For the last six years on the CCD, we’ve talked about pretty much nothing but best practices. Along the way, we’ve also looked at a number of crashes that have sadly resulted in environments where best practices just aren’t practiced. A story I came across today involves that of Jillian Brown, now 8, who was internally decapitated in 2016 as a 5-year old when involved in a side impact crash along with her mother, Lindsey, and sister, Samantha. Without knowing all of the details of the case, I’m going to take a look at it from the perspective of the crash analysis itself, her car seat configuration, what we know about best practices, and which factors could and could not have led to different outcomes. The goal here isn’t to place blame on Evenflo, the family, or US laws and customs. As always, it’s to figure out the difference between what’s being done and what would be done if best practices were followed, and to advocate for the latter.  Let’s go.

What were the circumstances of the crash, and what factors did the vehicles play in them?

First of all, this was a side impact crash. As we’ve discussed in a myriad of articles, these are the most severe kinds of crashes you can be involved in  (vs frontal and rear crashes). This is why I’ve written article after article comparing side impact penetration levels in vehicular crash tests, why I advocate placing the most vulnerable children (by age or car restraint) in the center seats, and why I talk endlessly about the importance of Vision Zero-based road designs that limit vehicle speeds to survivable crash energies.

With that in mind, this was a severe crash. Brown was driving a Suzuki Forenza, a vehicle whose production stopped in the US in 2008 when it was renamed the Chevrolet Cruze. Per the IIHS, the car had a poor side impact rating, with a poor structural and safety cage score, poor scores for rear passenger head and neck injury, and only acceptable injury scores for the rear passenger pelvis and leg. To put it bluntly, in a side impact crash with a small SUV-sized vehicle at 31 mph, you’d expect a significant risk of head and neck injury (e.g., a concussion, brain damage, skull fractures, broken necks, etc), terrible levels of vehicular intrusion (as in the vehicle hitting you inside your vehicle), and significant risks of broken legs and pelvises.

The simplest way to describe the potential impacts of such a collision is to state that death or severe, catastrophic injury would be likely. It’s a fortunate surprise that both girls and their mother weren’t killed on the spot.

Which injuries did the girls receive, and which car seats did they use?

The crash occurred. Samantha was on the driver’s side behind her mother. She was on the side of the impact. The ProPublica article doesn’t mention her injuries in any detail, but a GoFundMe notes she suffered a broken pelvis. Jillian suffered neck and spinal injuries and eventual paralysis from the neck down. Both girls were in car seats–booster seats by all appearances, because we know Jillian was in one and as the older sister, Samantha would not have been in an earlier stage seat (i.e., a harnessed seat). Jillian weighed 37 pounds. Samantha would have weighed more. No article I’ve found mentions which specific car seat she sat in. We can assume it was a booster, but only her parents know which one.

What do best practices suggest would have been best placements for these girls?

There’s all kind of press about how Evenflo was in the wrong for allowing kids to be boostered from 30 pounds onward instead of from 40 pounds. However, I don’t think that was the core issue here. Jillian weighed 37 pounds; she was much closer to 40 than she was to 30. I don’t think the 3 extra pounds had anything to do with the unfortunate issues she suffered. The argument put forth online is that, had the parents known that 40 pounds was a safer minimum for boostering than 30, they’d have placed her in a harnessed seat. Perhaps. However, at the same time, parents are already highly fond of ignoring safety recommendations, and the majority of states allow children to be boostered from the time they turn 4 or 5 already, regardless of weight. In all probability, Jillian’s parents would have boostered her whether the seat had said 40 pounds or 30. But let’s take a look at best practices. What would the Swedes do?

The truth is that best practices are rather straightforward here. The Swedes are fine with boostering from as young as 5. That said, they’re fine with doing so because kids are expected to sit properly in such seats and are taught to do so. I have no idea how Jillian was sitting in her booster seat at the time of the crash, but it’s a given that if a child isn’t sitting appropriately in a booster seat, she’s not going to be as safe as she would have been in a forward-facing harnessed seat, which essentially forces her to sit properly due to the harness. For all we know, she might have had the shoulder belt around her neck or behind her arm. Or not. We just don’t know. But we do know that she’d have been in in a booster seat in Sweden.

Does this mean she’d have suffered the same injuries there? Possibly. Probably not. For one thing, the intersection that led to the collision may not have existed in Sweden, or at the very least, may have had much lower speeds and speed cameras present, reducing the odds of the collision occurring to begin with. Additionally, it’s likely that the vehicle her parents drove would have had more safety features like a better side impact score and perhaps side airbags, given Swedes’ greater propensity to adopt safety-minded technology than Americans and American manufacturers in general.

What if she’d been rear-facing? Would that even have been possible?

On an entirely different note, as a 5-year old who weighed 37 pounds, Jillian could still easily have been rear-facing, whether in Sweden (where 55 pound rear-facing seats are available), or in the United States, where seats like the Clek Fllo, Clek Foonf, and Diono Rainier –all 50-pound rear-facing seats existed back in 2016, and would have allowed her to have rear-faced then and continued to rear-face for several more months, if not years, given her weight.

Would rear-facing have offered her more protection? Yes, by virtue of the fact that she’d have been pushed into her seat rather than out of it due to the forward motion of the collision (despite being a side impact, the vehicle was still traveling forward, which is why Jillian was found slumped forward after the crash). Additionally, she’d have received all the benefits of being in a harnessed seat. This would have been the absolute best seating configuration for her.

We can’t judge the effectiveness of a car seat from a crash test video

As tempting as it is to watch a video of a dummy being flung in one direction and use it as evidence of the effectiveness or lack thereof of a car seat design, we just can’t do so in a reality-based world–even if we’re physicians and members of the AAP. That’s not how crash tests work. That’s not how the NHTSA, NTF, IIHS, NCAP, or any other reputable organization tests vehicles. The dummies aren’t simply used as visual props; they’re filled with sensors which are read to determine the actual forces an individual of a certain size (weight and height and proportions) may have faced in a similar position under similar forces in a similar crash. It doesn’t move the discussion forward to quote individuals (even physicians) stating breathlessly that they would or would not have their children in particular seats based on their viewings of videos. With all due respect, you can’t tell a 300 HIC-15 head trauma from 3000 HIC-15 trauma by watching a dummy’s head snap back and forth. One leads to brain damage. The other does not. You tell them apart by sensors.

Despite our best efforts, tragedies can and do still occur when children are in cars

I’m the last person to defend corporations; my history on this site shows that I take the sides of individuals and not companies or institutions, because all too often, institutions in profit-based countries put people last, and we all suffer because of it. But underneath it all, I advocate for best practices, regardless of where they come from.

Had Samantha–who had also been boostered–suffered Jillian’s injuries while Jillian had suffered hers in exchange, her parents would not be blaming Evenflo, despite the fact that both children would have been–again–in nearly the same crash conditions. Had Jillian passed away and not been confined to a lifetime of paralysis, again, Evenflo would not have been on trial here, and the situation would have been viewed as what it was–a severe, tragic collision. Bringing a suit against Evenflo may help pay for Jillian’s considerable medical costs (especially since we refuse to adopt a single payer healthcare system that would make such costs bearable for families), but it doesn’t accurately reflect the circumstances of her injuries.

The only car seat configuration I’m sure would have offered significantly greater protection, given what we know, was rear-facing. But I can’t blame parents for not rear-facing a 5-year old. And I can’t blame Evenflo for an internal decapitation involving a boostered 5-year old. She either wasn’t mature enough to use the seat or she was. If she weren’t, she wouldn’t have sat properly. If she were, the fact that she weighed 37 pounds was irrelevant; a 5-year old can legally sit in a booster and can safely do so, as evidenced by its being the standard age in Sweden. Blaming Evenflo for this tragedy is a bad call.

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