I wonder if I could help clear up some of the confusion about car seats, I am a car seat technician/'instructor and work at a hospital, on the labor and delivery floor. The car seat test that is done in the NICU and/or the newborn nursery is a test to see if the child can tolerate the 30-45% angle that a rear facing car seat sits at and maintain a good oxygen saturation level and heart rate. The parent should be bringing in the car seat they intend to use for this purpose. Although this is a good time to check a few things about the car seat (whether it is used, within the appropriate height and weights for the infant etc.) this is not necessarily a 'car seat check' it is a test to ensure the child is as stable in the car seat as they are in their crib. It is not a test in which the goal is to get the child to 'pass', it is an evaluation of the childs' ability/maturity to withstand the extra abdominal pressure that is created when seated at that angle. Sometimes this test can reveal some anomolies with the child that were previously unseen.
The car seat check is not an 'installation' but more an education for the parent- since using car seats is not necessarily instinctive parental behavior. In fact, technicians are not intended to be installers, since we do not follow the parent or child throughout their lives, just installing the seat for them is a disservice to the family. They learn very little from that, it is the education one on one that is key. The misuse rate for car seats is very high due in great part to the many different sizes of children, car seats and cars. This misuse rate unfortunately translates into the leading cause of death for children from unintentional injury, more than all the childhood diseases combined.
Different designs of car seats appeal to different people and car seat manufacturers have to find a way to mesh all of the safety concerns with what sells car seats. Car seat technicians and instructors are specialists, just like EMT's or other kinds of technicians, they have to go through specialized training and then more hands on training to be able to adequately instruct a family on proper car seat use, for all members of the family, not just the infant.
Fire fighters are not always trained in this area, in some communities it may be law enforcement officers, non profits or hospitals or any concerned group.
Sometimes to the untrained eye, it may look like something is wrong in a car seat or an untrained person may believe something is true about car seats, such as the handle always having to be in this position or that position yet their assumption is not necessarily true. I often find that nurses that are not car seat technicians believe something to be true about car seats or positioning of a child (because that is how they have been doing it with their own families,) only to find out they are part of the misuse group and with the best of intentions actually end up instructing the parents incorrectly.
For those of you that really feel you are seeing misuse (no doubt you are) and kids going home unsafely, handing out flyers or referring patients to 'fit stations' in your community is totally appropriate, most states have organizations at the state level that can refer families to techs in their area, if not, all car seat technicians are trained to the same curriculum by the National Highway Traffic Safety Administration, NHTSA.gov, and there is a tech locator on their website. There are also many great informational handouts in various languages that can be given to patients not only to help the patient, but to give you piece of mind as well. After all, you have just invested part of yourself in that child's care, you would not be in the field you are in if it did not matter to you. Of course it does, that is why you are so good at what you do!
The liability issue becomes a problem when you are working outside of your scope of training, attempting to install or instruct regarding the car seat without really knowing or having the resources to stay current-advising and referring are totally appropriate in this situation for these new parents..as you know, they are usually pretty overwhelmed.
The AAP is currently working on clearer guidelines for nurses regarding car seat instruction and clearer clinical guidelines on the angle test-the first hurdle is what to call the test since it currently has so many different names. The AAP has guidelines currently that address the testing of newborns, the proper instruction of parents and transportation of newborns as well as older children. The AAP has a great website at brightfutures.aap.org. The child passenger safety community has done a great deal to protect children with regards to traffic safety, it only makes sense to have these two groups working together to protect patients better.
I hope this helped clear up some issues and questions. There is a great deal about car seats that is counter intuitive, if handouts or referrals are not an option for you (and even if they are) simply instructing the parent to read their vehicle owners manual and their car seat instruction manual and to read them together is great advice. That is where car seat techs start, good technicians read the manuals with the parents.