Currently browsing Involvement

Finally – A Step Towards Safe Transport for Kids in Ambulances!

Last updated on August 8th, 2019 at 07:02 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.(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)

Wednesday September 19, 2012, 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 !!



Editorial Update: Quite a bit has happened since the original publication of this article. Suffice it to say that while this was a terrific step in the right direction – it was not enough to cause the system-wide level of change hoped for. According to… unanswered questions remain, primarily due to the lack of ambulance crash testing research specific to children.To address this, in 2017 the National Association of State EMS Officials (NASEMSO) established the Safe Transport of Children Ad Hoc Committee, with the goal of improving the safety of children transported by ambulance through the creation of evidence-based standards. Pediatric Safety will continue to follow their efforts in future articles as they work to improve the national standard of care and establish consistent guidelines for the safe transport of all our children on ambulances. Every ride, every time.



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

Car Seat LATCH Rules to Change in 2014: Please Read This Today

Last updated on August 7th, 2019 at 02:42 pm

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???

New Crash Test Dummy Will Keep Older Kids Safer in Cars

Last updated on March 3rd, 2018 at 11:14 am

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.

New FAA Recommendations for Transport of Children on Planes

Last updated on September 4th, 2015 at 09:58 pm

Reported on ABC News by Tanya Rivero, and in an article written by Lisa Stark and Jordyn Phelps in ABC World News with Dianne Sawyer.

The current Federal Aviation Administration (FAA) policy, allows children under the age of two, to fly free, if seated on an adult’s lap; the adult is safely restrained, the child is not.

As recently as March 2011, the National Highway Traffic and Safety Administration (NHTSA), in collaboration with the American Academy of Pediatricians (AAP), changed many parameters for the safe transport of infants and children when it recommended new guidelines for age, weight and seat orientation for safety seats in cars. (See the article on the Pediatric Safety website here).

On May 24, 2011, Randy Babbitt, an FAA administrator, announced at a press conference in Washington, DC, that the FAA has come up with a new set of recommendations for the airline industry, regarding the transport of children on airplanes, who weigh forty pounds-or-less. The Association of Flight Attendants (AFA) has concurred with those recommendations.

Focusing on the safety of child passengers on a plane, the FAA believes that it is much safer to transport a forty-or-under pound child if he/she is secured in a FAA-approved safety seat that is properly attached to an airplane seat of his/her own, than if that child sits on an adult’s lap during flight.

Although the FAA clearly stated its recommendation, it will not make it a requirement, at this time, because of the concern that cost issues (the purchase of an additional seat) may deter families from flying. They also maintain that It is still safer for the child to fly while seated on an adult’s lap, than it is for that child to be a safely-restrained passenger in a car.

Overweight Children are NOT Adequately Protected in Car Seats

Last updated on March 3rd, 2018 at 11:59 am

For the past ten years, the news media has consistently focused our attention on the fact that obesity is on the rise; that it has become a major problem in the United States, and that childhood obesity, in particular, has put young children at-risk for a multitude of health-related issues.

One surprising health-related issue stems from the fact that many infants and toddlers are being transported in car seats that are not safe for them to be riding in, and I am not referring to the improper installation of those seats. The problem I AM referring to is the fact that when car seats are crash-tested, the crash-dummies that are used to simulate the effects of an accident impact do not reflect the overweight child population being transported.

With so many young obese children today, common sense should dictate that the crash-dummy’s weight and dimensions more closely match that of the children using the car seats being tested.

In an article on the ThirdAge.Com website, March 29, 2011, under Boomer Health and Lifestyle, Katherine Rausch highlights a problem that although acknowledged for some time, has been awaiting a solution since 2004, but researchers have not come up with a product. The National Highway Traffic and Safety Administration is using smaller adult version dummies for child crash-testing. Why? According to a recent article in the Washington Post, it’s because crash test dummies are expensive to develop and funding is not readily available to develop larger “life-like” child test dummies. This leaves child safety seat manufacturers self-regulating their own products. It also means that seats made just a few years ago to hold 65lb children are now marketed for those up to 85lbs.

It appears that heavier-weight crash-dummies have been in development for adults for decades now. Why haven’t overweight children been given the same attention?

With so many recent news reports about the American Academy of Pediatrics’ and NHTSA’s “new safety seat guidelines”, are we deluding ourselves into thinking our kids are safe?

A Public Meeting on Safe Transport for Kids on Ambulances

Last updated on January 3rd, 2018 at 03:02 pm

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.

The PedRESTIn 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 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, 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.Pediatric Rapid Emergency Safe Transport (PedREST)

In its “Innovation” section, 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:*

  1. Approximately 1 in 10 patient ambulance transports involve children. The result: 6 Million Children are transported by emergency medical vehicles each year
  2. 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
  3. 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:
  • 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.

Sandy Schnee