Since 2003, not a single child in King County has died from a helmet-preventable bicycle injury.

What helped lead to this victory? King County’s Child Death Review – a collaborative effort to identify opportunities and interventions that prevent children from dying.

As the ‘doctor’ for the community, we are responsible for looking at broad trends and understanding the systems, policies and practices in our community that can prevent disease and death.  Our local hospitals look at deaths in their systems, and we look at deaths in our communities to see if more can be done to prevent future deaths.

Child Death Review (CDR) recounts the details of unexpected and unintentional deaths that occur in King County. Several times a year, three-hour CDR meetings are scheduled based on need, two months in advance. Each CDR covers six to eight cases and focuses on a specific manner of death (traffic-related death, suicide, overdose, etc.) and results in recommendations for prevention. CDR started as a statewide funded effort in 1998, but it was cut from the budget in 2003. Given the importance of this work, we have prioritized CDR and funded it locally.

Bicycle collisions – a CDR case study
In 2002, a CDR of bicycle-related fatalities set in motion the bike helmet mandate in King County.

After five children died in bicycle collisions, Public Health convened a CDR involving physicians, public health experts, law enforcement, the medical examiner, social services providers and many others. The group recapped the details of each child’s fatal injury and identified modifiable risk factors across some or all of the cases. One of these risks factors was a lack of protective head gear. At the end of this and all CDRs, the committee works collaboratively to compile a list of recommendations, including policies, programmatic changes, or other prevention efforts for implementation. Then, someone in the group is assigned to follow-up on the recommendations. In this case, the group recommended a policy change around helmets.

But, CDR isn’t over when the meeting adjourns.

From there, a team of public health experts (including several physicians) presented findings to the Board of Health, urging them to adopt a bicycle helmet mandate. They argued that this policy would save lives and money and prevent disability.

In July 2003, the Board of Health adopted Regulation 03-5, citing CDR’s findings.

Beyond bike helmets
The bike helmet law was a significant policy and practice change resulting from Child Death Review, but it’s certainly not the only one.

Here is a list of just a few (there are hundreds) of the CDR recommendations that have been put in place:

• After the death of three youths involved in high-speed chases, many King County area law enforcement altered their pursuit policies to reduce risks.
• After recognizing that several drowning deaths were occurring every year in the Lake Washington’s Ship Canal, it was closed to swimming, and child deaths reduced to zero.
• As a result of reviewing child pedestrian deaths on train tracks, a letter was written to Sound Transit to support the education of local communities about preventing railroad deaths. Additionally CDR members engaged with specific school districts to alter the routes children took to school. The child deaths related to this issue ceased.
• In recognition of child deaths occurring in out-of-bounds ski incidents at local ski resorts, a letter was written to Professional Ski Instructors of America – Northwest Division (PSIA-NW) to encourage resorts to educate skiers about hazards out of bounds. Suggestions were then incorporated into instructor education, and since then, there have been no reported deaths due to out-of-bounds skiing.
• In an effort to reduce bedsharing, which was linked to SIDS/SUIDS cases, Public Health purchased and is distributing baby bed boxes. Using the Finnish Bed Box model, these cardboard cribs are offered to families in conjunction with messaging about safe sleep practices from healthcare providers. This pilot project is still underway.
• Following the recommendation to provide firearm safe storage information for the community, Public Health launched the Safe Storage Saves Lives (LOK-IT-UP) campaign.

The next generation of Child Death Review
Thanks to the effectiveness of CDR, we have not had to hold a review for helmet-preventable bicycle deaths in years. But, our work is not over, and it isn’t getting easier. Suicides, sudden infant deaths/sudden unexpected infant deaths (SIDS/SUIDS), and homicides require input from Child Protective Services, social workers, educators, and counselors, and the opportunities for prevention can be less straightforward. These deaths bring up issues of poverty, housing, racism, and equity. While these meetings are difficult for participants, the CDR committee is increasingly committed to this work.

Whitney Taylor, who took over as manager for Child Death Review a little over two years ago, said, “As horrific as it is to review the unintentional or unexpected deaths of children, the power of each review is convening experts who are giving their time to engage in thoughtful discussions that lead to recommendations to prevent future deaths of children in King County. And that’s inspiring.”