AS AN EMERGENCY MEDICINE PHYSICIAN, Randall S. Jotte, MD, sees what are arguably some of life’s most preventable tragedies — drug overdoses, suicide attempts, kids riddled with bullets from gang violence.

But the type of case that affects him most is treating the aftermath of a motor vehicle accident in which a small child or infant wasn’t restrained in a car safety seat.

After witnessing hundreds of injuries caused by a child not being restrained or being improperly restrained, Jotte and his emergency medicine team decided to take a proactive approach. Earlier this year, the team launched Safe and Secure, a prevention program that provides car and booster seats to Missouri children at the highest risk for motor vehicle injury and death.

“The single greatest threat to a child’s health is motor vehicle collision,” says Jotte, associate professor of medicine. “The contrast between when small children are restrained in motor vehicle accidents compared to when they’re not is devastating. It’s often the difference between a child coming in with minor cuts and bruises or suffering major trauma, often resulting in death.”

Randall S. Jotte, MD: working to curb childhood
mortality in Missouri.

According to the U.S. Centers for Disease Control (CDC) and Prevention, car crashes are the leading cause of death for children. Nearly 2,000 children ages 14 and under are killed in automobile crashes each year; another 280,000 are injured.

Car seats reduce the risk of death significantly — as much as 71 percent for infants and by about 55 percent for toddlers. The CDC estimates that 50,000 serious injuries would be prevented and 455 lives saved each year if all children under age 5 used safety seats.

Unfortunately, 40 percent of American children ages 4 and under routinely ride unrestrained.

Furthermore, fewer than 10 percent of 5- to 8-year-olds use booster seats, the recommended safety seat for this age group.

“This is such a fixable problem,” Jotte says. “We anticipate that the Safe and Secure program will result in fewer Missouri children dying or being seriously injured from motor vehicle crashes.”

With support from the Missouri Foundation for Health and the university, Jotte and his team received a $120,000 grant to fund the distribution of the Safe and Secure program.

Working in cooperation with physicians, nurse practitioners and county health departments, Safe and Secure is offering free car and booster seats to families who live in the Missouri areas with the highest pediatric mortality rates from car accidents.

A study by Jotte’s team determined that Carter, Reynolds and New Madrid counties in southeast Missouri and the 63104 district of Soulard in St. Louis have the worst childhood mortality rates.
The program is providing more than 2,000 free car and booster seats to families from these areas who are living below the poverty level determined by Medicaid.

As a young mother, Tondra Holman couldn’t afford to purchase a car seat for her 1-year-old daughter, Kenisha. When the family needed to go somewhere in the car, the only option she had was to use a standard seat belt. And she admits that made her very nervous.

“I really just tried not to take her anywhere,” Holman says. “Now I know Kenisha will be safe in the car. It’s surprising to me that such a generous programs exists.”

Even at discount stores, a new car seat costs $50 to $140.

AmeriCorps member Felicia Edwards, who works at the Grace Hill Soulard Neighborhood Health Center, says the response to the Safe and Secure program has been incredible.

“There is a serious need for this program in the community because many families just don’t have the extra money to purchase a safety seat,” Edwards says. “The young mothers who receive the free safety seats are so grateful because they know this gift could save their child’s life — and that’s what this safety program is all about.”

Ensuring kids’ safety: Randall S. Jotte, MD, associate professor of medicine; Felicia Edwards, AmeriCorps; Jane Clark, Grace Hill Soulard Neighborhood Health Center; and Gerald Banet, assistant director of research, division of emergency medicine, with Tondra Holman and her daughter, Kenisha.

Jotte and his staff have teamed up with physicians and other care providers in the eastern Missouri counties and at the Grace Hill center to educate underprivileged families on the lifesaving benefits of safety seats and to provide instructions on how to properly use the seats. Once the educational session is completed, the family is given a voucher for each child who needs a safety seat, which can be picked up at their local community center.

“Parents of children in the regions targeted by Safe and Secure face several barriers to assuring child passenger safety, the most formidable being financial and educational,” explains program director Gerald Banet. “The financial strain makes it impossible for some parents to purchase car seats for their children. They have to spend what money they have on food, clothing and shelter.”

Jotte and his team plan to seek additional funds from state and federal resources and other foundations to expand the Safe and Secure program in additional Missouri communities.

“Our emergency medicine team has a commitment to underinsured and uninsured patients,” Jotte says. “Because we see so many of these patients in the emergency department, we have a special connection with and sense of responsibility to these underserved patients.”