As an emergency medicine physician, Randall S. Jotte, M.D., sees some of life's most preventable tragedies — drug overdoses, suicide attempts, victims of gang violence.

But the cases that affect him most involve the aftermath of a motor vehicle accident when a small child or infant wasn't restrained in a safety seat.

After witnessing hundreds of such injuries, Jotte and his team in the Emergency Department at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis have decided to take a proactive approach to help remedy these preventable tragedies.

Last month, 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 a motor vehicle collision," says Jotte, an associate professor in the Division of Emergency Medicine at Washington University. "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 scrapes and bruises and the child suffering major trauma, often resulting in death."

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

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

In spite of the dangers, 40 percent of American children 4 and under routinely ride unrestrained. In addition, 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 mean fewer Missouri children die or are seriously injured in motor vehicle crashes."

With support from the Missouri Foundation for Health and Washington University, Jotte and his team received a $100,000 grant to fund 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 counties 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 neighborhoods located in the 63104 zip code in the city of St. Louis have some of the worst childhood mortality rates in the state.

The first rule of car-seat safety is to use one "The biggest mistake people make is thinking that their child can go without a car seat because it's such a short drive," Jotte says. "It's so easy to do that." Jotte and his team also offer the following important car seat safety tips to help ensure that your most precious cargo rides safely. Use rear-facing seats for infants from birth to at least 1 year and until the child weights at least 20 pounds. Use forward-facing seats for children who are at least 1 year old to about age 4 and weigh 20 to 40 pounds. A child who is under age 8 and less than 4-foot-9-inches tall and who has outgrown a child safety seat should use a booster seat with a lap and shoulder belt. A booster seat raises a child up so the belt fits correctly. A child who is about 8 years old or over 4-foot-9-inches tall can use a seat belt without a booster seat. Children ages 12 and under should always ride in the back seat.

The Safe and Secure 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.

"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 Benet. "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."

Even at discount stores, new car seats can cost $50 to $140.

Jotte and his staff have teamed up with physicians and care providers to help educate underprivileged families about the lifesaving benefits of safety seats and to provide instructions on how to properly use the seats.

Once the educational session is completed, families receive a voucher for each child who needs a safety seat, and the seats can be picked up at their local community center or county health department.

In the coming months, Jotte and his team plan to seek additional funds from state and federal resources and other foundations to expand the program in additional Missouri communities.

"Emergency physicians have a unique 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."