1. Booster Seat Use in San Diego Barbara M. Stepanski, MPH Leslie Upledger Ray, MA, MPPA Isaac Cain, BS Louise Nichols David Thompson Cindy Hearrell, RN Roxanne Hoffman, M.Ed Alan Smith, MPH, PhD(C) County of San Diego Health and Human Services Agency, Division of Emergency Medical Services

2. County of San Diego Division of Emergency Medical Services EMS Background 80% of child passengers are incorrectly restrained (NHTSA, 1996) 97% of infants (birth to 1 year old) traveling in safety seats in 1998, an increase of 12% from 1996 91% of toddlers (for 1 -4 year olds) are now traveling in safety seats, up 31% from 1996

3. County of San Diego Division of Emergency Medical Services EMS Background Booster seat use is low for children who have outgrown their infant/convertible/forward-facing seat (Partners for Child Passenger Safety) –29% of 3 year olds are inappropriately graduated to a booster seat –16% of 3 year olds are inappropriately moved to the adult seat belt –83% of 4-8 year olds are inappropriately moved to the adult seat belt

4. County of San Diego Division of Emergency Medical Services EMS Background Child restraint use issues –Wide variety of child safety seats –Child’s age, weight, height, and maturity –Vehicle seat and belt configurations –Recalls –Number of other passengers in vehicle

5. County of San Diego Division of Emergency Medical Services EMS Background Most states have primary laws allowing police to stop and ticket drivers for broken taillights or throwing out trash, however only 17 states and DC have primary seat belt laws California Laws (enforces minimum protection) –Before 1/2002 - Safety seat required for children until 4 years of age and at least 40 pounds –As of 1/2002 - Safety seat required for children until 6 years of age or at least 60 pounds (only need to meet one of these criteria)

6. County of San Diego Division of Emergency Medical Services EMS Shield Booster Seats

7. County of San Diego Division of Emergency Medical Services EMS Belt Positioning Boosters

8. County of San Diego Division of Emergency Medical Services EMS Why is analyzing restraint use among children so important? 0-9 YO Cause of Injury Prehospital Statistics In FY 9900 in San Diego County, 7% of children 0-9 seen by paramedics/EMT’s were due to injuries suffered in a MVC 43% of 0-4 year olds were NOT restrained in a child seat Of these 43% (above), 19% were completely unrestrained 11% of 5-9 year olds were completely unrestrained Note: Chart does not include medical chief complaints. County of San Diego, Health & Human Services Agency EMS Prehospital Data FY 99/00.

9. County of San Diego Division of Emergency Medical Services EMS Data Source Buckle Up San Diego/San Diego Safe Kids Coalition infant/child restraint inspection events, 1999 - 2001 –41 inspection events –963 seat positions that had a determined seat type County of San Diego EMS Prehospital Patient Records, FY97/98 –Paramedic/EMT calls in which a patient was transported to a medical facility or refused care. San Diego Association of Governments (SANDAG) Population Estimates

10. County of San Diego Division of Emergency Medical Services EMS Methods - Inspections Logistics Various locations (schools, retail stores, health fairs, etc.) Weekend and non-school hour times Volunteers NHTSA certified technicians and instructors Each inspection took approximately 30 minutes Standard data collection tool

11. County of San Diego Division of Emergency Medical Services EMS Results - Inspection Logistics 41 inspections 18 locations 9 communities (SRAs) 963 seat positions with determined seat types

12. County of San Diego Division of Emergency Medical Services EMS Results Types of Child Safety Restraints Rear-Facing (481/50%) –Infant –Convertible Forward-Facing (393/41%) –5-Point Harness –T-Shield –Tray Shield –Toddler/Booster –Integrated Seat Belt Positioning Boosters (47/5%) Shield Booster Seats (10/1%) Vehicle Safety Belts (31/3%) Other Child Restraint (1/0.1%) (25 seat types were not documented)

13. County of San Diego Division of Emergency Medical Services EMS Results - Booster Seats 6% of seats inspected were Booster seats –82.5% Belt Positioning Boosters –17.5% Shield Boosters Inspection Criteria –3 measures for the Belt Positioning Booster –7 measures for the Shield Booster

14. County of San Diego Division of Emergency Medical Services EMS Results – Age of Children in Booster Seats Age Note: There were 19 unknown ages The County of San Diego Health and Human Services Agency Division of Emergency Medical Services

15. County of San Diego Division of Emergency Medical Services EMS Results - Age and Weight Age The County of San Diego Health and Human Services Agency Division of Emergency Medical Services # of children

16. County of San Diego Division of Emergency Medical Services EMS Results - Inspection Criteria for Belt Positioning Boosters Percent that met criteria The County of San Diego Health and Human Services Agency Division of Emergency Medical Services

17. County of San Diego Division of Emergency Medical Services EMS Results - Inspection Criteria for Shield Booster Seats Percent that met criteria ***No longer recommended, no upper body protection*** The County of San Diego Health and Human Services Agency Division of Emergency Medical Services

18. County of San Diego Division of Emergency Medical Services EMS Results - Errors 37% demonstrated at least one error Most frequent errors –Shield Booster seat correct use of the locking clip (33.3% correct) and the vehicle belt holding the seat tight, 1- inch test (37.5% correct) –Belt Positioning Booster correct routing of the vehicle safety belt (82.6% correct) Significant difference in misuse by booster type –28% for Belt Positioning Booster –80% for Shield Booster –RR = 2.96

19. County of San Diego Division of Emergency Medical Services EMS Results 60% in Shield Boosters and 11% in Belt Positioning Boosters were under 40 lbs Two children in Shield Booster were only 2 years old 75% of the children who had their booster seat inspected also had a sibling’s seat inspected, most of whom were younger 83% of the booster seats inspected were manufactured after 1996

20. County of San Diego Division of Emergency Medical Services EMS Keep in Mind…. Participants may be unique Most came to have younger child’s seat inspected Lower misuse rate in boosters compared to harness seats Challenge: getting parents to USE booster seats!

21. County of San Diego Division of Emergency Medical Services EMS Acknowledgements The investigators would like to thank Buckle Up San Diego San Diego Safe Communities 2000 San Diego Safe Kids Coalition San Diego County Prehospital Agencies, Hospitals, and Paramedics/EMTs For more information please contact: Barbara M. Stepanski, MPH County of San Diego HHSA Division of Emergency Medical Services 6255 Mission Gorge Road San Diego, CA 92120 phone - (619) 285-6429 Barbara.Stephanski@sdcounty.ca.gov