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

Booster Seat Use in San DiegoBarbara M. Stepanski, MPH

Leslie Upledger Ray, MA, MPPAIsaac Cain, BSLouise Nichols

David ThompsonCindy Hearrell, RN

Roxanne Hoffman, M.EdAlan Smith, MPH, PhD(C)

County of San Diego Health and Human Services Agency,

Division of Emergency Medical Services

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


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


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


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)


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Shield Booster Seats


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Belt Positioning Boosters


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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

0 200 400 600 800 1000 1200

Fall

Auto/ Trk Pass

MV vs Ped

Blunt Trauma

Cut/ Pierce

MV vs Pcycle

Fire/ Hot Sub

Note: Chart does not include medical chief complaints.

County of San Diego, Health & Human Services Agency EMS Prehospital Data FY 99/00.


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


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


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Results - Inspection Logistics

• 41 inspections

• 18 locations

• 9 communities (SRAs)

• 963 seat positions with determined

seat types


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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)


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


EMS

Results – Age of Children in Booster Seats

2

12

24

79

20 0 0

1

0

5

10

15

20

25

2 3 4 5 6 7 8 9 10 11

AgeNote: There were 19 unknown ages

The County of San Diego Health and Human Services Agency Division of Emergency Medical Services


EMS

Results - Age and Weight

AgeThe County of San Diego Health and Human Services Agency Division of Emergency Medical Services

0

2

4

6

8

10

12

14

2 3 4 5 6 7 11

<40 lbs

40-44 lbs

45-49 lbs

50-54 lbs

55-59 lbs

60+ lbs

# of children


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Results - Inspection Criteria for Belt Positioning Boosters

83.9

97.8

82.6

0

10

20

30

40

50

60

70

80

90

100

Lap/shoulder belt

positioning

Within height

/weight range

Safety belt

routed correctly

Percent that met criteria



EMS

Results - Inspection Criteria for Shield Booster Seats

60

70

40

100

37.5 33.3

44.4

0

10

20

30

40

50

60

70

80

90

100

shiel

d sn

ug ag

ainst

child

within

ht &

wt r

ange

only

lap b

elts a

vaila

ble

saf e

ty be

lt ro

uted

corr

ectly

seat

tigh

t in v

ehicl

e

lockin

g clip

used

corr

ect ly

saf e

ty be

lt loc

ked

Percent that met criteria

***No longer recommended, no upper body protection***



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


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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


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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!


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AcknowledgementsThe 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

[email protected]

Documents

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