Reference no: EM13841285

OVERVIEW OF THE CASE (3 scenarios)

Inez Salcedo, is a 25-year-old Hispanic immigrant from Central America who is about to take her new infant home from the hospital.  Her husband arrives to pick them up in their 1996 small SUV, but they do not have a car seat for the infant.   In addition, their two other children (a four-year-old and a five-year-old) are in the rear of the car without child car seats or booster seats, strapped in with the adult seat belts.  On the way home, the Salcedos are involved in a motor vehicle accident with an impaired driver.  Serious injuries and death result.

Inez Salcedo is a 25-year-old woman who has just delivered her third child at a local hospital.  She has two other children, ages 4- and 5-years-old.  She has been discharged from the hospital, and her husband arrives to pick her up at the front entrance.  The nurse escorting Ms. Salcedo to the car notes that the 1996 Sport Utility Vehicle does not have an infant safety seat.  In addition, the 4 -and 5-year-old children are sitting in the back seat, restrained with the adult seat belts. 

The Salcedos are brought to the emergency room 30 minutes later after a motor vehicle accident. Their vehicle was struck on the front passenger side door by an impaired driver who ran a red light at approximately 30 miles per hour.  Mr. Salcedo has head and chest injuries, apparently from contact with the steering wheel; he was not seat-belted.  The infant was in the back seat in an infant safety seat, which broke loose upon impact.  The infant was killed instantly. The 4- and 5-year-old children restrained in the back seat suffered severe injuries.

Complete the discussion of learning objectives.

A.   Describe the current epidemiology of auto safety issues including motor vehicle-related mortality and contributing risk factors.What is the epidemiology of infant and child auto-related injury and mortality?

B.  Identify relevant auto safety risks for Ms. Salcedo and her children, including but not limited to:

Lack of infant car seat

Lack of child car seats

Older vehicle that may not have airbag passive restraint system or LATCH restraint system

Older SUV that is prone to rollovers

How are infant and child safety seats used?  Misused?

What other safety features of cars are designed to reduce passenger injury?

What laws or regulations govern infant/child auto safety in this jurisdiction?

What laws or regulations govern such safety features?

C.   Identify community resources for families to assist with the purchase or acquisition of infant and child safety seats and educational programs to improve the correct use of restraint devices.

What can the nurse do to assist the Salcedos in acquiring appropriate infant and child restraint systems?

D.   Explain how to safely restrain both an infant and a child, identifying the safest locations in the car for infant and child seating.

How and where should children and infants be restrained in a car?

E.   Explain currently available programs or experimental devices designed to reduce the probability of alcohol-impaired driving. 

What can/is being done to reduce alcohol-impaired driving?

Background Information Regarding the Learning Objectives

Epidemiology of Auto Safety

Motor vehicle accidents account for 96% of fatal transportation injuries and 99% of all transportation related injuries.  In 2006, there were 5,973,000 traffic accidents leading to 42,642 fatalities and 2,575,000 non-fatal injuries.  Motor vehicle accidents are the leading cause of death for all ages from 4-34 in the United States.

Despite this, there has been considerable progress over the past 50 years in reducing motor vehicle fatalities.  Since 1996, there has been a 4% reduction in the number of fatalities to motor vehicle occupants, but an increase of over 50% in motorcycle-related fatalities has kept the total number of fatalities fairly static.  Nevertheless, there has been a reduction in the overall fatality rate when adjusted for the total vehicle miles traveled (VMT) from 1.69 to 1.42 per 100 million VMT.  The fatality rate per 100,000 of the population has also fallen from 1,313 to 860 from 1996 to 2006.

The use of restraints (seat belts) has increased from 58% in 1994 to 81% in 2006.  Seat belt use reduces the probability of fatal injury in an accident by 45-60%.  The use of infant and child safety seats reduces the probability of fatal injury by about 54-71%.  Unfortunately, restraint use rates could be improved.  Fourteen percent of infants involved in fatal crashes are unrestrained.  This percentage rises to 45% among young drivers in the 15-20 age group.  Passive restraint systems (airbags) are estimated to reduce the risk of fatal injury by 11-14%. 

Approximately 40% of all fatalities occur in alcohol-related crashes.  This has decreased approximately 4% over the past decade.  Twenty-one percent of children under that age of 14 who die in traffic accidents are victims of alcohol-related crashes.  Rates of alcohol-related crashes are highest in the 21-24 year old age range and among motorcyclists. 

Infant and Child Auto Safety

Infants should ride in approved child safety seats in a rear-facing position until they are at least one year of age and weigh over 20 pounds.  Thereafter, children should ride in forward-facing harness seats until they are aged 4 and approximately 40 pounds.  Children over 40 pounds but less than 4 feet 9 inches tall should ride in a forward facing booster seat until they can safely use adult lap and shoulder belts (this may not be until the ages of 8-12 years old depending on their height).  All children younger than 13 should ride in the rear seat of vehicles.  Infants in rear-facing safety seats should never ride in the front passenger seat of a car that has a passenger side airbag.  If a child or infant must be seated in the front seat, the seat should be moved back as far as possible and the airbag disabled. 

Twenty-five percent of children involved in motor vehicle accidents are unrestrained at the time of the accident.  Forty-five percent of children involved in fatal accidents were unrestrained at the time of the accident.  The proper use of restraints reduces the probability of fatal infant death (0-1 year old) by 71% and toddler death (2-4 years old) by 54%.  Booster seats for children over 40 pounds and less than 4 feet 9 inches reduce the probability of fatal injury by 59% compared to safety belts alone.   Unfortunately, up to 75% of infant and child safety seats may be used or secured incorrectly, increasing the risk of child injury during an accident.

Community Resources for Families Regarding Safety Seats

Some jurisdictions have programs that provide free child safety seats to families completing a training course in their use or who otherwise qualify for the benefit.  Virtually all jurisdictions have free seat inspection stations that can provide education on correct use of infant and child safety seats and check the installation of a seat.  These can easily be identified via the National Highway Traffic Safety Administration's locator system at https://www.nhtsa.dot.gov/cps/cpsfitting/index.cfm.

Programs to Reduce the Probability of Alcohol-impaired Driving

Alcohol use is associated with almost 40 percent of all fatal crashes, and nearly 10% of all motor vehicle accidents in the United States.  Young men and motorcycle drivers have the highest rates of alcohol use and driving as well as the highest mortality rates for alcohol-associated accidents.

A wide array of interventions is known to be effective in reducing alcohol-impaired driving and injuries.  These include .08% blood alcohol concentration (BAC) laws, sobriety checkpoints, minimum legal drinking age laws, mass media campaigns, school-based education programs, "zero-tolerance" laws for young drivers (e.g. any BAC considered as driving under the influence), and education programs for alcohol servers (Shults RA et. al. Reviews of Evidence Regarding Interventions to Reduce Alcohol-Impaired Driving.  American Journal of Preventive Medicine. 2001;21(4S):66-88).

Over the past two decades, interventions to reduce alcohol-impaired driving have been successful in reducing the rate of alcohol-related fatal accidents by 55-60% in drivers under the age of 20.