Safety Archive

Proper Transport of the Non-Critical Pediatric Patient in an Ambulance (aka how to properly install a carseat on a stretcher/cot)

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On this warm, sunny, spring day – parents were obviously busy doing something other than coming to our check event. That left us techs with a little free time. At one point, some of the fabulous volunteers from the local ambulance corp showed up and the conversation quickly turned to transporting babies and young children in ambulances. I think I shocked a few of the local techs when I admitted that I had never actually installed a carseat on an ambulance cot (What? Something involving carseats that Kecia has never done??? Alert the presses! Lol.) Yes, I understand how it’s supposed to be done. I’ve read the research papers and I’ve seen several presentations on the subject at various CPS conferences over the years but I had never actually done it myself. Well, wouldn’t you know it – a short time later, an ambulance pulls up. Yes, boys and girls – it’s play time! 😀

It was actually a fairly simple install on this nice, new Stryker cot with this particular convertible (original model Cosco Scenera).  For the record, the only type of conventional carseat that should ever be installed on an ambulance stretcher/cot is a convertible. You need to be able to secure the carseat on the cot using two different beltpaths and this is only possible if the carseat has separate beltpaths for the rear-facing and forward-facing positions. Obviously, this setup is only going to work if the child actually fits in the convertible (and that will vary depending on the child and the specific convertible model being used) and if the child can tolerate being transported in the semi-upright position.

First we reclined the carseat into the position meant for a rear-facing installation. Then they showed me how to raise the head of the cot until we had it flush against the back of the convertible. Next we routed the straps nearest the rear-facing beltpath through that beltpath and routed the straps nearest the forward-facing beltpath through that beltpath. They helped me tighten everything up and Voila! Then we strapped in our “non-critical pediatric patient” for good measure (and for the photo op)! Finally, the guys showed me how to load this particular stretcher into the ambulance and secure it. I have to say, I was really impressed with this particular Stryker Powered Ambulance Cot. The hydraulic system was sweeet!

     

On this particular day, this exercise was all about learning something new in a relaxed and friendly environment. However, in reality, pediatric transport in an ambulance can range from “as safe as possible under difficult circumstances” to “downright scary for no good reason”. Why does it vary so much? Because currently there are no federal guidelines for  pediatric transport in an ambulance. Therefore,  EMS services are free to transport patients in any way they deem appropriate. Personally, I wouldn’t allow my kids to be transported to the hospital in an ambulance unless they really needed to be attended to by a medic on the way there. Unconscious? Not breathing? Massive head trauma? Get him into the ambulance fast and I’m not going to care or worry about how he’s restrained. Broken foot? Get in the car and I’m driving you to the hospital myself.

For more information on the subject see “Crash Protection for Children in Ambulances”: http://www.carseat.org/Resources/Bull_Ambulance.pdf

Babies in Hot Cars: It Can Happen to You

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temperature - hotTemperatures are on the rise, and soon the reports of children left in hot cars will be on the rise, too. I have a lot to say about that, but first I want to share a couple stories.

Sometimes when we’re cleaning up after dinner, my husband will take out the trash. He’ll announce to me that he has removed the trash bag from the garbage can so that I’ll know not to throw anything in there until he has come back inside and replaced it with a new bag.

I’ll hear him and acknowledge him. And then, almost inevitably, I’ll go over to the empty garbage can and throw something in.

I’m not stupid and I’m not trying to be a jerk. It’s not that I didn’t hear him. It’s that when I have something to throw away, my instinct is to do what I always do: Throw it away.

Then there was this one time in college when my friend and I were planning a drive to Arizona for spring break. I had been looking forward to it for months, and it was an easy drive I’d made before: Get onto I-10 (just down the street from my school) and head east for about six hours.

So when the morning of our trip arrived, my friend and I packed up my car and we headed out. Ten minutes later, my friend said, “Um…aren’t we going the wrong way?” Indeed we were. Instead of heading east to Phoenix, we were headed west toward Los Angeles. Why? Because that’s the route I took to drive home every week or two. It’s what I was used to, so it’s what I did without thinking about it, even though I knew to head east to Arizona.

What do trash cans and roadtrip detours have to do with heatstroke? A heck of a lot.

There are caregivers who intentionally leave their children in a hot car, usually because they don’t realize the danger. Sometimes these parents are downright negligent, like when they leave a child to go gambling. That happens in less than 20% of cases, though. Usually when we hear about children dying in hot cars, it’s a tragic instance of the parent forgetting the child was there. Most often that happens when there’s a change in routine.

It’s very easy for people to claim they would never be those parents. They love their children too much to forget them. They are too smart to let something like that happen.

If you think it can’t happen to you, you’re wrong. It can happen to anyone, including very intelligent, diligent, loving, caring parents who are just as human as the rest of us. They don’t forget their children because they don’t love them or don’t care. They forget their children because humans are wired to follow routines. We’re creatures of habit, and habits are hard to break.

When I throw some food scraps into a liner-less trash can or head the wrong way on the freeway, it’s because that’s what I’m used to doing, despite “knowing” I’m supposed to do something different.

It’s the same with the parent whose morning routine usually involves driving straight to the office. That’s what they do and what they’ve done, maybe every weekday for months or years. Then one morning, something changes. Maybe the parent who usually takes the baby to daycare is sick, so the other parent needs to drop him off. The parent knows this, of course. He or she packs up the diaper bag and straps the baby into the car seat. Maybe he or she talks or sings to the baby as the drive starts. But then the baby falls asleep and the parent focuses on driving. And then the routine takes over. The parent goes on autopilot—like we all do, more often than we realize—and he or she instinctively makes the right toward the office instead of the left toward the daycare. And then tragedy strikes.

You can say it’ll never happen to you, but the truth is that it can happen to anyone. I guarantee that every person reading this has had one of “those” moments, where they fully intend to do one thing but then do another out of habit. Usually those moments are nothing more than a slight inconvenience; usually they don’t have dire consequences.

Heat stroke deaths chart - 5.2016

If you’re still feeling smug about being a superior parent, read this piece from the Washington Post, and try to do it without crying.

Over the past few years, as the media has paid more attention to the issue of children dying in hot cars, several inventions have emerged to try to prevent the tragedy from happening. There have been a couple car seats, including the Evenflo Advanced Embrace with SensorSafe, designed with technology built in to remind parents a child is with them. GMC has introduced an alarm that sounds when it senses a child might be in the back seat (due to a back door having been opened and shut before the drive started). Aftermarket chest clips and mats have been created, and people have marketed gadgets like a device that blocks a driver’s exit from the car to remind them that their child is in the back.

Some of these products are more reliable than others. Electronic technology can fail (though Evenflo’s system seems to be more reliable than many other methods). Some (like thick mats or non-approved chest clips) could potentially be dangerous.

The good news is that you don’t need technology or fancy gadgets to help prevent these tragedies, but you should do something. If you have your child in the car—especially if that’s out of the ordinary—put your purse or briefcase in the back seat (preferably on the floor so it’s less likely to fly around). If you don’t use a purse or briefcase, put some other item back there that you’ll need once you get to your destination: Your phone (that will also cut down on the temptation to use it while driving), your coat, one of your shoes.

Talk with your preschool or daycare about procedures for when a child doesn’t show up: Do they call to try to locate the child? If not, see if they will. If your spouse or another person usually handles drop-off, keep in touch with them, too, if possible. If Dad is changing his routine to drop off the kids, Mom can call him around drop-off time to make sure he made it. You and your childcare provider can take Ray Ray’s Pledge.

Don’t intentionally leave children in the car, even if you’re just running into the store for five minutes. In that time, the car could already be heating up to deadly levels. Always keep your parked vehicle locked – even if it’s in your garage. Kids die every year because they get into open cars or trunks and then can’t get out.

If you see a child left alone in a car, immediately call 911. Do not wait for the parent to return because chances are you have no idea how long the child has been in the car already. If the child appears to be in distress, check for unlocked doors or break a window (away from the child) if you need to.

And as you encounter stories of babies accidentally left in cars, take a moment to have some compassion instead of judgement. Everybody makes mistakes. Be thankful if yours aren’t fatal ones.

Takata Airbag Recall: Get Your Car Fixed NOW!

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An attempt to save money takes lives and ultimately costs millions in fines. Are you flipping mad yet? You should be.

Takata logoIn the largest auto recall in history, tens of millions of vehicles have been recalled to have 28.8 million airbags replaced. Takata airbag inflators have injured more than 100 people and killed 11 people: 10 in the U.S. and 1 in Malaysia, with the most recent being a 17 year old Texas girl on March 31. The 17 year old was driving a 2002 Honda Civic and, according to Honda, several recall notices had been sent to the registered owners (they claim not to have received any).

This story has been in the news for years and you’ve probably paid some attention to it just because of its frequency on the news, but with the media’s fixation on the election, disease du jour, ISIS, and so on, a few airbag deaths get left behind in our daily news consumption of dread.

What’s been happening is that the airbag itself isn’t killing drivers: it’s shrapnel from the explosive device used to deploy the airbag. These metal fragments explode out at such a force that they slice right through skin, eyes, arteries, and even spinal columns. This is happening when the airbags deploy in minor crashes, collisions from which the victims should be walking away.

Before you run out and disconnect your airbags (and I know some of you will), these explosive devices, or inflators, are needed in order to deploy the airbag. In fact, they’re in other safety devices throughout your vehicle and activate in crashes, but we’re focusing on airbags here. When the airbag sensors detect a crash, the inflators ignite, starting a chemical reaction that fills the airbag with gas. It sounds crazy scary, but airbags have saved thousands of lives. Between 2010 and 2013 (the latest year from which we have data), 9,554 lives were saved by frontal airbags. Many thousands upon thousands more lives have been saved since the frontal airbag was introduced in the ‘70s.

Background

Problems with exploding airbags initially cropped up back in 2004 in Alabama when a Honda Accord airbag exploded, injuring its driver. Because it was the first incident, both Honda and Takata chalked it up to being an anomaly and moved on without issuing a recall. According to the New York Times, Honda did report the incident to NHTSA, but didn’t elaborate in the report that it was an airbag rupture. Then again in 2007, three more ruptures were reported to Honda, and again, Honda did not elaborate in their reports to NHTSA that the airbags were exploding. In 2007, Honda told Takata of the ruptures and Takata went to work to find the cause: manufacturing problems at their Mexican plant. However, the ruptures continued and after more testing, Takata linked the problem to manufacturing problems at their Washington state factory.

Recalls began in 2008 and initially only driver’s side airbag inflators were recalled, but passenger airbag inflators were added as those started to rupture as well. Then in August 2015, side airbag inflators came under inspection when a Volkswagen Tiguan’s seat mounted side airbags ruptured after a collision with a deer. GM also reported a rupture to NHTSA. This “SSI-20” inflator is found in Volkswagen and GM vehicles and has been recalled in those vehicles too.

Takata Timeline

Evenflo Transitions 3-in-1 Combination Seat Recall

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Evenflo Transitions - Maleah pinkA recall has been issued for the Evenflo Transitions 3-in-1 combination seat. No injuries have been reported, but Evenflo has identified a potential safety concern and voluntarily issued a recall. Some children are able to reach the harness adjuster mechanism, allowing them to loosen the harness while they’re in the seat. Evenflo has developed a remedy kit that should eliminate a child’s access and activation of the central front adjuster (CFA) mechanism.

This recall includes model numbers 34411686, 34411695, and 34411029, all manufactured prior to January 29, 2016. Owners should be contacted by mail if they registered their seats, or consumers can submit a form to Evenflo or call them at 1-800-233-5921.

Owners of the recalled seats will receive a kit that includes a replacement seat cushion, a new harness adjuster assembly, and instructions. You can view a video of how to replace the adjuster here. The video is very helpful because it is a detailed process and you want to make sure you’ve done it correctly.

Evenflo transitions - recall CFA

If you own a Transitions and are using it in harnessed mode, you have a couple options while you wait for your fix kit to arrive:

If your child has not shown an interest in loosening it, or cannot reach the central front adjuster (CFA) with the harness straps tightened properly, you can monitor the situation while continuing to use the seat.

Evenflo Transitions - 4 yo 2If your child is loosening the harness, the first thing you should do is the Pinch Test to double check that the harness straps are tight enough. It’s a lot easier to reach the CFA if the harness isn’t properly snug. A snug harness has no visible slack and you cannot pinch any webbing in the straps above the chest clip near the collar bone. In our experience, most younger kids can’t manipulate the CFA if the harness is appropriately snug because their arms just aren’t long enough. Older kids with longer arms are more likely to be able to reach the CFA and unlock it. If the harness is snug but the child can still reach the CFA and the behavior persists, Evenflo suggests using the seat in booster mode (if the child is at least 40 pounds and 43.3 inches tall) until the remedy kit arrives. If the child is under that height/weight and playing with the adjuster, Evenflo recommends discontinuing use of the seat until the remedy kit is applied.

Note: This recall is for the Evenflo Transitions, not to be confused with the Graco Tranzitions which is a completely different carseat.