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
We depend on EMS to help us in times of medical or traumatic crises, and we teach our children the 911 system if there is ever an emergency… shouldn’t the emergency crews that respond to that call be properly equipped to handle it? That is what they need to focus on in this meeting.
As a former EMT Instructor, I know it is essential that a safe and standardized method of infant/child transport be adopted ASAP. Restraint devices save lives; does it make sense not to use them on ambulances?
Children are precious commodity. The health of their lives are in your hands. Do what is right
In the Federal Register, dated July 19, 2010, a notice and invitation was posted by the National Highway Traffic Safety Administration of the Department of Transportation (NHTSA). This Thursday – August 5th – NHTSA will be hosting a Public Meeting to hear comments regarding the newly-submitted draft recommendations for the safe transport of children in emergency ground ambulances.
What wonderful news! It’s about time that positive steps are finally being taken in the effort to establish consistent Federal guidelines for the safe transport of infants and children in emergency vehicles. This is most definitely a banner day for the Emergency Medical Service (EMS).
The issue of inconsistent guidelines for child emergency transport was first highlighted in a 1998 survey of state requirements for child safety restraints in ambulances, and the resulting report was the first to identify the many variations in guidelines existing from one state to another.
In 1999, a national consensus committee was convened to review EMS child transport practices. The resulting document, the “Do’s And Don’ts of Transporting Children in an Ambulance”, provided general guidance for EMS practitioners in the field. This document has remained the guide for the industry from then until now, even though protocols and practices remained inconsistent, often varied across jurisdictions and sometimes provided limited or inadequate guidance.
This problem is finally being publically recognized. The July 19th issue of the Federal Register states: “Currently 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 regarding the transportation of children in ground ambulances complicates the work of EMS professionals and may result in the improper and unsafe restraint of highly vulnerable child passengers. As a result, EMS agencies, advocates and academicians have turned to NHTSA for leadership on this issue.”
In September of 2008, in recognition of the need for improving child-oriented, safe, emergency ambulance transport, NHTSA initiated a project called: “Solutions To Safely Transport Children In Emergency Vehicles”, and formed a Working Group of experts in the field of Emergency Medical Services for the purpose of “drafting consistent national recommendations that will be embraced by local, state and national EMS organizations, enabling them to reduce the frequency of inappropriate and potentially unsafe transportation of ill, injured, or not sick/uninjured children in ground ambulances.”
In June of 2009, this website, Pediatric Safety.net was launched. This site made public awareness of the lack of safety guidelines and the use of inappropriately sized, non harness–equipped stretchers for child transport a primary concern. As a means of promoting awareness of the problem, pediatricsafety.net established a cause, ANSR (Ambulances Need Safety Regulations) for kids, which included a petition to be forwarded to each signer’s congressmen. The hope was that if enough people signed the petition, attention would force the government to play an active role in finding a viable solution to the problem.
In its “Innovation” section, pediatricsafety.net followed the development of the PedREST, a child-size safety transport system for infants and young children. From its humble beginnings as a crayon drawing concept idea, to a video prototype and now a physical prototype, the PedREST seemed to be a credible answer to the problem. Designed by an Emergency Medical Technician, it could, with a small amount of additional design modification by a qualified engineer, become this desperately needed safety transport device.
I am the cause advocate for Pediatric Safety. Two of my daughters were key in developing the PedREST. It took 15 years to get the PedREST through the patent process and the building of a prototype. Once created, it was disheartening to realize that companies were not falling all over themselves for the opportunity to take the idea and help commercialize it, so that it could be put to use as quickly as possible. What could be more important than protecting the life of an infant or small child already in the care of the very people committed to doing just that? What was even more upsetting was the fact that, even though so many articles had been written about the need for government intervention to establish industry guidelines, nothing had been publicly introduced over all these years to show that steps were at least being taken to that end.
Statistics say it all:*
- Approximately 1 in 10 patient ambulance transports involve children. The result: 6 Million Children are transported by emergency medical vehicles each year
- 3 out of every 100 transports involve children under 5 years of age. The result: approx. 1.8 million children are transported by emergency vehicles each year
- 5,000 ambulance crashes per year with minor to fatal results. The result: approx. 4 child fatalities per year
I think the time has finally come for action!
- Participate in the public hearing concerning the draft recommendations on safe transport for children on ambulances. Register for the webinar by sending an email to: firstname.lastname@example.org
- Please sign the ANSR petition and tell your congressman/woman that we require that our kids be transported safely on ambulances – anything else is unacceptable!
Help us help NHTSA pass formal regulations and guidelines to be used on local, state, and national levels to keep our kids safe when they need it the most.
With thanks from all my grandchildren, and from me.
Dr Nadine Levick, MD/MPH, “Ambulance Transport Safety – Where is the State of the Art?”, Child Passenger Safety Conference NHTSA Region II, Sept 26th, 2008