SAFETY IN THE CAR CHILDREN AS PASSENGERS Jorge Fiorentino MD* and Graduate Axel Dell’ olio* * Chief of Urgency Department in Hospital de Niños R. Gutiérrez - **President of ADISIV (Asociación para la Disminución de Siniestros Viales). INTRODUCTION: Being inspired by the seat belts used by aircraft pilots, Nils Bohlin registered and integrated the seatbelt with a diagonal sash in VOLVO automobiles, while working for that company in the 50s. A few years later, a series of accidents in the care of the Chevrolet Corvair triggered a public campaign in the United States in view of saving users’ lives. The lawyer who fostered this campaign was Ralph Nader, the author of “Unsafe at any speed.” His book brought about a true revolution in the automobile industry and made people aware of the situation. The industry had now realized that to protect and value human life, this passive safety device needed to be used. (1) Thereafter, the seat belt has saved many lives. However, what would have happened if nobody had thoroughly explained its importance and usage? Without awareness, fastening systems would have been excellent elements of passive safety, but they would have not been able to save the substantive number of drivers and passengers that participated in car accidents while using seatbelts. Child car seats started to be manufactured in the year 1980. They were thought to prevent injuries in the event of accidents or collisions. These safety and protection systems were designed by taking into account the children’s anatomy, their growth, and their typical behavior. Thus, in their standard we can recognize the result of a thorough investigation carried out by performing tests with “dummies.” Nowadays, these car seats are simple and are being used correctly. They are the equivalent of the seatbelts that adults use. If they are correctly secured in the car seats, they provide great immobilization and fastening, thus being a reliable method in terms of passive safety (2) , as well as the best life insurance for young passengers. Seats belts are manufactured and installed according to ECE R16 regulations, which means that their manufacturing is supervised by trained and specialized professionals. On the other hand, child car seats are manufactured according to ECE R44/04 regulations, which means that parents and other users must somehow interpret the instructions manual. In this environment, the technical advice is not always professional, so parents have no choice but to place the child car seat in the car relying upon a simple … The Transport Code, in the unremembered Act 24449, article 40, section “g” states that children under 10 years old must travel in the back seat. Its amendment in 2008 establishes that it is obligatory to “transport 4-year-old children in their corresponding child car seats.”
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SAFETY IN THE CAR
CHILDREN AS PASSENGERS
Jorge Fiorentino MD* and Graduate Axel Dell’ olio*
* Chief of Urgency Department in Hospital de Niños R. Gutiérrez - **President of ADISIV (Asociación para la Disminución de Siniestros Viales).
INTRODUCTION:
Being inspired by the seat belts used by aircraft pilots, Nils Bohlin registered and integrated the seatbelt with a
diagonal sash in VOLVO automobiles, while working for that company in the 50s.
A few years later, a series of accidents in the care of the Chevrolet Corvair triggered a public campaign in the
United States in view of saving users’ lives. The lawyer who fostered this campaign was Ralph Nader, the
author of “Unsafe at any speed.” His book brought about a true revolution in the automobile industry and made
people aware of the situation. The industry had now realized that to protect and value human life, this passive
safety device needed to be used. (1)
Thereafter, the seat belt has saved many lives. However, what would have happened if nobody had thoroughly
explained its importance and usage? Without awareness, fastening systems would have been excellent
elements of passive safety, but they would have not been able to save the substantive number of drivers and
passengers that participated in car accidents while using seatbelts.
Child car seats started to be manufactured in the year 1980. They were thought to prevent injuries in the event
of accidents or collisions.
These safety and protection systems were designed by taking into account the children’s anatomy, their
growth, and their typical behavior. Thus, in their standard we can recognize the result of a thorough
investigation carried out by performing tests with “dummies.”
Nowadays, these car seats are simple and are being used correctly. They are the equivalent of the seatbelts
that adults use. If they are correctly secured in the car seats, they provide great immobilization and fastening,
thus being a reliable method in terms of passive safety (2), as well as the best life insurance for young
passengers.
Seats belts are manufactured and installed according to ECE R16 regulations, which means that their
manufacturing is supervised by trained and specialized professionals. On the other hand, child car seats are
manufactured according to ECE R44/04 regulations, which means that parents and other users must
somehow interpret the instructions manual. In this environment, the technical advice is not always
professional, so parents have no choice but to place the child car seat in the car relying upon a simple
… The Transport Code, in the unremembered Act 24449, article 40, section “g” states that children
under 10 years old must travel in the back seat. Its amendment in 2008 establishes that it is
obligatory to “transport 4-year-old children in their corresponding child car seats.”
instruction provided by a salesman (who may not always be an experienced one) or even other parents when
their child is born.
Pediatricians, teachers and road safety educators are in a privileged position when it comes to advising users.
What we are trying to do is to encourage users to use these safety devices correctly, so they can prevent a
great deal of foreseeable deaths.
ISSUES RELATED TO EPIDEMIOLOGY:
Unintentional traumatic injuries as a whole (formerly called accidents) are the third cause of death among all
ages worldwide. It is also the first cause of death among people under 35 years old. Out of every deceased
person, there are three patients with severe disabling injuries. (3-4)
In addition to the social and emotional pain that may be caused by the death or disability of a child, we should
take into account the high economic cost that society has to face as a whole. This means that this child would
be missing school years, and as a consequence, there would be a lack of future work productivity. In
Argentina, these costs amount to the equivalent of 1.5 to 2% of the annual Gross Domestic Product (GDP). (3)
Morbidity and mortality rates on traffic related injuries are an important problem because of the differences in
the coding of deaths and also because of deficiencies in notification and registration. As an example, traffic
related injuries are one of the main three causes of deaths. The other two causes are heart diseases and
cancer (1-2-3-4).
People who die from the former diseases are mainly adults, while the people who die in traffic related injuries
may also be – in a great extent- adolescents and youngsters (3). According to the WHO, traffic related injuries
are the second cause of death among children between 5 and 14 years old in the world. The first cause is
acute lower respiratory infections. (Report on the global situation of road safety: It is time to take some action.
Magazine No. 6, page 3, year 2004.)
It is extremely necessary to focus on the different private and public prevention campaigns. It is also crucial to
endorse the role of pediatricians, technicians, parents and teachers in order to stand for policies that increase
the available resources needed to prevent and reduce the frequency of this devastating disease.
It is necessary to name some elements related to the physical environment of the City of Buenos Aires in order
to understand the importance of the accidents (which are, as already said, mistakenly named.) According to
the census of 2010, Buenos Aires has a permanent population of 3.000.000 inhabitants and an area of 202
km2.
The Greater Buenos Aires conurbation has 9.500.000 inhabitants, and a total of nearly 12.500.000 inhabitants
including the City of Buenos Aires, approximately 30% of the total population of Argentina (4- 5).
Traffic figures in the City of Buenos Aires:
In addition to the 3,000,000 people who live in the City of Buenos Aires, there are 3,000,000 other people who
enter the city from the conurbation during business hours and days. Half of them enter the city by car,
especially because of the weak public transportation that Argentina has. Thus, approximately 1,500,000
vehicles circulate daily in the City of Buenos Aires. It is also estimated that in rush hours, there are 2 cars out
of 3 inhabitants. This calculation does not include other means of transportation, such as over 9700 buses of
diverse lines, 35,000 cabs, 3,500 remises, 3,500 “free offer” buses, and 50,000 trucks, motorcycles, bicycles,
trains and subways that complete this reckless cocktail that takes place in this territory. Unfortunately, it is not
rare to see children travelling with no protection in their car seats, or even sharing a seat with an adult. This is
a clear demonstration of how ignorant adults are; as they ignore the risk they are taking.
Children who do not use seat belts or child car seats are more likely to suffer from serious injuries and to be
expelled from the inside of the vehicle in the event of a collision, or simply hitting other passengers or internal
parts of the vehicle.
TRAUMA IS A PREVENTABLE DISEASE!
That is why we suggest that the term “incident” is used rather than “accident.” The connotations that the term
“accident” carry, such as unpredictability and lack of control are counter-productive as regards prevention (4).
3,300,000 of them are children under the age
of 15. (5)
Injuries suffered by vehicle passengers are one of the most frequent
causes of death and morbidity among children under 16 who are taken
in the Hospital de Niños Ricardo Gutiérrez.
Traumatic brain injuries are the most frequent injuries among children who are not fastened. This can be
explained if we take into account their anatomy.
The correct use of child car seats reduces the risk of death in nursing babies to a 70%, while in children
between 1 to 4 years the risk is reduced to a 54% (7).
In contrast, injuries suffered by children who are correctly fastened in their seats are usually minor injuries,
such as abrasions, lacerations and contusions, except when there is an intrusion of elements, impacts with
objects that are inside the vehicle or injuries caused by airbags (6-7-8-9-10).
CHILDREN AND CAR SEATS:
During their growth stage, children change their weight, height, size and body proportions very fast.
Babies and children have very different anthropometric sizes than those of an average adult, for whom
safety measures are usually designed.
The heads of nursing babies are disproportionately large, while their gravity center is too tall and is placed
above their umbilicus. Their neck is short and their encephalic support is relatively poor. Their cervical
structures are weak and their scapular waist is poorly developed (11-12).
Intraabdominal organs (liver, spleen and kidneys) are poorly protected and are more exposed than those of
adults. The bony pelvis does not provide a complete coverage of the bladder; hence the organs are highly
vulnerable and may be seriously harmed in the event of a collision.
As the iliac crests are not fully developed, the anchor points of seatbelts are unsatisfactory. That is why they
may slide upwards, thus directly discharging the force on the abdomen. As a result, two things may occur: 1.-
the child may bend over the seatbelt in a collision (probably generating a spinal fracture caused by an hyper
flexion of the spine over the seatbelt with a pressure injury of intraabdominal organs, or 2.- the pelvis may be
immersed under the seatbelt (submarine effect.) As a result, the child falls on the floor and suffers
unpredictable injuries.
Children should use the diagonal band over the shoulder and clavicle. It should never be placed on the neck,
simply because in the event of a collision, there may be serious injuries in the cervical spine. If the diagonal
band is placed under the arm, it functions as another abdominal belt. In other words, it functions as a two-point
seatbelt, which is basically a dangerous and unsatisfactory fastening (13).
The trunk, pelvis and extremities have their own restrictions in movement. Given the important weight and
volume of children’s heads, – the younger they are, the bigger their heads are – they should be facing
rearwards when their weight is less than 10 kg. This should be done to avoid a cervical hyper flexion in the
event of a head-on collision. Nowadays, a change in legislation to carry children who weight under 18 kg
facing rearwards is being discussed in Europe, the United States and Canada.
Children should never travel in the front seat, especially if the vehicle has airbags in the companion
seat.
The airbag is inflated with force (between 200 km/h and 300 km/h). This may cause serious burns and
wounds, and even death in the event of an impact. However, if the child is facing rearwards, the situation does
not improve, since the airbag may push the child to the back of the seat, thus causing an extremely violent
impact.
It is crucial to properly fasten the child car seat with the back seat seatbelt in three fixed points.
BE CAREFUL
In Argentina, some vehicles only have a two-point seatbelt in their central back seat. This would cause
the child car seat to flip over without any resistance, since it does not have an upper anchor.
Latest news: There is a safer anchor. ISOFIX (ISO 13216 regulation) is a system that has been used by
the European Community as of February, 2011. This system has 3 anchor points. Two of them fasten the
lower part of the child car seat to the vehicle (picture No. 1). The third point – named TOP TETHER – secures
the upper part of the child car seat, avoiding a forward ejection in the event of a head-on collision (picture No.
2). It is also useful to enhance the stability of the seat in the event of lateral impacts.
To be on the same page, the name it received in Canada is UAS (Universal Anchorage System) and in the
United States LATCH (Lower Anchors and Tethers for Children.) Both countries established that as of
September, 2002, their vehicles (national or imported) shall incorporate these necessary modifications.
The Ministry of Internal Affairs, the Ministry of Industry and the National Road Safety Agency (ANSV) signed
an agreement with the manufacturers and importers of cars. This agreement stated that as of the year 2016,
every vehicle shall have an ISOFIX system or the like. In the meantime, vehicles that do not have this system
must have a child car seat that should be fastened with the car’s seatbelts so that the seat is correctly fastened
and stabilized. (11-12)
Picture No. 1 Picture No. 2
Child car seats also have strict regulations as regards production. In Europe, the current legislation is the ECE
R44/04, while in North America is the FMVSS 213 (Federal Motor Vehicle Safety Standard.) These regulations
establish the manufacturing materials of the seats, the type of labeling they should have, and the tests that
they have been subject to. That is why it is always better to buy approved child car seats. Unlike national
seats, those that are approved have undergone strict quality tests. The way to identify these products is by
reading the following label, which should be different if applicable to Europe (Figure No. 1) or to the United
States (Figure No. 2.) In Argentina, approval standards for child car seats will enter into force in 2013 under
the TIAM 3680.1 and 3680.2 regulations, in which work is currently being done. (11-12-13)