which components of pediatric trauma systems impact outcomes and cost-effectiveness; and the impacts of ED crowding, boarding, and diversion on pediatric patients.

Health Promotion and Injury Prevention

Injury prevention is important for all age groups but particularly for children, whose unique needs must be taken into account (see Box 7-1) (IOM, 1985). Injury not only is the leading cause of death for children, accounting for more deaths among those aged 1–18 than all other causes combined, but also is responsible for more years of potential life lost than any other health problem (Baker et al., 1992). Injuries are the most common cause of pediatric ED visits as well (McCaig and Ly, 2002). Although emergency care providers are not commonly linked to public health prevention activities, their potential role in such efforts has been recognized (Maclean,

BOX 7-1

Airbags and Children

Just as new medical technologies and information systems must be designed with pediatric patients in mind, prevention efforts must consider the potential implications for children. Passenger side airbags are an example of a prevention device designed for adults that resulted in unintended harm to child passengers.

Since the early 1970s, airbags, in concert with seat belts, have saved thousands of lives (McCaffrey et al., 1999). Because of their potential to reduce the burden of injury in a crash, dual air bags were required as standard equipment in all cars and light trucks in the United States in the late 1990s. However, many children—as many as 35 percent of child passengers in the 1990s—ride unrestrained in automobiles (National Center for Statistics and Analysis and NHTSA, 2005). As the number of vehicles equipped with dual air bags increased, federal regulators noted a sharp increase in the number of fatal injuries to children resulting from airbag deployment. Many of these injuries stemmed from children being unrestrained or improperly restrained, but a small number occurred to children who were properly restrained in the front seat (CDC, 1996).

Because airbags must deploy at the moment of impact to catch an unrestrained passenger, they literally explode open, fully inflating within milliseconds. The speed of airbag deployment can exceed 140 to 200 miles per



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