Kids and Cars by Dr. Meredith

Motor vehicle crashes are the number one cause of death from injury in children. It’s more than 50 percent of all pediatric trauma injuries, according to the Centers for Disease Control and Prevention.

The number of deaths spike sharply as kids approach getting their driver's license. There's a great deal we can do in terms of preventing deaths and injuries. Those prevention strategies include driver's license strategies, drinking and driving strategies, automobile design and safety strategies, all of which have been effective and need to significant resources investments to continue and improve.

It is safer on our highways than it's ever been before. Per vehicle mile driven there are fewer deaths both in children and in everyone else. Nonetheless, it will be a long, long time before we eliminate motor vehicle crashes as a cause of injury or a cause of death.

Until that time occurs, another strategy that needs to be implemented is the development of trauma systems so that kids who are injured in crashes can be identified. Researchers are working on automatic crash notification systems that will identify if people are likely to have significant injuries in them and notify the system automatically.

You think about commercials of cars that look for the crash potentials, automatically slow down and proactively help the driver. It is equally possible for a car to sense how severe a crash is and automatically notify folks, from notification through the response. Once EMS is notified, they need to have localized people who can get to crashes quickly. When they arrive they need to have the training, expertise and equipment that is necessary to recognize and treat the injuries. 

In addition to funding crash notification research, the Childress Institute is committed to developing and providing training programs for all health care professionals. Surgeons, who treat mostly adults, need extra help in knowing how to treat kids. It's not as common and it's so emotionally charged which makes it difficult. The same thing is true for paramedics. They need that training and we're committed to developing it and disseminating educational programs for first responders. 

When an injury occurs, we need a good trauma system that can recognize kids with triage protocols. Responders need to comprehend who has injuries that require trauma center care and have ready access to get to trauma centers.

There are not enough trauma centers or pediatric trauma centers in our country. There's not enough coordination of the children's hospitals with the trauma centers and the trauma systems in our country. The Childress institute is working very hard to foster the development of more children's hospitals becoming trauma centers. We have worked very hard to support the Pediatric Trauma Society, which is a group of professionals whose goal is to further the knowledge and develop trauma systems and improve trauma centers.

The last piece of the puzzle is the actual care of injury victims and understanding more. So much of the treatment for these high energy crashes and the injuries that occur in them comes from extrapolation of injuries that occur in adults and the way we treat them. The research that is necessary to figure out the best way to treat specific injuries in children has not yet been done. And it must be.

The Childress Institute has already funded research investigating the relationship of shock and head injury, which are the top two causes of death from trauma in children from car crashes. The outcomes of this research could be revolutionary for the treatment of injured children. It's full impact and how generalizable that is, needs further research. We need to be at the forefront of helping get that done and we need funding to help us make that kind of research a reality. Then after we develop new knowledge, we need better tools to disseminate that knowledge to the caregivers in our country.

Currently it takes sometimes ten years for new knowledge to become the standard of care widely used. We need to shorten that cycle time. Can you imagine the cycle time of learning to develop a new way of setting up the shock absorbers for a certain race track? If that took ten years, many teams would be extinct. You have to make these turnarounds at least every week. Health care needs to get there and trauma leaders need to forge the path.

- Dr. J. Wayne. Meredith, Medical Advisor, Childress Institute for Pediatric Trauma

What is a Trauma Center? By Dr. Meredith

What's a trauma center? When people discuss the number of trauma centers in the country and the number of children's trauma centers they are referencing the American College of Surgeons' standards for being a trauma center. The American College of Surgeons writes those standards and it also has the ability to, through its verification committee, to verify that any given hospital meets those standards.

It does not designate, it verifies. The difference being it verifies that those resources are available. Only a state or a government body can designate a hospital as a trauma center. It is very common to see the words American College of Surgeons Verified State Designated Trauma Center. There are a lot of very good trauma centers in the country that have not gone to the American College of Surgeons for verification but are designated by their state. In doing so, in general, the state will require the hospitals to demonstrate basically the same requirements as the American College of Surgeons does.

So what is a trauma center? A trauma center is a hospital that has made a tremendous commitment to the care of an injured patient. It's made a tremendous commitment in terms of readiness and terms of expertise. Trauma is a disease which can occur in any part of our population, in any place in our country, at any time of day, on any day of the week.

It is a societal investment in the care of our citizens similar to the fire department or a police department. There are very good studies that analyze the effects of improving trauma care, most notably the NSCOT study, the “National Study on Cost and Outcomes in Trauma,” published by Mackenzie, Jurkovich and Rivara. In the New England Journal of Medicine it shows that the death rate for severe to serious injuries was 25 percent less in patients treated at trauma centers than in patients treated in non-trauma centers.

This is a huge difference. We go to an awful lot of trouble to administer, for instance, chemotherapy to a cancer patient with the hopes of garnering a 2 or 3, maybe a 5 percent increase in survival, or decrease in death rates. A 25 percent reduction in death rate is the sign of a very good treatment.

The marked improvement is made because these verified trauma hospitals have made a commitment to have a certain level of training and expertise amongst well-defined staff members, including surgical, emergency medicine, anesthesia, and other medical specialties. They make a commitment to have certain services immediately available, including diagnostic services like CT scanning. Most importantly, trauma centers have the ability of those surgical specialists and operating rooms and intensive care units to take care of the most seriously injured patients immediately and with a high level of expertise.

This is a huge commitment on the part of these hospitals. It's a huge cost on the part of these hospitals and trauma centers, and the public owes them a debt of gratitude. Many of us are privileged to live in communities and states that make this commitment. For others, there is still much work to be done. 

Of the 5,700 hospitals in the U.S., only 1,200 of those are trauma ready. That means only 20 percent of hospitals are truly equipped to handle a trauma. If we can save many more lives and reduce disabilities by having more trauma centers, then we need to discover how that can be done effectively and efficiently and share those plans with hospitals. We can save more lives, especially the lives of injured children, by improving the care they receive when emergencies happen.

Dr. J. Wayne Meredith, Medical Advisor, Childress Institute for Pediatric Trauma

Research Saves Injured Kids by Dr. Alison Gardner

I always wanted to be a pediatrician. First as a pediatrician and now as a researcher, it’s my job to care and lobby for kids. 

Sometimes our kids are injured no matter how many precautions we take and it’s our job to find the best ways to treat these seriously injured children. The golden hour is where you can intervene and improve outcomes from issues like airway troubles, and blood loss, and that sort of thing. That's where, in the emergency room, I come into play. 

Dr. John Petty and I were talking and he brought up the fact that he sees many kids come to the emergency department after trauma with low blood pressure but they have not lost blood. In fact, oftentimes their primary and only injury is a bad head injury. 

In medical school we are taught through the American College of Surgeon’s Advanced Trauma Life Support (ATLS) manual how to respond during that golden hour. It defines the standards of care for trauma patients. It says that if we see evidence of low blood pressure, or shock, that hemorrhage is what we're supposed to think. They're losing blood somewhere. If it's not blood loss out of their body, they're probably bleeding inside their abdomen or internally somehow. There is a sentence in the manual that says isolated or intracranial injuries don't cause shock.

Dr. Petty and I discussed and decided this might be different for kids than adults, and we decided to investigate because it might change our care. Instead of giving them fluids and blood we might do something different to help their blood pressure. In fact, if you've injured your brain, more fluids could cause the brain to swell more and that would be detrimental.

We started a very small study of patients that were treated at our Level I trauma center. We reviewed the details of 31 kids with low blood pressure to see the final cause of their injuries when they were discharge. We found that in kids under 5 years old that came in with low blood pressure and evidence of shock, 50 percent of the time they had an isolated head injury. They didn't have injuries that cause internal blood loss.

The question then becomes, what is the problem? That's guides our treatment. We found it was age dependent. In kids 5 to 11 years old, we found that about 25 percent of those kids had a head injury. This phenomenon disappeared in our teenagers.

After discussion with colleagues at other institutions, we decided to expand our study to review cases from the National Trauma Database. We don't know all the answers to our questions yet, but more research is needed. We need to find better ways to help save more injured kids during the crucial golden hour of treatment. Head injury is a real problem in kids, and it's something that's not entirely preventable.

Our infectious disease colleagues began studying the causes of mortality in pediatric patients decades ago and were able to develop vaccines and improve antibiotics in the mid-1900s. We don't see kids dying a lot from infectious disease anymore. Now we see the same thing with cancer. Childhood leukemia is not a death sentence anymore, and that’s due to hard work in the mid-1980s and 1990s. Their work is impactful.

Now childhood trauma is killing more kids than all other causes combined. I’m involved in the care of these injured kids every day. Since we can’t completely prevent injuries, it's our time to take on this challenge and help save the lives of injured kids.

- Dr. AlisonGardner, Assistant Professor of Pediatrics and Emergency Medicine at Wake Forest Baptist Medical Center

Fire Safety Saves Kids' Lives by Pamela Elliott

Life-saving fire sprinklers should be more prevalent

While on my flight to speak at a fire safety event, an article caught my attention. It was titled “U.S Requires New Cars to Have Backup Cameras.” My first thought was there must be a huge problem if the National Highway Traffic Safety Administration is requiring new cars to have backup cameras. Then I was somewhat surprised to read that there are nearly 210 backover deaths each year. About a third of those deaths are children, and many of these accidents are caused by parents. The article stated that rear-facing cameras would save between 59 and 69 deaths a year.

By contrast, the United States Fire Administration reports that fire kills 3,400 and injures 17,500 people each year. I was burned as a young child in a house fire. As such, I am acutely aware of the number of people who needlessly die or are injured in fires.

I sat on that flight with many mixed feelings. As a fire safety advocate, I’m excited any time a safety measure that will save even just one life is enacted. However, as a burn survivor, I felt frustrated and angry that similar safety measures haven’t been implemented in homes to prevent fires. What makes me even angrier is that the technology to prevent these deaths and injuries exists—they're called fire sprinklers. It’s taken quite a few decades to install them in new homes at a very slow rate.

NHTSA is to be highly commended and applauded for their public safety efforts. Since its inception, seatbelts have saved 280,000 lives and air bags have saved 28,000 lives. Now another safety device will be added to cars to prevent even more deaths.

Because of my past, I investigated how many children die in fires. I looked at the FEMA report “Fire Risk to Children 2010.” In 2010, 357 children died in fires. That’s about five times more children than those killed in backover deaths annually. The children most likely to die or be injured are newborns through age four -- those who can’t escape by themselves. If those statistics don’t grab at your heartstrings, I don’t know what would.

Anthony Foxx, United States Secretary of Transportation, said in the article, “Safety is our highest priority, and we are committed to protecting the most vulnerable victims of backover accidents—our children and seniors. As a father, I can only imagine how heart-wrenching these types of accidents can be for families, but we hope that today’s rule will serve as a significant step toward reducing these tragic accidents.”

Sometimes when children die in fires, no body is found. I can’t imagine having to bury a child, but I certainly can’t comprehend not having a body to bury. 

According to the FEMA report, 87% of fire-related casualties to children occurred in homes. That’s 87% of 357 children — 310 children who die in their own homes. We have the capability of saving 310 children a year. The technology exists — it’s a scientific fact that fire sprinklers save lives, reduce property loss and decrease injuries.

There’s no way to comprehend the devastating effects of burn trauma unless it happens to you or a family member. Why do we wait for a horrific event that warrants litigation before we’re compelled to change? Unless prevention becomes the highest priority of the fire service and its advocates, we can expect to continue to see these horrific statistics; this makes me very sad and irate at the same time.

I can only hope that comparing these statistics will somehow motivate fellow safety advocates and the fire service to take action. We need to stand united in the message that fire sprinklers save the lives of both citizens and firefighters.

- Pamela Elliott, RN and fire survivor