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

[Just Plain Ruff]

1 hour ago, scubanurse said:

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. 

Might have been one of those hanging stretcher ambucab setups that somehow still exist out there.  

[medicgirl05]

Actually we pulled the stretcher mounts out and left the stretcher at the scene, one backboard on the bench and 2 on the floor. Not safe and I wouldn't recommend it, but we really didn't have much option that day. In 10+ years that's the only time I've felt it necessary to transport like that, so I'm not suggesting it at all. 

[bkelley]

15 hours ago, scubanurse said:

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. 

That is the exact problem we are working to solve at the national level. There are tools available, they haven't been tested in the way we want, but that isn't the fault of the manufacturers who make them. There isn't a test, it simply doesn't exist. My group at NASEMSO is almost done with a guidance chart that will help EMS agencies make these decisions while a standard is developed. We want to prevent these injuries that occur in ambulances due to no equipment, poorly utilized equipment, and lack of policies and training.

[Just Plain Ruff]

So who's on your group?  Do you have field providers in your group, not to be contentious, but you know the people who are actually in the trenches who deal with this every single day and are forced to improvise and often are left to pick up the pieces when their improvisation turn tragic.  

Without the proper tools and when we are forced to improvise, when something goes wrong, we are the ones who are hung out to dry because we are not given the tools to properly do our jobs.  

So are their field providers in your group?  and if NOT, why NOT? and not that is not meant to be argumentative, but just a SMH moment if true. 

Edited April 14, 2017 by Just Plain Ruff

[bkelley]

1 hour ago, Just Plain Ruff said:

So who's on your group?  Do you have field providers in your group, not to be contentious, but you know the people who are actually in the trenches who deal with this every single day and are forced to improvise and often are left to pick up the pieces when their improvisation turn tragic.  

Without the proper tools and when we are forced to improvise, when something goes wrong, we are the ones who are hung out to dry because we are not given the tools to properly do our jobs.  

So are their field providers in your group?  and if NOT, why NOT? and not that is not meant to be argumentative, but just a SMH moment if true. 

You can read about the make up of the group here: https://www.nasemso.org/Committees/STC/index.asp

I hear what you are saying. Until I moved out of the field, I lacked perspective on how big the EMS picture really is. For example:

Your own field impression of the situation: "Without the proper tools and when we are forced to improvise, when something goes wrong, we are the ones who are hung out to dry because we are not given the tools to properly do our jobs" 

So lets break that into a simple (not perfect) problem statement:

The EMS workforce lacks the proper training, policies/protocols, and equipment to always provide the safest transport of pediatric patients in ambulances. Agree?

So in order to solve the problem we first have to break the problem into its respective parts. Basically the main parts of it are:

1. Pediatric patient safety needs in ambulances;

2. EMS workforce needs regarding the care they must provide to pediatric patients;

3. Equipment options that satisfy both of the above;

4. Policies and procedures that reflect all of the above, adjusted based on local needs and resources;

5. Training that encompases all of the above, tailered to fit the local agency having the responsibility; and

6. Finally, Laws and regulation that ensures and measures compliance with the now prevailing standard of care.

 

It is only by looking at the problem and its respective moving parts individually that you can see the scope, and consequently the players who need to be at the table for the various parts of solving the problem. The field provider has a critical role, absolutely in every single part of the problem. The group I am currently working with is also equally and vitally important. We represent the regulators, standard writers, and researcher component. Think of us as the folks who plan the road that you are going to build and drive on. Our role is to select the path (based on science and fact), secure the land the road is built on, and then lay out the foundations of the road bed. The manufacturers of pediatric ambulance safety products will be the ones that make the material for the road (asphalt, concrete, whatever). Guess who has to pave it and then drive on it, refine it, smooth it, make it pretty, functional, and the favored path to take? When its ready, we come back and put up the signs along the way for speed limits, hazards, and mapping. I don't remember if I shared this already, but: https://www.nasemso.org/Committees/STC/documents/WY_ChildTransportProtocol.pdf

 

Additionally: There has been tons of effort on this issue already, has your agency administrator read it? Have you? check this out: https://www.nasemso.org/Committees/STC/Resources.asp  There is so much out there to build the road map, you have the patient. I drive a desk in Cheyenne Wyoming. What are you doing to make YOUR world right? If your not go do it... take this material, teach your peers, change the world one EMT at a time. That is the same thing I am trying to do. Help me.

 

As a matter of fact my friend, you have inspired me.... We can use this forum to beat each part of that problem statement up. Then the field, the docs, the regulators all have a place to talk. I am gonna start a new thread for part 1: Pediatric patient safety needs in ambulances

 

Come play everyone

[Arctickat]

On 2017-04-12 at 7:48 PM, scubanurse said:

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

 

If you've been in this job long enough....

We had a 1981 Chevy low roof van, had a main cot, portable cot mounted on the squad bench, and a hanging cot that hung above the squad bench. I'm pretty sure I uploaded a picture of the cot hangars in here some time ago.

Ahhh, the good old days.

[Off Label]

All of our Stoner Ford Type II's  (mid/late 80's) had stretcher hooks you could suspend over the squad bench and put a third patient "bunk bed" style  on a scoop or flat folding stretcher over the bench patient.

[Just Plain Ruff]

Our 1998 braun had the same set up.  We transported 3 patients 4 patients out of one wreck, 1 hanging, one on the bench, and one on the cot.  adn finally one on the captains chair.