Passenger Safety Information Research Articles

An Assessment of Neonatal Nurses' Knowledge and Provision of Child Passenger Safety Information.

Nurses who care for newborn infants in the hospital have an opportunity to serve as a resource for child passenger safety (CPS). Literature lacks information on what CPS knowledge and provision of information exists for neonatal nurses. In this study, we assessed neonatal nurses' knowledge and provision of CPS information. The study design included an adapted, cross-sectional, and anonymous survey. A generic survey link was distributed to National Association of Neonatal Nurses' members. Descriptive and univariate analyses were used to summarize the data. One hundred thirteen registered nurses working in the hospital, representing 27 states, completed the survey. Approximately 38.1% (N = 43) "high knowledge" respondents answered 2 scenario-based and 3 knowledge-based CPS questions correctly. Nurses addressed CPS for parents/caregivers during newborn hospitalization through car seat tolerance screenings (85.8%), verbal education or answering questions (83.2%), and providing a pamphlet or handout (52.2%). Barriers to providing CPS recommendations were nursing staff not being trained in CPS (55.8%), perceived liability (50.4%), and lack of understanding/unaware of CPS guidelines (47.8%). Neonatal nurses can benefit from CPS training and hospital policies which outline nurse expectations and liabilities.

Safety on automated passenger ships: Exploration of evacuation scenarios for coastal vessels

Many advancements are being made within the domain of autonomous shipping, motivating discussions of corresponding amendments to international safety regulations within the International Maritime Organization. Near-coastal passenger ferries are a form of sea traffic that has been the target of automation trials due to their short voyages and relatively protected waters of operation. This study investigated emergency evacuation from a range of such ships, covering both the current situation (focused on crew tasks, external rescue actors and interactions) and safety aspects that should be considered when automation brings about new work patterns, such as remote supervision and control. The study employed qualitative methods – interviews, field visits and a stakeholder workshop. Results give insight into ferry evacuation processes and challenges in their current form. In addition, results from the application of different automated evacuation scenarios suggest that more detailed studies are needed within the areas of remote operation situation awareness, remote operator and onboard personnel competencies, passenger safety information and communication, simple and robust evacuation equipment, technical means allowing assistance between autonomous and regular ships, and lastly, both procedures and interfaces for collaboration in a changing rescue network.

Sociodemographic disparities in child restraint selection and variation in child passenger safety information sources

PurposeMarginalized and otherwise vulnerable groups remain at higher risk than their counterparts for not having all of their children appropriately restrained during vehicle trips. Little is known about potential sources of these disparities, however a commonly theorized factor has been where caregivers find or obtain information (i.e., their information sources). The objective of this study was to: (1) characterize caregivers’ actual and preferred sources of information related to child passenger safety information, overall and within sociodemographic groups; and (2) determine if, and if so how, sources impact appropriate child restraint use (i.e., child/seat fit). MethodsWe conducted an online, cross-sectional survey of US caregivers. Caregivers answered questions about themselves, their child(ren), their child(ren)’s restraint use during trips, and their information sources to learn which seat their child should be using. We used Fisher’s exact and Pearson chi-square tests to compare used and preferred sources of information across caregiver demographics (age, education, race/ethnicity), as well as to determine whether information sources were associated with caregivers’ appropriate child restraint use. ResultsA total of 1,302 caregivers from 36 states with 2,092 children completed the survey. The majority (91%) of children were appropriately restrained. More caregivers from marginalized and otherwise vulnerable groups had children inappropriately restrained when compared with their counterparts. We identified multiple differences in both used and preferred information sources by caregivers’ age, race/ethnicity, and education level. In addition, we found a trend that caregivers from populations with higher rates of inappropriate use seemingly used fewer information sources. Ultimately, information sources were not associated with appropriate restraint use; however, within vulnerable populations, almost all caregivers had all of their children appropriately restrained if they had used a Child Passenger Safety Technician (CPST)/Inspection Station or their Pediatrician. ConclusionOur findings reiterate calls for more tailored interventions and efforts to combat widening disparities in child restraint use and crash outcomes and suggest one promising method may be providing more access to child passenger safety experts. Future studies must untangle the likely complex relationship between information sources and appropriate/accurate child restraint use.

Reducing child restraint misuse: national survey of awareness and use of inspection stations

Objective Research indicates that hands-on instruction on installation and use of child restraint systems (CRSs) is an effective method to reduce misuse. However, use of these services is low. The objective of the Awareness and Availability of Child Passenger Safety Information Resources (AACPSIR) Survey was to estimate the degree of awareness caregivers have of CRS inspection stations. The survey also evaluated the relationships among caregiver confidence and risk perceptions as well as potential barriers and facilitators to inspection station use. Methods The AACPSIR was a web-based cross-sectional survey targeting a nationally representative sample of adults who drove with children aged 0–9 at least twice a month. An address-based sample was selected using a cluster sample design. Caregivers who reported driving frequently with child passengers answered questions on awareness and use of inspection stations, confidence related to CRS use, and barriers and facilitators to inspection station use. Results Data were collected from 1,565 households. In all, 66.9% of respondents were aware of inspection stations, but only 44.2% reported that they had used these services. Most caregivers indicated that they were confident (91.7%) that the car seat was installed correctly. A quarter of the respondents indicated a reason that might prevent them from using an inspection station was that they “don’t think it’s necessary”. A long wait time (66.5%), distance (65.2%), and schedule conflicts (63.9%) were also frequently indicated as potential barriers. Conversely, among inspection station users, most did not need to make an appointment (73%), and over half indicated that the station was five miles or less from their home and within a 15-minute drive. Conclusions The AACPSIR Survey results suggest a segment of caregivers share a positive safety culture, including knowledge of CPS services and use of those services. Of concern are caregivers who did not access an inspection station because they indicated it was not necessary, they already knew how to install the CRS, or pointed to other inconveniences. Future intervention programs that target caregivers unfamiliar with inspection stations or believe that the services are not necessary have the potential to improve child passenger safety.

Results of an RCT in Two Pediatric Emergency Departments to Evaluate the Efficacy of an m-Health Educational App on Car Seat Use

The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting. This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted. Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area. A theory-based, stage-tailored educational program, Safety in Seconds v2.0TM, delivered on a mobile app. Four car seat behaviors: (1) having the correct restraint for the child's age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child's restraint inspected by a child passenger safety technician. At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p<0.01) for using the correct car seat; 2.37 (p<0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p<0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p<0.01) and having the car seat inspected (OR=1.73, p<0.01). Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education. Clinical Trial Registration # NCT02345941.

A smartphone app to communicate child passenger safety: an application of theory to practice.

Child passenger safety remains an important public health problem because motor vehicle crashes are the leading cause of death for children, and the majority of children ride improperly restrained. Using a mobile app to communicate with parents about injury prevention offers promise but little information is available on how to create such a tool. The purpose of this article is to illustrate a theory-based approach to developing a tailored, smartphone app for communicating child passenger safety information to parents. The theoretical basis for the tailoring is the elaboration likelihood model, and we utilized the precaution adoption process model (PAPM) to reflect the stage-based nature of behavior change. We created assessment items (written at ≤6th grade reading level) to determine the child's proper type of car seat, the parent's PAPM stage and beliefs on selected constructs designed to facilitate stage movement according to the theory. A message library and template were created to provide a uniform structure for the tailored feedback. We demonstrate how messages derived in this way can be delivered through new m-health technology and conclude with recommendations for the utility of the methods used here for other m-health, patient education interventions.

Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years

Observed racial disparities in child safety seat use have not accounted for socioeconomic factors. We hypothesized that racial differences in age-appropriate restraint use would be modified by socioeconomic status and child passenger safety information sources. A 2-site, cross-sectional tablet-based survey of parents seeking emergency care for their 1- to 12-year-old child was conducted between October 2011 and May 2012. Parents provided self-report of child passenger safety practices, demographic characteristics, and information sources. Direct observation of restraint use was conducted in a subset of children at emergency department discharge. Age-appropriate restraint use was defined by Michigan law. Of the 744 eligible parents, 669 agreed to participate and 601 provided complete responses to key variables. White parents reported higher use of car seats for 1- to 3-year-olds and booster seats for 4- to 7-year-olds compared with nonwhite parents. Regardless of race, <30% of 8- to 12-year-old children who were ≤4 feet, 9 inches tall used a booster seat. White parents had higher adjusted odds (3.86, 95% confidence interval 2.27-6.57) of reporting age-appropriate restraint use compared with nonwhite parents, controlling for education, income, information sources, and site. There was substantial agreement (82.6%, κ = 0.74) between parent report of their child's usual restraint and the observed restraint at emergency department discharge. Efforts should be directed at eliminating racial disparities in age-appropriate child passenger restraint use for children <8 years. Booster seat use, seat belt use, and rear seating represent opportunities to improve child passenger safety practices among older children.

Availability of Child Passenger Safety Resources to Emergency Physicians Practicing in Emergency Departments Within Pediatric, Adult, and Nontrauma Centers

More can be done to eliminate preventable motor vehicle collision (MVC)-related injuries through correct and consistent use of child passenger restraints. This study sought to determine emergency physician awareness of and referral patterns to child passenger safety resources and to compare awareness and referrals by practice setting. This was a cross-sectional mailed survey of a national random sample of 1200 emergency physicians drawn from the American Medical Association Physician Masterfile. Responses were returned by 638 (64%) of 1000 of physicians with a valid mailing address. Fifty-two percent reported working in an emergency department (ED) within a pediatric trauma center, 23% in an adult trauma center, and 25% in a nontrauma center. Police or fire department car seat installation programs were most frequently available (65% pediatric, 56% adult, 48% nontrauma center), and free/reduced-price booster seat programs least frequently available (46% pediatric, 30% adult, 23% nontrauma center) (P < 0.001). Half of pediatric trauma center physicians would always recommend replacement of a 3-year-old's car seat following a roll-over MVC compared with one third of adult and nontrauma center physicians (P < 0.001). There were no significant differences by practice setting for distribution of discharge instructions containing child passenger safety information or referrals to available resources. Availability of child passenger safety resources for children discharged from EDs following an MVC varies by practice setting. Pediatric injury prevention outreach to general EDs is needed to increase the number of children who are benefiting from existing community child passenger resources.

Emergency Physician Perspectives on Child Passenger Safety: A National Survey of Attitudes and Practices

ObjectiveTo understand attitudes and self-reported practices of pediatric and general emergency physicians regarding child passenger safety. MethodsWe conducted a cross-sectional mailed national survey of 600 pediatric emergency medicine (PEM) physicians and 600 emergency medicine (EM) physicians who provide clinical care in the United States randomly sampled from the American Medical Association Physician Masterfile. Survey questions explored attitudes related to the role of the physician and the emergency department (ED) in child passenger safety and self-reported frequency of performing specific child passenger safety practices. ResultsResponses were received from 638 of 1000 (64%) eligible physicians with a valid mailing address. Surveys were completed by 367 PEM and 271 EM physicians. Regardless of their training background, emergency physicians overwhelmingly agreed that it is their role to educate parents about child passenger safety (95% PEM vs 82% EM) and that they can make a difference in how parents restrain their child (92% PEM vs 93% EM). Physicians were similar in their views that the most appropriate person to provide child passenger safety information in their ED was a nurse/midlevel provider followed by a physician. Self-report of child passenger safety practices in response to 2 hypothetical scenarios showed physicians infrequently provide best-practice safety recommendations to families. ConclusionsEmergency physicians are supportive of the ED as a setting to promote child passenger safety, yet do not consistently promote child passenger safety themselves. Differences between PEM and EM physicians’ attitudes toward child passenger safety may necessitate different approaches on injury prevention in general and pediatric EDs.

Emergency Physicians’ Knowledge and Provision of Child Passenger Safety Information

While physicians provide discharge instructions to patients and families following emergency department (ED) visits, injury prevention information may not be routinely included in these instructions. This study assessed emergency physicians' knowledge and provision of child passenger safety (CPS) information to patients following motor vehicle crashes (MVCs). This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution. Members of the American Academy of Pediatrics (AAP) Section on Emergency Medicine were invited to participate in the survey. Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations. The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home. There were 317 survey respondents from 1,024 eligible physicians, of whom 43 began but did not complete the survey. The data analyzed are from the 274 who completed the survey. While 85% (95% confidence interval [CI] = 81% to 89%) of physicians believed that CPS information should be included in discharge instructions, only 36% (95% CI = 31% to 42%) correctly answered all knowledge questions. Of the 51 self-identified division/department chiefs, 15 (29.4%; 95% CI = 16.9% to 41.9%) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs. For the medical record review, of the 152 randomly selected MVC visits, 13 (8.6%; 95% CI = 4.1% to 13.0%) had documented CPS information in the discharge instructions. Patients with documented CPS information were younger, but there were no significant differences in race, sex, or maximum abbreviated injury scale score between patients with versus without CPS information. While emergency physicians value the use of CPS information in discharge instructions following MVCs, they do not have adequate knowledge of, nor do they regularly disseminate, this information.

The Comprehensibility of Airline Safety Card Pictorials

Airline safety cards are an integral component of passenger safety information. Brochures depict compulsory safety and emergency information such as how to adjust a seatbelt and how to exit a plane in an emergency. Few cards, however, have been developed that consider whether or not passengers actually understand the information contained on the cards. A study is reported that examined the efficacy of airline safety cards to convey the meanings of safety and emergency information. One-hundred and thirteen participants were given a questionnaire that tested the comprehension of 36 airline pictorials selected from 50 airline safety cards. Comprehension for most of the pictorial information was uniformly low. Twelve met the International Organisation of Standards (ISO) comprehension standard. An analysis of ‘emergency floor lighting’ and ‘do not use electronics’ is given.

Understanding of Aviation Safety Pictograms among Respondents from Europe and the U.S.

Conveying safety information to aircraft passengers is an important task for the designers of aircraft passenger safety information cards. Since the information must be understood by all passengers, regardless of native language or nationality, many designers use pictorial representations that are considered “culture free.” The current study investigated the comprehension of 13 pictograms from a sample of actual safety cards among participants from four language groups in Europe and the U.S. One-hundred-and-fifty students whose native languages were English (British and U.S.), French, or German, respectively, interpreted 13 pictograms. From their responses, three main conclusions can be drawn: 1. Conveying aviation safety information by pictorial means appears to be largely effective, as indicated by general comprehension levels above 85%. 2. While passengers may get the “essence” of a particular pictogram, it is often difficult for them to recognize specific details. 3. There are relatively small differences in the comprehension levels between participants from different language groups, pointing towards the “universality” of pictograms in conveying safety information. Future research needs to focus on identifying exactly which features of pictograms are most effective in conveying safety information, without introducing cultural or language biases.