We’ve all gotten the call: “Child locked in a vehicle, vehicle not running, child is in distress.” It is no secret that pediatric calls make our heart rates rise as it is. Sometimes we get there quick enough to smash out a car window, rescue our patient, and render care. And other times, thanks in part to our digital age and community awareness, a Good Samaritan has already broken the window, retrieved the child and is in the process of cooling them down when we get there.
Most states, Florida included (where I practice), have Good Samaritan laws protecting private citizens from litigation when they perform such an act. As long as the rescuer acted in good prudent faith, wasn’t seeking any monetary compensation (yes, it actually says that in Florida State Statute 768.13), and did so without any malicious intent or gross negligence, they are safe from prosecution. Good for them. We usually shake their hand after and give them a big thank you.
Then there is the darker side to this type of call: The child has been forgotten in a vehicle by a busy caregiver, or slipped in unattended and gotten trapped, left there often for hours – and it doesn’t take hours for that child to suffer life-threatening injuries. According to the National Highway Traffic Safety Administration (NHTSA), in just 10 minutes the temperature inside a vehicle with its engine off can rise by 20 degrees. Every five minutes after that, the temperature increases by 3.2 degrees. Even if it is only 60 degrees outside, it only takes a couple of hours for that thermometer to climb up to 110 degrees.
Physiologically speaking, pediatric patients overheat about four times faster than our healthy adult patients. So let’s take a close look at those temperatures and what they can do to a child left unattended in a vehicle. At body temperatures of 104 degrees, for just as little as 15 minutes, vital internal organs begin to shut down, causing brain damage and sometimes irreversible kidney damage. A spare few minutes after that? A child’s body temperature can reach as high as 107 degrees, a condition called super hyperpyrexia.
A child dies once their core temperature reaches 107 degrees. And according to the NHTSA, vehicular pediatric heatstroke deaths are on the rise. This year alone, with four months left to go, the number of deaths nationwide has nearly tripled from last year’s total numbers. The NHTSA, who partners up with the National Safety Council, refers to a study done by San Jose State University’s Department of Meteorology and Climate Science. Nationwide, in 2015, 24 children died due to being left unattended in a hot vehicle. As of this writing, in 2016 there have already been 27 deaths reported across the county. Obviously it is more prevalent in hotter climates, but every state has had an occurrence. Ranked by state, the highest number of deaths per capita is in Arkansas. Nevada is number two.
But why? How does this happen? And why is it on the rise? It may be our busy lives, our constant multitasking of errands with too little time to get them done. The National Safety Council describes it as almost a perfect storm of unintentional events: A parent/caregiver in a rush; a departure from the usual routine or a new schedule; a child sleeping soundly in the car seat; a cellphone glued to the caregiver’s ear as they hurry to get the morning’s responsibilities taken care of; relying on autopilot and muscle memory rather than focusing on the child. They turn off the engine, grab their things, get out of the car, and lock the door. Just like they have done a thousand times before. It is estimated that 54% of pediatric vehicular hyperthermia deaths happen exactly this way. (An additional 29% climbed into a vehicle on their own to play and got trapped inside.)
So then EMS gets the call. And we pull into a department store parking lot or at an office building somewhere and see a crowd of people, a wailing parent, and a Good Samaritan performing CPR on a child that has been baking in the hot sun for hours. We know what the outcome will be, but then we go to work. While protocols and medical directives vary agency to agency, it still doesn’t help the dilemma you as the responding clinician are faced with at that very moment: Do you perform every intervention possible to save that child, even though you understand that the child is not viable, to at least give the parents some small assurance that everything that could have been done, was done? Or do you save running them through that extra trauma of violent resuscitative efforts, an emergency transport, a frantic ER scene – and explain that the child has passed away, that nothing more can be done?
While our reliance on the digital world may partly be responsible for such incidents, that same digital world is trying to come up with ways to prevent these tragedies. There are mobile applications for almost all smartphones that remind you (verbally and via alarm tones) to check on your child when you are exiting the vehicle. And two fathers from Tampa, FL invented a device called Sense-A-Life, a small compact digital sensor that comes in two parts. One goes under the child’s car seat; the other, under the driver’s seat. When the driver gets out of the car and the child does not, it triggers both an audio and verbal command to check on the child. A secondary alert goes through the driver’s smartphone if the first alert is ignored.
As with most preventable tragedies, community education and awareness is the key. Many municipalities have launched educational campaigns on this topic. For most of us EMS providers, critical pediatric calls will never get easier, or hurt less, no matter how much training and preparation we put into our craft. And an infant hot car death is certainly one of those calls that at least requires a review, if not a full critical incident stress management intervention. Watch each other. Talk to each other about it. Take care of each other.
Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.
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