The history of CPS stretches back about 40 years, including the institution of the first CR standard in 1972, the dynamic testing standard in 1981, the passage of legislation in all states by 1985, and community education efforts. This article, by long time CPS professional Joe Colella, chronicles the past 15 years, encompassing issues such as compatibility, booster use, and national training that still are evolving today. For more detail, go to www.saferidenews.com to view a chronological timeline of CPS events*.
It was 1994 when I unexpectedly became involved in occupant protection efforts. My 3-year-old niece, Dana Hutchinson, had just lost her life in a tragic, head-on crash while riding in a car seat. I spent hours in research libraries, sifted through manufacturer instructions, and made countless phone calls, only to learn that there was an admitted incompatibility between the vehicle seating position she was riding in and car seats. I also learned that such incompatibilities were quite common then, that the related safety issues had been documented since the early 1980s, and that incorrect use of car seats was clearly the norm.
The lay of the land was very different for advocates and parents in those days. Automatic seat belts were a common feature in the front seating positions of many vehicles, and vehicle systems were often incapable of holding child restraints (CRs) securely. Children often rode in the front seat. Many vehicles had back seats with only lap belts, since the seat belt standard had only recently changed to require outboard lap and shoulder belts, and tethers had been phased out of the market since 1985. Though all states had child restraint laws, many were minimal or not widely enforced. In practice, most kids were being restrained in CRs only until between ages 1 and 4, if they were using CRs (or any restraint) at all. Essentially all convertible CRs were required to be used forward facing with children over 20 pounds, and shield boosters were far more common than belt-positioning boosters. The largest dummy used in required performance testing simulated a 3-year-old who weighed 33 pounds.
CPS efforts were typically limited to children from birth through age 4. During that year, 681 children in that age range were killed in motor vehicle crashes. This was 1994 – barely 15 years ago!
Since the 1970s, advocacy efforts had concentrated on developing better product standards, passing state laws, and educating parents locally using volunteers. But even by the 1990s, few educational resources were available nationally, and the Internet barely existed. SafetyBeltSafe, U.S.A., a leader in education, training, and advocacy, was extremely underfunded. Shelness Productions had first produced the video, Don’t Risk Your Child’s Life in 1978 and had updated it several times. The American Academy of Pediatrics and Safe Ride News Publications produced small runs of advocate news and materials, and NHTSA had published a CPS Resource Manual.
NHTSA had sponsored one- or two-day advocate training courses in the states during the early 1990s. National SAFE KIDS Campaign (now Safe Kids Worldwide) had an audiotape training series for its coalitions. The available courses were not standardized, and there were few resources to verify accuracy. CR check up events were available in some localities, but were sporadic at best. The service did not even exist in some states.
1995 – A Turning Point
In response to national media attention to incompatibilities, due in large part to the circumstances of Dana Hutchinson’s death, NHTSA convened the Blue Ribbon Panel on Child Restraint and Vehicle Compatibility. The panel brought representatives from vehicle and CR manufacturers together with CPS advocates for the first time. Panel members began to understand issues from a variety of perspectives and then published a series of educational and technological recommendations.
Simultaneously, research was being done on child air bag interaction and injury, and the requirements for lockable seat belts and frontal air bags were about to be put into effect. Major revisions to the CR standard, including requiring testing with a 6-year-old dummy and highly visible air bag warning labels, were being finalized.
Media attention expanded to include misuse following the release of a study that showed a 79.5% misuse rate, and incompatibilities continued to be highlighted. Thirty-nine children had been killed by air bags, and a medical journal article on the subject created even more national attention.
When $10 million from a vehicle recall settlement was earmarked to be spent on CRs, NHTSA leaders knew that distribution had to be accompanied by education, so they surveyed advocates from each state to identify effective outlets. The resulting information showed that only 30 out of approximately 3,000 practitioner respondents were fully trained and updated. Although four- to 16-hour awareness classes for law enforcement, first responders, and advocates were being introduced, the concept of a five- to eight-day national CPS certification program was just being born.
Progress in the Past 15 Years
Due to the untiring efforts of advocates, manufacturers, researchers, and national organizations, the CPS field has come a long way since 1994. Every state has some type of educational program available, and many communities have trained advocates available to help educate parents and caregivers. CRs and vehicles are safer and easier to use, and most incompatibilities have an available solution. Educational and regulatory focus is more related to real-world data than it has been in the past, CPS efforts are being expanded to cover children to age 15 (along with efforts targeting young drivers), and a wider range of advocate partners is involved. Also, much more attention is given to CPS for kids with disabilities and those on school buses.
Federal Funding Via Legislation
The Child Passenger Protection Act (Dana’s Bill) was a funding effort first introduced in 1995 and eventually passed in 1998. The result was that $30 million was distributed to the states as Section 2003(b) monies. This largely funded the expansion of technician training, inspection stations, and CR distribution over a four-year period.
Dana’s Bill was followed by the Child Passenger Protection Act of 2000, part of the TREAD Act. It led to improved CR standards, enhanced booster education, and the NHTSA CR rating system.
Anton’s Law, passed in 2002, led to booster seat testing advancements and the requirement of lap and shoulder belts in center rear seating positions. This law was enacted due in great part to the advocacy efforts of Autumn Skeen, whose son Anton might be alive today if he had been using a booster seat.
States Extend CPS Laws
The National SAFE KIDS Campaign produced a comprehensive rating system of all child occupant protection laws starting in 2001. At that time, only two states covered booster-size children with child restraint requirements (California and Washington). As of January 2009, forty-five child occupant protection laws have been enhanced to cover at least some booster-size children.
Partners for Child Passenger Safety (PCPS), a partnership between The Children’s Hospital of Philadelphia and State Farm Insurance, has developed the largest database of crashes involving children between 1998 and 2007. PCPS looked at real-world cases of children who were injured or uninjured in crashes, and has published numerous findings that help define, support, and evaluate education and technological improvements.
The Crash Injury Research & Engineering Network (CIREN) has produced additional information on real injury trends, joining trauma center admissions with crash reconstruction and patient treatment results.
Federal Motor Vehicle Safety Standard (FMVSS) 213 has been enhanced many times over the past 15 years, most extensively in 1996, 1999, and 2005. It now includes more stringent protection requirements, labeling and instructions, and crash testing up to 65 pounds.
FMVSS 208 now contains air bag requirements, which have been modified over the years to minimize risks to children by including manual on/off switches, depowered air bags, and the current advanced air bags. In addition, the standard also requires shoulder belts in center rear seating positions.
FMVSS 225 was created to require universal lower anchors and tether anchors (LATCH) in vehicles, and it has been modified to better reflect real-world LATCH experience.
Other notable improvements to regulations include FMVSS 214 (side impact protection), FMVSS 202 (head restraint), and FMVSS 222 (school bus occupant protection).
Technical & Awareness Training
The National Standardized CPS Training Program was developed and piloted by NHTSA in 1997 and formalized in 1998. It has been updated several times to reflect changing technology and educational needs. Over 50,000 people have completed the training, and over 33,000 are currently certified through the Safe Kids Worldwide certification program.
Additional training for CPSTs who help children with special transportation needs was developed through Riley Hospital for Children. An indicator noting completion of this course has recently been added to the online posting of CPST information.
Various awareness courses have also been created for law enforcement officers, first responders, healthcare providers, childcare providers, school bus drivers, and Native American advocates. While these courses are not centrally monitored for attendance or certification, they provide functional awareness for attendees.
Safe Kids Buckle Up was enhanced to focus on CR inspection, and over a million seats or children have been checked through that program alone. Formed as a partnership with General Motors, after a SAFE KIDS employee, Ginny O’Donnell, pilot-tested auto dealer education at her father’s dealership, the program continues to devote millions of dollars to CPS education.
Volkswagen, Chrysler, Ford, Nissan, and many other vehicle and CR manufacturers have also supported community CPS education, and all major manufacturers now have CPSTs on staff.
Many independent educational/programmatic efforts, materials, and websites have been developed that don’t rely on government or major industry efforts, including those by SafetyBeltSafe U.S.A., Safe Ride News, and many state-level and local CPS groups.
Where We Are Now
We have obviously made amazing strides during the past 15 years! In 2007, the most recent year for which final data are available, 385 children from birth through age 4 were killed in crashes, compared to 681 in 1994, despite the growth in population and vehicle miles traveled over that same period. More than one third of those killed in 2007 were either unrestrained or restraint use is unknown, while 24 children were inappropriately riding in adult seat belts.
Although the reduced fatality numbers speak for themselves, our job as occupant protection educators is far from complete. Expanding the age range to look at all children from birth to age 14, 1,670 children died in motor vehicle crashes in 2007. An estimated 174,000 were injured. Correct restraint selection and use would have prevented many of these fatalities and reduced the severity of or eliminated many of the injuries. Yet the rates of incorrect use still exceed 80% for installed CRs and 72% for all CRs including boosters (NHTSA, 2002). Less than 50 percent of children between ages 4 and 8 ride in booster seats (NHTSA, 2008).
We have good training available. We have educational resources and supporting research. We have products with improved performance that are easier to use. Armed with these tools, what will our progress report look like in another fifteen years?