In 2008 the National Highway Traffic Safety Administration (NHTSA) convened a working group of representatives from the American Academy of Pediatrics, Emergency Medical Services for Children, the American Ambulance Association, and other key organizations and started a project called “Solutions to Safely Transport Children in Emergency Vehicles”. Finally a long-standing problem was being recognized and addressed: “there are no Federal standards or standard protocols among EMS and child safety professionals in the U.S. for how best to transport children safely in ground ambulances from the scene of a traffic crash or a medical emergency to a hospital or other facility. The absence of consistent national standards and protocols … complicates the work of EMS professionals and may result in the improper and unsafe restraint of highly vulnerable child passengers.”(1)
In fact a 1998 study regarding the use of child restraints in ambulances revealed that 35 States did not require patients of ANY AGE to be restrained in a ground ambulance. Of those States that did require some sort of child restraint system, requirements for an “acceptable restraint” varied significantly.(2)
It is illegal in the US to travel with an unrestrained child in an automobile. However, when a child is already sick or injured, we have been willing to transport them in a vehicle where the passenger compartment is exempt from most safety requirements, they cannot be properly restrained and they have a higher probability of an accident than an automobile. We might not if we knew the following:
It is estimated that up to 1,000 ambulance crashes involve pediatric patients each year. It is also estimated that there are approximately 4 child fatalities per year.(3)
In a collision at 35mph, an unrestrained 15kg child is exposed to the same forces as in falling from a 4th story window.(4)
This past Wednesday, after an intense 2 year research effort, a public meeting in August 2010 to review the findings and gather input (see Pediatric Safety Post by Sandy Schnee “A Public Meeting on Safe Transport for Kids on Ambulances“), and 2 additional years refining the results, NHTSA has released the official:
The working group outlined 5 potential child transport “Situations” (see chart below) and for each described their “Ideal” solution – the best practice recommendation for safe a safe transport for each situation. They also presented an “If the Ideal is not Practical or Achievable” alternative – basically an “acceptable” backup plan.
They also came up with guidelines to assist EMS providers in selecting a child restraint system – particularly important because due to the lack of regulation and testing requirements specific to ground ambulances, many of the available child restraint devices were not designed for use in ambulances, some were tested to automotive standards and others were not tested at all.
In the end, the ultimate goal of ALL the recommendations: Prevent forward motion/ejection, secure the torso, and protect the head, neck, and spine of all children transported in emergency ground ambulances.
In short – transport these children safely.
We know that since the adoption of “mandatory use laws” in the U.S. for child safety restraints in automobiles, that thousands of children’s lives have been saved. Yet for years we have continued to allow children to be transported unrestrained on ambulances. With this report, we have finally taken a step in the right direction…
“It is hoped that the recommendations provided in this report will address the lack of consistent standards or protocols among EMS and child passenger safety professionals in the United States regarding how to most safely transport children in ground ambulances from the scene of a traffic crash or medical emergency to a hospital or other facility. It should be noted that the expectation is that States, localities, associations, and EMS providers will implement these recommendations to improve the safe transportation of children in emergency ground ambulances when responding to calls encountered in the course of day-to-day operations of EMS providers. In addition, it is hoped that EMS providers will be better prepared to safely transport children in emergency ground ambulances when faced with disaster and mass casualty situations”.
…. Amen to that !!
1. Notice published by NHTSA of Public Meeting on August 5th, 2010 to discuss draft version Recommendations for Safe Transport of Children on Ground Ambulance Vehicles: Federal Register, July 19, 2010,
2 & 3. Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances: NHTSA / USDOT, September 2012
4. “EMS to Your Rescue?” Int’l Forum on Traffic Records & Hwy Safety Info. Systems – Levick N, July, 2008Pin It
A new rule that goes into effect in 2014 will require car-seat makers to warn parents NOT to use the Latch anchor system to install a car seat if the combined weight of the child and the seat is 65 pounds or higher.
The LATCH anchors (Lower Anchors and Tethers for Children) were designed to make child seats easier to install and have been required in vehicles since 2001, but child-safety seat advocates say the strength of the anchors can’t be guaranteed because they don’t take into account the weight of the child seat, which typically weighs 15 to 33 lbs.
In the June 6th USA Today, according to Joseph Colella, one of five child-safety advocates who petitioned the National Highway Traffic Safety Administration (NHTSA) for a change to the rule, “the anchor requirements are based on old child seats and outdated recommendations on how long kids should be in child seats”.
And children are getting heavier and staying in child seats longer. Just this past year the American Academy of Pediatrics and NHTSA issued enhanced new guidelines on booster seat use for older children, recommending that children ride in a booster seat until they are big enough to fit in a seat belt properly, typically when the child is somewhere between 8-12 years old and about 4 feet 9 inches tall. Colella says “car makers aren’t able to guarantee the safety of heavier kids given the strength of LATCH anchors”. And that to me, sounds a bit risky
So what does this mean for you?
Transportation Department spokeswoman Lynda Tran told USA Today: “While Latch makes it easier to properly install car seats in vehicles, it’s important for parents and caregivers to know that securing a child seat with a seat belt is equally as safe — and that they have the flexibility to use either system.” Very good to know.
So…if you have a child that weighs around 30 lbs, double check the weight of your car seat with the manufacturer. Make sure the weight of your child + the weight of that seat does not exceed 65 lbs. And while you’re having that conversation with them, double check the weight their LATCH anchors are rated to support. And if you have any doubt – use a seat belt to secure the car seat.
In my opinion, waiting until 2014 to require car seat manufacturers to warn parents about a potentially dangerous situation is being overly “nice” to car-seat manufacturers…but when the safety of a child is even a question, “nice” should not be an option.
I’d prefer we start notifying parents today. What do you think???
As a former paramedic, I can tell you there are few things as heart-wrenching as responding to an event dealing with a child. Especially those events that are preventable such as drowning, poisoning and the following. Please read.
This week the National Highway Traffic Safety Administration (NHTSA) launched its first-ever national campaign to get the message out about the harmful and potentially fatal effects of leaving children in hot cars.
The Where’s baby? Look Before You Lock message asks all parents, grandparents, and other care-givers to be mindful when leaving your vehicle.
Cars heat up quickly – even with a window rolled down two inches, if the outside temperature is in the low 80s, the temperature inside a vehicle can reach deadly levels in just 10 minutes. Young children, those under 4 years old, are particularly at risk because their bodies overheat more easily.
So this campaign is a call-to-action for parents, families, and everyone who cares about the safety of children. As NHTSA Administrator David Strickland said, “While parents are the first line of defense when it comes to preventing heatstroke in hot cars, everyone in the community has a role to play in keeping kids safe.”
NHTSA also offers Hyperthermia Prevention Safety Tips:
- Never leave a baby or young child unattended in a vehicle—even if you leave the windows partly open or the air conditioning on.
- Make a habit of looking in the vehicle – front and back – before locking the door and walking away.
- Do things to remind yourself that a child is in the vehicle, such as:
- Writing yourself a note and putting it where you will see it when you leave the vehicle;
- Placing your purse, briefcase or something else you need in the back seat so that you will have to check the back when you leave the vehicle;
- Keeping an object in the car seat, such as a stuffed toy. When the child is buckled in, place the object where you’ll notice it when leaving the vehicle.
- If you see a child alone in a vehicle, call the police. If they are in distress due to heat, get them out as quickly as possible. Cool the child rapidly. Call 911 or your local emergency number immediately.
PS. Dogs left in cars can suffer the same fate as children.
It’s important to insist that your kids wear bike helmets. Research shows that wearing one while riding reduces a child’s risk of brain injury by 88 percent. But, the truth is, it’s best to buy a bike helmet new. It could have been damaged in a crash — even if you don’t see cracks — and might not be able to withstand another one. When purchasing a helmet, look for the CPSC seal, which means it meets the standards of the Consumer Product Safety Commission. The helmet should sit flat on top of your child’s head and be snug enough so that it doesn’t slide down over the eyes when pushed or pulled. The chin strap should be snug. Many kids wear their helmets loose and tipped back, exposing their foreheads. But this doubles their chances of suffering a serious head injury. Never buy a helmet that’s too big so that your child can “grow into it.” It might not protect him in an accident. For an illustration of exactly how a bike helmet should fit your child, check the NHTSA (National Highway Traffic Safety Administration) web site.
There’s a new kid on the block at NHTSA, the National Highway Traffic Safety Administration. Last week NHTSA unveiled a new “10-year old child” crash test dummy – joining 12-month, 3-year and 6-year old siblings – for use in testing child restraint devices for older children weighing up to 80 pounds.
This crash test advancement follows enhanced guidance on booster seat use with older children, issued last year by NHTSA and the American Academy of Pediatrics. As stated in their press release on February 21, 2012, NHTSA “recommends that children ride in a booster seat until they are big enough to fit in a seat belt properly, which is typically when the child is somewhere between 8-12 years old and about 4 feet 9 inches tall.” This is an important issue, as many kids are currently not restrained in a booster seat until they meet these guidelines, as I noted in a post in January of this year, entitled “I’m 9 Years Old – Do I Really Still Need a Booster Seat?”. Despite the growing body of evidence supporting the use of booster seats for older kids, most states have not yet enacted laws in keeping with the guidelines – and, frankly, most parents just aren’t aware of the issue or need.
Nevertheless, car restraint systems and booster seats for older, heavier kids have proliferated on the market in recent years….but no crash safety tests have been conducted for kids weighing more than 65 pounds. With the introduction of this new crash test dummy, parents will eventually be able to assess the safety and performance of car seats marketed for their older kids, as simulated in tests of a 30-mile-per-hour car crash. However, the data on your current booster seat may not be available for a while, as manufacturers have two years to conduct tests and ensure their restraints meet the safety requirements. But at least this is a development moving in the right direction.