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
05.15.10 – 05.25.11
The future car safety of
Giana Rayne and Kiara Rayne
©Ray Ray’s Pledge™ 2014
Forgotten in the Backseat:
More Common than You Think
http://youtu.be/kYGAIagq-Wg
©Ray Ray’s Pledge™ 2014
651
The number of child hot car deaths
reported in the media since 1990
Data on file. KidsandCars.org, 2013.
©Ray Ray’s Pledge™ 2014
Forgotten Daycare Drop-off
The #1 source
of child hot car deaths
©Ray Ray’s Pledge™ 2014
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
©Ray Ray’s Pledge™ 2014
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.
©Ray Ray’s Pledge™ 2014
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.
©Ray Ray’s Pledge™ 2014
Heatstroke in Children

Children are more prone to overheating
than adults:

Immature thermoregulatory system: less
efficient than adults

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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.
©Ray Ray’s Pledge™ 2014
Child Vehicular Heatstroke:
An Unintended Consequence of
Moving Children to the Backseat
www.KidsandCars.org/heatstroke.html. Accessed 3/15/14.
©Ray Ray’s Pledge™ 2014
Child Injury from Front
Passenger Airbag Deployment
49 Deaths; 19 Serious Injuries
(1993- Nov. 1997)
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
Marshall KW. AJNR Am J Neuroradiol 1998; 19:1599–1607.
©Ray Ray’s Pledge™ 2014
Front Airbag Death vs.
Backseat Heatstroke Death
Average deaths per year
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?
Marshall KW. AJNR Am J Neuroradiol 1998; 19:1599–1607. Data on file,
KidsAndCars.org.
©Ray Ray’s Pledge™ 2014
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://wwwnrd.nhtsa.dot.gov/Pubs/811655.pdf. Accessed 3/15/14.
©Ray Ray’s Pledge™ 2014
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.
©Ray Ray’s Pledge™ 2014
Understanding the Cause (cont.)
KidsAndCars.org All-Heatstroke Fatality Data
(1990 – 2012; n = 651)
©Ray Ray’s Pledge™ 2014
Children Left in Vehicles:
How Hot? How Fast?

Rate of temperature rise in first 20 minutes: 6.25˚F/ 5 minutes

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Overall rate of temperature rise through 60 minute study: 3.1˚/ 5 minutes
80% of temperature rise in first 30 minutes

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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 ©Ray
12/1/11.
Ray’s Pledge™ 2014
“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/2010Feature-Writing.
©Ray Ray’s Pledge™ 2014
Common Factors Associated with
Parents Who Forgot their Children

Stress

Emotion
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Lack of sleep

Change of routine
Weingarten G. Fatal Distraction. IN: Washington Post 2009. http://www.pulitzer.org/works/2010Feature-Writing.
©Ray Ray’s Pledge™ 2014
…..in other words….
What parent IS NOT at risk of
forgetting a child in the
backseat?
©Ray Ray’s Pledge™ 2014
Prevention Efforts:
It Takes a Village!
©Ray Ray’s Pledge™ 2014
Three Easy Prevention Steps
www.RayRaysPledge.com; Accessed 3/15/14.
©Ray Ray’s Pledge™ 2014
LOOK before you LOCK™

Recommended by: NHTSA,
KidsAndCars.org, Ray Ray’s Pledge
©Ray Ray’s Pledge™ 2014
Ray Ray’s Pledge™
www.RayRaysPledge.com; Accessed 3/15/14.
©Ray Ray’s Pledge™ 2014
Car Seat Alarms?
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Suddenly Safe ‘N Secure Systems (SSNSS)
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TOMY iAlert Car Seat
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Weight-activated devices
Smartphone-activated devices (NEW!)
Safety 1st convertible car seat built-in alarm (NEW!)
Alarm system built-in to car seat
Baby Alert International

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Car seat harness clip-based devices
Weight-activated devices
©Ray Ray’s Pledge™ 2014
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
©Ray Ray’s Pledge™ 2014
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
©Ray Ray’s Pledge™ 2014
Future Directions (cont.)

State Childcare Heatstroke Training/
Absence Verification Requirements

TX AC Chapter 746: Minimum Standards for
Childcare Centers

746.1316 (Jacob’s Law)
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746.5625


2 hr annual transportation safety training
Requirement for child presence reminder alarms on
daycare vehicles
Ray Ray’s Pledge (or equivalent)

Absence verification requirements in 5 states
©Ray Ray’s Pledge™ 2014
For Heatstroke Information
Please 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
©Ray Ray’s Pledge™ 2014