1. CPS Conference Call Tuesday February 24, 2009 12:00 – 12:30 Please hold any questions you have for the Q&A session at the end of the call. This conference call is hosted by MIEMSS EMSC, CPS & OP Health Care Project and is sponsored, in part, by a grant from the Maryland Highway Safety Office/ State Highway Administration.

2. Why is Rear-Facing so Important? Emilie Crown, RN, CEN Program Manager Montgomery County Fire Rescue

3. Outline Scientific Evidence: Injury Prevention 2007 Scientific Evidence: Injury Prevention 2007 AAP Guidelines AAP Guidelines CPS Certification Class Curriculum CPS Certification Class Curriculum Available Car Seats Available Car Seats How to educate parents How to educate parents

4. Scientific Evidence

5. Research Used data from NHTSA crash database from 1988-2003 Used data from NHTSA crash database from 1988-2003 Children from 0-23 months who were restrained in RF and FF seats were included—total of 870 children used Children from 0-23 months who were restrained in RF and FF seats were included—total of 870 children used Found that children who were FF were significantly more likely to be seriously injured in all crash types Found that children who were FF were significantly more likely to be seriously injured in all crash types

6. Research continued Benefit of rear facing was evident in both children < 1 year and children 12-23 months Benefit of rear facing was evident in both children < 1 year and children 12-23 months Benefit of rear facing was particularly great in side crashes Benefit of rear facing was particularly great in side crashes Findings have significant implications for car seat manufacturers, as there may need to be new designs to accommodate children up to their second birthday Findings have significant implications for car seat manufacturers, as there may need to be new designs to accommodate children up to their second birthday Larger rear facing seats have been available in Europe which often use support legs or bases that extend to the vehicle floor to support the restraint. These legs are not currently allowed in US. Larger rear facing seats have been available in Europe which often use support legs or bases that extend to the vehicle floor to support the restraint. These legs are not currently allowed in US.

7. How children ride in Sweden Children ride rear facing to age 4 and then transition to booster seats Children ride rear facing to age 4 and then transition to booster seats Volvo did a recent crash study and data supported the policy of children remaining rear facing until age four Volvo did a recent crash study and data supported the policy of children remaining rear facing until age four Few children die on Swedish highways— 11 in 2005! Few children die on Swedish highways— 11 in 2005!

8. American Academy of Pediatrics (AAP) Guidelines “for optimal protection, the child should remain rear facing until reaching the maximum weight for the car safety seat, as long as the top of the head is below the top of the seat back” “for optimal protection, the child should remain rear facing until reaching the maximum weight for the car safety seat, as long as the top of the head is below the top of the seat back”

9. What does the NHTSA Curriculum say about rear-facing?

10. Why Children Should Travel Rear-Facing Physical Development Physical Development Babies have big heads Babies have big heads Bones, tendons, and muscles are not fully developed Bones, tendons, and muscles are not fully developed Child’s Body Proportions

11. Why Children Should Travel Rear-facing Increased crash protection: Spreads crash forces along the entire head, neck, and back Spreads crash forces along the entire head, neck, and back Protects head, neck, and spinal cord Protects head, neck, and spinal cord CR absorbs forces of the crash CR absorbs forces of the crash Video Courtesy of Children’s Hospital of Philadelphia

12. Direction – Always Rear Facing For optimal protection, use rear-facing CR to highest weight or height according to the CR instructions. For optimal protection, use rear-facing CR to highest weight or height according to the CR instructions. At a minimum, use rear- facing CR until child is at least 1 year old and at least 20 pounds At a minimum, use rear- facing CR until child is at least 1 year old and at least 20 pounds 14 months, 24 pounds

13. Installation – Angle Parents should use angle given in CR manufacturer’s instructions (30 to 45 degrees) Parents should use angle given in CR manufacturer’s instructions (30 to 45 degrees) CR spreads crash forces along the entire head, neck, and back CR spreads crash forces along the entire head, neck, and back Correct position helps keep airway open Correct position helps keep airway open CR may be moved more upright as child grows & ages CR may be moved more upright as child grows & ages There are car bed options, if prescribed by physician, for children with special health needs There are car bed options, if prescribed by physician, for children with special health needs Courtesy of Kathleen Weber Child Passenger Protection Research Program University of Michigan Medical School

14. Seats that go to 30-35# RF All convertible seats on the market now go to at least 30# rear facing All convertible seats on the market now go to at least 30# rear facing Three infant seats are rated to 30# rear facing Three infant seats are rated to 30# rear facing All Dorel convertible seats are rated to 35# rear facing, and several Evenflo convertibles and many Britax convertible seats also go to 35# RF All Dorel convertible seats are rated to 35# rear facing, and several Evenflo convertibles and many Britax convertible seats also go to 35# RF

15. Infant seats with 30# weight limit

17. Educating parents Let them know that RF is 76% safer than FF for children under 2 years old Let them know that RF is 76% safer than FF for children under 2 years old Give them educational materials in writing to back up what you tell them Give them educational materials in writing to back up what you tell them Educate them about how rear-facing seats protect children—give example of flight attendants… Educate them about how rear-facing seats protect children—give example of flight attendants…

18. How rear-facing seats protect children Support entire back, neck, head and pelvis so that crash forces are distributed over the entire body and not just points where seat belt touches child Support entire back, neck, head and pelvis so that crash forces are distributed over the entire body and not just points where seat belt touches child Having the head supported is key, as it is large compared to the rest of child’s body especially when compared to the small neck and weaker neck muscles Having the head supported is key, as it is large compared to the rest of child’s body especially when compared to the small neck and weaker neck muscles

19. Resources Injury Prevention 2007 : 13: 398-402 by Henary, Sherwood, Crandall, Kent, Vaca, Arbogast, Bull Injury Prevention 2007 : 13: 398-402 by Henary, Sherwood, Crandall, Kent, Vaca, Arbogast, Bull Safe Ride News Fact Sheets 2009: Selecting the Right Car Seat, This is the Way Baby Rides, Check Your Child’s Car Seat Safe Ride News Fact Sheets 2009: Selecting the Right Car Seat, This is the Way Baby Rides, Check Your Child’s Car Seat

21. Thank you for your time! Questions? Questions?

22. Thank you for your time and your interest in child passenger safety ! FINAL INSTRUCTIONS: Feedback Form emailed to all call participants Feedback Form emailed to all call participants Feedback Form also available online: Feedback Form also available online: http://www.miemss.org/EMSCwww/CPSHome.htm http://www.miemss.org/EMSCwww/CPSHome.htmhttp://www.miemss.org/EMSCwww/CPSHome.htm Complete Form and fax to 410-706-3660 or email (cps@miemss.org) Complete Form and fax to 410-706-3660 or email (cps@miemss.org)cps@miemss.org Also, complete and submit page 2 of Feedback Form if you would like a Also, complete and submit page 2 of Feedback Form if you would like a Certificate of Participation mailed to you Certificate of Participation mailed to you