ND Conference on Injury Prevention & Control “Preventing & Responding to Injuries” October 28-30, 2008 Speaker ~ Connie Rongen ~ Common Solutions to Special Needs Transport

What is Special Needs Transport? Finding the safest way to transport any child with a short or long term disability

Why would I need it? Special needs transport may be needed for a short or long term disability to maintain the families day to day life. A plan for safe transport should be made with the child’s medical team.

Statistically Nationwide, an estimated 9.36 million children have long term special healthcare needs This comprises 13-18% of all children in the US Children with special healthcare needs: Minding the gaps. National Health Policy Forum(2005)

Statistically Motor Vehicle crashes remain the #1 cause of death for children & adolescents ages 1-21 in the United States American Academy of Pediatrics

Long Term Disabilities muscle tone ~ poor trunk control, breathing issues (cerebral palsy, spina bifida, paralysis or severe scoliosis) cardiac & respiratory conditions ~ heart rhythm problems, breathing difficulties behavioral issues ~ autism, ADHD, cognitive impairments

Short Term disabilities Premature, low birth weight ~ less than 37 weeks gestation or under 5 pounds post operative/medical devices ~ tracheotomy braces/casts ~ developmentally(dislocated hip), post op (tendon release), trauma (fracture)

Travel Tips for Children with Special Needs Children with certain medical conditions can ride in conventional car seats that are found in stores Others may need a special medical car seat or restraint. A variety of options are available of both conventional and special needs car seats.

Travel Tips for Children with Special Needs Consult your surgeon or pediatrician about child’s positioning & transportation needs Never alter a car seat, stay up-to-date on what is available, keep child in seat to upper weight or height limits

Things to Consider for Conventional or Special Needs car seat Child’s age, weight & height Medical, physical, &/or behavioral condition Positioning requirements allergies/physical sensitivities Family members/caregivers responsible for transport

Things to Consider for Conventional or Special Needs car seat Financial situation Help with transportation resources/networks (adapt vehicles, etc) Medical equipment needed Type of vehicle to be used

Things to Consider for Conventional or Special Needs car seat Always use car seat according to manufacturers instructions Consult vehicles owners manual pertaining to car seat use Never place anything under or behind child in car seat

Conventional Car Seats Infant Seats Premature/Low Birth Weight Babies Use rear-facing infant CR with small internal harness dimensions Use CR designed for child’s low birth weight Center infant in CR with rolled receiving blankets and crotch roll, if necessary

Conventional Car Seats Infant Seats Premature/Low Birth Weight Babies Infant should be tested while in car seat AAP policy ~ Angle Tolerance Testing Use CR for transportation ONLY

Conventional Car Seats Rear facing Convertible First Option ~ use a Conventional Car Seat if it meets child's needs Check rear facing Weight limits Less Expensive Easier to find & use

Conventional Car Seats Forward Facing Seat Car seat in Upright position Some manufacturers allow semi-reclined position when Forward Facing Some car seats have harnesses that have weight limits up to 65#

Special Needs Car Seats The following slides feature examples of some of the more common special needs car seats.

Infant Car Beds For infants who must lie down or fail angle tolerance test Infant’s head placed toward center of vehicle in all beds

The Roosevelt Car Seat by Merritt Manufacturing 35# to 115# ” $ approx.

Columbia Car Seat Good option for kids needing Harnesses to higher weight limits Example: Cerebral Palsy Made with Latex & silicon free materials 2 sizes ~ # & # approx. $780.00

Recaro Start Plus Car Seat Latex-free car seat for children with special needs children 30 to 80 lbs. max. user height is 60” Backrest tilts from 90 to 105° Approx. $1,300.00

Snug Seat Hippo Commonly used for hip casts RF 5-33# FF 1 yr. & 20-65# FF recline to 40# approx. $450.00

Casts & Other Conditions Follow weight limits using casted weight Specialized Child Restraints aap.org or preventinjury.org for specific product Recommendations & Q/A

E-Z-ON Vest 2 yrs & over # For Children who can sit upright Works with lap belt only vehicles Must be used with tether anchor Approx. $ Check website for more details

Modified E-Z-ON Vest Use for body casts, hip spica casts, braces Supine, prone, side-lying 2-5 yr ~ 20-65# ~ 19-25” extremity belt 5-12 yr ~ # ~ 25-32” extremity belt

Modified E-Z-ON Vest For children 2–12 years old who must lie down Child must fit lengthwise on bench seat Follow weight limits using casted weight If not casted, this child would ride facing forward

Common Solutions to Complicated Issues Behavioral management counseling Reward system Your solution may be as simple as a seat with a buckle type retainer clip, or a vest that zips up the back, or one that has lower sides to accommodate a cast. Many options are available.

Travel Tips for Children with Special Needs from the American Academy of Pediatrics Never place rear facing seat in front of a passenger side air bag If you must transport a medically fragile child in the front with an air bag, have air bag switched off by contacting NHTSA 888/DASH-2-DOT or Back seat safest place to ride Source:Safe Transportation of Children with special needs: a guide for families AAP

Travel Tips for Children with Special Needs from the American Academy of Pediatrics Limit car travel depending on condition Stop often if trip is long Cell phone Adult ride in back with child if possible Source:Safe Transportation of Children with special needs: a guide for families AAP

Travel Tips for Children with Special Needs from the American Academy of Pediatrics Develop medical care plan in case of medical emergency during travel, attach a copy of the plan to child's car seat Carry an emergency kit with medications/supplies that child may need, use checklist to ensure correct medications/supplies are in kit (do not leave kit in vehicle due to temperature changes) Source:Safe Transportation of Children with special needs: a guide for families AAP

Travel Tips for Children with Special Needs from the American Academy of Pediatrics Never use a reclined vehicle seat to transport a child Professional transport may be needed (ex: ambulance) Apply for handicap parking permit if necessary Source:Safe Transportation of Children with special needs: a guide for families AAP

Travel Tips for Children with Special Needs from the American Academy of Pediatrics NEVER leave your child alone in the vehicle, even for a few minutes. Your childs safety is worth the effort to remove him/her from vehicle and take with you. Federal law gives special needs school age children the right for equal services including transportation Source:Safe Transportation of Children with special needs: a guide for families AAP

Travel Tips for Children with Special Needs from the American Academy of Pediatrics Medical equipment must be secured in the vehicle to prevent them from becoming projectiles. Wedge equipment on vehicle floor with pillows or secure with available seat belts. There are no products to secure medical devices at this time. Always make sure devices using batteries have enough power for twice the length of your trip. Source:Safe Transportation of Children with special needs: a guide for families AAP

Special Needs Resources How to find them ~ consult the child's medical team & local school special needs How to access them ~ set up a meeting with the team of those with access to all areas of the child's life including transportation.

Special Needs Resources If long term issues consult medical team, if in school, all teachers including special needs teachers, principal, bus drivers, parents, etc. This “Child Study Team” is a group that will work out the best plan for all areas of the child's needs to create the IEP-Individual Education Plan.

Special Needs Resources Consult the American Academy of Pediatrics “Car Seat Shopping Guide for Children with Special Needs” Contact ND State Health Dept. Internet is a great Special Needs resource try adaptivemall.com

Questions??

Please help protect those who can’t protect themselves! Buckle up our kids! Thank you