What don't you know about the safe transport of pediatric patients?

[bkelley]

Hello folks I wanted to start a discussion about ambulance safety, specifically about transporting pediatric patients in ambulances. This should be a safe space for EMS workers to discuss this topic and be free to admit what you do not know. I have learned so much in the past 3 years on the topic, from US ambulance operations to similar issues in other countries. I have access to the top experts on the subject from NIOSH, NHTSA, Pediatrics researchers and professors, equipment manufacturers like Ferno, Quantum, and IMMI. Lets talk! I will start with something I didn't know, that I know now.

1. There is no "standard" in the United States that measures whether or not a product designed to restrain a child in an ambulance actually works as intended. The only thing close is FMVSS-213 which sets requirements for car seats in passenger vehicles.... which does NOT include ambulances. This means that no device on your ambulance has ever been scientifically proven to reduce death and disability in a similar way to how car seats have been tested.... scary huh?

I attached some guidance from NASEMSO on the topic (I was one of the authors).

Safe Transport of Children by EMS- Interim Guidance 3-8-17 final.pdf

[Just Plain Ruff]

Actually, this tidbit of information does not surprise me in the least.  

Let me ask one question, if you put a car seat on a ambulance stretcher, secure it to the stretcher, does that qualify as providing a car seat in the ambulance? Do you provide the same level of securitysafe transport to that pediatric patient compared to a properly secured/installed car seat in a automobile?

[bkelley]

9 minutes ago, Just Plain Ruff said:

Actually, this tidbit of information does not surprise me in the least.  

Let me ask one question, if you put a car seat on a ambulance stretcher, secure it to the stretcher, does that qualify as providing a car seat in the ambulance? Do you provide the same level of securitysafe transport to that pediatric patient compared to a properly secured/installed car seat in a automobile?

That is a two part answer.

So yes, by putting a car seat on a stretcher you have indeed provided a car seat in the ambulance. There are some catches to that though:

1. There has been some testing done on this set up see: http://www.carseat.org/Resources/Bull_Ambulance.pdf. The problem is that this test was done using a modified stretcher. In testing, the model they were using would not maintain an upright back, so they welded a piece of steel to it to make it stay upright during testing. You do not have a piece of steel on your stretcher so the same results may not appear in your realistic scenario as occured during these tests. 

2. FMVSS-213 (the standard for car seat designs) does not test for the conditions that are present in an ambulance patient compartment. So a car seat is no more of a "sure thing" solution that any other devices out there for this purpose. 

All of that said, using a car seat is absolutely better than using adult straps on a child; allowing them to be unrestrained (held by caregiver, mother, etc); or putting them on a bench seat. 

Your second question "Do you provide the same level of securitysafe transport to that pediatric patient compared to a properly secured/installed car seat in a automobile?"

Absolutely not! The only place in an ambulance that has supporting science that compares to the testing that car seat design has had is in the passenger seat, properly positioned, with the airbags off. This placement is not out of line for an uninjured/ not ill child who is a passenger with an injured/ill adult for example. The sad truth is that the safest place for a kid in an ambulance... is to not be in the ambulance at all.

[medicgirl05]

Most 911 services I have worked for had a child safety seat built into the captains chair, it made it quick to secure the child, but I'm not sure if that is the best option.

I also was told that if a child was in a wreck and you didn't take the child out of their car seat you could transport them in it, but if they were removed from it then the car seat couldn't be used. 

[paramedicmike]

15 minutes ago, medicgirl05 said:

 

I also was told that if a child was in a wreck and you didn't take the child out of their car seat you could transport them in it, but if they were removed from it then the car seat couldn't be used. 

Was there any logic offered for this?  On its face it doesn't make much sense.

[bkelley]

45 minutes ago, medicgirl05 said:

Most 911 services I have worked for had a child safety seat built into the captains chair, it made it quick to secure the child, but I'm not sure if that is the best option.

I also was told that if a child was in a wreck and you didn't take the child out of their car seat you could transport them in it, but if they were removed from it then the car seat couldn't be used. 

So the integrated seats actually have testing behind them. You just have to be careful about weight ranges. There is a tag on the pull out portion that tells you the weight ranges for the patient. The downside is that if you really need to work a patient, that seat is less than ideal. 

As far as removed versus non removed, wrecked seat vs. non-wrecked.... Agree with Mike here, as the removal of a patient doesn't really make a difference. If you took them out you can put them back in, no problem.

Is a seat that has been in an MVA safe, well it depends. If you have another option, that other option is most likely safer. If that seat is all you have, then that seat is better than no seat. Does that make sense?

[medicgirl05]

I'm not sure the logic behind it, maybe because you wouldn't otherwise use a car seat that's been in a wreck?

Interesting story-I once worked a bad single vehicle rollover. 5 adult patients and 1 probably 3 month old. Rural area and we were the only ambulance within about 30 miles. Bad weather so no air support. On arrival all the patients were scattered over the scene, I assessed the baby first and it was in a car seat, no obvious trauma, and crying. I went to assess everyone else and the whole time I was listening for that babies cry, because if I could hear it crying it was breathing. At one point one of the volunteer firefighters walks up to me with the baby in his arms wanting me to make it stop crying. You know when you're super busy and somebody disturbs the "plan" you have? I was super frustrated because in my head I couldn't put the baby back in the car seat and it wasn't big enough to secure in the onboard system. 

I put the baby back in anyway because there was literally nowhere else to transport it. I had 3 adult patients on backboards in my ambulance. 

[bkelley]

Did you choke out the firefighter? quite a call for sure!

[medicgirl05]

He was a super nice guy, but that day I literally could have strangled him! 

The same guy was cutting a lady out of her wrecked vehicle and I pointed out the metal hanging out of her arm so he wouldn't disturb it, well he thought I wanted him to pull it out and he did exactly that! In the situation it was a bit of a relief because it turned out to be superficial but it could have been a BAD deal.

Now back to the actual thread...sorry for my reminiscing. 

[scubanurse]

I'm really curious how 3 adults on backboards fit in the back of an ambulance...

 

On the topic at hand, I've been the scared mother riding with her infant in the back of an ambulance and I was not a happy camper with how she was secured.  If I had any other option, I would have done that but seeing as she was seizing, I was limited in my options.  A lot of the EMS crews in my area strap the car seat to the pram using the seat belts and tighten down so the car seat won't budge and then put kiddo in the seat.  This works if the seat hasn't been in an accident and if it has and you have no other way to transport a kiddo, then I guess it would work too.  The problem comes with transporting a critically sick kiddo who isn't stable enough to be in a car seat.  The way my daughter was transported was not safe as the harness they slipped over the pram wasn't designed for an infant her size and had we been in an accident, it could have been catastrophic.