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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*

Embrace Life by Buckling Up [Video]

It never ceases to amaze me how many people do not use their seat belts while driving or riding as a passenger, even with all the statistics and evidence that proves the risk of severe and/or fatal injuries is immensely higher for those who do not buckle up. As a registered nurse, I’ve seen too much to ever think of being in a moving vehicle without my seat belt on to protect me.

An ad has been circulating to promote seat belt usage in a new way. It is a short, simple message, and yet so powerful and it is the hope of the creators that it will inspire people to stop and think about all they stand to lose if they should ever be in an accident while unbuckled.

Do yourself, your family, friends, and all of us a favor – BUCKLE UP and drive safely! Your loved ones will be glad you did!

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

What You Need to Know About Car Seat Safety? Ask a Fireman

Being a firefighter, I come across a lot of situations that make me shake my head in wonder. The one that my fellow firemen and I continually come across is installing and checking car seats and the many interesting and creative ways people have managed to improperly install a car seat. Whether you are the SUV with a few seats that have been installed for a while, or the new dad sweating on the way to the hospital stopping at the fire station asking the nice firemen to install your brand new seat, there are a few things that need to be taken into account when choosing your car seat and then installing your car seat.

What choice could matter more than that of the one your child is going to be sitting in as you motor around town? Choosing the correct car seat for your new baby or young child requires some homework and label reading.

First there is price. Car seats come in all price ranges, from free at some local fire stations and community organizations to very expensive with extra padding, lights and toys. Just because a seat costs more does not make it a better seat than the one next to it. Check online at places like www.consumerreports.com or www.safekids.org to find out how these seats compare to one another will give you better insight as to the correct choice for you and may even surprise you.

Next is the correct size seat for your child. This is the part about label reading that I mentioned before. Car seats are designed with a specific weight and height in mind for each seat and making sure the seat is the correct size for your specific child maximizes the safety of the seat for your child. Seats that are too big may allow for too much room for movement and seats that are too small may make your child uncomfortable and ultimately unsafe. Car seats should be securely snug but not a tourniquet.

Installation. Having your brand new car seat is wonderful and having it installed correctly is the most important factor of all. Where can I go to have my new car seat installed? There are many places that will correctly install your new car seat by using certified installation experts that have been trained on many different types of vehicles and the important points of each type of vehicle. You may want to call your local fire department or hospital for information on places to go for installation and you can also consult websites like www.safekids.org or the national highway traffic safety administration website http://www.nhtsa.gov to find installation centers in your area and may even find info on installation events going on in your area right now.

If you have any questions about a soon to be purchase of a car seat or the one that is in your car right now, please feel free to stop in at any fire station and ask for a check. We may shake our head but we love knowing your kids are safe.

God Bless!

What You Need to Know About the New AAP Child Seat Guidelines

The American Academy of Pediatrics has dropped the age milestone that children should remain rear-facing until age 2, and replaced it with the new recommendation that children should remain in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat.

The past decade has seen an incredible dramatic evolution in improvements to child passenger safety. Never-the-less, motor vehicle crashes continue to be the leading cause of death for children ages 4 and older.

baby in rear facing car seatAccording to Dr. Benjamin Hoffman, MD, FAAP, lead author of the policy statement and chair of the AAP Council on injury, Violence and Poison Prevention, “Car seats are awesome at protecting children in a crash, and they are the reason deaths and injuries to children in motor vehicles have decreased”. However, according to the AAP, what many parents don’t realize is that each transition – from rear-facing to forward-facing, from forward-facing to booster seat, and from booster seat to seat belt alone – reduces the protection to the child.

Using the right car safety seat or booster seat, says Dr Hoffman, lowers the risk of death or serious injury by more than 70 percent.

When a child rides rear-facing, the head, neck, and spine are all supported by the hard shell of the car safety seat, allowing the car seat to absorb most of the crash forces, and protecting the most vulnerable parts of the body. When children ride forward-facing, their bodies are restrained by the harness straps, but their heads – which for toddlers are disproportionately large and heavy – are thrown forward, possibly resulting in spine and head injuries.

According to Dr. Hoffman: “if you have a choice, keeping your child rear-facing as long as possible is the best way to keep them safe.”

Here is what the American Academy of Pediatrics is recommending:

  1. Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more.
  2. Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats through at least 4 years of age. Many seats can accommodate children up to 65 pounds or more.
  3. When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old.
  4. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
  5. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

One of the most important things a parent or caregiver should do is to read the manufacturer’s manual and labels for that particular car seat to find the correct weight and height limits. When a child is approaching one of those limits, it is time to think about transitioning to the next stage.

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Reference:

School Bus Stop Arms Are Being Ignored: How to Fix That

school bus stop sign armWithin the next several weeks most or all schools across the country will be back in session. Some already are. Last year, as in previous years, many of the headlines were about school shootings. These are tragedies by every definition. However these are well covered in the media as are many steps to prevent future occurrences. There have also been recent headlines about tragic school bus crashes and this is perhaps the subject of a different article. The National Highway Traffic Safety Administration states that by design and other factors, school buses are the safest transportation method to get children to and from school. Most injuries and fatalities happen off the bus.

In this piece I want to instead focus on a different school hazard and that is the act of driving past school bus stop arms. We will not likely hear much about this in the media until a group of students is run down.

Once a year the state of Kansas conducts a survey asking bus companies/drivers to participate.

  • For 30 days they ask the drivers to record and report the number of times other drivers pass an extended stop arm sign.
  • In the most recent survey (2017) nearly 10,000 occurrences of stop arm violations were reported.
  • Simply multiply this number by 50 states and there could be as many as 500,000 stop arm violations each and every month school is in session.

The laws may vary by state, whether the road is divided and if so how many lanes etc. Confusing laws is no excuse for violating laws- for putting children’s lives in jeopardy. In one study up to 2% of all violations are on the passenger side- the side where the door is when students are being off loaded. The side where the curb is; where students gather to wait for the bus. This is not allowed in any state for any reason. Think about it 2% of 500,000 is 10,000. The number and the potential is staggering. This risk is real. A child hit by a vehicle going often 25 plus MPH has little chance of a good outcome- perhaps little chance of surviving.

What can be done.

Know the laws and obey them. Talk about stop arm safety at back to school orientations and PTA meetings. Get your local police involved. Have them wait at known high hazard bus stops. Contact local TV and radio stations ask them to run public service announcements (PSA’s). There has been considerable media in the past – there is chilling video. This is a story with a real human interest. Consider stop arm cameras. These specialized cameras make it easier to prosecute violators. A few states don’t require stop arms on school buses- ask your legislators to reconsider.

What you should not do.

Don’t wait until tragedy strikes your area- a car strikes a child- a child is crippled or killed. Don’t regret that perhaps being proactive could have prevented the loss. Don’t assume someone else in your community is taking care of this. The more people involved- the higher the success.

Like this article- share this article- spread the word.

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