The Child Passenger Safety Technician Technical Webinar will begin at 10:00 am

1. The Child Passenger Safety TechnicianTechnical Webinar will begin at 10:00 am Please remember to mute your phone – thank you. SafetyBeltSafe U.S.A. www.carseat.org

2. California Department of Public Health Vehicle Occupant Safety Programwith the support of California Office of Traffic Safety Child Passenger Safety TechnicianTechnical Webinar July 31, 2014 Stephanie M. Tombrello, LCSW, CPSTI Kate Quirk, PhD, CPSTI SafetyBeltSafe U.S.A. www.carseat.org

3. Topics Training Opportunities/Tools for Techs From SafetyBeltSafe U.S.A. Hypothermia & Kids: How Does It Happen? Research Focus: Are Multiple Recalls Reducing Occupant Deaths? Tips for Techs Research Review: Autos for Teens, ATVS Research Review: Traffic Safety Facts CEU Process SafetyBeltSafe U.S.A. www.carseat.org

4. Educator Workshop (3 CEUS for Techs, 6 for nurses): • Tuesday, September 16, Family Health Center, Long Beach • Safety Seat Checkup: • Saturday, September 20, Harbor-UCLA Medical Center, Torrance • National CPS Certification Course – Fall 2014, dates TBC TrainingOpportunities: L.A. County SafetyBeltSafe U.S.A. www.carseat.org

5. Tools For Techs SafetyBeltSafe U.S.A. www.carseat.org

6. Today is National Heatstroke Prevention Day • A Day of Social Media Conversation • NHTSA/Safe Kids • Safety advocates asked to tweet/FB every hour with hashtag #heatstroke National Heatstroke Prevention Day SafetyBeltSafe U.S.A. www.carseat.org

7. Jan Null – www/ggweather.com/heat • Statistics • Average number of child deaths from heatstroke after being left in cars each year: 38 • Deaths in 2013: 44 • Deaths so far in 2014: 17 • Circumstances • 51% child “forgotten” by caregiver • 29% child playing in unattended vehicle • 18% child intentionally left in vehicle • 1% unknown Research: Hyperthermia SafetyBeltSafe U.S.A. www.carseat.org

8. Ages • 31% less than 1 year • 22% 1 year • 20% 2 years • 14% 3 years • 6% 4 years • 10% 5 years + Research: Hyperthermia SafetyBeltSafe U.S.A. www.carseat.org

9. Demographics of Persons Responsible for Child Victims Accidentally Left in Vehicle (312 children, 1998 - 2013) Research: Hyperthermia SafetyBeltSafe U.S.A. www.carseat.org

10. Education Messages • Buckle an essential item into the back seat • ‘Look Before You Lock’ • Keep a stuffed animal in child’s safety seat; put in front when baby in seat.. • Arrangements for calls to be placed with daycare/babysitters. • Keep vehicles locked at all times, and keys away from children. • Be especially careful at busy or stressful periods. Research: Hyperthermia SafetyBeltSafe U.S.A. www.carseat.org

11. “Traffic Fatality Reductions: United States Compared with 25 Other Countries,” Leonard Evans, PhD, American Journal of Public Health, 6/12/14 online Methodology: Compares traffic deaths in a specific year w/those in the year with highest annual toll in that country to obtain decline rate. Findings: Highest death tolls in 1972: U.S. 54,589, France 18,113, Netherlands, 3506 Reduction by 2011: U.S. 41%, Netherlands 81% 22,075 more deaths than if U.S. reduction matched Netherlands Research in Focus: Why is Our Death Rate so High? SafetyBeltSafe U.S.A. www.carseat.org

12. Comparison with Netherlands in rules followed. Examples: • Despite bicyclists being 1/3 of fatalities, helmets aren’t required in deference to increasing cycling for convenience, health, economic & environmentally positive reasons. • Legal speed on motorways: 80 mph. But where risky, speeds lower than in U.S. • Measures Compared: Findings • 1. Reduction compared with Great Britain, Australia & Canada: U.S. 16%; other three, avg. reduction of 49%. Research in Focus: Why is Our Death Rate so High? SafetyBeltSafe U.S.A. www.carseat.org

13. Measures Compared: Findings continued 2. U.S. has least rate of decline in fatalities compared with all 25 countries surveyed. 3. Rank of countries by fatality per 1000 registered vehicles: 1970: U.S. #1; 2011: U.S. #19 Rates declining faster in 25 countries surveyed than in U.S. Rank of countries by fatality per billion kilometers traveled: Of 19 countries collecting comparable data: 1970: U.S. #1; 2011, U.S. #13. Research in Focus: Why is Our Death Rate so High? SafetyBeltSafe U.S.A. www.carseat.org

14. Discussion: “The failure of the United States in traffic safety is of near incomprehensible magnitude.” Attitudes: ‘Accident’ conveys inevitability. Exonerates policymakers from responsibility as it is “fate.” [Hard to get public mass media to drop word as NHTSA tried for many years.] Traffic harm not considered part of public health. Speeding tickets seen as fundraiser for government. [Often staff are on “soft” funding.] Policymakers often ignorant of science of traffic safety which has been pursued in depth for decades. Research in Focus: Why is Our Death Rate so High? SafetyBeltSafe U.S.A. www.carseat.org

15. Editorial by Evans: 20,000 + die because traffic science rejected. NHTSA-funded study* in 1970s reviewed 1000’s of crashes, finding contributing factors: a. User: 94% sole or contributing factor b. Vehicle: 2%. Most cases worn brakes, tires, etc – thus generally also user-related. Evans’ contention: focus in media & government on vehicle issues ignores the real problem – human behavior. Need for respect for scientific findings on what affects death rates; focus on effective prevention (e.g. anti-speeding). Issue: Vehicle technology to reduce crashes? *Institute for Research in Public Safety. Indiana University. Tri-level study of the causes of traffic accidents. Interim Report 1. Prepared for US DOT, NHTSA, 8/1973 . http://ntl.bts.gov/lib/25000/25300/ 25340/DOT-HS-034-3-535-73-TAC_ 001.pdf. Research in Focus: Why is Our Death Rate so High? SafetyBeltSafe U.S.A. www.carseat.org

16. Evenflo: attachments of plastic guide to lower anchor bars for ease of use in cars with recessed lower anchor bars. Can leave in place. • Goal: ease of transfer of seats between vehicles. • Use only with EvenfloSureLatch or push-on connectors. Tips for Techs: New LATCH Connector Guide SafetyBeltSafe U.S.A. www.carseat.org

17. Introduced by General Motors • Usually in front seating locations • Clamps on webbing during crash to: • Hold lower torso in place to reduce leg & pelvic injury. • Increase control of upper torso. • Enhance pre-tensioner interaction with air bag. • Notsufficient to hold a safety seat in place for stability in ordinary driving. Tips for Techs: Dynamic Locking Latchplates SafetyBeltSafe U.S.A. www.carseat.org

18. Tips for Techs: 3 in a Row Vehicle Owners’ Manual, Toyota Highlander 2014 Parent Question: Is it unsafe to place a safety seat in the center IF it fits? SafetyBeltSafe U.S.A. www.carseat.org

19. Factors from Manufacturers’ Alliance for CPS: Is tight installation possible? Positions on vehicle seat are unchanged by contact. No contact/force to bend or deform seat. Lower connectors or belts do not cross over one another to install seats. Tips for Techs: 3 in a Row Photo of Highlander w/2 seats. SafetyBeltSafe U.S.A. www.carseat.org

20. Status Report, Vol. 49, No. 5 Special Issue: Vehicles for Teens, July 16, 2014 • Design for Choosing: • Principles built on comparative fatality statistics • No “muscle cars” to tempt teen drivers to speed, race, etc. • Vehicles with electronic stability control essential. • Heavier vehicles; exclude mini or small cars. • Highest safety ratings possible, including side-impact protection, good test results on moderate overlap crashes, good head restraints, NHTSA 4-5 Stars on NCAP tests. Research Review:Vehicles: Good Choices for Teens SafetyBeltSafe U.S.A. www.carseat.org

21. Key Data: Telephone survey: • 83% of parents buy used cars or share older vehicles already owned by family. • $9800 average price, but median price only $5300. • Hard to find safest cars under $5300. • Risks to Teens: Comparison of fatality rates for 15-17 year olds with 35-50 year olds: • Teens: 29% in mini-cars, 82% older vehicles • Adults: 20% mini-cars, 77% older vehicles Research Review:Vehicles: Good Choices for Teens SafetyBeltSafe U.S.A. www.carseat.org

22. Research Review:Vehicles: Good Choices for Teens • Vehicle Recommendations: • Both Best and Good Choices among all types of vehicles meeting IIHS criteria but few at $5300 median or less: • Best Choices, lowest cost: $7300 (Volvo XC90, ‘05 or earlier) • Good Choices, lowest cost: $4600 (Kia Sedona, ‘06 or later) SafetyBeltSafe U.S.A. www.carseat.org

23. “ATV riding and helmet use among youth aged 12–17 years, USA, 2011: results from the YouthStylessurvey”. Ruth A Shults & Bethany A West, Injury Prevention, published online 6/10/14 • Based on YouthStyles online survey conducted by Porter, Novelli. • ATV defined as 3- or 4-wheel vehicle ridden astride and meant for use on non-paved roads; may weigh up to 1000 lbs. • 10.6 million 4-wheel ATVs in U.S. [Note: often have replaced horses in rural areas.] • Subgroup of 12-17 year olds whose parents answered HealthStyles online survey earlier in 2011. Weighted survey included 833 teens. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org

24. Focus: how much travel on ATVs by teens? • Asked for estimate in months; review of data led to focus on differences among those stating “never” vs. one trip vs. 6 or more trips. • Grouping of answers on frequency of helmet use led to always vs. not always (including the range from never to nearly always). Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org

25. Findings: grouped by • gender • U.S. regions (northeast, midwest, south, west) • urban (50,000 population or more) vsrural • Overall, 25% rode at least once in past year but varied from 23-28% by region and on urban/rural axis: 22% vs 44% • Helmet use: 45% Always, 10% Seldom, 25% Never Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org

26. Helmet Use: additional findings by subgroup ‘Always’: • Gender:Male & female: 45% • Location: Urban, 47% vs. rural, 39% • Frequency of riding: • once a year: 68%; • 2-5 times/year: 48%; • 6 or more times annually: too few to establish meaningful % (not always, 81%) • 3 times as many males as females rode 6 or more times in year: data link to prevalence of death/injury for males Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org

27. Size of the Problem: • Consumer Product Safety Commission statistics • 30 years from 1982: 12,391 fatalities, 24% for children under age 16; • 2008 (most recent year with firm, final data): 14% of 755 deaths were under age 16. • Emergency room visits: 2012 – 107,900 of which 25% were under 16. Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org

28. Social issues: • Consumer Product Safety Commission recommends: • Youth under 16 not ride adult-sized ATVs • Helmets be used • No passengers be carried. • No truly effective method so far for achieving goals so far. • Most state laws exclude private property, have many options for not prosecuting violations. Dealers only must “try their best” not to sell adult-sized ATVs for youth use! Research Review: ATV Riders & Helmet Use SafetyBeltSafe U.S.A. www.carseat.org

29. 1168 children 0 – 14 killed (3% increase from 2011) • 169,000 children injured (1% decrease from 2011) • 3 killed, 462 seriously injured every day • 33,561 total traffic fatalities; children 3%. • Largest decrease – 8 – 14 years Research Review: NHTSA Traffic Safety Facts 2012 SafetyBeltSafe U.S.A. www.carseat.org

30. Restraint use: • 4888 child passengers involved in fatal crashes. • 18% unrestrained. 40% fatalities unrestrained. • 298 child fatalities under 5 – 31% unrestrained. • Children under 5 years – estimated 284 lives saved. Research Review: NHTSA Traffic Safety Facts 2012 • Estimated potential additional lives saved through 100% safety seat use – 58. SafetyBeltSafe U.S.A. www.carseat.org

31. NHTSA Report – Blincoe, Miller, Zaloshnja, & Lawrence (2014),  ‘The Economic and Societal Impact of Motor Vehicle Crashes, 2010’. (Report No. DOT HS 812 013). 2010 – total economic cost of motor vehicle crashes: $277 billion Includes lifetime economic costs of 32,999 fatalities, 3.9 million non-fatal injuries, 24 million damaged vehicles. Total value of societal harm (including quality-of-life valuations) $871 billion. Research Review: Costs of Motor Vehicle Crashes SafetyBeltSafe U.S.A. www.carseat.org

32. 1 CEU awarded by Safe Kids • To claim: • www.carseat.org • Click on Calendars, Professional and Technician Training, California Technical Teleconference, Request for CEU • Download form, complete & email to i0680@hotmail.com • Verification Code: 1968TotGuard CEUs SafetyBeltSafe U.S.A. www.carseat.org

34. A Lifesavers presentation by Dana Walraven, Cook Children’s Hospital, Ft. Worth, TX • With access to professional data collectors, team decided to measure retention of best practice over 3 months by attendees at checkups. • Sample: over 11 months, gathered 300 participants from 683 checkups (44% response) • 75% were mothers • 80% were ages 22-40 • 83% were white or Latino • 94% had at least HS education • 92% safety seats with harnesses, 8% boosters Research in Focus:Impact on CPS Knowledge of Safety Seat Checkups SafetyBeltSafe U.S.A. www.carseat.org

35. Findings: • Messages recalled by respondents • 96% tight installation • 90% retainer clip level • 85% pinch test for harness snugness • 75.7% expiration time period (15.5% didn’t know; 8% said there wasn’t one) • 91% high confidence in checkup station • 98% believed they learned new information • 98% believe child was now better protected • 2.7% in crash since checkup Research in Focus:Impact on CPS Knowledge of Safety Seat Checkups SafetyBeltSafe U.S.A. www.carseat.org

36. I have notes from O’Neil at Lifesavers Marilyn Bull’s team Save for Sept. Research in Focus: Car Seat Inspection Stations – Who Attends and What is the Benefit? SafetyBeltSafe U.S.A. www.carseat.org

37. Caregivers’ Confidence in Performing Car Seat Installations: What Matters Most, Jessica Mirman et al., CHOP, Injury Prevention, 8/13 Motivation for Study: Field evidence: high levels of incorrect use (SBS USA data 90%+) Telephone survey evidence: high levels of confidence among caregivers of safety of way transport children In-depth study of competence and confidence based on 68 parents, 8 grandparents, 7 other caregivers. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

38. The Setting: • Choice between provided minivan or own vehicle; all but 1 chose minivan. • Caregiver installed seat and assessed their installation within 30 minutes using combination seat & specially summarized instructions. • Findings: All either gave up or installed in time frame; MEDIAN length of time was 3 minutes. • Accurate installation – 53 % (77% used belt, 14% LATCh; 8% both) • Secure attachment – 16% • No assessment of harness use Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

39. Findings (continued): Caregivers were asked additional questions. • Less concern about risk of crash or injury = more confidence in accuracy of installation. • More concern about risk of crash or injury = less confidence in installation AND more formal sources of information consulted in learning to buckle up their own children. • Conclusion: With misperception rampant, parents not in the know are unlikely to seek out help. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

40. The Effects of Child Restraint System Features on Installation Errors, Kathy Klinich et al., Applied Ergonomics #45, (2014) • Setting: • Detailed laboratory study of subjects doing 4 complete installations. • 16 safety seats used with carefully varied exposures so that learning & other factors would not weight 1 model more than others. • Models evaluated on 17 features for ease-of-use. • Each model installed at least twice in each subject group & 8 times overall. • Each caregiver installed twice w/belt & twice w/lower anchors, initially being able to choose way. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

41. Setting (continued): • Caregivers asked to assess their installations, to rate features for usefulness, & queried re. types of children who could use each seat. • CPST assessed installations, using pinch test and 1-inch movement test as well as detailed measurements. • 42 factors were assessed in the “checkup”. • Findings: Factors about caregiver with impact • Education: effect on tight installation & correct belt path • Experience w/seats: effect on tight installation & snug harness • Only 1 participant with both lowereducation & experience got a tight attachment. • Men more likely to get seat & harness snug. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

42. Findings: Tight installation • Subjects didn’t learn between 1st & 4th installations • Direction of seat had no effect on error rate (28% FF, 32% RF) • No effect from use of lower anchors vs. belt. • What helped? • LOCKOFFS:RF: 50% tight vs 18% without; FF: 32% vs. 24% • Push-on lower anchor connectors (but much more complex picture here) • Recommendations: self-tightening best; push-on next; how come out of box affected correct attachment: better if hooked on safety seat, not “hanging”. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

43. Findings: Snug Harness • Type very important: • 85.7% for tabs on harness • “infinite slide” • 53.8% side knobs • Tether use • Forward-facing: Tether storage method was key feature for appropriate use: • 83% hook-on to seat • 63% compartment • 50% pouch • Rear-facing: 10% were to be used RF weren’t; 10% weren’t to be used but were. 49.2% rethread 46.7% rotate levers 14.3% side handles Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

44. Findings: • Choice- lower anchors vs. belts for 1st 2 trials of 4: No participant factor predicted choice. One participant used both methods incorrectly in all in 4 trials for RF installations. • Harnessing (dummy used): 53% correct. No participant or seat factors predicted choice. Even the difference of 83% correct for experienced vs. 65% for inexperienced wasn’t. • Retainer clip: 95% used; 98% threaded correctly;53%at armpit level. No significant predictive pattern. • Correct angle of recline: 91% FF, 66% RF. RF error mostly too upright. No significant predictive pattern. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

45. KeyFindings • Attachment routing: • Lower anchor attachments:key was need for rerouting between RF & FF. Re-routing required: 78% correct; not required: 96% correct. No predictor for correct belt use. • Belt: 3 categories: • 46% unlocked; 35% locked correctly; 19% locked but not as instructed. • Instruction use: no predictive link. • 92% used seat manual • 21% used vehicle owner’s manual (35% 1st trial; 8% by 4th trial) Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

46. Findings: • Installation time: • Inexperienced took twice as long as experienced caregivers. • Average time: 33 minutes, lower anchor install; 28 minutes, belt. Education level non-factor. • Knowledge of correct use: • Correct answers on match between hypothetical child & particular seat: • 95% for 5 y/o, 37-lb. child & RF seat. 21% for 4-lb. 3 day old & RF seat. • Scary answer: 12% would put 3-day-old in FF seat. • Length of manual linked with some correct answers pattern but some better w/lengthier and some, shorter manual. Tended to get more correct answers for FF if just finished FF trial, ditto for RF. • Perceived ease-of-use: no linkage to correct use. Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org

47. The Findings: Summary • Disconnect between competence & confidence continues without feedback on errors. • Safety seat features can help to reduce errors: lockoffs, infinite slide harnesses, tethers & lower anchors visibly attached to seat on arrival, lower anchors with feedback mechanisms & no need to re-route to achieve correct path. • Fit with other studies: findings similar to field studies, reports from checkups. • Dilemma: how to do hands-on training with every parent/every child. • Consider integrating Ride Safe from the Start from SBS USA Research in Focus: The Disconnect: Competence vs. Confidence in CPS SafetyBeltSafe U.S.A. www.carseat.org