Healthy Mothers Healthy Babies Webinar and Safe Kids Buckle Up. July 25, 2011
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1 Healthy Mothers Healthy Babies Webinar and Safe Kids Buckle Up July 25, 2011
2 Presenters Martin Eichelberger, M.D. Founder, Safe Kids Worldwide Children s National Medical Center Professor of Surgery and Pediatrics George Washington University Washington, D.C. Jan Null, CCM Adjunct Professor San Francisco State University Lorrie Walker, MS CPS Technical Advisor and Training Manager Safe Kids Worldwide
3 Safe Kids History About Safe Kids GM s Never Leave Your Child Alone Brochure Traveling display Ongoing education efforts Bringing the issue to national partners Targeting efforts to key states and national stakeholders Physical attributes of hyperthermia How can caregivers forget a child? Future efforts
4
5 Heat Illness Thermoregulation: heat dissipation Brain: Hypothalamus control Ambient Temperature + humidity Circulating Blood Volume Water and salt Predisposing condition Duration of exposure Rectal Temperature
6 Thermoregulation Imbalance of loss and gain: Temp, Water or Salt Core temperature within 0.6 o C Hypothalamus Dilation of skin blood vessels Sweating Inhibition of heat production (convection) (evaporation)
7 Thermoregulation Body heat is generated Endogenous Physical activity and Metabolic rate Exertion/Agitation Medication Exogenous Environmental temperature exceeds body temperature Set point is normal but overwhelmed Ambient temperature exceeds core temperature Unable to maintain set point
8 Hypothalamus Thermoregulatory Center Core temp: >40 C (104F) Maximal peripheral vasodilation Sequestration of large blood volume Reduction in effective circulation Increased HR and force of contraction Splanchnic vasoconstriction Decrease blood flow to GI, Liver, Kidneys
9 Heat Exchange Mechanisms Heat Loss: Conduction: Convection: surface Radiation: one object to another water or air particles contact photons of light (~60% of heat loss) Evaporation: sweat and breathing 25-30% of heat loss (sweating) Humidity: limit
10 Who is vulnerable? Cystic Fibrosis Congenital absence of sweat glands Cerebral Palsy/Physical Disability Infants left in automobiles on hot days Obesity/Eating disorders Diabetes Familial dysautonomia Heart disease Alcohol/Drug user
11 Children Neonates and Infants Increased body surface area to weight ratio Limited sweat glands Increased metabolic rate Limited ability to recognize and adjust behavior Children and adolescents Dehydration + Strenuous activity Sweat less Football camp, marching band, swim (warm ocean)
12 Heat Illness Rash Cramps < 38 C Exhaustion C ( F) Stroke >40 C (104 F)
13 Heat Cramps <37 C (98.6F) Salt Depletion: affects Ca+ skeletal muscle Strenuous exercise: hot environment Drinks water or hypotonic fluid Leg cramps Sweating: Profuse Spasms: During or hours after activity Mental status: Normal
14 Heat Cramps Treatment Remove from hot environment Mild dehydration (orthostatic) One teaspoon: NaCl (4g) 500ml water over 1-2hr Moderate to severe IVF with 20cc/kg NS
15 Heat Exhaustion: F Most common in athletes and soldiers Precursor to heat stroke Result of exposure to High temperatures Excessive sweating Inadequate replacement of salt and water
16 Heat Exhaustion Clinical syndrome: Fever; core temperature between 38 o C - 40 o C Headache/lightheadedness Nausea/vomiting Muscle cramping Rapid heart rate: increase Respiratory rate: increase Progressive irritability and lethargy Mental status: Normal
17 Heat Exhaustion Water depletion High temperature exposure and insufficient fluid intake Occurs within a few hours Salt depletion Develops over several days in pts who adequately replaced fluids, but not salt High salt content sweat
18 Heat Stroke >104 F Medical emergency Temperature control: lost Heat dissipation: lost Injury to cells and organs Sweating: lost Mental Status: Abnormal Mortality: 10-20%
19 Heat Stroke Two subtypes Non-exertional (Classic) Maximal environmental heat load Exertional Endogenous heat load
20 Heat Stroke Classic (Non-exertional) Common: infants, ill children, elderly Develops over a period days: heat wave Nausea, vomiting, headache, mental status change Sweating: loss Sever dehydration: common Severe organ dysfunction: uncommon
21 Heat Stroke Exertional Develops rapidly Common in young individuals vigorously exercising that have not acclimatized to a hot environment Dramatic: acute headache, seizure and collapse Profuse sweating: Organ dysfunction : common common
22 Heat Stroke Clinical manifestations temp> 40C (104F) Blood pressure: down Severe Headache Respiration rate: elevated Heart rate: elevated Sweat: elevated or absent Mental status: Abnormal
23 Cooling Ice Bath Spray: continuous + cool water + fan Nasogastric lavage Peritoneal Lavage Medication: Chlorpromazine (shivering)
24 Heat Illness: Summary Prevention Hypothalamus: monitors blood temperature Vasodilatation + Sweating Ambient Temperature + Humidity Heat Exhaustion: mental status normal Heat Stroke: mental status abnormal Treatment: Cool, fluids, salt
25 Contact Information Martin Eichelberger, M.D. Professor of Surgery and Pediatrics The George Washington University School of Medicine (202)
26 Jan Null, CCM San Francisco State University Safe Kids USA
27 Recent Headlines Girl, 2, dies in daycare van Toddlers died of hyperthermia Police: Baby left in Car Died from Overheating New Braunfels infant dies in hot car Child dies after being left in pickup New Orleans police investigating death of small boy and 14 more similar headlines this year.
28 21 28
29 49 29
30 How Many?
31 31
32 Airbag Deaths/yr 11 Hyperthermia/yr <1 Airbag death/yr 38 Hyperthermia/yr
33 What Circumstances?
34 How Old?
35 When?
36 More states have laws against Current Law leaving pets in vehicles 36
37 My Involvement? 10 Years July 24, 2001, San Jose California Kyle Patrick Gilbert (5 mo) Left by 19-year-old father Media asked How hot did it get in the car? Only study was by LA State Med. Soc. for only a single 93 day
38 How Hot? How Fast? Summer 2002 observational study 16 study days Outside air temperatures from F On two days, measurements were also made with the windows cracked 1.5 inches
39 How Cars Get Hot Incoming Shortwave Solar Radiation Warms Interior Objects Outgoing Longwave Radiation Heats the Air Air and Windows are Transparent to Sunlight
40 How Hot? How Fast?
41 An 80 Day
42 An 80 Day
43 An 80 Day
44 An 80 Day
45 An 80 Day
46 An 80 Day
47 An 80 Day
48 Future Efforts Temperatures Extended time periods Different vehicle types Incident Statistics Find unknown cases Lexis Nexis Networking Outreach Safe Kids National Weather Service
49 Safety Recommendations Never leave a child unattended in a vehicle. Not even for a minute! If you see a child unattended in a hot vehicle, call Be sure that all occupants leave the vehicle when unloading. Don t overlook sleeping babies. Have a plan that your childcare provider will call you if you child does not show up for school. Teach your children that vehicles are never to be used as a play area. Keep keys and remote entry devices out of reach. If a child is missing, Check the pool first Check the car, including the trunk
50 Safety Recommendations
51 Contact Information
52 Risks to Young Children HYPERTHERMIA Trunk entrapment Vehicle backovers/frontovers Power windows Seat belt entanglement Improper or no restraint: boosters/belts
53 Safe Kids Objectives REDUCE HYPERTHERMIA DEATHS Increase awareness of the issue Create an education campaign Involve partners and caregivers Provide caregiver tips
54 Education Campaigns Work Airbags (19 Years) 181 Deaths National Education/Media Media bonanza Car seat and vehicle manufacturers collaboration- government mandated labels for both Coordinated national education NO DEATHS SINCE 2008 Unattended Children (13 Years) 513 Deaths Local Media Case by case reports No national surveillance Random local education No national education campaigns AVERAGE 38 DEATHS/YR
55 Safe Kids Education Campaign Promote a strong education campaign until technology solution available in every car- could be decades Engage our 600 coalitions and chapters to provide community and statewide messaging Cultivate partnerships with child focused businesses Research parental attitudes, knowledge, behavior
56 Use the Established Safe Kids Network More than 600 coalitions and chapters Get coalitions on board Target key states Offer grant funds to enable outreach Provide materials and support Develop research findings into credible messaging Develop key messages
57 Approach 2010: Webinar for national partners Increase media activity 2011: Brainstorm meeting, January National partners and coalitions from TX, FL, AZ Develop key messages Online speaker s bureau; media kits; collateral such as posters and parent tip sheets Engage key government agencies: NHTSA, NTSB, CDC, NWS Conduct research- Salter Mitchell
58 Potential Partners Agencies that license childcare providers Associations of childcare providers Head Start and early childhood educators Pediatricians Child care referral agencies Churches and child care providers Child safety seat programs Traffic safety
59 National Media Launches March 15: Austin, Texas May 4: Palm Beach County, FL July 20: San Antonio, TX
60 8 Targeted States: Grants Texas Arizona Florida New York Kentucky North Carolina Ohio Georgia
61 What You Can Do Engage your network Promote the 911 message so that bystanders feel empowered to call for help if they see an unattended child Establish policies for child care settings Promote awareness among parents/caregivers
62
63 Contact Information Lorrie Walker, MS CPS Technical Advisor and Training Manager Safe Kids Worldwide 1301 Pennsylvania Avenue, N.W., Suite 1000 Washington, DC Phone:
64 Further Resources To obtain more information about hyperthermia and to access hyperthermia resources, visit The Forget Me Not flyer can be accessed and printed at Any other questions can be directed to Torine Creppy Director, Safe Kids Buckle Up Safe Kids USA 1301 Pennsylvania Avenue, NW Suite 1000 Washington, DC Phone Fax
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