hospital Contact & CPS Technician Liaison Transporting Children:Special Health Care Needs Guidelines on Best Practice for Health Care Facilities Links to CPS Resources Posters on safe passenger safety for all ages Proper Occupant Protection video/DVD order form
The End Thank you for your time and your interest in Child Passenger Safety !
Questions Recorded questions run approximately 17 minutes