Femur breaks?

I have a friend who is a tech, and an EMT (husband is also a tech, and firefighter)... She firmly believes that FFing is safER than RFing. She says that if a child breaks their thigh bone, that they can bleed to death in under 7 minutes. This is the reason she uses as to why she FF her 8 month old. (He is now 3.) She says she's seen it happen.

Can anybody tell me yes or no on this?

I'm not trying to argue with her, b/c both of our minds are made up. But just so *I* know... I do believe that the risk associated with internal decapitation are much greater than a broken thigh bone.

I agree that's scary. And I'm sure its happened and that's horrible. But statistics show that rear facing is safer than forward facing. I can't predict what kind of accident a kid will be in. I'm sure some would be better rear facing, some forward facing, some side facing, some in the front, some in the middle, some on the driver's side, etc. So I just go with what the statistics say. No point in driving myself crazy over situations I can't predict.

I agree. She says that the test bench doesn't show real life crashes... She says that based on what SHE'S seen, she will tell her friends and family that FF as soon as legally possible is safe.



Just a question here... but WHY would they make a "legal limit" that you HAVE TO RF to, if FF was safer??

I have ready studies that FFing kids have broken a femur, but not a RFer.

Have you told her that leg injuries are more common with FFing kids?

Those legs aren't going to be terribly useful when her FFing 8-month old is internally decapitated. :thumbsdown:

I totally agree, but she says that a RFing baby can be decapitated, too...

I told her, that the RISKS were greater FFing.

She says, well the risks of SIDS is *GREATER* if you don't put them on their back, it's *GREATER* if you don't co-sleep, but that doesn't mean that doing so is deadly... Basically saying that the risks of FFing are greater, but not deadly enough for her to consider RFing.

This reminds me of the people that their Mom's 1970 blah blah steel frame "saved their life" and they won't drive anything different. Congrats, you lived, but there is a safER option!

Seriously, she's a tech? 'Cause if she were a tech in my city, she'd be re-educated so fast her head would spin. As a tech, her *beliefs* get in the way and shouldn't play a part in the advice she gives parents. She should give facts to parents. The facts are that ff kids' legs strike the vehicle interior (unless there's absolutely nothing in front of them, like the kiddos are in a 3rd row with the 2nd row removed) and are more likely to be broken. The facts are that in rf carseats, the head, neck, and back are protected and the spinal column is less likely to be injured; it's considered to be safer than ff. There are studies to prove these things. Click the link in my signature.

As a tech, she needs to toe the party line, suck it up and spout at least the 1 and 20 lbs. line (which isn't the law everywhere--it's not in my state), which I hope she is doing with whomever she's advising. If she's not, she's dangerous. She can do whatever she wants with her own kid, but not anyone else's.

lil.miss32 said:

She says that if a child breaks their thigh bone, that they can bleed to death in under 7 minutes.

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I'm calling that bologna. While my little BIL is not a child, he broke BOTH femurs in a total of 7 places is a serious collision and remained awake the entire hour it tooks jaws of life to extract him from the car.

I was just cleaning out my inbox and came across this reminder email to all techs that was sent out by Safe Kids on May 1:

1 and 20 - Current thinking

This is a reminder from Safe Kids Buckle Up that the recommended practice of keeping infants rear-facing until age one and 20 pounds has not changed even though we now suggest that parents keep their children rear-facing for as long as they possibly can. The “one and 20” recommendation is a minimum standard. Our mantra remains one that guides parents to follow their manufacturer’s recommendations. Current "best practice" suggests that technicians encourage parents and caregivers to keep children rear-facing for as long as possible, up to the highest height or weight permitted by the seat. For some children that will be until at least age 2 and for other children even longer.

Child restraint manufacturers have done great work in "upping" the rear-facing weight limits on their harnesses. Most harnesses in rear-facing convertible seats (and even in some infant only seats) now serve children to 30, 35 or even 40 pounds. As always, the final decision remains with the parent who may want to turn their child forward-facing despite our best sales job. It is not wrong for parents to make this decision if their child is at least age one and at least 20 pounds. It may not be best practice, but it is still their choice and that decision meets the minimum standard. What WOULD be wrong is for a technician to employ scare tactics, and insist that a child will not be safe if they are turned forward-facing before two years of age, or to say that parents MUST keep them rear-facing beyond one year and 20 pounds in order for them to be safe.

When completing your checklist forms, it is recommended that you consider a forward-facing child who is at least age 1 and 21 pounds "correct" unless the parent has disregarded manufacturer's instructions for their particular car seat. Technicians are right to inform parents of the current best practices, listen to their questions and then assist them in whichever decision they make. What could be worse than forcing a parent into doing it our way only to have them change the orientation of the seat as soon as they leave our event? This interpretation will no doubt elicit some strong feelings in those who see this issue in more concrete terms.

The national curriculum has not changed to say that every infant and child MUST be rear-facing to a higher weight, only that it is highly recommended. NHTSA still uses the “one and 20” as a minimum while promoting the “rear-facing longer” message. The American Academy of Pediatrics recommends using a seat rear-facing to the highest weight or height possible but still says that one and 20 is the minimum for changing seat direction.

It would be great if we could assure that 100% of infants remained rear-facing until a minimum of age one and 20 pounds. We still have a lot of work to do, even though we see more and more children better protected to those higher weights in rear-facing seats. For questions contact Lorrie Walker at . . .

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Heather's signature has a link to the page with lots of resources, studies about why RF is safest, that might help...

I thought that everyone here said there were no reports of a rear-facing child breaking their legs in an accident, full stop? I have to wonder if she's seen REAR FACING kids break their femurs like that. And if she HAS, I have to wonder what projectiles were in the vehicle that hit the child's legs. The physics of it don't make sense for a child in a rear-face seat to break their legs.

In a non-tethered rear-face seat, the child is encapsulated. A child will bend at the location of least resistance. This means the hips and knees. A child with the legs 'froggy' or 'criss cross apple sauce' will have their legs 'accordion' up, folding at knees, ankles and hips, and their knees will (or may) hit the chest. A child with their legs up will fold in half. The most likely risk for them is knee dislocation if the force is severe. The femur is the path of MOST resistance. A child is INCREDIBLY unlikely to bend there.

In a tethered/ARB rear-face seat, the entire seat will move AWAY from the back seat with the momentum of the car, assuming a frontal or front offset collision, then move in a straight line back towards the back of the seat. The movement won't be that great and the child's legs will end up 'accordioning' (as explained above) even if the feet are up on the seat back as they will likely slide down slightly when the seat shifts towards the front of the car.

A rear-face child will NOT see the collision coming and will therefore not instinctively tense (as a forward face child might), which would reduce the risk of broken bones even further. Rear-face children are also more likely to sleep in the car, anecdotally, and people who are asleep during accidents are even LESS tense and therefore even less likely to have broken bones.

The physics and the instincts simply do not match up to what she is saying.

In order for a child to have broken its femur rear facing, the crash would have had to have been a) one of those SEVERE rear-end collisions that we occasionally hear about, though I don't think that's LIKELY, from considering the physics, b) would have had to have had involved multiple (or just one) projectiles or c) would have had to have been a very severe crash that had passenger cabin intrusion, and quite a lot of it. In the case of a and c, this is why we say you can't choose your crash and, really, c is most likely to be declared an 'unsurvivable' crash anyway. In the case of b, this is why we discuss getting rid of as many projectiles as possible. Also, if the case was c, I have to wonder. Would the child have had seven minutes of possible time to be saved if he/she had been forward facing, or would the child have been killed instantaneously from neck breakage? Seven minutes isn't much time, but your odds are better if you've got seven minutes to be helped in (and people DO survive from femoral arteries being severed on occasion) than if you had zero minutes.

birdflippin' said:

I'm calling that bologna. While my little BIL is not a child, he broke BOTH femurs in a total of 7 places is a serious collision and remained awake the entire hour it tooks jaws of life to extract him from the car.

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Kids bleed out a LOT faster. I believe her when she's said she's seen a kid with a broken femur bleed out in seven minutes. That's why lapbelt fit is so important. A kid can go from upright and walking to dead in about three minutes from internal abdominal bleeding. And the femur has the femoral artery right there, so if it gets nicked you're looking at some bad stuff happening.

However, I agree that it sounds like my uncle, who was saved because he wasn't wearing his belt and he slid across the vinyl bench seat to safety during a crash. He wears his seatbelt now.

Wendy

Yes, breaking your femur if it nicks an artery can cause blood loss and death in minutes. It happens. Is it common? No. Internal bleeding is serious and can kill you fast. However, it is not that common and not happening all the time like she claims.

My DH has been a firefighter/EMT for 11 years on a full time fire department(running 6000 calls a year). Wanna know how many times he's seen it(death in minutes from femur fractures)? Zero


I've been a firefighter/EMT for 9 years on a part time fire department (running 1000 calls a year). Wanna know how many times I've seen it? Zero

Wanna know how many accidents we've been on total in our careers together? Probably close to 300.

Wanna know how many femur fractures we have seen in those accidents? Four. Neither was fatal. All were adults with major intrusion into the passenger compartment

Wanna know how many femur breaks we've seen from rear facing? Zero

Wanna know how many femur breaks we've seen from forward facing(children)? Zero

Wanna know how many rear facing kids I've seen die? one. And it was non survivable (and it was a newborn)

Wanna know how many forward facing kids I've seen die from neck/head/abdominal injuries? Four. Four too many.

Wanna know how many forward facing kids I've seen die from leg injuries? Zero

My point is, if anything, femur's will break forward facing from the legs flying every which way. However, they mainly don't. Femur's most likely will not break rear facing unless the force is so strong to drill the kid into the seat his legs are touching. IN that case, most accidents will not be survivable anyways.

So I'm not sure where she is an EMT that there is a magical femur breaking bubble in her service area, but it's not happening. I've worked in a level 2 trauma center as a nurse for years as well, and I've seen 2 or 3 femur fractures on a kid from an accident, and they didn't die. Kids are SO flexible, it would have to most likely be severe blunt force trauma to cause it. So for her to see "all these cases" leads me to believe she's lying

I don't doubt it could happen in some rare cases. But it is NOT common and overall is not happening frequently. It's the exception, not the rule. And if anything, it would be happening FFing, NOT RFing.

Too bad she couldn't have been on the call with me with the two year old with internal decapitation to really know what happens in fatal crashes :twocents:

The only cases of death within minutes from bleeding out I've seen on accidents are from ruptured and torn aortas. In serious accidents the force literally tears the aorta and that patient bleeds out into their abdominal cavity and are usually dead in 30 seconds-5 minutes. Other cases involved a belt (seatbelt syndrome) hitting a blood rich organ and rupturing it causing bleeding out and death within 1-10 minutes. From femurs though? Unless the artery is nicked which honestly doesn't happen often, the patient will not die in minutes. They *can*, but overall, they don't. I've been on more femur fracture calls than I can remember(accidents/falls etc) , and not one has died from it. Aorta and organs? Yes. Plenty. Femur? None.

Now put a 3 year old RFing in a bucket not properly restrained with a loose harness in an expired seat, and yeah, I'm sure a leg injury could happen. But a properly restrained young infant(which is what she most likely saw as it was 3 years ago and I highly doubt it was a 2-3 year old she saw) whose legs don't even extend past the car seat because they are too small still? i can't see that being a common occurance

Seven minutes bleed-out time is, as Wendy said, more than enough. That said, not every femur break will hit or nick the femoral artery. A lot of them will not. There was a guy in my 12th grade class, captain of both the football and rugby teams who broke his femur during rugby practice. No bleeding at all. He was in a really nasty looking cast for the rest of the season, but it didn't hit his femoral artery. There was a boy hit by a car in my brother's 9th grade class who broke his femur and it hit the femoral artery. He ended up in a coma because of oxygen deprivation to the brain (from blood loss, they said) and his family took him off of life support.

Different breaks are different and not every break gets that artery. There's also a difference between a nick to the femoral artery and the artery being severed.

wendytthomas said:

Kids bleed out a LOT faster. I believe her when she's said she's seen a kid with a broken femur bleed out in seven minutes. That's why lapbelt fit is so important. A kid can go from upright and walking to dead in about three minutes from internal abdominal bleeding. And the femur has the femoral artery right there, so if it gets nicked you're looking at some bad stuff happening.

However, I agree that it sounds like my uncle, who was saved because he wasn't wearing his belt and he slid across the vinyl bench seat to safety during a crash. He wears his seatbelt now.

Wendy

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Agreed. She may have seen a case. It does happen. However, for her to make it sound like it's happening often and is a reason to FF is just strange, especially being a tech and it's irresponsible as an EMT as well to make it sound like she sees all these cases.

It reminds me of another post a long time ago saying a PT was saying he see's "so many cases" of kids RFing with broken legs. We all called his bluff because first of all, how many older kids are even RFing? 2nd-how many are even breaking their legs? 3rd-how many are ending up at this particular OT for therapy???

Most of us with experience chimed in saying if we were not seeing those cases, then he sure wasn't. THere are hardly any kids in accidents RFing past age 6-12 months to begin with, and I think most of us said we've NEVER seen a RFing child break a leg unless it was a fatal crash.

I think people's experience sometiems gets skewed and after a while they think the one injury they've seen is common. It happens all the time in this field LOL.

This is one reason I never use the "never been a documented case" of breaking legs rear facing, because I have heard of one. And rear facing saved the child's life, anyway, as there were other fatalities in the car. I wish I could remember the specifics, though.

I also remember that pt thread, and there was another that actually said the complete opposite, that most of her patients were forward facing with broken legs.

THere was another that talked about an increase of hip injuries rear facing, but never came back with the cases, either.

There's a difference between, "Never been a case," and "never been a case due to rear facing." When I use that phrase I say, "There has never been a documented case of lower extremity injuries due to rear facing." I can guarantee kids have had broken legs, ankles, feet, etc. while riding rear facing. But they likely would have been much worse if they had been forward. So the injuries were due to the collision, NOT to the fact that they were rear facing.

Wendy

Even if it's true that broken femurs are common when RFing, and those broken femurs are commonly hitting the artery, causing bleeding, I'll still take that risk.

Internal decapitation takes no time. None. It's over and done with. No chance for any one to apply pressure. No chance for EMTs to arrive with additional fluids. Very little chance that the broken bone won't hit something else vital.

Broken femur: may or may not send broken bone in the direction of the artery. If it does, the artery is a tough structure that may or may not be punctured. If it is, it still takes time to bleed out.

Broken neck: Little chance that broken bone won't impact the spinal cord. There is nothing protecting the cord other than the bone, so no second chances. Damage is instantaneous and can't be mitigated with first aid.