Wednesday, June 18, 2014

The Right Place at the Right Time – Crash Notification Research

Trauma remains the leading cause of death and disability for children in the United States. Motor vehicle crashes contribute to a huge portion of such traumatic injuries in children, and cause over 50 percent of traumatic injury deaths of children. While most research regarding children in motor vehicle crashes focuses on preventing injuries, my research group recognizes that prevention is not 100 percent effective. Therefore, we chose to focus our efforts on the treatment of children injured in motor vehicle crashes when prevention fails.

One of the most important factors in the treatment of injured children is the process of trauma triage. Triage is the process of transporting the “right patient to the right place at the right time.” The “right place” depends on the severity of the child’s injuries.  For severely injured patients, the right place is usually a specialized trauma center, where doctors specialized in the treatment of traumatic injuries are on-call 24 hours a day.  Failure to identify these children in need of treatment at a trauma center can result in disability and death. However, it is not practical to send every child to a trauma center.  This would put an undue strain on the trauma system’s resources and may thus impair care of those more seriously injured patients. 

Currently, most triage systems rely on assessment of the child after Emergency Medical Technicians (EMTs) have already arrived on the scene. EMTs assess the child, determine the severity of the injuries and decide whether or not they need to be transported to a trauma center. This is problematic for several reasons. First, the assessment and determination of whether or not a child needs transport to a trauma center may be highly subjective. Second, it may be impossible to determine, based on the limited diagnostic tools available in the field, the specific injuries a child has sustained and thus how severe they actually are. Third, this process may be long and arduous for children in rural areas who often live long distances from trauma centers. Such children would require transport by helicopter to the nearest trauma center. By the time the EMT team arrives on the scene, determines helicopter transport is necessary and sends for such transport, critical time is wasted that is best spent treating injuries.

For these reasons, some began to wonder if it would be possible to determine which children injured in motor vehicle crashes were likely to need treatment at a trauma center with a systematic approach even before EMTs arrived at the scene. Such a system could eliminate some of the bias of the current subjective triage process and could save precious time for children living in rural areas. This could be accomplished through an Advanced Automotive Crash Notification (AACN) system. While AACN systems have been developed for adults, no such systems have been developed specifically for children.

Our research is focused on creating an AACN system that will help EMTs decide which children need treatment at a trauma center after a motor vehicle crash. AACN systems use information recorded in a vehicle at the time of the crash, such as speed and direction of impact. They can then use this information to predict the severity of the injuries occupants in the vehicle are likely to have sustained. This information can be transported from the vehicle’s black box to EMTs so that the appropriate resources can be immediately utilized. AACN will not replace the ability of EMTs to assess and treat children but will improve the ability with which they can do so quickly and correctly. 

We hope that our AACN system can help improve the care of children injured in motor vehicle crashes throughout the U.S., making it possible to get many more of them to the right place at the right time, no matter where they are injured.

Dr. Andrea Doud, Wake Forest University School of Medicine and CIPT Scholar


Wednesday, June 11, 2014

Where’s Baby? The Dangers of Heatstroke

With hot summer days already upon us, the thoughts of many turn to family car trips and vacations. But as the weather warms, please also remember that leaving a child in a car is never safe and could lead to heatstroke. Too many Americans are not aware of this deadly problem, with potentially two million children being left alone in a car and put at risk.

When outside temperatures are in the low 80s the temperature inside a vehicle can reach deadly levels in only 10 minutes, even with a window rolled down two inches. Young children are particularly at risk because their bodies heat up three to five times faster than an adult's.

When a child's temperature reaches 107 degrees, that child dies. Last year alone, at least 43 children in America died after being left in unattended vehicles—and an unknown number of others were moderately or severely injured.

We clearly need to do more to spread the message about the dangers of heatstroke. According to a new study by Safe Kids Worldwide, 14 percent of parents stated they have left a child alone inside a parked vehicle despite the risk of heatstroke. That means that nearly two million parents transporting more than 3.3 million children may have intentionally left children in a parked vehicle and risked their lives.

To make Americans more aware of the dangers of heatstroke, the National Highway Traffic Safety Administration is again conducting our "Where's Baby? Look Before You Lock" campaign, which will be taking to the airwaves and the Internet on May 5 and running through September. This year, on July 31, we’ll also be conducting our second National Heatstroke Tweet Up Day to spread to word on Twitter.

When I began thinking about this year’s campaign, I immediately thought about reaching out to our friends at the Childress Institute, their supporters, and the entire community that works to care for injured children. As leaders in protecting children, I know that you’ll do all you can to help us spread to word about heatstroke.

NHTSA and its safety partners urge parents and caregivers to take the following precautions to prevent heatstroke incidents from occurring:
  • Never leave a child unattended in a vehicle – even if the windows are partially open or the engine is running and the air conditioning is on
  • Make a habit of looking in the vehicle – front and back – before locking the door and walking away
  • Ask the childcare provider to call if the child doesn't show up for care as expected
  • Do things that serve as a reminder that a child is in the vehicle, such as placing a purse or briefcase in the back seat to ensure no child is accidentally left in the vehicle, or writing a note or using a stuffed animal placed in the driver's view to indicate a child is in the car seat
  • Teach children that a vehicle is not a play area and store keys out of their reach.
Parents and caregivers are the first line of defense against the needless heatstroke tragedies but everyone has a role to play. NHTSA will be working with our safety partners and local communities to get the message out to never leave children unattended in a vehicle and always check the backseat before walking away. If you see a child alone in a car, call 911 immediately.

When the weather heats up it’s time for all of us to step up and prevent heatstroke. As a community, we can prevent these deaths and injuries, and parents should always remember: Look Before You Lock.

- By David J.Friedman, Acting Administrator, NHTSA

Thursday, June 5, 2014

Concussion Summit Results

As you saw in my post last week, my wife, Lisa, and I were invited to attend President Obama’s Healthy Kids & Safe Sports Concussion Summit at the White House on May 29. We were invited for several reasons and were able to bring together all of our passions, including our work with The Matthew Gfeller Foundation, UNC’s Matthew Gfeller Sport-Related TBI Research Center, and my role as executive director of the Childress Institute for Pediatric Trauma. At the end of my post are a few commitments these organizations have made in response to the President’s summit.

The power of the Presidential position brought a large team of people to the White House that are interested in positively impacting this invisible threat to our kids – medical professionals, sports advocates/players (football, soccer, hockey, etc.), parents and other family members, corporate supporters, the military, media and others.

The first speaker was Tori, a high school soccer star with an opportunity to attend college and continue playing her sport. Unfortunately, the effects of initially unrecognized and repeated concussions meant Tori’s dream of playing soccer in college is over, but she is working hard to recover and remains active in sports by teaching young children how to play soccer. She eloquently told her story and introduced the President, which allowed him to reference her experience as an example to other young athletes and parents about the commitment ahead of us to change perceptions and improve outcomes.

“We’ve got to have better research, better data, better safety equipment, better protocols,” said President Obama. “We’ve got to have every parent and coach and teacher recognize the signs of concussions. And we need more athletes to understand how important it is to do what we can to prevent injuries and to admit them when they do happen. We have to change a culture that says you suck it up. Identifying a concussion and being able to self-diagnose that this is something that I need to take care of doesn’t make you weak -- it means you’re strong.”

The President shared a very powerful and balanced message:  our kids want and need to play sports to be productive. The collective “we” at the summit need to invest all we can, including treasure, talent and time, to insure that they play safely. Sports and recreational TBI are the invisible epidemic that demands attention right now across the board. Did you know that 70 percent of the U.S. football-playing population is younger than 14? Many people are talking about the NFL, but kids make up the majority of players and they are vastly understudied. It’s vital that we research ways to improve outcomes. Until then, “when in doubt, sit it out,” and keep yourself informed.

The effort required is huge, but we must lead and move with coordinated speed. Thanks for helping us share this initiative. 

Stay inspired! Bob Gfeller

The Childress Institute funds research to improve the treatment for critically injured children in the U.S., including an ongoing study to measure head impacts that youth sustain while playing football. The published results from 2013 comprised 111 youth football players ages 6 to 18 – the largest ever conducted. Players received an MRI before and after the football season, and also wore helmets instrumented with sensors to measure head impacts during practice and games. We will continue this study to determine short- and long-term effects, and next steps.

We have developed an innovative behavior modification program aimed at reducing the risk of sports-related concussion in high school football athletes. This fall we will study the intervention by employing a two-pronged approach in several North Carolina High Schools: 1) quantitatively capture head impact biomechanics using accelerometer systems to identify at-risk player profiles, and 2) employ a clinician-coach-player mentorship approach to affect change in playing techniques to reduce risk of concussions.

The Matthew Gfeller Foundation (MGF) was founded in 2009 after the death of our son who sustained a catastrophic TBI during his first high school varsity football game in August 2008.  Matthew’s injury was caused by a severe helmet to helmet hit and he never regained consciousness. The Matthew Gfeller Foundation’s mission is to help prevent, recognize, and treat youth sports head injuries. The MGF works to raise awareness and fund research and treatment centers through a variety of community based programs. The MGF supports the following organizations in furtherance of its mission: The Matthew Gfeller Sports Related Traumatic Brain Injury Research Center at UNC-Chapel Hill, The Childress Institute for Pediatric Trauma at Wake Forest University, and the high school athletic trainers of Forsyth County, NC.