What I Remember and Why It Matters: A 1978 Child EMS Transport
St. Petersburg, FL., the year was probably 1978 or 79. My partner and I had responded to a drowning in a large apartment complex at the north end of town. When we arrived we found a bunch of people doing or trying to do CPR. While we were getting into position to take over care a news crew arrived and began to film the action- the cameraman positioned right behind me.
The child was blue and just had that look and feel. The outcome was not going to change and it was not right that it was being filmed- solely for the benefit of the TV station. Somehow when I stood up I bumped into the cameraman and into the pool he went.
Fencing could have, would have prevented the death of this child. Parental oversight could have, would have prevented the death of this child. These were not the only mistakes to be made. We put the child on the stretcher and began the very long trip to the hospital.
We did not secure the child in any special way to the stretcher. We never had any means to do so and nothing bad ever happened. Each time we transported a child back then, we did so either using the stretcher or more commonly held the baby in our arms- as though we could hold onto a 30 pound baby in a high speed collision. But we did it time and again and nothing bad ever happened.
That’s not to say that there could not have been a catastrophic outcome from the transport – it just never happened – to me.
Back then we were not taught any better and frankly did not know better. Back then the world was a lot larger. We did not know what happened across the country or the world like we do today- only ‘major news’ received that level of exposure. And the fact that we did not believe anything bad would happen kept us from seeking change or improvement. As a society we have enacted universal laws that govern how we transport children in ordinary vehicles. We made these changes because bad things do happen. Emergency vehicles are the same as other cars- only riskier- they run red lights and go fast. We need to adopt the same laws as those that apply to all vehicles
How children are transported today is about the same as it was back then and largely for the same reason- we take a risk and nothing bad happens.
There are those who advocate for safer transport of children and infants and some states have enacted legislation to require safe transport equipment for emergency vehicles. Most people just assume that EMS, 911 responders, know what to do and do the right thing.
So what is the moral to this story? We often get angry when bad things happen and lash out in the wrong direction. Hindsight is most often crystal clear but too often we fail to use this vision to change the future.
* Learn CPR ** Insist that all states require EMS vehicles to carry and use approved child and infant transport equipment ** Ask questions and get involved *
* No Excuses*
Finally – A Step Towards Safe Transport for Kids in Ambulances!
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:
“BEST PRACTICE RECOMMENDATIONS FOR THE SAFE TRANSPORT OF CHILDREN IN EMERGENCY GROUND AMBULANCES” …Thank you NHTSA!!
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 !!
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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 ems.gov… “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.
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References:
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
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
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
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 t
wo, 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
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?
