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Social EM: Safety Belt Safety With Stephanie Tombrello

Updated: Mar 9, 2022

TED 53 | Safety Belt

Safety belts are a very important yet often overlooked part of car safety etiquette. Today, we discuss how to properly set up your car safety seats and belts up to standard with Stephanie Tombrello, the Executive Director at SafetyBeltSafe U.S.A from 1982 to 2021. In this episode, she discusses two of the most misunderstood or neglected aspects of child passenger safety: the five-step test and why children need booster seats and; the dangers of riding with an impaired driver. Stephanie also goes into detail on the proper use of child safety seats and seat belts. Join her chat with Dr. Victor Cisneros and Dr. Alaina Rajagopal as she explains child passenger safety tips and best practices that will help reduce and mitigate injury during collisions.


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Social EM: Safety Belt Safety With Stephanie Tombrello

We are excited to be talking with Stephanie Tombrello, who had served as the Executive Director for SafetyBeltSafe U.S.A. from 1982 to 2021. SafetyBeltSafe U.S.A. is a national nonprofit focused on reducing deaths and injuries of children and their families through the correct and consistent use of safety seats and safety belts. She continues as a Senior Program Consultant.

Her work led to the federal requirement for rear-seat shoulder-lap belts in motor vehicles in 1989 to other efforts to improve the resources and programs in the field through laws, regulations and program developments. She has been the recipient of national and statewide recognition over the years. She was made an initial member of the Child Passenger Safety Hall of Fame in 2017. She also received the National Highway Traffic Safety Administration Award for Public Service in 1983.

Her focus is on two of the misunderstood or neglected aspects of child passenger safety. It's the need to understand how to use and teach the five-step test that shows that children need booster seats until ages 10 to 12, and the occupant protection risks to children riding with their drivers who are impaired. Stephanie, tell us a little bit about how you got involved in promoting safety values. I would also love to hear the story of the first time you used a safety belt.

In 1962, I was preparing to drive across the United States in a brand-new car. It's the '62 VW Beetle. On the dashboard was a little paper message that said, "Fasten your seat belt." I buckled up with the lap belt that was all that was in the front seat of a brand-new car. That was my first experience with a safety belt. It took many more years until my daughter was born for me to truly understand child passenger safety.

How did you get involved in promoting safety belt use?

What started was that I received an article written by the first female automotive safety columnist in Women's Day. It explained how important it was to choose particular safety seats that were crash-tested. From that, I tried to buy one for my then-five-month-old daughter. Slide number one shows what I put her in that she used for seven years before Tot-Guard, which was the first crash-tested safety seat. It first came out in 1968 and it wasn’t easy to get.

That led me to join a group of women who were working on consumer product issues. In the course of that, we dealt with grocery stores. We arranged to get the state to require that drug stores give you the prices for prescription drugs. We went into protecting children from injuries, which was the number one cause of their deaths and therefore very important to do but not very popular for safety belts themselves because they were not required in the way that you see them now when we first got started in the 1970s.

TED 53 | Safety Belt
Safety Belt: As the community became more safety aware, then the companies heard that, and their engineers knew that these things were important, but the priority only comes when the public begins to be interested.

It took years to work on this, but there were lots of contacts with the federal government between volunteers and officials during that time. Safety belts themselves came from Sweden. They are the most effective safety equipment freestanding. In other words, the more equipment that you have in the car to protect you and your loved ones, the better, but the safety belt itself has been very effective.

It’s so funny because we take safety belts and child safety seats for granted. They just exist. In my entire life, we have always been told to use them. This is something you had to work toward and advocate for over the last few decades.

The safety seats didn’t have a good standard right away. We had to work on that. We do have the Federal Motor Vehicle Safety Standards 213 and 225 now. When you purchase a seat in a legitimate store, you get a seat that has to meet that standard. If it doesn’t, the manufacturer must make it good. That’s one part of the standard. As soon as money changes hands, the manufacturer is responsible if the federal government or if they themselves find a problem that it’s not meeting the standard. We are pretty well protected if you purchase from a legitimate resource.

You are saying that the seat belt came from Sweden. I’m assuming it’s not Ikea. When did they become a required law or requirement?

The National Highway Traffic Safety Administration was started in about 1966. One of their first acts was to start on the belt. They put the shoulder-lap belts in the front but not in the back. What we were working on was getting shoulder-lap belts in the back seat. I petitioned the federal government in 1988 for that on behalf of SafetyBeltSafe. We were granted that, but they laughed at us about wanting to have them in the center of the back seat. They said that was impossible. They only required them on the outboard positions next to the doors. It took twenty more years going through Congress to make that into a standard. As you can see, each step in safety takes a lot of research and description.

What was their excuse for not wanting to have that center belt in the rear?

They said it was impossible. There was nothing to attach it to. The thing that also happens is that as the community became more safety-aware, the companies heard that. Their engineers knew that these things were important, but the priority came when the public began to be interested. Now, it’s hard to believe because safety is one of the things that people look for in a vehicle. There are all these rating systems. Consumers Union announced that they are going to be doing more ratings of the rear seat in terms of protection. All the focus has been on the front seat. Our focus has been on the rear seat because that’s where children should stay until they are at least thirteen.

It's extremely important that people use a booster seat to position the shoulder lap belt properly, but also to put them in the correct range for the safety equipment that's already in the car.

The same question for child safety seats then. When did we realize we needed them? When did they become a law?

The first child passenger safety law was introduced in Tennessee. Thanks to the late pediatrician, Robert Sanders. He and his wife Pat were behind that. The initial law still had to allow people to hold their babies in their arms. It took him several years to get them to take that out. Between that law going into effect in Tennessee, the last state to pass the law was only until 1985. One of the impressive parts of this is there was no paid campaign. I can assure you that the manufacturers of safety seats did not pony up a lot of money to get volunteers to go to statehouses and say, “We need a law.”

The way we did it in California, a volunteer set up a booth at the LA County Fair. We had a little rear-screen projector with some silent footage of what happens in a low-speed crash at 20 to 25 miles an hour. We had postcards and people could look at the video if they wanted to. They could write out a postcard for us to take to the legislature. Day and night, the volunteers stayed there through the whole county fair for three weeks.

We took all those cards with us. We had a receptive state legislator carrying the bill and getting it through. It has been improved several times since and it needs more improvement, mostly to make it clear to the public that children will need to be in a booster seat until they are at least 10 to 12 years of age and that they should ride in the back seat until age thirteen. I’m speaking about California law. Every state has its own variety.

I should probably still be in a booster seat if they are my size.

You bring up a very important point. Because you are an adult, your bones are fully formed. As physicians, you know that. A child’s hip bones don’t start to form well until they are about ten. There’s nothing to keep the lap belt down low and out of the abdomen. It’s extremely important that they use a booster seat to position the shoulder-lap belt properly and put them in the correct range for the safety equipment already in the car, like the padding, possibly side airbags, and so forth.

Booster seats are for older kids. We have a five-step test that you can use. It’s very simple. Every child can learn it and that tells you whether the belt fits. In your case, you want to make sure that you look at the car and see if there’s an adjuster on the shoulder belt so you can bring it down a little lower on your shoulder. The belt should be in the center of the shoulder and below the hip bones for everyone.

TED 53 | Safety Belt
Safety Belt: If you're sitting in the backseat and you're not buckled in, you're going to travel toward the point of impact, and you could injure or kill somebody else in the car because you're not held back.

Stephanie, correct me if I’m wrong, but I believe that there are states that don’t require seat belts. What are the current laws and rules in the United States concerning seat belts and car seats?

Safety seats are required to some age in every state, but you are correct that New Hampshire does not have a safety belt law at all. Many states have what is called secondary laws for people in the back seat. That is not safe because of what happens in a crash and a lot of people don’t understand this. When your vehicle hits something, everything in the car goes toward that point of impact at the speed the car was going at the time that it hit. Only use this for your multiplier because mathematics is very special. You can take the weight of the object, person, dog, hammer or whatever and multiply that by 30 to get the weight. If you weigh 100 pounds, you are going to be 3,000 pounds of force.

If you are sitting in the back seat and you are not buckled in, you are going to travel toward the point of impact and you could injure or kill somebody else in the car because you are not held back. Princess Diana is probably one of the most famous people who lost in a crash that people know about. She would have lived if she had been buckled up, but she flew through the car and went into the windshield. It’s a tragic story, but it’s one more example of how people don’t quite understand what happens in a crash.

I hope that some of your readers will look at some of the slides that we have because you can see the difference between the safety seat that my daughter was in than what her twins were using at about the same age. You can also see the breadth of the areas that we work on. It’s everything from a sad picture of a tree with ribbons on it that commemorates the loss of a woman and her son because the boyfriend was driving impaired and the child was not in a booster seat to the much more cheerful aspects of what we do, which we check safety seats and educate people to be able to help. For the professionals who are reading, I hope that you will be able to incorporate some of this information into what you share with the families you serve. We are happy to help.

We have an international audience. Can you talk a little bit about seat belts and car seat safety in the rest of the world?

One of the things that many don’t know is that injuries are one of the major causes of death all over the world. That’s the first thing. Traffic injuries are a major part of that. They continue to grow as more and more people get into cars, trucks, and motorbikes to get around, but not every country has well-designed roads or safety equipment in their vehicles or regulations. One of the slides that we have, slide number three, shows us in Malaysia training child passenger safety technicians there. They have been effective. They have gotten a law in their country. It’s important because they had as many deaths in Malaysia of children in car crashes as we in the United States and our population is far greater.

There are a number of different standards. The EU, European Union has a very fine standard. It’s somewhat different from ours, but it’s a good standard. Australia, New Zealand, Japan and many countries have adopted standards. However, because they are not all one standard and each of them has some positives and some better parts, it’s hard to get everybody to agree on a single one. For example, in the United States, we have made huge strides in getting seats to be able to be used rear-facing. We are catching up with Sweden. Sweden had seats that children could ride rear-facing until age four for decades.

Injuries are one of the major causes of death all over the world and traffic injuries are a major part of that.

We have another problem that has come along with all this and that is the fake, counterfeit or totally inappropriate “safety seat” that is sold a lot on the internet. I want to warn people that, number one, if you live in the United States, you are required in every state to be using the seat that meets that Federal Motor Vehicle Safety Standard that I mentioned. Also, another important part of that is you should register your seat when you buy it. It comes with a card or you can do it online.

That's very important because the companies are responsible for keeping that seat up to the standard. They can't find you unless you register with them. They are not allowed to send you any advertising information, sell your name or anything like that. Only about 20% of people do that. If you can think about passing that word on to everybody, that's a big help. In the EU, you have to go and check with a lab that did the testing of the particular seat. My colleague in Malaysia has to check the actual label and find the lab to find out whether a seat is fake or not.

I feel like there are some statistics that show that buckling up has decreased automobile deaths by almost 50%. It's still amazing that people don't buckle up. Can we talk a little bit about the proper and improper use of seat belts?

Everyone needs to wear the belt properly, which means in the center of the shoulder and down low on the hip bones when you are talking about a shoulder-lap belt. When you are talking about a woman who is pregnant, however, there's some interesting research that shows that perhaps 90% of the women who queried about this said that they were wearing the belt, but they weren't wearing the belt parts correctly. It's very important to have that belt across the center of your chest and down underneath the bump and a little bit to the side so that the forces are taken on the strong parts of the body.

It's extremely important for pregnant women to buckle up. The data are not kind. Trauma in pregnancy is an issue and this is not the only source of it. There is an estimate that five times as many fetuses are lost as children in the first year of life from car crashes. It's well to deal with that. Lap belts, we have managed to get them out of the newer cars. If you have a very old car and all you have is a lap belt, that's fine for holding a safety seat in. That's the way they are tested.

Also, even for a person, it's better to be attached to the frame of the vehicle rather than to be loose in the vehicle. Just because shoulder lap belts are better doesn't mean that you shouldn't take advantage of any protective equipment that's there. Please don't go on the internet and buy items that are advertised to fix your car. I also say this about some of the equipment in a modern vehicle, but sometimes people try to sell stuff on the internet inappropriately. Don't be taken in by some of the things that are advertised there.

How about car seats? What are the biggest misuses or common malpractices that you have seen or noticed?

TED 53 | Safety Belt
Safety Belt: You should register your seat when you buy it. It comes with a card or you can do it online. That's very important because the companies are responsible for keeping that seat up to the standard. They can't find you unless you register with them.

I have a slide showing both the pregnant woman properly buckled up and a rear-facing child and then another one of two children who are buckled up in a forward-facing seat with a harness and booster seat, as well as a youngster who is rear-facing at what to some people might seem to be a lot older than they would expect. Let me go through what is important. Remember, facing the rear is the best way to ride. If we were rational, everyone in the car would face the rear except the driver. When we have automatic vehicles where there are no steering wheels, that is definitely what we should do, but it's hard to overcome people's expectations of how they should ride.

Your back is far stronger than your spine and neck. What happens in a frontal crash is you are thrown toward the front. Your head moves toward the front, but your lower body is held in. There's a lot of stress there. It's hard enough on an adult, but on a child, it's dangerous. If you think about it, a child is all head and we are all body. The head leads the child, but if you have the child restrained and they are not flying through the car, there's a lot of stress on that spinal cord and you can have it snap.

Please, rear-facing at least until age two. This day's safety seats, thanks to the pressure and excitement from Child Passenger Safety Technicians, families and leadership people, our safety seats go as high as 45 to 50 pounds facing the rear so you can come up to what the Swedes are doing if you want. They have an extraordinarily low death rate from car crashes.

When do you guys recommend changing from a rear-facing seat to a forward-facing seat for kids?

The phrase is usually as long as possible, checking what your seat says. First, you want to choose a safety seat that will allow your child to ride facing the rear until 45 or 50 pounds. You have that possibility. If you can keep a child rear-facing for four years or more, that's excellent. When you turn the child forward, which you might have to do if the youngster's head is too close to the top of the plastic of the rear-facing seat, you want to make sure that the strap is on the top of the seat with a hook on it. It’s called a tether strap and is attached to the car. This is in addition to the safety belt. The reason for that is that it holds the whole top of the seat back and there's not as much pressure on the child's spine.

One of the biggest errors is that people don't realize they need to attach that strap. If you have an older car, say one that's before 2001 or 1999, you probably can have that belt put in even though it's not in there already. Due to Canada requiring it much earlier than we did and some of the choices that some of the manufacturers made, they can be retrofitted. Don't go on the internet and try to buy something to do this. Please get in touch with SafetyBeltSafe U.S.A. so we can make a referral for you and explain to you what you can have done for your car. We run the Toyota Lexus Retrofit Program for that company. I talked to parents all over our country who have older vehicles and we can help them to get it done at a reasonable price.

I would also like to point out that besides having the safety seat in tightly, you put your hand on the seat above where the safety belt goes through it. You take your hand and try to move it to the safety seat to the sides in front of the car and it shouldn't move more than an inch. That's the first thing that people often don't do. Secondly, the harness system on the child needs to be snug enough so you cannot pinch the fabric of the harness between your thumb and forefinger. What I advise, especially with a newborn, is to put the baby in the bottom first. Put the harness on and it should be coming at or below the child's shoulders. Snug it up.

If you live in the United States, you are required in every state to use a seat that meets the Federal Motor Vehicle Safety Standards.

You will see with a newer seat. There will be a plastic clip. We call it a chest clip. Keep it down low, to begin with. Snug the harness. Take your thumb and forefinger and try to pinch the harness between them. If you can't pinch any fabric and it slides off, then push the chest clip to armpit level. If you push the clip up first and then try to tighten it, especially with a newborn, you might send it into their chin and then you will be nervous. We don't want that. We want you to feel comfortable about it.

It's a snug harness, a tight safety belt and a tether attached when the seat is forward-facing. Please don't add anything to your safety seat. If it's cold, strap before you wrap. In other words, strap the child in and then you can put a blanket over the child. As physicians know, children don't need to be bundled up that much. They get warm pretty quickly. Don't be as worried about that as a lot of parents are. I'm not saying don't put clothes on them, but don't add a lot of thick padding.

I have read that the heavy coats can stay in the car seat and allow the child to slide out in an accident in some cases because of the compression of the puffy coats and things like that.

I'm going to correct you. It's not an accident. It's a crash, collision or incident because we know that vehicles hit one another. Our secretary of transportation made it very clear. Human beings make mistakes. We try to be perfect, but we are not always perfect. It's likely that there will be incidents in which two cars will hit one another or a car will hit something else. We don't want people to think that this is something that happens. There's no expectation of that.

From this point forward, I will say collision.

I'm sure you will because I know how much we care about the people with whom we work. I hope that people will look at the pictures of pregnant women and children. One of the questions that we get all the time is, "If I leave my child rear-facing until age four, what about legs and feet? We are going to have broken legs." To tell you the truth, we don't start to see a leg injury until children are forward-facing. It's remarkable how well a rear-facing seat works.

Thank you for bringing that up because that is a misconception that I feel I have heard commonly or seen on the internet when looking at seat safety as a parent. The research supports keeping them on a rear-facing seat and that children have fewer rearward-facing injuries than forward-facing, like you said.

TED 53 | Safety Belt
Safety Belt: You want to choose a safety seat that will allow your child to ride facing the rear until 45 or 50 pounds.

It's not only that. We bring our own experiences to things and situations. It gets harder to get your legs in weird positions as you get older, but children are very flexible. They will cross their legs. They will put them up at the back of the seat. They will hang them over at the sides of the seat. They will find a way. They will not be uncomfortable in the way you or I would be if we had to do the same thing. That's another part of understanding the difference between children and adults in terms of development. All of these factors go into what we would recommend.

Let me tell you about the five-step test. The first thing I would say is if you are talking to a pregnant woman, let her know that she has at least ten years of safety seats ahead of her. How do you know when your child fits in the belt? Here it is. The child should sit in the back seat with his or her back up against the vehicle seat back. You put the shoulder lap belt on and you look, "Are the child's knees folded over the front of the seat?" If they are, they have already failed the five-step test.

The second thing is, "Is the shoulder belt resting naturally between the neck and the top of the arm?" Children do not strangle in safety belts. If they are uncomfortable with the position, they may put that belt under the arm or behind their back. They are in real trouble. The part of the belt that almost no one looks at is the lap belt. That has to be low under those hipbones and touching the thighs. Finally, children are not dummies. Children are children. You have to decide whether they can stay in that position no matter how long the trip is.

A booster seat helps because it supports the thighs as well as positions the child within the right parts of the vehicle to take advantage of the safety equipment and avoid having the safety belt in the wrong parts of the body. Years ago, we had to put children in booster seats at age four because there weren't any high-weight seats. Now, you can buy a very reasonably priced seat that goes to 65 pounds. Be on the lookout for that.

Now that we have some background in the proper use of child safety seats and seat belts, we are going to discuss a case. A mom and dad are driving home from the hospital with their newborn baby. The baby came a little early, so they didn't have the car seat set up yet. Dad had a little champagne in the hospital room. He went out to the parking garage and attached the car seat by wrapping the seat belt around the outside. It seemed like it was pretty secure.

Mom and dad brought the baby down together and then put the baby in the seat. They didn't want the straps to be too tight because they didn't want the baby to choke. Mom got in the back seat next to the baby, but she didn't put her seat belt on because it hurt her C-section incision. Dad got in the front seat to drive. He put his seat belt on and they started driving home. We made this case to highlight some of the issues that can occur with good intentions. Can you walk us through some of the important learning points from this case?

I will be happy to do that. It's an important piece because it starts out with the whole concept of instructions. My impression of Americans is that we don't think we need to read instructions. We think we can figure it out by looking, but with your safety seat, that is number one. If somebody is helping you put a safety seat in and they are not using the instructions, you have to question whether they know what they are doing because they should show you that they understand the instructions are important. You would never wrap a safety belt around a safety seat. There's a very specific belt path. If you have a seat that goes both rear-facing and forward-facing, there will be two different belt paths.

About 20% of the children who die in car crashes are in crashes where there's an impaired driver.

As far as harnessing the child, you want to strap close to the child's body over normal clothing. It's always a good idea for the baby to be in something with legs so you can see easily where the crotch strap goes. You want to snug it and do the pinch test. You also mentioned that mom didn't buckle up. Not only is that dangerous for her, but she is probably facing the rear-facing child. I'm assuming they at least put the baby in facing the rear. She might be thrown on top of that youngster.

Remember, we are at 30 miles an hour. We are going to multiply her weight by 30 to see how much force she would put on that little tiny baby. She is a danger to herself and everyone in the car. Her baby needs her, so we don't want her to be injured. You mentioned the dad had a little champagne. Probably that little sip of champagne isn't going to change the way he drives, but remember, he is nervous too. That combination probably isn't a good idea.

One of the things that we are working on is that most people don't realize that about 20% of the children who die in car crashes are in crashes where there's an impaired driver. It's someone who has taken on board alcohol or drugs. When you look at those statistics, you find that the majority of the children who die, die in a car with an impaired driver. Children cannot get out of the car on their own. They cannot ask friends not to drive while drunk. They rely on us to get the message across that when children are involved, for sure, zero alcohol, zero drugs, zero distraction is the message that we want to get across.

We know that people don't believe that a sip or two is going to impair them, but if you have ever tried one of those tests where they set it up as if you have been drinking and you tried to drive, you will find out how distorted your impressions are of what is going on around you. I will tell you that a lot of people don't understand that cannabis has a major effect and prescription drugs as well. With all of these possibilities, we are trying to get that message across to people. Please, zero alcohol, zero drugs. Help those children because they cannot get out of the car on their own.

You hit an interesting point. The fact that sometimes polypharmacy, grandma or grandpa driving or grandkids sometimes under certain medications could be considered impaired and some people forget that. I'm glad that you highlighted that. I'm very interested to know. Is there a place in the back rear that it's safer? For example, is it safer to have it on the right rear, left rear or center rear of the car seats? I have read somewhere where the left rear tends to be, for whatever reason, a higher mortality rate in terms of collisions.

Statistically, we don't have evidence for one side or the other. What we do know is that the center of the back seat is the farthest from all the points of impact. If you can get a good fit, then take advantage of that. There's another piece that I didn't go into because we can't cover everything in child passenger safety, but I do think it's important. Due to the adjustments that were made to safety belts to try to make them fit on adults better in the back seat, there were problems where the safety belt was forward of the crack of the seat. A system that includes lower connectors was added to the safety seats and bars in the back seat crack. They are usually in two locations and they are rarely in the center. That's another time where you need to look at the instructions.

Your safety belts have had to be lockable manually since 1996. In most cars, you can use the safety belt from the beginning. If you choose to use those lower connectors and the connector bars that are in the car, they have a total weight limit of 65 pounds. That means the seat and the child. Be aware of that because a lot of parents who use them, to begin with, never notice that and don't make the change to the belt. Your safety belt will take 6,000 pounds of force because it's designed for a 200-pound man.

TED 53 | Safety Belt
Safety Belt: The heat in a car goes up much faster than the outside temperature because of the way cars are made, the materials in them, and the concentration of the exterior heat on the vehicle.

It's a good question about the center of the back. If you get a good fit there, you can get a tight belt. You can meet all the components. With a newborn, the angle of recline is important because we have to keep that airway open. The child's head has to lie back naturally. Now that we keep children rear-facing longer, we can have two different rear-facing angles. As they get older, they can be more upright, which is safer for the bigger child.

Speaking of the airway, I read a story about a child who was left in their car safety seat, brought into the house, remained restrained in the seat and suffocated. Can you talk a little bit about why we should not do that?

I'm glad you brought that up. Especially when people have rear-facing-only seats that have handles, there's a great temptation if the baby falls asleep in the car to take the safety seat into the house and leave it. The point is that the child can move around. The seat can topple. Often, parents have a loose harness, especially if the baby is sleeping. They think to loosen the harness and they get twisted in it. The other thing that happens is people put blankets over them again and then the child can't move the blanket off the nose. Safety seats are for the car.

If you go into the restaurant, you take the child in and the safety seat. It's right next to you. You keep an eye on that baby. When you are home, the phone rings or you have to go and pick up a message or you go to wash the dishes. You are distracted and the baby stays there. I can tell you that this does happen. Unfortunately, one of our technician instructors, who was also in law enforcement, had that happen with a relative. It isn't just little babies. It's also toddlers and this can happen in a daycare setting.

The case that I read was a two-year-old at daycare.

While we are talking about forgetting, I can tell you we all have this capability. Children have been dying of heatstroke because they were forgotten in a vehicle because they were in the back seat, especially if one of the parents is very tired or out of a regularly scheduled pattern. For example, mom always takes the baby to daycare except for this day, dad was supposed to.

You get in the car and you go on automatic pilot, "I go to work. I parked my car. I don't take my child to daycare." Suddenly, eight hours later, you find a deceased child. This is one of the great tragedies. One of the things that happened in the bill that President Biden signed is that there has to be a standard set for recognizing when a child or an animal is left in a car. That's going to be a part of the regulations in the relatively near future.

When your baby is in the backseat, put the phone and the briefcase and the purse in the back. You'll be more likely to check the backseat.

There are a number of points to make on your checklist. When you have a baby in the back seat, take a stuffed animal, your purse, phone, briefcase or whatever it is that you wouldn't leave the car without. Put the stuffed animal in the front seat when the baby is in the back seat. Put the phone, briefcase and purse in the back seat when the baby is in the back seat. You will be more likely to check the back seat, "This is the day I was supposed to stop by daycare." Help yourself and your child.

In California, we have a higher rate of children who were on purpose left in the car alone. That is against California law. It will be a $500 fine, including court costs. Don't do that for the child's welfare and for your pocketbook. Kaitlyn's Law came from a tragedy in which a childcare provider went to do something inside and left Kaitlyn in the back. When she came out, Kaitlyn was no longer alive. Her mother and grandmother worked with the legislature to get that law.

If you are a good Samaritan and you see a child or an animal that's in the back seat of a vehicle and obviously struggling, look for someone in law enforcement. Try to get someone from the fire department. If you cannot find anyone and that youngster is clearly in trouble, you have permission to get into that car and then call for help. Open that car so the child can breathe because the heat in a car goes up very fast. It's much faster than the outside temperature because of the way cars are made, the materials in them and the concentration of the exterior heat on the vehicle.

I made it sound like it was all disaster. I can tell you that once children are used to riding in the car in a safety seat, you are going to be so happy because there are a lot of things that happen when a child is loose in the car that you don't want to have to happen while you are driving. They will get along much better. It will be easier for you in the long run too. Please take a look at our slides. If you have any questions at our helpline, we love to get calls or emails. We always try to get back to people. Take advantage of that.

We even have on our website a few little YouTube videos that are very short that deal with some of the questions that people have that we often don't get to because there's so much information. If you are a professional and work with families, I encourage you to take a look at all of this information so you have a sense of the basics. We provide different kinds of training so that we can help people to help the families for whom they care.

Stephanie, that was very interesting and informative. Thank you so much for your time. For our readers, don't forget to buckle up. Don't forget to use proper seat belts and child seat etiquette. Don't google things. Ask the experts. Hopefully, we can have you back.

Thank you very much.

As emergency providers, we see what happens when people don't wear their seat belts, aren't using proper child safety seats, or are driving impaired. You don't want to end up in our emergency departments on a gurney after a collision. Thank you so much, Stephanie. We appreciate your time. Do you have any final tips or anything else you would like everyone to know before we wrap this up?

TED 53 | Safety Belt

I went into this field because of my daughter. A lot of people get interested in this thing because they are now parents. I wanted to say that it is such a thrill to be working with you in the emergency room because you can impact this issue. People are under stress. That's true, but you can have some information for them and you can be alert to some of the issues. Kindly help people to realize that they wouldn't be facing the problem exactly the way they are that day or you can say to someone, "I know you brought your child in to be checked. Was the youngster in a safety seat?" "Yes," the parent says. We are so glad because there was no injury.

One of our board members was traveling in another state. She had three children. Her husband was driving. Luckily, she was sitting in the back seat with her children. They came around a bend. They were going at freeway speed and there was something in the road. When the van hit that, it rolled. One week later, we had our annual special event. All of them were there. One child, the forward-facing child, had a broken leg. The rear-facing child had no injury at all.

Guess what injured the mom? It's her cell phone. She was holding her cell phone. It gashed her arm. It shows you she had put all the suitcases and stowed them away, so they did not become missiles in that crash. Research done in Norway showed that when they found children who died in crashes but were properly buckled up, a large percentage of them were hit by suitcases. These are the Laws of Physics. We can't change them.

My purse probably qualifies as a suitcase, so I should think about that.

Anything you have, think to yourself, "Would I like it to hit my child in the face at 30 times its weight?" If you use that little formula, it's accurate. It meets the physics. Having been married to a physicist, I had him do all the calculations. I know that it's accurate. Keep that in mind because we want everyone to have a good ride and every ride a safe ride.

Thank you so much, Stephanie. That's it for this episode. If you would like to learn more, you can visit or you can call 1-800-745-SAFE. If you like what you read, please give us a five-star rating, review, subscribe or send this episode to someone you know who might enjoy it. Feel free to connect with us on our website at or Instagram @TheEmergencyDocs. Until next time.

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About Stephanie Tombrello

TED 53 | Safety Belt

Today we’re talking with Stephanie Tombrello who served as Executive Director of SafetyBeltSafe U.S.A. from 1982 to 2021. SafetyBelt Safe USA is a national non-profit focused on reducing deaths and injuries of children and their families through use of the correct, consistent use of safety seats and safety belts, and continues as Senior Program Consultant. Her work led to the federal requirement for rear-seat shoulder-lap belts in motor vehicles in 1989 and to other efforts to improve the resources and programs in the field through laws, regulations, and program developments. She is the recipient of national and statewide recognition over the years and she was made an initial member of the Child Passenger Safety Hall of Fame in 2017. She also received the National Highway Traffic Safety Administration Award for Public Service in 1983.


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