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Today’s Program is Dedicated to:

It Takes a Village: Prevention of Vehicular Heatstroke in the Childcare Setting Kristie C. Reeves-Cavaliero, Pharm.D. President and Co-Founder, Ray Ray’s Pledge™ (a project of KidsAndCars.org). Today’s Program is Dedicated to:. The memory of Sophia Rayne “Ray Ray ” Cavaliero

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Today’s Program is Dedicated to:

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  1. It Takes a Village:Prevention of Vehicular Heatstroke in the Childcare SettingKristie C. Reeves-Cavaliero, Pharm.D.President and Co-Founder,Ray Ray’s Pledge™(a project of KidsAndCars.org)

  2. Today’s Program is Dedicated to: The memory of Sophia Rayne “Ray Ray” Cavaliero 05.15.10 – 05.25.11 The future car safety of Giana Rayne and Kiara Rayne

  3. Forgotten in the Backseat:More Common than You Think http://youtu.be/kYGAIagq-Wg

  4. 651 The number of child hot car deaths reported in the media since 1990 Data on file. KidsandCars.org, 2013.

  5. Forgotten Daycare Drop-off The #1 source of child hot car deaths

  6. Objectives Provide brief overview of child vehicular heatstroke (“child hot car deaths”) Understand the most common scenarios in which child hot car deaths occur Review common ways to prevent child hot car deaths Discuss future heatstroke training requirements and childcare accountability

  7. Heat-Related Illness • A spectrum of symptoms due to excessive heat exposure • Key initial physical sign to distinguish mild illness vs. heatstroke: • Core temperature: • ≥104˚F: heatstroke Becker J. Am Fam Physician 2011; 83(11):1325-30.

  8. Heatstroke • Also known as “hyperthermia” • Body temperature exceeds 104˚F • + Body’s thermoregulatory mechanism is overwhelmed and can no longer cool itself • + Symptoms: • Central nervous system effects: disorientation, sluggishness, hallucinations, seizure, loss of consciousness • Other: hot/dry skin that is flushed but not sweaty, rapid heart rate, other heart rhythm disturbances • Body temperature >107˚F: organs shut down, cellular damage • Fatal if not rapidly reversed Becker J. Am Fam Physician 2011; 83(11):1325-30. http://ggweather.com/heat, Accessed 12/1/11.

  9. Heatstroke in Children • Children are more prone to overheating than adults: • Immature thermoregulatory system: less efficient than adults • A child’s body overheats 3-5 times faster than an adult body • Adults more likely to modify behavior based on environment (eg: remove excess clothing, get out of a hot car) Tsuzuki-Hayakawa K and Tochihara Y. Eur J Appl Physiol 1995;72:12–17. http://ggweather.com/heat, Accessed 12/1/11.

  10. Child Vehicular Heatstroke:An Unintended Consequence of Moving Children to the Backseat www.KidsandCars.org/heatstroke.html. Accessed 3/15/14.

  11. Child Injury from Front Passenger Airbag Deployment N=37 N=12 N=11 N=8 * *40 children unrestrained or improperly restrained *8 child deaths reviewed: 2 properly restrained; 6 improperly restrained or not restrained 49 Deaths; 19 Serious Injuries (1993- Nov. 1997) Marshall KW. AJNR Am J Neuroradiol 1998; 19:1599–1607.

  12. Front Airbag Death vs. Backseat Heatstroke Death 38 10* *Most deaths involved children who were forward-facing and either unrestrained or improperly restrained Was the Solution More Dangerous? Where is the Public Outrage? Average deaths per year Marshall KW. AJNR Am J Neuroradiol 1998; 19:1599–1607. Data on file, KidsAndCars.org.

  13. Child Deaths Due to Vehicular Heatstroke:Why Are We Talking About It? Vehicular Heatstroke: 3rd leading cause of death! #1 cause of non-crash, non-traffic child car fatalities! http://kidsandcars.org/heatstroke.html, Accessed 12/1/11. NiTS Data. http://www-nrd.nhtsa.dot.gov/Pubs/811655.pdf. Accessed 3/15/14.

  14. Child Vehicular Heatstroke:Understanding the Cause Data from 494 child hot car deaths (1998 – 2010) • More than 1 in 5 heatstroke DEATHS • Kids were supposed to go to DAYCARE that morning • FORGOTTEN in the backseat instead • Whereabouts went unquestioned http://ggweather.com/heat, Accessed 12/1/11. Graph Courtesy of Jan Null, CCM.

  15. Understanding the Cause (cont.) KidsAndCars.org All-Heatstroke Fatality Data (1990 – 2012; n = 651)

  16. Children Left in Vehicles:How Hot? How Fast? • Rate of temperature rise in first 20 minutes: 6.25˚F/ 5 minutes • Overall rate of temperature rise through 60 minute study: 3.1˚/ 5 minutes • 80% of temperature rise in first 30 minutes • Temperature rise begins within five minutes of shutting off ignition • Temperature begins to plateau at 60 minutes McClaren C et al. Pediatrics 2005; 116:e109-11. http://ggweather.com/heat, Accessed 12/1/11.

  17. “How Can ANYONE Forget that a Child is in the Backseat??” “If you’re capable of FORGETTING your CELLPHONE, you are potentially capable of FORGETTING your CHILD” David Diamond, Ph.D., USF Weingarten G. Fatal Distraction. IN: Washington Post 2009. http://www.pulitzer.org/works/2010-Feature-Writing.

  18. Common Factors Associated withParents Who Forgot their Children • Stress • Emotion • Lack of sleep • Change of routine Weingarten G. Fatal Distraction. IN: Washington Post 2009. http://www.pulitzer.org/works/2010-Feature-Writing.

  19. …..in other words….What parent IS NOT at risk of forgetting a child in the backseat?

  20. Prevention Efforts:It Takes a Village!

  21. Three Easy Prevention Steps www.RayRaysPledge.com; Accessed 3/15/14.

  22. LOOK before you LOCK™ Recommended by: NHTSA, KidsAndCars.org, Ray Ray’s Pledge

  23. Ray Ray’s Pledge™ www.RayRaysPledge.com; Accessed 3/15/14.

  24. Car Seat Alarms? • Suddenly Safe ‘N Secure Systems (SSNSS) • Weight-activated devices • Smartphone-activated devices (NEW!) • Safety 1st convertible car seat built-in alarm (NEW!) • TOMY iAlert Car Seat • Alarm system built-in to car seat • Baby Alert International • Car seat harness clip-based devices • Weight-activated devices

  25. Future Directions in Vehicular Heatstroke Safety • 2012 US Transportation Bill: “Unattended Passenger Reminder” Provisions • Safety research initiative • Development of performance requirements to warn driver of presence of backseat passenger after vehicle motor is disengaged

  26. Future Directions (cont.) • HHS 45 CFR Part 98 (Child Care and Development Fund Program) • 98.41 (a) (3) (xi): transportation and child passenger safety training

  27. Future Directions (cont.) • State Childcare Heatstroke Training/ Absence Verification Requirements • TX AC Chapter 746: Minimum Standards for Childcare Centers • 746.1316 (Jacob’s Law) • 2 hr annual transportation safety training • 746.5625 • Requirement for child presence reminder alarms on daycare vehicles • Ray Ray’s Pledge (or equivalent) • Absence verification requirements in 5 states

  28. For Heatstroke InformationPlease Visit Us: Sophia Rayne “Ray Ray” Cavaliero 5.15.10 – 5.25.11 www.RayRaysPledge.com www.facebook.com/rayraycavaliero Twitter: @rayrayspledge Instagram: rayrayspledge Youtube: ray rays pledge Email: info@rayrayspledge.com

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