BY:   Bridget Bushue
                   Anchorage Fire Department
                   Anchorage, Alaska

An applied research project submitted to the National Fire Academy
           As part of the Executive Fire Officer Program

                         November 1999
                                   ABSTRACT                                     2

        The problem was that although Alaska law requires child safety seats and

seat belts, no formal plan existed to confirm proper installation for those who

were in compliance with the law. The purpose of this research was to evaluate

the feasibility of adopting a child safety seat inspection program within the

Anchorage Fire Department response area. The research employed both

descriptive and evaluative research methodologies. The research questions


        1. Is the Anchorage Fire Department the most effective organization that

can provide the primary service?

        2. What were the anticipated benefits and impacts upon the Anchorage


        3. What organizational changes will be required by the Anchorage

Department to facilitate adoption of a safety seat inspection program?

        The procedures involved analysis and comparison of motor vehicle

accident statistics in Anchorage the nation. Current service agencies both public

and private were evaluated. Surveys were conducted of fire department

employees holding the rank of Engineer, Captain and Senior Captain. In addition

65 residents, either current parents or care providers were surveyed on vehicle

restraint requirements.

        The results indicated that citizens are lacking in knowledge regarding

proper installation of safety seats. There are great misconceptions regarding

size, weight, ages of children, and the corresponding safety seat. Both survey

groups agreed that verification of safety seat installations within specific

parameters would reap positive benefits; resulting in a decrease of serious and

fatal injuries to children.

       The recommendations were to: a) provide certified training for prevention,

suppression, and medical personnel on safety seat inspections, b) establish a

multi-agency media and marketing campaign for safety seats and seat belt

usage, c) consolidate existing area-wide training for comprehensive health and

safety education; including education and information components for citizens,

and, d) expand partnerships between public and private agencies within the child

safety profession.
                   TABLE OF CONTENTS       4


Table of Contents………………………………………..4


Background and Significance…………………………..6

Literature Review………………………………………...9





Appendix A………………………………………………..23

Appendix B………………………………………………..24

                                INTRODUCTION                                    5

        The problem was that although Alaska law requires child safety seats and

seat belts, no formal plan existed to confirm proper installation for those who

were in compliance with the law. The purpose of this research was to evaluate

the feasibility of adopting a child safety seat inspection program within the

Anchorage Fire Department response area. The research employed both

descriptive and evaluative research methodologies. The research questions


        1. Is the Anchorage Fire Department the most effective organization that

can provide the primary service?

        2. What were the anticipated benefits and impacts upon the Anchorage


        3. What organizational changes would be required by the Anchorage Fire

Department to facilitate the establishment of a safety seat inspection program?

        The project approach was based upon two key principles. First, continue

to support and enhance existing efforts to promote and encourage adults to use

seat belts. Involve both public agencies and private organizations that currently

provide community leadership within the vehicle restraint system and child safety

arena. Second, once safety seats and seat belts are in use, ensure proper

installation through the use of education, information, and inspection. Capitalize

on existing resources by incorporating fire service, emergency medical and

enforcement personnel as active participants in passenger protection and injury

                       BACKGROUND AND SIGNIFICANCE                                   6

       The Alaska State Legislature passed a law (AS 28.05.095) in June of

1984, requiring children aged six and under to be restrained while being

transported (Child Seat Belt Act,1984). In February of 1989 the legislature

amended the original provision of the Child Seat Belt Act. Children less than four

years of age were to be placed in a restraint that complies with federal safety

standards (Child Seat Belt Act,1984).

       Primary enforcement seat belt laws allow police officers to stop and ticket

a driver for not wearing a seat belt, similar to other routine traffic violations.

Sixteen states and the District of Columbia have enacted these laws according to

the National Safety Council (NSC,1999a). Alaska and the remaining 32 states

have secondary laws that allow law enforcement officers to ticket a driver only if

the person has been stopped, or ticketed for another violation (NSC,1999a).

       Motor vehicle crashes are the leading cause of death for children of every

age, (NHTSA,1998c). Despite numerous campaigns, programs, and public

education efforts promoting the use of safety belts and car seats, vehicle crashes

continue to kill and seriously injure children at an alarming rate. Six out of every

ten children killed in crashes are unbelted (NSC,1999a). In 1998, the Anchorage

Police Department issued a total of 1153 citations for safety seat and seat belt

violations (Anchorage Police Department,1998).

       Safety seats, when correctly installed and used, are extremely effective in

saving lives. Research has found that child safety seats reduce fatal injury by

71% for infants (less than 1 year old) and by 54% for toddlers (1-4 years old) in

passenger cars (NHTSA,1998b). The Alaska Safe Kids (ASK) coalition

conducted between 800 to 900 car safety seat inspections between May of 1998

and February of 1999 (Alaska Safe Kids,1999).

       Anchorage has an 85% rate of incorrect installation (ASK,1999) compared

to the national data of 80% (National Safe Kids,1999). Anchorage and the rest of

the nation both had an 11% rate of grievous misuse (child less than one year

turned facing forward rather than backward) during the same time period (ASK,

1999). In addition to incorrect installation, only 5% of booster seat age children

ride in booster seats (Karp,1999, p.77).

       Well-intentioned parents and care providers have been shocked to find

they were restraining their children incorrectly. Proper installation and use is a

critical factor. Studies have found that as many as four out of five car seats are

installed or used incorrectly (NHTSA,1995). Safety seats can be complicated.

Errors are very common. Contributing factors to the difficulty of using seats

properly include: a variety of age and size requirements; compatibility between

car seat and the vehicle itself; improper seating position; and definite gaps in

child occupant protection laws (NSK,1999a). In addition, improper installation

can’t always be readily observed or recognized by the most well intentioned

driver or care provider, unless that individual has been educated on correct

safety seat and seat belt installation (NSK,1999a). There are numerous vehicles

and safety seat models. Each and every child safety seats requires a two-step

process. The safety seat itself must be properly and firmly attached to the

vehicle. The child must then be properly secured to the safety seat. There are

no exceptions to these basic requirements (Breitenbach, Carnes, &


       According to Alaska Safe Kids, 60% of Anchorage drivers fail to tighten

the safety belt that holds the seat to the vehicle. Another 34% fail to tighten the

harness straps around the child (ASK,1999). Ejection from the vehicle is one of

the most injurious events of motor vehicle crashes (NHTSA,1998b). These

errors can be effectively corrected through a hands-on safety seat checkup.

       The Anchorage Fire Department responds to more than 2500 vehicle

accidents each year (Anchorage Fire Department, 1998). The northern climate

and hazardous road conditions, hours of daylight, and significant alcohol

consumption, all contribute to high-risk driving behaviors.

       Fire stations are strategically located throughout the city. Compared to

other public and private agencies, these stations would be ideal for safety seat

inspection sites. The department enjoys an excellent relationship with the

community. Paramedics and firefighters are intimately involved with safety and

injury mitigation. As the department is “open” every day, weekend and evening

checkups are easily accommodated.

       The “Introduction To Community Risk Reduction” (National Fire Academy,

1997) offered through the Strategic Analysis of Community Risk Reduction

course at the National Fire Academy (NFA) provided the necessary procedures

and outlines to follow. I learned how to develop coalitions and promote

educational and behavior changes. Verification of proper safety seat installation

is a “primary prevention activity” discussed throughout the course. These were

essential skills, which evolved into critical factors with this study.

                               LITERATURE REVIEW

       There is a critical relationship between motor vehicle restrains systems

and the extent of traffic fatalities and serious injuries according to NHTSA, the

National Highway Traffic Safety Administration. Safety ranks quite high in

vehicle purchase decision, and the public prefers a strong role by the

government in setting safety standards (NHTSA,1996a). During a survey in

1995, NHTSA noted that 81% of respondents felt that vehicle safety standards

for all fifty states, should be the same (NHTSA,1996a).

       All fifty states have child occupant protection laws, yet there is variation

from state to state regarding age, size, and weight limitations. Many of the laws

have serious gaps and exemptions in coverage which diminishes the protection

children need (NHTSA,1996b). States with primary laws have seat belt use that

is consistently 10 to 15 percentage points higher than secondary law states, as in

Alaska (NSC,1999a).

       According to the National Safety Council, adults who don’t buckle up are

far less likely to buckle up kids (NSC,1999a). Studies have shown that when a

driver is buckled, children riding with them are buckled 94% of the time. When

drivers are unbuckled, child restraint use drops to 30% (NSC,1999a).

       Other compelling reasons support primary seat belt laws. Failure to

buckle up contributes to more fatalities than any other single traffic safety-related

behavior (NSC,1999d). Of the children under the age of five who died in motor

vehicle crashes in 1997, more than half were completely unrestrained. Of those

who were restrained, 39% were not in age and size appropriate safety seats, but

rather were buckled in adult seat belts ( NHTSA,1996c).

       We all pay higher health care and insurance costs because of unbelted

drivers and passengers (Saperstein,Saperstein,1994). Society picks up 85% of

these costs, not those individuals involved in the crash (NSC,1999d). “13% of

Americans who regularly drive children age twelve and under actually admit that

they don’t always make sure children are buckled up” (NSC,1999d,p.1).

Government data shows that one out of four children ride completely unbuckled,

putting more than fifteen million kids at risk (NSC,1999d). The Alaska Trauma

Registry reports that 178 children under the age of 15 required hospitalization

between 1991 and 1998 (Alaska Trauma Registry, 1999).

       The evidence is clear. To protect children we must reach the adults.

Studies have shown that the most effective way to get adults to wear seat belts is

through the passage of primary enforcement seat belt laws (NSC,1999d).

       Primary laws will enable police officers greater authority for more effective

enforcement (NSC,1999d).

       Technological advances have improved safety seats and seat belts. Air

bags have greatly impacted the proper placement of children in the vehicle

(NHTSA,1999). Children must be properly restrained in the back seat in any

vehicle that has an air bag (NSC,1999b). With or without air bags, the rear seat

is the safest place for children to ride (NSC,1999b). Several European countries

have requirements that all children under the age of twelve must ride in the back

seat (National Swedish Road Safety Office,1999). This has been a law in

Germany for more than twenty years. This requirement is currently a strong

recommendation throughout the United States (NHTSA,1996b).

       Many parents believe that if booster seats aren’t mandatory they are

unnecessary. Booster seats raise the child so that the vehicle’s lap and

shoulder belt fit properly. Generally children under 80 pounds and 58 inches tall

should ride in a booster seat (Breitenbach, Carnes, & Hamond,1995). The early

graduation of children from safety seats into adult lap and shoulder belts is one of

the leading causes of child-occupant injuries and deaths according to the

Automotive Coalition for Traffic Safety (Karp,1999).   Booster seats are effective

only when used with the appropriate lap and shoulder belts. Vehicles built

before 1989 were not required to have shoulder straps in rear seats (Karp,1999).

       Physical hands-on inspections are one of the most effective methods to

ensure proper installation and correct use of child safety seats and seat belts

(NSK,1999b). Children are not small adults, and they need special protection.

Their skulls are more fragile, their heads proportionately larger, their rib cage is

thinner, and they’re shorter (NSC,1999c).

       There are a wide variety of motor vehicles, numerous types of belts, and

ever changing safety seats themselves. These three components are critical to

protect passengers (NHTSA,1997). The United States is the first country to

adopt a requirement for universal anchor systems for child restraints

(NHTSA,1999). The universal anchor rule will provide devices independent of

safety belts to attach child restraints to the vehicle. It allows restraints to be

anchored more securely than is possible with current seat belts (NHTSA,1999).

       The literature supports the fact that improper installation is a critical factor

affecting child occupant protection. It reinforces the fact that improper installation

can’t always be readily observed or recognized. But the literature emphasizes

that improper installation can be corrected. Statistics readily illustrate that adults

continue to require stronger regulations to ensure that children are protected.

Evidence indicates that even the most diligent parent or guardian needs

additional safeguards to ensure safety seats and seat belts are installed

                                PROCEDURES                                  13

Population – Fire Department Employees

       Two sample groups were used for this study. The first were Anchorage

Fire Department employees holding the rank of Engineer and Captain. A total

of 77 personnel occupy these positions. 54 surveys were completed from the

employees group. The second group consisted of Anchorage residents, who

confirmed they were parents or care providers for children under the age of 16.

A total of 52 citizen surveys were completed. Both surveys were tabulated and

the data combined (See Appendix A and Appendix B).


       The goal for the employee surveys was to answer research questions one

and three. Question one asked respondents whether they supported child safety

seat inspections. Question two asked whether respondents had ever

participated in a child seat inspection activity. Question three asked whether fire

stations would be the most acceptable community location to hold safety seat

inspections. Question 4 asked whether the employees had children, and what

their ages were. Question 5 asked employees whether fire department

employees should perform safety seat inspections, after obtaining the necessary

training and certification. Question 6 asked employees to identify potential

negative impacts or problems that could surface with current routine and training

demands. Question 7 asked employees to select ways to evaluate the success

or impact of the proposed program.

Assumptions and Limitations

       Employees surveyed are members of the Anchorage Fire Department,

and include the rank of Engineer and Captain. There are 77 total employees in

these ranks. They must have a minimum of 6 years service on the department.

The surveys occurred over a six week period, with an exceptionally busy EMS

activity period. Response was voluntary, no names or signatures were

requested. Surveys were routed to the Captain in charge of their respective

apparatus, and distributed to qualifying personnel. All 54 surveys were

tabulated. No analysis occurred to determine the margin of error in the survey


Population – Random Parents

       Surveys for the citizen group occurred over a two month period. Subjects

were queried at the main city library on weekends. The Loussac Library has

weekend reading programs and community events specifically targeted for young

children. The Loussac is centrally located in Anchorage, and is the largest public

library in the state of Alaska. It has quick and easy access for both vehicle and

pedestrian traffic and ample parking. Subjects were approached as they entered

the main exterior access stairway. Each entrant was asked whether they were a

parent or care provider for children under the age of 16. Many had children in

hand. If yes, they were requested to answer the survey. Each survey took

approximately five minutes to complete. 80% of the respondents were female.


       The goal of the citizen surveys was to answer questions one and two.

Question one asked the parent if they always used a seat belt. Question two

asked parents if they always buckled up children while they were driving. These

questions were significant because research has indicated that if the parent

doesn’t buckle up, the children won’t be buckled up either. Question three asked

if the parent had installed their child’s safety seat. Question four was also critical.

Did the parent know how much their child weighed? Question five asked

whether their vehicle had air bags. Questions six and seven asked where the

safety seat was placed, and whether children under twelve, ride in the front or

back seat. Question eight asked how the program would impact or benefit the

community. Question nine asked parents if they were aware of any groups or

local organizations that currently perform safety seat inspections.

Question ten asked parents if they would participate in a courtesy safety seat

inspection at their nearest fire station.

Assumptions and Limitations

       This survey was conducted at a public assembly occupancy. It is limited

to those who attended the Loussac Library during the weekends of July and

August 1999. Participation in the survey was voluntary. A total of 62 surveys

were tabulated. No analysis was made to determine the margin of error. The

surveys for the most part required a yes or no response. As the Loussac Library

is centrally located, participants were not limited to any one geographical area.
                                   RESULTS                                16

Answers to Research Questions

       Research Question 1: Is the Anchorage Fire Department the most

effective organization that can provide the primary service? Many other

departments have implemented safety seat inspection programs. The

transformation from response to prevention can be tedious. Children and safety

elicit a deeper response than other programs. Of the employee surveys, 98% of

the respondents had children, yet 97% had not participated in a child safety seat

inspection of their own safety seats. Support for the inspection program was

strong, provided time allowance and training goals were adjusted to

accommodate additional duties. Liability was a major caveat. This issue is the

“make or break” roadblock. This question generated a whole plethora of related

questions. Use of the stations for the inspections was supported, as long as the

inspections were on controlled dates and times. Random inspections would be

difficult due to normal emergency response activity. Training was another area

of concern. Certification and education incentives were suggested, but training

demands currently exceed availability.

       The parent group supported the Fire Department’s role as the lead

agency. Paramedics and firefighters are the most qualified to fill the need. The

available work hours and the facilities themselves were ideally suited for the task.

Parents felt that the employees would be confident in performing the inspections.

Only 6 of the parental respondents were aware of Safe Kids, but knew of no

other agency or organization that currently perform safety seat inspections.

Two respondents had participated in inspection programs in Oregon. The

courtesy inspection participation was positive. All except two individuals stated

they would participate. A free service for child safety was well received. Some

parents were concerned over punitive or legal action if their seats failed to pass

the inspection. Would they get a ticket right then and there?

       Research Question 2: What were the anticipated benefits and impacts

upon the Anchorage community? Both survey groups felt that decreased serious

injuries and fatalities for children would be a direct result of installation

inspections. Education and information would be secondary results, with a

significant increase in understanding of restraint systems. Many parents had

little knowledge of proper safety seat location and installation. 30% stated they

knew what their children weighed, only because they had recently visited their

pediatrician. 60% still transported their children in the front seat (all pick-up

trucks don’t always have a back seat). Of the 60%, 3 parents stated that they did

not have air bags. All respondents had installed or had another family member

install their safety seats. 90% stated they always buckled up children, but 26%

did not always buckle up themselves. This was interesting, as research literature

indicated that if the adults buckles up, then the child is buckled.

       Employees felt that response statistics would most likely remain the same,

but severity of injuries and numbers of fatalities should decrease. In addition, the

number of citations for noncompliance should decrease. As more education

and information was distributed, fewer violations would probably occur. The

trend for injury prevention has been emerging. The positive benefits of fewer

injuries and less severe injuries can be measured.

       Information about other safety organizations and other child advocate

groups would serve to increase the awareness of vehicle restraint systems

community wide.

       Additional impacts on the community may be increased demands for

changes in the current laws. Exemptions should be eliminated for overcrowded

vehicles. In nearly half the states, children can ride unsecured, if all safety belts

are in use (NHTSA,1996b). Drivers may be held responsible for all children

under the age of 16. Current safety belt law states that the parent or guardian

has responsibility for children under 16, and they may not be the driver, or even

in the car with the child.

       Research Question 3: What organizational changes would be required by

the Anchorage Fire Department to facilitate the adoption of a safety seat

inspection program? More than 86% of the employees stated that with current

tasks, hours, and staffing levels it would be difficult to devote large amounts of

time to these inspections. However, if the program had specific controls and time

limits, they would support it. Training would have to be a department priority.

As this program is more “outside the norm” than usual department activities,

there will be less organizational changes and more adaptive changes to fit the

demands of the program.
                                    DISCUSSION                                  19

       The purpose of this research was to evaluate the feasibility of adopting a

safety seat inspection program. The evaluation includes recommendations for

adjustment to current department demands and entering into an interactive role

with the community.

       The study results are compatible to the findings of others in the literature

review. All agree that we must convince or demand that adults and children must

use restraints. These safety seats must be installed correctly. To ensure this,

visual and hands-on inspections may be performed. Education and information

needs to occur simultaneously.

       Once the seat belts are being used and are correctly installed, the laws

must be enforced. NHTSA recommends strengthening current laws and closing

the gaps on exemptions (NHTSA,1996b). Raise the age limit on child restraint

laws to cover up to age 16. Convert all secondary to primary enforcement laws.

Make it illegal to carry children in the cargo areas of pickup trucks. Eliminate

exemptions for overcrowded vehicles. Last but not least NHTSA recommends

eliminating the exemption for “attending” to the child. This encourages parents to

carry children on their laps while feeding or other activities (NHTSA,1996b).

       The surveys indicated that drivers need to be educated. Research

indicated that more than 80% of safety seats are improperly installed

(NSK,1999a).    Without proper installation, children are at risk, and parents face

a false sense of security.

       The Anchorage Fire Department can take the lead and initiate the process

to combat the problem. Safety seat inspections demand simple but necessary

actions. Fire and emergency medical responses are gradually making the

transformation from response to mitigation. Additional training and education is

necessary. The evidence is overwhelming.

       Incorrect installations of child safety seats include; safety belt not holding

the child safety seat tight enough; harness straps not snug enough; retainer clip

placed at chest level (it should be at armpit level); use of a safety seat that’s

been recalled; harness straps incorrectly routed; child less than one-year old

facing forward; and failure to use a locking clip where the seat belt doesn’t

automatically lock (NSK,1999b).

       Of the more than 1000 citations issued by the Anchorage Police

Department, 501 citizens were cited for failing to wear a seat belt. 366 were

cited for failing to have children under the age of 16 in a seat belt. Another

265 drivers were cited for failing to provide a child safety seat.

(Anchorage Police Department,1998). Literature supports the demand for

stronger enforcement. Even after all of the statistics, the massive seat belt

campaigns, the fatalities, and the laws themselves, it’s unbelievable that people

today still don’t or won’t wear a seat belt or provide a safety seat for children.

       Every day an average of seven children ages 14 and under die and

another 908 are injured in motor vehicle related crashes (NHTSA,1998c).
                              RECOMMENDATIONS                                  21

       There is a need and a demand for safety seat inspections. Child fatality

and injury statistics are quite clear and confirm data derived from the literature

review. As far back as 1986, studies have indicated that seat belts and safety

seat usage though on the increase, still remain an option for some


       It is recommended to adopt a safety seat inspection program, coordinate

efforts with existing health and safety organizations, and to reorganize specific

areas within the Anchorage Fire Department.

Methods of Implementation

       In order to adopt and implement a program, it will be necessary to provide

certified training for medical, fire, and prevention personnel. Partnerships with

established child and safety advocates will be necessary. No one agency can

effectively work alone. A multi-media and marketing campaign is necessary to

increase public awareness. Health and safety education training for the citizens

is a critical component. All care providers and parents must know: a) how to

install a safety seat, or b) where to go to make sure the seat is installed.

       A pilot program at one single station can be utilized as the training ground.

Identifying destabilizing forces within the organization is essential. Establishing

the pilot program will help troubleshoot for upcoming problems. Many employees

have been through numerous programs and therefore are cynical and skeptical.

Many will have the “wait and see” attitude. Failure to provide effective

communications can sabotage the entire program. Employee support is critical.

       There are numerous agencies and organizations that all contribute to

safety seat and seat belt awareness and concern. Integrating first responders

with these organizations will help create a greater understanding of the problem.

The more people understand the goal, the easier the battle.

       Inspections will bring the community to the stations. An organized

approach can provide a community service with the greatest of return.

The statistics are clear. Safety seats and seat belts save lives. Proper

installation is critical. Education and information will provide parents the

necessary knowledge to ensure their child’s safety, and in turn save their lives.

Borrowing from existing inspection programs already operating can assist the

Anchorage Fire Department when selecting the criteria for its program.

       Publicity and education can raise the awareness of proper child passenger

protection. Many parents and others who transport children do not understand

the potential deadly results from errors in seat installation. This inspection

program can eliminate those errors.
                              APPENDIX A                                       23

                Child Safety Seat Inspection Program Survey

1. Would you support a child safety seat inspection program?
   YES_____ NO_____ Comments:________________________

2. Have you ever participated in a child safety seat inspection?
   YES_____ NO_____ Comments:_______________________

3. Are fire stations the most effective locations for community interaction?
   YES_____ NO_____ Comments:________________________

4. Do you have children? YES_____ NO_____

5. With proper training/certification should fire department personnel perform
   YES_____ NO_____ Comments:________________________

6. With current training and routine demands list any negative impacts which
   might affect you at your present duty station:

   Not enough time_____           Other______________________
   Workload demands_____
   Liability concerns_____

7. How would you rate or evaluate the success or improvement of the program?
   (Check All That Apply)

   Reduction of improper installations____
   Reduction of motor vehicle child serious injuries____
   Reduction of motor vehicle child fatalities____
   Increased public awareness for correct child safety seats____
   Increased compliance of safety seat and compliance____
   Reduction of citations for safety seat noncompliance____

8. Any additional suggestions,comments, input, ideas, complaints…
                                  APPENDIX B                                   24

                          Anchorage Fire Department

                    Child Safety Seat Information Survey

1. Do you always use a seat belt? YES___NO___

2. Do you always buckle up children while you’re driving? YES___NO___

3. Did you install your child’s safety seat? YES___NO___

4. Do you know today – how much your child weighs? YES___NO___

5. Does your vehicle have air bags?

6. Where do you place your safety seat?
   Front Seat____Back Seat____

7. Where do your children under age 12 ride?
   Front Seat____Back Seat____

8. How would you rate the success or improvement of the program?
   Number of injuries___        Reduction of fatalities___
   Number of citations___       Reduction of serious injuries___

9. Are you aware of any groups or organizations that currently perform child
   safety seat inspections? YES___NO___

10. Would you participate in a courtesy safety seat inspection program?
   YES___NO___ Comments:_____________________________

        Thank you for your participation in this safety information survey.

               If you have further questions please call 267-4972.

                        The Anchorage Fire Department
                             REFERENCES                                  25

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seats. Anchorage, AK.

      Alaska Trauma Registry. (1998). Alaska children and youth motor vehicle

occupant injuries on the highway. Juneau, AK: Dept. of Health and Human

Services, State of Alaska.

      Anchorage Fire Department. (1998) . End of year report.

Anchorage, AK: Municipality of Anchorage.

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Anchorage, AK: Municipality of Anchorage.

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and you. Richmond, VA: Virginia Commonwealth University.

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Anchorage: University of Alaska, Anchorage, Institute of Social and Economic


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Reader’s Digest, p. 74-79.

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reduction: student manual. Emmitsburg, MD: U.S. Fire Administration.

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                National Safety Council. (1999). Why child safety seats.

          National Safety Council. (1999). Air bag and seat belt safety.

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Estimating lives saved by restraint use. Washington, D.C: Government Printing


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Technology Transfer Series, No. 132. Washington, D.C: Government Printing


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State legislative fact sheet. Washington, D.C: Government Printing Office.

          NHTSA. (1996c). Passenger occupants killed by state and by restraint

use. Traffic Safety Facts. Washington, D.C: Government Printing Office.

          NHTSA. (1997, March). Video Protecting your newborn. Produced by

Ford Motor Company.

          NHTSA. (1998a). Revised estimates of child restraint effectiveness.

Research notes. National Center for Statistics and Analysis. Washington, D.C:

Government Printing Office.

      NHTSA. (1998b). Occupant protection. DOT HS 808 954.

      National Highway Traffic Safety Administration (NHTSA). (1998c).

Children. DOT HS 808.

      NHTSA. (1999) Universal anchor standard for child restraints. Safety

Technical Report . Spring.

      National Safe Kids (NSK). (1999A) Child passengers at risk in America, a

national study of car seat misuse.

      NSK. (1999b). Safe kids buckle up, program profile.

      Saperstein,R., Saperstein,D., (1994). Surviving an auto accident.

Ventura, CA: Pathfinder Publishing of California.

      The National Society for Road Safety. (1999). The Swedish national road

safety programme, a new approach for road safety.

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