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Studies examine alcohol's influence on preventable child auto deaths

Two studies in the Journal of the American Medical Association offer new findings about the ways children are affected by drinking drivers and recommend actions to reduce child injury and death associated with alcohol impaired drivers.

Looking at the association between drivers' alcohol use and mortality for child passengers, pedestrians, and bicyclists, one study reports that approximately 550 children died in the US as the result of alcohol related motor vehicle crashes during each of the years studied. The authors recommend clinical interventions and policy initiatives, particularly for teen drivers, because “a disproportionate share of the deaths was associated with drivers younger than 21 years” (Margolis LH. Alcohol and motor vehicle-related deaths of children as passengers, pedestrians, and bicyclists.

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The other study reported what the injury community has long known: that motor vehicle related injury is the leading cause of death to children and young people ages 1–24, with 24% of these deaths involving alcohol. But further, the majority of these deaths occurred to children who were passengers of drinking drivers and who were unrestrained by seat belts or other restraining devices. The authors determined that “among drivers involved in a crash in which their child passenger died, drinking drivers were over six times more likely than non-drinking drivers to have prior convictions for driving while impaired” (Quinlan KP. Characteristics of child passenger deaths and injuries involving drinking drivers.

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An accompanying editorial urges strong action to reduce the number of alcohol related deaths in the US, calling for federal law to send a message of zero tolerance to every driver by making it illegal to drive with a blood alcohol concentration above 0.02%. The author writes that anything other than a zero tolerance policy amounts to “tacit acceptance of thousands of preventable deaths each year” (Li G. Child injuries and fatalities from alcohol-related motor vehicle crashes: call for a zero-tolerance policy.

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Australian recall web site

In these columns recently, I sought information on other web sites that contain product recall data. Peter Brian Williams of the Consumer Affairs Division of the Treasury has told me about the Australian government site, recalls.consumer.gov.au. It contains the product recall information about voluntary safety related product recalls notified to the Australian Minister for Financial Services and Regulation. The information contained in this site is sufficient to enable any person to identify the product, the problem, and what to do—the sort of data you would expect to find in a notice placed in an Australian newspaper. Consumer Affairs Division promotes the key elements of consumer sovereignty—protection, choice, information, and redress—including product safety and product information standards.

Minibus deaths in Canada

The death of eight preschoolers on an outing with their day care centre in Quebec in April shocked Canadians into learning about the benefits of booster seats. All the children, ages 2–5, were in one minivan, on their way to make maple syrup, a Quebec spring ritual, when their teacher lost control of the van and collided with an oncoming vehicle. Two other children survived. All were reportedly wearing seat belts, but none had booster seats. Booster seats are not required by law anywhere in Canada. After the crash, the demand for information on child passenger safety soared at centres such as Safe Kids Canada. Quebec's public automobile insurance agency, Societe de l'assurance automobile du Quebec, was so swamped with car seat inquiries that it placed a full page ad in all major newspapers in Quebec and nearby Ottawa. The ads outlined how to use the infant, forward facing, and booster seats.

Meanwhile, across the border in the US, a major auto maker launched the “Boost America” program. Ford will distribute one million booster seats in the first year of this program, half to families in need and the other half through a voucher system to Ford US customers. The program is targeted at children aged 4–8 who are in what Ford refers to as the “child safety gap”—their bodies are too small to wear adult safety belts. No indications yet whether Canada or other countries will benefit from this corporate good will.

Report highlights US federal efforts to eliminate lead poisoning

A report issued by a presidential task force outlines the inter-related activities of various federal agencies seeking to eliminate childhood lead poisoning. Nearly one million children in the US have “blood lead levels high enough to impair their ability to think, concentrate and learn”. The report highlights key recommendations for eliminating lead poisoning in the US, including:

  • Act before children are poisoned by targeting federal grants for low income housing; promote education for universal lead safe painting and renovation/maintenance work practices; and ensure compliance with and enforcement of lead paint laws.

  • Identify and care for lead poisoned children by improving early intervention through expanding blood lead screening and follow up services for at-risk children.

  • Conduct research to help improve prevention strategies and quantify the ways in which children are exposed to lead.

  • Measure progress and refine lead poisoning prevention strategies by implementing monitoring and surveillance systems.

The report Eliminating childhood lead poisoning: A federal strategy targeting lead paint hazards can be found atwww.hud.gov/lea/leahome.html.

New report on safety of pedestrian and cyclists

The European Transport and Safety Council has published a new report The safety of pedestrians and cyclists in urban areas prepared by independent experts from across Europe. Its conclusions demonstrate how dangerous it has become to walk or ride a bicycle in towns even though it is healthy and environmentally friendly. It regards the legislation requiring safer car fronts for pedestrians and pedal cyclists on new car designs as very important in improving road safety and calls for EU legislation to bring forward mandatory fitment requirements for safer car fronts. It also recommends the introduction of the EU Whole Vehicle Type Approval for cycles, incorporating a range of technical safety criteria.

Preventing school injuries

A new publication Preventing School Injuries: A Comprehensive Guide for School Administrators, Teachers, and Staff by Marc Posner, published by Rutgers University Press, takes a fresh look at school injuries. Although nearly 25% of childhood injuries in the US occur within the school environment (in the school building, athletic fields, or on class trips), few schools or districts have explicit injury prevention programs. Other than routinely cautioning students to wear helmets while biking or skating, most schools respond to injuries on an ad hoc basis, and only after the damage has been done. The book examines how and why students are injured, both unintentionally and through violence or suicide. The author provides the motivation, knowledge, and tools needed to create and implement injury prevention activities. Readers will learn how to prepare for, and respond to those injuries that do occur, how to provide a quick, efficient, and effective emergency response to minimize the physical and emotional effects of the injury, and how to maintain trust between the school, students, and parents.

Changes at ANEC

Harry Harbottle, chairman of the ANEC Child Safety Working Group and its representative on the European standards playground technical committee for many years has moved on from his post with Leicester City Council and hence stood down from his ANEC roles at the end of March.

Playground safety

The (US) National Program for Playground Safety recently completed a two year study of the safety of the nation's playgrounds. It concluded that America's children are at potential risk while at play, particularly in regard to supervision and age appropriate design. The study examined 23 criteria within four overall areas including: Supervision, Age appropriateness, Fall surfacing, and Equipment maintenance (S-A-F-E). The state report cards can be found at www.uni.edu/playground/report.html.

Publications disappear

The immensely valuable current awareness bulletin, Child Safety News, from the Child Safety Centre at Melbourne's Royal Children's Hospital has ceased publication, largely for economic reasons. Also, the UK's Child Accident Prevention Trust newsletter, Child Safety Review, has been replaced by Focus on Injury, a news sheet that will focus on specific aspects of unintentional childhood injury rather than the broad overview of the subject of its predecessor. For details of Focus on Injury, contact Mike Hayes (contact details at end).

Ford Motor Company child passenger safety initiatives

Ford Motor Company CEO Jack Nasser has called for a “coordinated national network of child safety seat fitting stations to ensure that no child in America rides unprotected because mom or dad do not know how to install a safety seat or cannot afford one”. Ford is seeking partnerships with states to augment their child passenger safety efforts, including fitting stations and grants for:

  • Expanding the local pool of trained child safety seat instructors and technicians.

  • Increasing opportunities for parents and caregivers to attend fitting clinics.

  • Expanding efforts to reach low income populations and families in rural areas.

  • Education to motivate parents and children to use safety seats and to use them correctly.

Ford has also launched a “Boost America” program, mentioned earlier, designed to protect the “forgotten child”, those kids 4–8 years old, who often ride in motor vehicles either unprotected, or use adult safety belts that do not fit them properly. A key component to the program is a financial commitment to provide free booster seats for families that cannot afford to buy one. Ford expects to give 500 000 seats to families in need during the first year of the campaign. Volvo will also participate in the program. In addition, The Hertz car rental corporation will be involved by providing information about booster seats and encouraging their use at its car rental locations across the country. The Boost America program web site is www.boostamerica.org.

Child safety issues at ANEC

Among the topics of ongoing concern to ANEC, the body that coordinates consumer representation in European standards work are the lack of participation from consumer representatives at the ISO meetings on toys, baby swim seats, bath seats, soothers, trampolines, and drawstrings on children's clothes. The ANEC Secretariat has been asked to set up a specialist group drawn from its working groups on child safety, domestic appliances, and machinery to see what approach it should take on fairground equipment.

The CEN Technical Board has accepted the mandate M/293, written by ANEC in 1998, for a “guidance document in the field of safety of consumers and children—child safety”.

Aboriginal death rate variations in Canada

Aboriginal children in Manitoba, Canada, are nine times more likely to die of injury than non-First Nations children, reports the province's Paediatric Death Review Committee of the College of Physicians and Surgeons of Manitoba. Among teenagers, 10 of 24 deaths from injury in 1997 were First Nations teens. That is 42% of the deaths occurring in a group which makes up just 11% of the province's teenage population. This pattern is similar across Canada; the physician group recommends that injury and suicide prevention be targeted for northern and First Nations communities where this inequity persists.

Car makers ticked off

The chairman of the US National Transportation Safety Board criticized six automakers at the annual Lifesavers Conference for failing to establish programs to make sure children are properly secured in car safety seats. Chairman Jim Hall scolded Volvo, Mitsubishi, Kia, Subaru, Suzuki and Isuzu in a speech at this national highway safety meeting, saying the companies refused to set up “fitting stations” where parents could get advice on installing the seats.

Editor's note: Anara Guard who contributed this item queries whether it is coincidence that none of these are US automakers?

Trampoline injuries

A comprehensive overview of trampoline injuries, including a review of the literature, is provided in the March 2000 issue of Hazard, the publication of the Victoria Injury Surveillance System, updating the earlier look at the subject in 1992. Recent issues of Hazard, along with other information and publications of the Monash University Accident Research Centre can be found at www.general.monash.edu.au/muarc.

Mattress risks

The US Consumer Product Safety Commission (CPSC) has issued warnings on several companies that claim to offer baby mattresses that prevent sudden infant death syndrome via their web sites. The companies in question claim that parents can even put the babies to sleep on their stomachs as long as one uses their products.

New fitness to drive publication

Determining Medical Fitness to Drive: A Guide for Physicians is a collection of guidelines and expert opinions designed to help physicians assess their patients' medical fitness to drive. The guide discusses the impact of a variety of medical conditions (for example alcohol and drugs, cardiovascular disease, epilepsy, vision, etc) on driving, and also includes a chapter on medicolegal issues. Physicians, as well as the provincial and territorial ministries responsible for the licensing of drivers across Canada, have found this publication to be a useful resource for contributing to the safety of our road system. The first edition of the guide was published in 1977, and has undergone six revisions. Approximately 31 000 medically unfit drivers have their driving privileges suspended in each year, making Canadian roads safer, and reducing highway accidents, personal injuries, and fatalities. Further information: Carol Rochefort, Canadian Medical Association, Research Directorate, 1867 Alta Vista Drive, Ottawa, Ontario K1G 3Y6, Canada, fax: +1 613 731 1779, email: rochec{at}cma.ca).

Firearms agreement

Smith and Wesson, the largest manufacturer of guns in the US, came to an agreement with the Clinton Administration in March, accepting certain restrictions on sales and distribution of their firearms, as well as the uniform use of child safety locks. The agreement is intended to help protect Smith and Wesson from lawsuits filed against gun manufacturers by 29 cities and counties. Gun makers Glock and Browning announced that they would not agree to similar accords.

Australian/New Zealand shopping trolley update

Injury surveillance data shows that falls from shopping trolleys are among the leading causes of head injuries to young children. In January 1999, Standards Australia published a new standard for shopping trolleys (AS/NZ 3847.1:1999) which includes a requirement for child restraints. According to the March issue of Hazard, while the standard is not mandatory, there appears to be increasing industry support for the introduction of safety restraints in shopping trolleys.

Safety for home offices

After an initial flap in the press, the US Occupational Safety and Health Administration has affirmed that they will not be inspecting home offices for violations of health and safety standards, nor do they expect employers to attempt to conduct home inspections.

School bus safety consultation

School bus safety was the subject of a travelling consultation by Transport Canada in the first half of 2000. Because of the large number of public inquiries as to why school buses are not required to have seat belts, the consultation process was mandated to consider this topic. However, there is good (although not total) consensus among the industry, school and safety communities that the “compartmentalization” design of school buses adequately protects children and that seat belts are potentially a hazard in that environment. That said, there is concern about the increasing number of very young children (3–4 years old) who are riding in the big yellow buses, and that is the subject of research now underway at Transport Canada. Other priority topics were the behaviour of other drivers and the effectiveness of devices to prevent children from being struck outside the bus. School bus passengers in Canada suffer an average of one fatality a year, compared with six or seven deaths among children outside school buses; and that can be compared to some 3000 motor vehicle passenger deaths overall. For more information, including consultation reports, see www.tc.gc.ca/roadsafety.

Injury data via the web

The Centers for Disease Control and Prevention has announced a new interactive system that provides customized injury related mortality data via the internet. WISQARS (Web based Injury Statistics Query and Reporting System) can produce mortality data from 1981–97 by year, age, race, sex, Hispanic origin, and state. You can request reports by five year age ranges or define your own. Injury mortality reports can also be ordered by these specific definitions as well as other parameters. For example, you can request a report for a mechanism/cause and manner/intent in a specific state by sex and race. However, you cannot search by specific ICD-9 codes; these are available through the pre-existing WONDER system. Visit www.cdc.gov/ncipc/osp/wisqars for more details and access.

Hospital bed warning

The children's hospital in Winnipeg recently had a near miss of a child becoming trapped in a bed and circulated a warning to hospitals across Canada. Winnipeg staff are taking steps to create temporary entrapment protection, but recognise that the ultimate solution is to replace all hospital beds with a safer model. Further information: Professor Michael Moffatt, fax: +1 204 787 4807, email: mmoffatt{at}hsc.mb.ca.

Hazardous products via auction web sites

The CPSC has taken steps to make it easier for consumers to protect themselves from dangerous products being sold online. Online auction giants, eBay and Amazon.com Auctions, will link to CPSC's web site and prominently post guidance for consumers to help them get information about recalled products. The focus of the auction site initiative is children's products, including toys, tools, exercise equipment, and household items.

Psychosocial impact of childhood agricultural injuries

The spring 2000 newsletter from the National Children's Center for Rural and Agricultural Health and Safety outlined a pilot study of young people who had suffered serious injury. The victims and their families were interviewed to look at the psychosocial outcomes of the events. The availability of the report Economic and Psychosocial Impacts of Youth Farm Injuries can be obtained from the center (fax: +1 715 389 4996) or its web site, research.marshfieldclinic.org/children, which also contains a large amount of information about the center and its publications.

Recall of infant swings

Pennsylvania company Graco Children's Products has provided new safety restraints for about seven million infant swings after six deaths and many fractures, concussions, and entrapments. The injuries occurred when parts were missing or the restraints were not used and infants slid down the swings' seats, becoming tangled in the restraints. The restraint systems on the older swings consisted of a waist belt only and a hinged or removable tray, which served as a restraint. Graco has offered a free, new safety restraint, including a buckle that assures the crotch strap is used each time the waist belt is buckled, so that infants are securely fastened into the swings.

Lighter sentence!

A Tennessee man has been sentenced to two years' imprisonment for making a false statement to a CPSC investigator about removing child resistant mechanisms from disposable cigarette lighters. The man distributed cigarette lighters to convenience stores and other distributors across the US.

Fit for a Kid program

Working with Fisher-Price and the National Safety Council, DaimlerChrysler is the only automaker that provides free child safety seat inspections at permanent locations throughout the US with the Fit for a Kid program. There are more than 400 dealers across the country who offer this service. Fit for a Kid will be available nationally in 1000 dealerships by the end of the year 2000, creating the capacity to inspect an estimated 800 000 child safety seats a year. In January 1999, the National Transportation Safety Board called on car makers and others to create a national system of permanent child safety seat fitting stations. DaimlerChrysler is the only company to meet that challenge. Inspectors undergo a 32 hour National Highway Traffic Safety Administration training course and are certified by the American Automobile Association.

Child passenger safety web site

The National Child Passenger Safety Board now has its own web site, www.usaaedfoundation.org/ncpsb/, which will allow advocates and parents to obtain information relating to child passenger safety. Web site construction and development will be an on-going process. The USAA Educational Foundation has donated time and expertise to both the development and maintenance of the web site. To submit items to be included on this web site (such as information on child passenger workshops or classes) please review the information submission criteria in the listings. Further information: Steve Anderson, National Child Passenger Safety Board, fax: +1 210 498 9590, email: steve.anderson{at}usaa.com.

Study on pool alarm reliability

Many owners of domestic swimming pools use pool alarms designed to sound a warning if a child falls into the water. Sales of pool alarms have doubled in the US since 1994. A study released in May by the CPSC tested the performance of various pool alarm systems. The CPSC study looked at three types of alarms: floating alarms that detect waves on the surface; underwater alarms that detect waves under the surface; and a wristband alarm, which is worn by a child, and alarms when exposed to water. The CPSC's tests showed that underwater alarms performed the most consistently. Underwater sensors alarm more consistently and are less likely to false alarm. When a test object, intended to simulate the weight of a small child, was pushed into a pool, the underwater sensors detected it most reliably. The underwater alarms also can be used in conjunction with pool covers, whereas the surface alarms cannot. The wristband device alarmed well but can be impractical because the caregiver must remember to put it on the child, and it alarms when exposed to any water source, such as tap water. “Pool alarms can be used as an extra safeguard, but should never be relied upon as the only line of defense in preventing a child from drowning in your pool”, said CPSC Chairman Ann Brown. “The keys to preventing these tragedies are placing barriers around your pool, closely supervising your child and being prepared in case of an emergency”. The CPSC offers three free publications consumers can use to help prevent child drowning: Safety Barrier Guidelines for Pools, How to Plan for the Unexpected and Guidelines for Entrapment Hazards: Making Pools and Spas Safer. Copies of these publications can be obtained on the CPSC's web site at www.cpsc.gov, or by writing to “Pool Safety”, CPSC, Washington, DC, 20207, USA.

Adult seat belts do not keep children safe

Researchers at the Children's Hospital of Philadelphia have found that young children who are placed in adult seat belts rather than car seats or booster seats are four times more likely to suffer head, brain and other devastating injuries, according to a study in the June issue of Pediatrics. The research is the first to measure the danger of premature graduation of children into seat belts. “In our study we found that nearly 40% of 2 to 5 year old children are being placed in adult seat belts rather than car or booster seats, dramatically increasing their risk of injury in a crash”, says Flaura Koplin Winston, lead author of the Pediatrics paper and principal investigator of the Partners for Child Passenger Safety study. Based on the study of 13 853 children between the ages of 2 and 5 in crashes reported to State Farm Insurance Companies, nearly 10% suffered some type of injury. “Children in seat belts suffered injuries to all parts of their bodies”, says Dennis Durbin, co-principal investigator of the study. “Of particular concern to us was the large number of children with injuries to the head and brain. As pediatricians, we worry most about these injuries because of their potential for long term consequences”, said Dr Durbin. In addition, children in seat belts suffered the only reported cases of abdominal injuries, including intestinal, liver, and spleen injuries. The study found that 5% of 2 year olds and 16% of 3 year olds used adult seat belts, and they were the most common form of restraint for all children by age 4. Current recommendations for optimal restraint of young children specify car seats for children less than 40 pounds and belt positioning booster seats for children over 40 pounds until the adult seat belt fits properly. Further information: Maria Stearns of Children's Hospital of Philadelphia, +1 215 590 4091, email: stearnsm{at}email.chop.edu.

Disaster planning

Readers interested in those aspects of injury control dedicated to disaster relief and emergency preparedness may want to subscribe to Disasters: Preparedness and Mitigation in the Americas, a newsletter issued by PAHO, the regional office for the Americas of the World Health Organization. The newsletter is published every two months in English and in Spanish. Further information: The Editor, Disasters PAHO, 525 23rd Street NW, Washington, DC 20037, USA, disaster-newsletter{at}paho.org, or download the newsletter from their web site: www.paho.org/english/PED/disasters-no79-0100.pdf.

105 000 frogs and lizards recalled

Following a report of a 3 year old inhaling the tongue of a Bug Zapper, a toy given away at fast food restaurants across the US, the manufacturers are recalling all 105 000 of them as they present a choking and aspiration hazard. The Bug Zapper toy comes in two different styles: a frog and a lizard. When the toy is squeezed, the balloon tongue of the toy rolls out from the mouth about 2 inches.

Pedestrian problems in Dublin

Speaking at the announcement of the collaborative project between the police, the four Dublin authorities and the Eastern Regional Health Authority, the Assistant Garda Commissioner, Mr Jim McHugh, stressed that Ireland had the third highest pedestrian fatality rate in Europe. Pedestrians were killed in 26.7% of accidents around the State, compared with 46% of accidents in Dublin. The European average is 16%. The Deputy Lord Mayor of Dublin, Mr Brendan Carr, admitted the four week advertising campaign might shock some with slogans like “Some drivers won't break. You will”, showing a broken limb. Carelessness by pedestrians was the major factor in 23% of all accidents. An educational media and poster campaign urges pedestrians to “Look Left, Look Right, Look Out”. The most common form of carelessness was children dashing out on to the road, and wearing dark clothing at night was a factor in 5% of pedestrian errors in fatal accidents, as was taking medication, primarily by the elderly.

Regional correspondent moves on

Regular contributor to these columns, Anara Guard, has moved from the Children's Safety Network Injury and Violence Prevention Center to Safetytips.com, an internet startup company, as Director of Safety Information. Anara can be contacted at aguard{at}safetytip.com, tel: +1 781 478 2126, fax: +1 781 478 2525. She continues to be a regional correspondent of Injury Prevention and has taken over the popular Splinters & Fragments column.

Acknowledgments

Contributors to these News and Notes include Anara Guard, Barry Pless, Jan Shield, and Amy Zierler. Michael Hayes has edited the contributions. Items for the March 2001 issue should be sent to Michael Hayes at the Child Accident Prevention Trust, 18–20 Farringdon Lane, London EC1R 3HA, UK (fax: +44 (0)20 7608 3674, email: mh{at}capt.demon.co.uk) by 1 December 2000.

Safe Kids Canada issues playground alert

In preparation for the focus on playground safety in this year's Safe Kids Week, Safe Kids Canada commissioned a survey that revealed that two thirds of parents were more concerned about harm from strangers or bullying than those associated with unsafe playgrounds. The basis for the recommendations made are those reported in various articles in this journal: better equipment and shock absorbing surfacing. In Canada, approximately 25 000 children are treated in emergency departments each year for injuries at this locale. The survey reveals a low level of awareness of the dangers in most playgrounds.

Biased reporting?

Several papers have observed that the media often report injuries in what may be seen by some as a biased fashion. A recent example made me angry and frustrated. It was from the Irish Times, 3 June 2000, titled: “Rates of pedestrian deaths is high in Dublin”. The writer is Clare Murphy. After stating that almost half of all road traffic deaths in Dublin last year were pedestrians, Murphy notes that most of the 27 pedestrians killed were under the age of 10 or over 55. Fifteen of those killed were within 100 metres of a controlled crossing, as were one third of the 58 pedestrians seriously injured. The writer adds that “Alcohol was a factor in a quarter of the deaths and 16 per cent of the serious injuries”.

So far so good. Then comes the rub: “Carelessness by pedestrians was the major factor in 23 per cent of all accidents”. To bolster this misleading statistic, the piece includes a reminder that “An educational media and poster campaign . . . urges pedestrians to `Look Left, Look Right, Look Out'”. I can't quarrel with the statistics (though they are often based on driver's possibly self serving reports), but why not emphasise the fact that 77% were due to carelessness, or worse, by drivers?

Murphy goes on to say: “The most common form of carelessness was children dashing out on to the road . . .”. In light of my point above, this is shockingly misleading. To state that “Six of the pedestrian deaths were due to driver error, with 13 seriously injured as a result of driver error” prompts the reader to conclude that all the others were the pedestrian's fault.

Murphy's piece ends with a comment from the Deputy Lord Mayor of Dublin, Mr Brendan Carr. He noted that a four week advertising campaign might shock some by the use of slogans like “Some drivers won't break. You will” and then showing a broken limb. For me, that was the last straw: blaming the victim yet again!

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