emergency nurse urges booster seat advocacy after encounter at traumatic crash scene
TRANSCRIPT
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Author: Pamela Smith, RN, BSN, Charleston, SC
Section Editor: Gail Pisarcik Lenehan, RN, EdD, FAAN
Pamela Smith is Clinical Nurse Leader, Childrens Emergency Services,Medical University of South Carolina.
For correspondence, write: Pamela Smith, RN, BSN; E-mail: [email protected].
J Emerg Nurs 2005;31:185-7.
0099-1767/$30.00
Copyright n 2005 by the Emergency Nurses Association.doi: 10.1016/j.jen.2004.11.010
Emergency N
Booster Seat Advocacy
Traumatic C
I N J U R Y P R E V E N T I O NApril 2005 31:2As I ran from my car, my first thought was to stabilize
the C-spine of the child being held. I encouraged the
bystander to place the child on the ground and showedMore than 2500 children died in 2003 as a
result of motor vehicle crashes, which are the
leading cause of death of children ages 4 to
14 years. An additional 28,000 children had incapacitating
injuries as a result of car crashes.1 Although advocates have
promoted booster seat use to protect children,2 booster
seat use remains low. According to a study conducted in
2000, 86% of children who should be restrained in car
seats or belt-positioning booster seats are inappropriately
placed in seat belts.3
My journey home from work includes a stretch of a
2-lane historical road that usually provides a pleasant ride.
On this day, however, as I came upon multiple cars pulled
over to the side, the journey became a very different, life-
changing experience. As I slowed, I saw a limp child in the
arms of an adult and a sport-utility vehicle (SUV) with its
rear against a tree. What I did not see was the presence of
emergency providers, and I realized I was the first provider
on the scene.
urse Urges
After Encounter at
rash Scenehim how to hold the childs head and neck properly. The
child was pale and had obvious seat belt marks across his
abdomen. I quickly ran to the vehicle to assess the number
of casualties and found the father of the child entrapped in
the drivers seat with the steering wheel pushed back into
his lap. He was pale, diaphoretic, and complaining of pain
in both legs and hips. When I returned to the child, he
began to retch. As we rolled him to his side, I noticed an
obvious deformity of his lumbar spine.
I realized I had 2 severely injured patients and few
resources at my immediate disposal. I was wishing that we
JOURNAL OF EMERGENCY NURSING 185
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extremities. He was also beginning to have intermittent
peri ally
resp s. I
pray old
the f ly,
as w en-
ter w r. I
was ew
Sou ghs
mor ght
agai the
seat lt.5
Wit ilo-
I N J U R Y P R E V E N T I O N / S m i t hit put him that much closer to the trauma center and
more definitive treatment.
I later learned the details of the accident. My patient
had been restrained in the second seat of the SUV with
just a lap belt. The father was speeding on the wet roads
when he lost control and hit a tree on the passenger side.
After the initial impact, the speed and velocity of the
SUV caused it to go back across the road and hit another
tree. The father suffered multiple lower extremity
fractures and a pelvic fracture. The 5-year old boy had
a complete spinal cord injury at L2 as well as an injury tohis
186ods with gasping respirations. He was minim
onsive, other than to answer yes and no question
ed that the f light team would land quickly. I t
f light team on arrival that both patients needed to
e were more than 30 minutes from the trauma c
ithout any traffic congestion, and this was rush hou
happy to turn the child over to the f light team. I knwere in the controlled environment of the trauma center!
When the first sheriff s car arrived, I immediately asked
him to have a helicopter deployed to our location. The
dispatcher was hesitant to take the word of a bystander
until the officer became insistent that he had a trauma
nurse on scene asking for helicopter support. The county
EMS supervisor arrived and let me know the nearest
paramedic truck was 20 minutes away. We decided that I
would stay with the child, and she went to the father to
begin needed extrication and interventions.
As I slowed, I saw a limp child in thearms of an adult, and a sport-utilityvehicle (SUV) with its rear against atree. . . . .and I realized I was the firstprovider on the scene.
The fire department had supplied oxygen equipment.
My next priority was to establish IV access and begin to
reverse the shock state of this vulnerable little boy, who had
thready pulses and a distal capillary refill of 5 to 6 seconds.
By the time the paramedic unit arrived, the first f luid
bolus was in, but the child continued to look pale, his
abdomen was firm, and he had no movement of his lowermesenteric vessels. The family owned a booster seat,
Jgrams, this child did not meet either of these criteria.
This scenario is not unique. The National Highway
Traffic Safety Administration (NHTSA) recently revealed
findings from a 2003 national random survey of 6000 per-
sons. About 85% of the parents and caregivers of young
children had heard of booster seats. Among those who
were aware of booster seats, 60% said they only used them
at some time with their children.6
Emergency nurses should urge policy makers at local,
state, and national levels to enact and fund legislation
and education regarding child restraint in automobiles.
NHTSA recommends the adoption of comprehensive
child occupant protection laws to cover all children up to
age 16 in all seating positions and encourages the en-
forcement of all child occupant protection laws, in-
cluding penalties. Further information can be found at
the NHTSA Web site at www.nhtsa.dot.gov. ENA also
provides training opportunities to enable emergency
nurses to teach and advocate in the community through
the Emergency Nurses Care (ENCARE) program (www.
ena.org).
Among those who were aware of boosterseats, 60% said they only used themat some time with their children.
ED staff members need to be aware of the child
restraint laws in their state and use every opportunity
possible to provide education to our parents and children.
Increasing funding for education and continuing to lobby
for strict policies and enforcement of legislation related to
child restraint in cars could help to decrease the incidenceof th
OURth Carolina, if a child less than 6 years of age wei
e than 80 pounds, or can sit with his back strai
nst the seat back cushion with his knees bent over
edge, then the child may use an adult safety be
h his small stature and estimated weight of 25 kbut it was in the third row of the SUV and was not used
to restrain the child.
The use of a lap belt as the only method of restraint in
small children has been associated with injuries such as
severe f lexion distraction injuries of the lumbar spine,
abdominal wall bruising, and hollow viscous injury.4 Inese very devastating injuries.
NAL OF EMERGENCY NURSING 31:2 April 2005
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When I thought about whether my future in this
endeavor would include teaching about booster seats in
the community, all I needed to do was to remember those
big, brown eyes looking up at me, and my decision was
very easy.
Acknowledgment
The author gratefully acknowledges the guidance and edits of JENSection Editor Angela Hackenschmidt, RN, MS, CEN
REFERENCES
1. National Highway Traffic Safety Administration. Traffic SafetyFacts 2003: Children. Available at: URL: http://www-nrd.nhtsa.
seats and reduction in risk of injury among children in vehicle
I N J U R Y P R E V E N T I O N / S m i t hcrashes. JAMA 2003;289:2835-40.
5. Car seat regulations for zone 4 website. Available at: URL: http://www.inventiveparent.com/lawsreg4.htm. Accessed October 15, 2004.
6. Parents/caregivers report 21 percent of children ages 4 through8 using booster seats. Available at: URL: http://www.nhtsa.dot.gov/people/injury/traffic_tech/2004/TrafficTech294/index.html .Accessed October 15, 2004.
Contributions for this column are welcomed and encouraged.Submissions should be sent to:
Gail Pisarcik Lenehan, RN, EdD, FAANc/o Managing Editor, 77 Rolling Ridge Rd, Amherst, MA 01002
800 900-9659, ext 4044 . [email protected]/pdf/nrd-30/NCSA/TSFAnn/TSF2003EarlyEdition.pdf.Accessed October 15, 2004.
2. Winston F, Durbin D. BUCKLE UP! is not enough: enhancingprotection of the restrained child. JAMA 1999;281:2070-2.
3. Winston FK, Durbin DR, Kallan MJ, Moll EK. The danger ofpremature graduation to seat belts for young children. Pediatrics2000;105:1179-83.
4. Durbin DR, Elliot MR, Winston FK. Belt-positioning boosterApril 2005 31:2 JOURNAL OF EMERGENCY NURSING 187
Emergency Nurse Urges Booster Seat Advocacy After Encounter at Traumatic Crash SceneAcknowledgmentReferences