Finally – Safe Transport for Kids in Ambulances…Thanks NHTSA!

Last updated on April 26th, 2018 at 03:48 pm

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, 2008

About the Author

Stefanie Zucker is President and co-founder of Pediatric Medical Devices and Managing Director and co-founder of Axios Partners, a strategy consulting firm. After a number of years spent researching the safety issues associated with transporting children on ambulances she became a child health safety advocate and formed Pediatric Safety with a goal of creating a world-wide movement of parents and caregivers inspired to protect the health and safety of kids.Stefanie is a member of the PedSafe Team


8 Responses to “Finally – Safe Transport for Kids in Ambulances…Thanks NHTSA!”

  1. Jim Love says:

    Congratulations to Stefanie and Pediatric Medical. This has been a pursuit that has lasted over ten years and is a landmark victory in her quest.

    • Stefanie ZuckerStefanie Zucker says:

      Thanks so much Jim! The victory is also for you…and for all the EMS folks who have been fighting for this for years…and for the kids who will be safer because of them! Thanks for caring so much!!

  2. Sandy Schnee says:

    Stefanie, not only is this a hard-fought victory for you, this is a victory for any child who needs to be safely transported for ANY medical reason by ground ambulances. Thank you NTHSA for bringing together all the responsible groups who can make an effective change in the way infants and small children can be carried (and treated in transit if necessary) by EMS crews. My hope is that these new guidelines will be implemented as quickly as possible, to be put in place and in use with the proper medical equipment, so that our youngest population can be protected when they are the most vulnerable position.

  3. God forbid my children ever need an ambulance but it’s reassuring to know they’ll potentially have a safe ride!

    • Stefanie Zuckersazucker says:

      I know…it’s a huge step in the right direction. And though we still have a long way to go to make ambulance travel truly safe for kids, you gotta start somewhere…and this is a biggie.

  4. Julie says:

    Saying hi from our SITS tribe! My son had an unexpected ambulance ride last year and I never even considered that it might not be safe for him! Thanks for sharing.

    • Stefanie Zuckersazucker says:

      Scary isn’t it? I had no idea until my sister who was an EMT told me about how dangerous it was…and then I spent the next 18 years working with her to try and make it safer. Pediatric Safety actually came out of all of that. Amazing the direction life takes us… Thanks for stopping by 🙂

  5. Hello,
    There is a patent pending child restraint system for newborn babies allowing “skin to skin” closeness between mother/child. Kangoofix

    Best regards


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