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Finally – Safe Transport for Kids in Ambulances…Thanks NHTSA!

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. It is also estimated that there are approximately 4 child fatalities per 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)

This past Wednesday, 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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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

To Breastfeed for 6 Months or Not To Breastfeed for 6 Months…

…that is the question…

This week a small group of pediatric health experts from the UK published a report in the British Medical Journal questioning the 2001 World Health Organization’s recommendation to provide 6 months of exclusive breast feeding. The WHO and UNICEF recommend:

  • Initiation of breastfeeding within the first hour of life
  • Exclusive breastfeeding – that is the infant only receives breastmilk without any additional food or drink, not even water
  • Breastfeeding on demand – that is as often as the child wants, day and night
  • No use of bottles, teats or pacifiers

This is based on significant evidence that breast milk reduces the rate of pneumonia, ear infections, gastroenteritis and other infections.

Given however the much lower incidence rate of these illnesses in “developed countries” some medical professionals have voiced their concern about applying the 6 month restriction universally. They argue that while “exclusive breastfeeding for 6 months is readily defendable in resource-poor countries with high morbidity and mortality from infections, in developed countries, other concerns can take precedence”.

This aligns with the new report which suggests that babies who are breastfed exclusively for six months are at a higher risk for iron deficiency and food allergies including celiac disease, and may also lead to a delay in developing a taste for food products which could have a long term impact on diet. Among the questions asked – “will babies who aren’t introduced to bitter-tasting foods in the first 6 months continue to have an aversion to them for the rest of their lives??” If this does in fact occur, will it make it even more difficult to win the battle against obesity?

All of that being said, the current debate is not one which attempts to answer the question of whether or not a mother should breastfeed. That is a separate conversation with its own proponents for and against. But even for those moms who make the decision to breastfeed, many still struggle to continue for the recommended 6 months – especially if they return to work. (According to the CDC , although 75% of new moms in the U.S. start breastfeeding, only 13% are still breastfeeding exclusively at 6 months).

So what is the right answer? Can solid foods be introduced as early as 4 months? The WHO and UNICEF are continuing to support a 6 month guideline while a number of experts are now recommending the alternative. One area they both seem to agree is that each child is different, and watching for baby’s cues will be the best guideline of all.

So what about you?? How did you know when your little one was ready for solids?

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References:

The Littlest Victims of The Recession – Part II

I wrote several weeks ago about the effect the economic crisis was having on our littlest ones. How 44% of children’s hospitals were reporting increases in ER visits this year because people were avoiding insurance and doctor’s office visits they couldn’t afford, and delaying care until it was absolutely necessary. The message was clear: children and their parents, the people working night and day to care for them, were flooding ER’s across the country. And the effect this was having on our children’s health and wellbeing was starting to take its toll.
But this we knew. I’m not saying we accepted it, but at least in knowing there was a threat we could try and do something about it. I emphasize this because today we discover yet another threat to our little ones courtesy of the recession…and like the one prior, this too has the potential to be deadly if ignored.
The US has a single poison control hot line (800-222-1222) available 24 hours a day, 7 days a week for questions about possible poisonings. About two million people call the hot line each year. Half the calls concern children 5 and younger. And today, according to a report published in the NY Times, as part of an effort to close its $24.3 billion budget deficit, Governor Arnold Schwarzenegger has proposed eliminating the state’s $6 million contribution to its four poison control centers making California the only state without a poison control program. (by Sarah Arnquist, NY Times http://ow.ly/g7Ob)

 
I sit here and wonder how can that be the right decision. Often I won’t question a budget until I can see all the numbers behind it, but there is a basic scenario here I have some difficulty coming to terms with and I can’t imagine that anyone – especially our children – come out ahead:
One of the nation’s largest poison control program closes – there are huge implications for some of the others since they are all budget constrained – but let’s put that aside for now. Unfortunately it is not hard to predict what will happen next. It is highly likely that without a poison hot line, people will either go directly to the emergency rooms or call 911, and the dispatchers who are not poison control experts will send an ambulance. There is a cost associated with this which studies have shown equates to approx. $7 of savings to every dollar spent on poison control. Beyond that is the fact that I am not sure how this will help an already overburdened ER system. Everyone will need to wait longer to be seen. Now we get to where this really hurts.
Forget the cost savings, forget that in the late 1980’s Louisiana eliminated its poison control program but later reinstated it after officials realized that it actually saved the state money. If you take nothing from anything else I’ve written here please remember these 2 points: Poisoning is the second leading cause of death from injuries after car accidents…and HALF of these calls are for little children under 5. Who is more frail…whose bodies are going to run that poison more quickly…who cannot afford to wait in a crowded ER?

 
Will $6M make a significant impact on a $24.3B budget deficit? Maybe…but is it worth it? I said it the last time I wrote about this subject and I say it again today: It is up to us to make sure this recession’s littlest victims do not become its casualties. If not for us, then who??