Characterizing the child passenger safety workforce in Michigan: A statewide survey in 2015

Objective: In this study, we assessed the number of child passenger safety technicians (CPSTs) in Michigan over 4 years and characterized the CPST workforce in 2015 to identify factors associated with high productivity and longevity in the field.

Methods: We determined the number of CPSTs and those newly certified using lists from the Michigan Office of Highway Safety Planning (OHSP) from 2012 to 2015. We conducted a statewide survey of Michigan CPSTs in October 2015. Analyses were conducted in 2016. The survey assessed demographic characteristics, reasons to enter the field and maintain certification, and motivations to conduct seat checks. We used CPST-reported time devoted to seat checks and average number of seats checked per month to create a composite “activity level” variable. We examined activity levels across several characteristics.

Results: The number of CPSTs ranged from 941 to 980 over the study period, with approximately 200 new certifications annually. In 2015, surveys were started by 496 of 962 eligible CPSTs and 427 submitted complete responses. CPST-instructors had a higher response rate than CPSTs in general (89 vs. 49%, P < .0001). The majority of respondents were women (71%) and self-identified as white (88%). More than one third were 35–44 years old. Just 7% were comfortable checking seats using a language other than English. “Personal reasons” were most often cited motivation for becoming a CPST and maintaining certification. Natural fit/job enhancement were more common reasons to maintain certification than become a CPST. Time and distance had the greatest influence on seat check participation. Perceived need, appointments vs. drop-in, and employer factors were very influential for 10–15% of CPSTs. Few CPSTs considered free food and payments/giveaways very influential. About 40% of respondents were considered high-activity (>24 seats checked/year), one third medium-activity (5 to 24 seats checked/year), and one quarter low-activity (<5 seats checked/year). High-activity CPSTs most commonly reported both being paid and volunteering their time to check seats, worked with a Safe Kids coalition, worked in law enforcement or social services, and had recertified at least once. Motivation to participate in seat checks did not vary with activity level.

Conclusions: Understanding the demographic characteristics and motivations of CPSTs can help Michigan OHSP recruit and retain a workforce dedicated to increasing the safety of child passengers. Agencies hosting seat checks can use these results to align the strategies they employ to incentivize CPSTs to serve in their communities with the factors that have the greatest influence on CPST participation.     

Parental awareness and perception for correct use of child restraint systems and airbags in Brazil

Objective: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil.

Methods: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags.

Results: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags.

Conclusion: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.     

Evaluation of interventions to make top tether hardware more visible during child restraint system (CRS) installations

Objectives: The objective of the study is to determine whether specific child restraint system (CRS) or vehicle conditions improve top tether attachment rates during volunteer installations.

Methods: A factorial randomized controlled trial was designed to evaluate 4 different experimental categories: (1) Color of tether adjuster casing (black or red), (2) labeling on tether adjuster casing (labeled with “Tether: Use for forward-facing” or unlabeled), (3) storage location of tether (bundled in a rubber band on the back of CRS or Velcroed over the forward-facing belt path), and (4) labeling in vehicle (labeled under head restraint and below anchor or unlabeled). Ninety-six volunteers were randomly assigned to one combination of conditions. One installation per volunteer was completed. The primary outcome measure was acceptable attachment of the top tether to the tether anchor. The secondary outcome measure was overall secureness of the installation. Pearson’s chi-square tests were used to identify significant predictors of acceptable outcomes and logistic regression was used to investigate interaction effects.

Results: A total of 66/96 subjects (68.8%) attached the top tether in an acceptable manner, with either zero errors (n?=?50) or minor errors (n?=?16). A total of 30/96 subjects (31.2%) had unacceptable tether outcomes, with either major errors (n?=?10) or nonuse the tether at all (n?=?20). None of the 4 experimental categories significantly affected tether outcomes. Subjects who opted to install the CRS with the lower anchors (LAs) had higher rates of acceptable tether attachment compared to subjects who installed using the seat belt or those who used both LA and seat belt together (χ² = 6.792, P = .034). Tether outcomes were not correlated with previous CRS experience, use of instruction manual(s), age, or sex. Only 15.6% of subjects produced overall correct and tight installations. Of those who used the seat belt in some manner, 70.2% neglected to switch the retractor into locking mode.

Conclusions: Conditions in this study including tether color, tether labeling, storage location, and vehicle labeling did not significantly affect tether attachment rates. High rates of tether misuse and nonuse warrant further exploration to find effective solutions to this usability problem.     

Predictors of restraint use among child occupants

Objectives: The objective of this study was to identify factors that predict restraint use and optimal restraint use among children aged 0 to 13 years.

Methods: The data set is a national sample of police-reported crashes for years 2010–2014 in which type of child restraint is recorded. The data set was supplemented with demographic census data linked by driver ZIP code, as well as a score for the state child restraint law during the year of the crash relative to best practice recommendations for protecting child occupants. Analysis used linear regression techniques.

Results: The main predictor of unrestrained child occupants was the presence of an unrestrained driver. Among restrained children, children had 1.66 (95% confidence interval, 1.27, 2.17) times higher odds of using the recommended type of restraint system if the state law at the time of the crash included requirements based on best practice recommendations.

Conclusions: Children are more likely to ride in the recommended type of child restraint when their state's child restraint law includes wording that follows best practice recommendations for child occupant protection. However, state child restraint law requirements do not influence when caregivers fail to use an occupant restraint for their child passengers.     

Rating child passenger safety laws relative to best practice recommendations for occupant protection

Background: State laws regarding child passenger protection vary substantially.

Objectives: The objective of this study was to develop a scoring system to rate child passenger safety laws relative to best practice recommendations for each age of child.

Methods: State child passenger safety and seat belt laws were retrieved from the LexisNexis database for the years 2002–2015. Text of the laws was reviewed and compared to current best practice recommendations for child occupant protection for each age of child.

Results: A 0–4 scale was developed to rate the strength of the state law relative to current best practice recommendations. A rating of 3 corresponds to a law that requires a restraint that is sufficient to meet best practice, and a rating of 4 is given to a law that specifies several options that would meet best practice. Scores of 0, 1, or 2 are given to laws requiring less than best practice to different degrees. The same scale is used for each age of child despite different restraint recommendations for each age. Legislation that receives a score of 3 requires rear-facing child restraints for children under age 2, forward-facing harnessed child restraints for children aged 2 to 4, booster seats for children 5 to 10, and primary enforcement of seat belt use in all positions for children aged 11–13. Legislation requiring use of a “child restraint system according to instructions” would receive a score of 1 for children under age 2 and a 2 for children aged 2–4 because it would allow premature use of a booster for children weighing more than 13.6 kg (30 lb).

Conclusions: The scoring system developed in this study can be used in mathematical models to predict how child passenger safety legislation affects child restraint practices.     

Factors affecting use and nonuse of child safety car seats in Gorgan,Iran

Objective: Motor vehicle accidents, which are among the main causes of child mortality in Iran and the Middle East, impose staggering costs for the community. Ignoring use of safety devices for children in most motor vehicle crashes will lead to death or serious injury. Because few studies have been performed on effective and predictive factors regarding use of child safety seats, the purpose of this study was to examine the factors affecting the use and nonuse of child safety seats, along with the factors that can facilitate how a child safety seat is used.

Method: This study was conducted in the urban area of Gorgan using a questionnaire. Through random selection, 204 parents with at least one child, aged 8?years or younger, reported their knowledge about the benefits of using a child safety seat.

Results: The results showed that 80% of parents never use a child safety seat, and 13% always use a child safety seat. More than 93% thought that it was necessary to make usage of the child safety seat obligatory. In addition, 80% of parents believed that a child safety seat prevents children from injury in crashes. In addition, 38% of parents were not aware of child safety devices and child safety, less than 20% said that they did not use a child safety seat because their spouse did not support its use, and 28% of them thought that a child safety seat does not affect the safety of the child. In general, 91% of parents reported that if child safety seat use were mandated, the frequency of use would increase. A law on the use of child safety seats is a very important variable in their use, which can enhance the chance of using a child safety seat by 6.5 times.

Conclusion: Special instructions should be developed to create incentive strategies for using a child safety seat. Mandating the use of a child safety seat, equipping cars with a child safety seat, encouraging children to use it, and providing continuous education and training are important factors for increasing the use of child safety seats.     

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0–17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.     

Investigation of Child Restraint System (CRS) Compatibility in the Vehicle Seat Environment

Objective: Child restraint system (CRS) misuse is common and can have serious consequences to child safety. Physical incompatibilities between CRS and vehicles can complicate the installation process and may worsen CRS misuse rates. This study aims to identify the most common sources of incompatibility between representative groups of CRS and vehicles.

Methods: Detailed dimensional data were collected from 59 currently marketed CRS and 61 late model vehicles. Key dimensions were compared across all 3,599 theoretical CRS/vehicle combinations and the most common predicted incompatibilities were determined. A subset of 34 physical installations was analyzed to validate the results.

Results: Only 58.2% of rear-facing (RF) CRS/vehicle combinations were predicted to have proper agreement between the vehicle's seat pan angle and the CRS manufacturers’ required base angle. The width of the base of the CRS was predicted to fit snugly between the vehicle's seat pan bolsters in 63.3% of RF CRS/vehicle combinations and 62.2% of forward-facing (FF) CRS/vehicle combinations. FF CRS were predicted to be free of interaction with the vehicle's head restraint in 66.4% of combinations. Roughly 90.0% of RF CRS/vehicle combinations were predicted to have enough horizontal clearance space to set the front seat in the middle its fore/aft slider track. Compatibility rates were above 98% regarding the length of the CRS base compared to the length of the vehicle seat pan and the ability of the top tether to reach the tether anchor. Validation studies revealed that the predictions of RF CRS base angle range vs. seat pan angle compatibility were accurate within 6%, and head restraint interference and front row clearance incompatibilities may be more common than the dimensional analysis approach has predicted.

Conclusions: The results of this study indicate that RF CRS base angles and front row clearance space, as well as FF CRS head restraint interference, are frequent compatibility concerns. These results enable manufacturers, researchers, and consumers to focus their attention on the most relevant CRS/vehicle incompatibility issues in today's market.     

Usability of non-standard lower anchor configurations for child restraint system (CRS) installation

Abstract

Objectives: The objective of this study was to determine whether the amount of tension required for proper child restraint system (CRS) installation varies with lower anchor spacing and to determine whether nonexperts can produce adequate tension on wider-than-standard lower anchor configurations.

Methods: CRSs were installed by certified child passenger safety technicians (CPSTs; n?=?6 subjects, n?=?72 installations) and nonexperts (n?=?30 subjects, n?=?120 installations) on a mock-up vehicle seat fixture with lower anchors set at 11 (standard), 15, 19, and 23 in. apart from one another. Each CPST installed a rear-facing (RF) infant base, RF convertible, and forward-facing (FF) convertible into each of the 4 spacing configurations in random order. The CPSTs were instructed to tighten the lower connector strap until the tension was exactly at the threshold between passing and failing the 1-in. test. Each nonexpert installed one CRS model into all 4 spacing conditions in random order. Nonexperts were instructed to install the CRS to the best of their ability. The tension produced on the lower connector strap was recorded via load cell in the lower anchor assembly of the vehicle seat. Resultant tension magnitudes were compared across spacing conditions using matched pair t-tests. The CPSTs’ mean 1-in. test threshold values were compared to tensions produced by nonexperts. Installations were visually evaluated for errors and qualitative usability feedback was collected via survey.

Results: CPSTs installed the infant base with higher tensions in the 15-, 19-, and 23-in. configurations compared to the standard 11-in. configuration (P = .034, .032, and .003, respectively). The nonexperts installed the infant base with higher tension in the 15- and 23-in. configurations compared to the 11-in. configuration (P = .004 and .026, respectively). The RF convertible and FF convertible installations showed no significant differences in tension among any of the spacing configurations for either group. Only 19% of the nonexperts’ installations were tight enough to pass CPST thresholds, and the pass rate did not vary with respect to lower anchor spacing. In feedback surveys, the nonexpert group did not show a consistent preference for either standard or wider-than-standard lower anchor configurations.

Conclusions: The amount of tension required to pass the 1-in. rule did not vary with lower anchor spacing configurations for the RF and FF convertible CRS, but the infant base required more tension in wider anchor configurations. Nonexperts tended to produce less than ideal tension in all configurations, although their tension magnitudes increased for the infant base in wider configurations.     

Restraint use in the Eastern Province of the Kingdom of Saudi Arabia

Objectives: This study set out to examine seat belt and child restraint use in the Dammam Municipality of the Kingdom of Saudi Arabia, based on the premise that an increase in seat belt use would significantly reduce personal injury in traffic crashes. It was expected that local data would help identify intervention strategies necessary to improve seat belt use in the region.

Methods: The research involved 2 methodologies. First, 1,389 face-to-face interviews were conducted with male and female adults in regional shopping plazas regarding their own and their children's restraint use in their vehicles and reasons for these attitudes and beliefs. Second, 2 on-road observation studies of adult and child restraint use were conducted by trained observers. Occupants of approximately 5,000 passenger vehicles were observed while stopped at representative signalized traffic intersections.

Results: The findings showed front seat belt use rates of between 43 and 47% for drivers and 26 to 30% for front seat passengers; rear seat belt use rates were lower. While there seemed to be some knowledge about the purpose and reasons for restraining both adults and children in suitable restraints, this failed to be confirmed in the on-road observations.

Conclusions: Reasons for these rates and findings are discussed fully, and recommendations for improving seat belt use in the Dammam Municipality are included.     

An observational study of child safety seat use in an international safe community: Tehran,Iran

Objective: Despite strong evidence of the effectiveness of child safety seats in reducing injuries, the use of these devices in some communities is still rare. The purpose of this study was to determine the prevalence of child safety seat use and the factors influencing its use in the safe community of Tehran.

Methods: This roadside observational study was conducted in 2015 and 2,178 personal cars with a child under 12 years aboard were observed on Tehran's streets in regard to use of child safety seats. Other variables such as the gender of the driver, driver's age group, type of street, region of municipality, time of day, and day of the week were also collected.

Results: Prevalence of child safety seat use was 4.3% and was significantly higher among women drivers, on freeways, and in municipal regions 1, 4, and 7.

Conclusions: The prevalence of child safety seat use in Tehran as a most populous member of the international safe community was very low and most children commuted in insecure situations in the vehicle. Therefore, it is proposed that plans should be made to increase the use of child safety seats in international safe communities.     

Knowledge,attitudes, and behaviors related to child safety restraint in citizens of Shenzhen Municipality,China, and the associations between these factors

Objective: A child safety restraint (CSR) is an effective measure to reduce the risk of child injury from traffic collisions. This study aims to explore knowledge, attitudes, and behaviors regarding CSRs in a Chinese population.

Methods: A cross-sectional survey regarding CSR use was conducted from April to May 2014 in Shenzhen municipality. Respondents were parents who had at least one child 0 to 6 years of age and owned a car. These parents provided a self-report of demographic characteristics as well as information about their knowledge, attitudes, and behaviors toward CSR use.

Results: Most respondents had a fair level of knowledge about CSRs, with higher mean knowledge scores demonstrated among the respondents who were male, had an advanced degree, had a higher income, owned an expensive car, had an older child, drove frequently with children, and routinely drove greater distances with children. In addition, most respondents had a more positive attitude toward CSR use, with a higher mean attitude score among those who had an advanced degree, owned an expensive car, drove frequently with children, and routinely drove greater distances with children. However, some myths regarding CSR use also existed (e.g., parents can effectively protect their children in a car collision by holding them, they are not required to purchase the CSR for child safety if there is no mandatory provision by law, among others). Among 3,768 respondents who had at least one child and a car, 27.8% (1,047) had a CSR and 22.9% (864) used the CSR. A logistic regression model showed the likelihood of CSR ownership to be higher if respondents drove frequently or greater distances and was dependent on both the education level of the respondents and the age of the children. The frequency of CSR use increased as the age of children decreased (P = .0274). Respondents who owned a CSR and those who frequently used CSRs had higher mean knowledge and mean attitude scores.

Conclusions: This observational study found that although the majority of respondents had fair levels of knowledge and positive attitudes, they had lower rates of CSR ownership and use. Therefore, efforts at developing opportunities to expand public awareness of CSR use should be made to improve child passenger safety practices and eliminate child injury caused by traffic collisions.     

Implications of head and neck restraint test repeatability for specification improvement

Objective: Since 2005, National Association for Stock Car Auto Racing, Incorporated (NASCAR) drivers have been required to use a head and neck restraint system (HNR) that complies with SFI Foundation, Inc. (SFI) 38.1. The primary purpose of the HNR is to control and limit injurious neck loads and head kinematics during frontal and frontal oblique impacts. The SFI 38.1 performance specification was implemented to establish a uniform test procedure and minimum standard for the evaluation of HNRs using dynamic sled testing. The purpose of this study was to evaluate the repeatability of the current SFI 38.1 test setup and explore the effects of a polyester seat belt restraint system.

Method: Eight sled tests were conducted using the SFI 38.1 sled test protocol with additional test setup constraints. Four 0° frontal tests and 4 30° right frontal (RF) oblique tests were conducted. The first 3 tests of each principal direction of force (PDOF) used nylon SFI 16.1 seat belt restraint assemblies. The fourth test of each PDOF used polyester SFI 16.6 seat belt restraint assemblies. A secondary data set (Lab B Data) was also supplied by the HNR manufacturer for further comparisons. The International Organization for Standardization (ISO) 18571 objective comparison method was used to quantify the repeatability of the anthropomorphic test device (ATD) resultant head, chest, and pelvis acceleration and upper neck axial force and flexion extension bending moment time histories across multiple tests.

Results: Two data sets generated using the SFI 38.1 test protocol exhibited large variations in mean ISO scores of ATD channels. The 8 tests conducted with additional setup constraints had significantly lower mean ISO score coefficients of variation (CVs). The Lab B tests conducted within the current specification but without the additional test setup constraints had larger mean ISO score standard deviation and CV for all comparisons. Specifically, tests with the additional setup constraints had average CVs of 3.3 and 2.9% for the 0° and 30° RF orientations, respectively. Lab B tests had average CVs of 22.9 and 24.5%, respectively. Polyester seat belt comparisons had CVs of 5.3 and 6.2% for the 0° and 30° RF orientations, respectively.

Conclusion: With the addition of common test setup constraints, which do not violate the specification, the SFI 38.1 test protocol produced a repeatable test process for determining performance capabilities of HNRs within a single sled lab. A limited study using polyester webbing seat belt assemblies versus the nylon material called for in SFI 38.1 indicates that the material likely has less effects on ATD upper neck axial force and flexion extension bending moment time histories than the test setup freedom currently available within the specification. The additional test setup constraints are discussed and were shown to improve ATD response repeatability for a given HNR.     

Child restraint use and parental perceptions of comfort

Objective: Suboptimal child restraint use includes incorrect and/or inappropriate restraint use and increases the risk of injury. Comfort has been suggested as an important factor impacting on optimal use of restraints by children. This article aims to examine the relationships between parent reported comfort and restraint misuse and age-appropriate restraint choice.

Methods: This is an analysis of data from a cross sectional observation study of child restraint use in New South Wales. Logistic regression was used to model the relationship between parent-reported comfort and restraint misuse and age-appropriate restraint choice.

Results: There was no significant relationship between either parent-reported comfort and restraint misuse or parent-reported comfort and age-appropriate restraint choice.

Conclusions: Parent perceptions of comfort of children in child restraints do not appear to be associated with incorrect child restraint use or age appropriate restraint choice. It is possible that the actual comfort of the child may be related to incorrect use but this remains to be tested. Further investigation of the relationship between parent-perceived comfort and the actual comfort of the child, as well as the impact of child comfort on optimal child restraint use is warranted.     

Observed LATCH use and misuse characteristics of child restraint systems in seven states

INTRODUCTION: Although the LATCH System (Lower Anchors and Tethers for Children) holds the promise of simplifying the installation of a child restraint system (CRS) to the vehicle's seat, many drivers transporting young children have difficulties using this technology. This paper reports on an observation study of LATCH use and misuse. METHOD: Observations of approximately 1,000 children less than 5 years of age in CRSs, in the back seats of vehicles that were equipped with tether and lower anchors, in seven states. RESULTS: Tethers were used for 51% of the children when the forward-facing CRS had tether straps and the vehicle had tether anchors. Lower anchors were used for 58% of the children when the CRS had lower attachments and the vehicle had lower anchors. The most common tether and lower attachment misuses were loose tether straps (18% of cases) and loose lower attachment installation (30% of the cases), respectively. Vehicle safety belts were used in combination with lower attachments in 20% of all lower anchor installations. CONCLUSION: As more caregivers of young children drive vehicles equipped with LATCH, it will be important to promote the proper installation of CRSs using this technology. LATCH education messages must also emphasize that the lower anchors may not always be the safest choice for CRS attachment -- the safest attachment is the one that results in a tight fit and will be used correctly consistently.     

Standardized error severity score (ESS) ratings to quantify risk associated with child restraint system (CRS) and booster seat misuse

Objective: Although numerous research studies have reported high levels of error and misuse of child restraint systems (CRS) and booster seats in experimental and real-world scenarios, conclusions are limited because they provide little information regarding which installation issues pose the highest risk and thus should be targeted for change. Beneficial to legislating bodies and researchers alike would be a standardized, globally relevant assessment of the potential injury risk associated with more common forms of CRS and booster seat misuse, which could be applied with observed error frequency—for example, in car seat clinics or during prototype user testing—to better identify and characterize the installation issues of greatest risk to safety.

Methods: A group of 8 leading world experts in CRS and injury biomechanics, who were members of an international child safety project, estimated the potential injury severity associated with common forms of CRS and booster seat misuse. These injury risk error severity score (ESS) ratings were compiled and compared to scores from previous research that had used a similar procedure but with fewer respondents. To illustrate their application, and as part of a larger study examining CRS and booster seat labeling requirements, the new standardized ESS ratings were applied to objective installation performance data from 26 adult participants who installed a convertible (rear- vs. forward-facing) CRS and booster seat in a vehicle, and a child test dummy in the CRS and booster seat, using labels that only just met minimal regulatory requirements. The outcome measure, the risk priority number (RPN), represented the composite scores of injury risk and observed installation error frequency.

Results: Variability within the sample of ESS ratings in the present study was smaller than that generated in previous studies, indicating better agreement among experts on what constituted injury risk. Application of the new standardized ESS ratings to installation performance data revealed several areas of misuse of the CRS/booster seat associated with high potential injury risk.

Conclusions: Collectively, findings indicate that standardized ESS ratings are useful for estimating injury risk potential associated with real-world CRS and booster seat installation errors.     

Analysis of rider and child pillion passenger kinematics along with injury mechanisms during motorcycle crash

Abstract

Objective: Traffic fatalities among motorcycle users are intolerably high in Thailand. They account for 73% of the total number of road fatalities. Children are also among these victims. To improve countermeasures and design of protection equipment, understanding the biomechanics of motorcycle users under impact conditions is necessary. The objective of this work is to analyze the overall kinematics and injuries sustained by riders and child pillion passengers in various accident configurations.

Methods: Motorcycle accident data were analyzed. Common accident scenarios and impact parameters were identified. Two numerical approaches were employed. The multibody model was validated with a motorcycle crash test and used to generate possible accident cases for various impact conditions specified to cover all common accident scenarios. Specific impact conditions were selected for detailed finite element analysis. The finite element simulations of motorcycle-to-car collisions were conducted to provide insight into kinematics and injury mechanisms.

Results: Global kinematics found when the motorcycle’s front wheel impacts a car (config-MC) highlighted the translation motion of both the rider and passenger toward the impact position. The rider’s trunk impacted the handlebar and the head either impacted the car or missed. The hood constituted the highest head impact occurrence for this configuration. The child mostly impacted the rider’s back. Different kinematics were found when car impacted the lateral side of the motorcycle (config-CM). Upper bodies of both rider and child were laterally projected toward the car front. The windshield constituted the highest proportion of head impacts. The hood and A-pillar recorded a moderate proportion. The rider in finite element simulations with config-MC experienced high rib stress, lung strain, and pressure beyond the injury limit. A high head injury criterion was observed when the head hit the car. However, the simulation with config-CM exhibited high lower extremities stress and lung pressure in both occupants. Hyperextension of the rider’s neck was observed. The cumulative strain damage measure of the child’s brain was higher than the threshold for diffuse axonal injury (DAI).

Conclusions: This study revealed 2 kinematics patterns and injury mechanisms. Simulations with config-MC manifested a high risk of head and thorax injury to the rider but a low risk of severe injury to the child. Thorax injury to the rider due to handlebar impact was only found in simulations with config-MC. However, a high risk of skull, lower extremity, brain, and neck injuries were more pronounced for cases with config-CM. A high risk of DAI was also noticed for the child. In simulations with config-CM the child exhibited a higher risk of severe injury.