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*

Remembering 911: Creating a New Future For Our Children

This past weekend was the twentieth anniversary of the worst attack against America and our way of life and is a day a national remembrance. The 911 attacks attacked differences. Differences of religion, differences in appearance. The attacks said we are worthy to live, you are not. The attacks said we are better.

Taking a moment to remember, reminds us to embrace our differences, to embrace other religions, different governments and different appearances. Taking a moment to remember says we all deserve to live. Doing so builds a better life and better future for our children, for all children, for many generations to come. Only we can teach hate and only we can erase hate in the future for our children with love.

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Editor’s Note: This post first ran on 9-11, 12 years ago. It is the author’s hope – and ours – that by remembering and telling our children, we create a better world for them. They deserve it. We all do!!
With heavy hearts…and with love…from Pediatric Safety.

Wishing You a Safe, Happy and Healthy 2021!

GOODBYE 2020!!!

The end could not come fast enough!

For many it’s been heartbreaking, lonely …at times terrifying

A year full of overwhelming grief at loss of loved ones and livelihoods …of every aspect of life as we knew it

But you were stronger than you ever thought possible …and you have survived

We know it is not over…there are still difficult days ahead…but we can see a light…even if it is just the glimmer from a candle burning in the darkness

I hope we as a people continue to value the heroes of 2020 – long after this nightmare is over

Thank you healthcare workers, emergency responders, police men and women and teachers! Thank you to every essential worker who kept a food service open, a building clean and safe, a transportation service operational. Thank you to every person who put their lives on the line so that the rest of us could live to see tomorrow.
It is to you we dedicate 2021!

And on a personal note from all of us at Pediatric Safety:

Our thanks to all of you who stayed with us

We’re honored you’ve let us
be a part of your life.

Have a Safe, Happy and Healthy 2021!

Stefanie, Clara, Audra and Jim….

These 5 Steps Help Teach Your Children How to Call 911

Calling 911 sounds simple, but put yourself in the place of a child is being told to do this under an extremely stressful situation or the child of an unconscious parent that does not know what to do or say? Not so simple now is it? Teaching your child how and when to call 911 is an extremely important lesson for them and will make it more comfortable for them should the need arise.

1. Teaching your child how to call 911 should start with a simple understanding of the phone and the three buttons.
2. If you are referring to 911 around your children as nine eleven, please understand how this can confuse a smaller child that may look for an eleven button, so make clear to the child there is no eleven button, it is three pushes of the buttons, 9-­‐1-­‐1.
3. Next should come the lesson of where you live,the address and apartment number. It is surprising when doing fire demonstrations how many children do not know their address or phone number. These are things that will help the 911 operator thus speeding up the arrival of the responding units. Some areas of the country have expanded 911 which allows the operator to trace the call in case a disconnection happens. But knowing it by memory is the best answer.
4. Children often feel they will be in trouble if they use the house phone or call 911. Teach your child to be honest with the 911 person and to calmly and clearly answer the questions they are being asked. For example, what is your address? Is the person awake? Is the person breathing?
5. Defining what an emergency is and when to call 911 is the next step. Having your child understand that major things like fires, seriously injured people and intruders in your home are real emergencies and things like a missing toy or a flat bike tire are not.

A test run should be in order when the child is ready. You can try an old phone or simply unplug your phone and have the child dial and answer the questions and see how well they do. Obviously the older the child the easier it will be and this may take more time with younger children but we have all seen the stories on the news of very your children calling 911 and saving a life. I hope and pray your child will never have to call 911 but always teach them that if there is ever any doubt that they should call. Better to be safe than sorry.

Be safe.

Photo credit: Dan Hatton; CC license

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

Knowing How to Use an AED Can Save a Child’s Life

We have a problem in this country, sudden cardiac arrest. Approximately 450,000 people die each year from sudden cardiac arrest (SCA) in the United States. It can happen to anybody, anywhere, anytime and without any warning, so helping a person suffering from cardiac arrest is all about what you do immediately following the persons collapse. The best “save” rates have been reported when using an automated external defibrillator or AED to deliver an electric shock or defibrillation within three minutes of the patient’s collapse. Early defibrillation in conjunction with C.P.R has been found to be the only definitive treatment for sudden cardiac arrest. For every minute that a person in cardiac arrest goes without being successfully treated by defibrillation the chance of survival decreases by 7 percent per minute in the first minutes, and decreases by 10 percent per minute as time advances beyond 3 minutes, so starting life saving measures such as CPR and using the AED as soon as it arrives it essential.

Symptoms of Sudden Cardiac Arrest include:

• Collapse
• Lack of pulse
• No breathing
• Unconsciousness

With time being of the essence and the average response time for emergency services being 10 to 12 minutes (which may not be fast enough for a patient because after approximately three to five minutes irreversible brain damage may begin to occur if there is no defibrillation), having access to an AED and knowing how to use it is very important. So how do you use an Automated External Defibrillator? As we said before, AED’s are very user friendly and speak in plain English and will walk you through the entire process, even reminding you to call for help if you haven’t already done so. In the basic life support class we have a pneumonic that helps people remember the 4 basic steps to using an AED: P.A.A.S. This stands for Power, Attach, Analyze, and Shock.

• Power: Most AED’s turn on when open but some may have a power button.
• Attach stands for attaching the defibrillator pads to the chest of the patient to match the pictures that are provided on the pads.
• Analyze means to let the machine analyze the patient’s heart rhythm and determine if the patient needs to be defibrillated,
• Shock means to manually press the shock button and shock the patient if and when the machine says it’s time to do so.

Now as we said before, having the proper training will make this whole process much smoother but is not a requirement. I would however recommend it.

Where to find an AED? AED’s either held by trained personnel who will attend events or are public access units which can be found in places including corporate and government offices, shopping centers, airports, airplanes, restaurants , casinos, hotels, sports stadiums, schools, and universities, community centers, fitness centers, health clubs, theme parks, workplaces and any other location where people may congregate. In many areas, emergency vehicles are likely to carry AEDs, with some units carrying an AED in addition to manual defibrillators. Some areas even have dedicated community first responders, who are volunteers tasked with keeping an AED and taking it to any victims in their area. AEDs are also increasingly common on commercial airliners, cruise ships, and other transportation facilities and with advances in technology and policy requiring AED’s to be placed in more and more places AED’s are becoming more accessible as well as more affordable.

Automated External Defibrillators are truly miracle machines and are changing people’s lives for the better and I hope this article has given you a basic understanding of how to use one should the time come. I encourage everyone to take a certified AED instruction course and really become familiar with these machines and the process involved in using them because you never know when you could be called to action and as we said before, there is nothing better you can do in a cardiac arrest situation than using an AED.

Thank you and Have a Safe and Happy Holiday Season.

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Editor’s Note: Sudden cardiac arrest among young athletes is nowhere near as common as it is across the general population, however when it occurs, it is unexpected and the results are often tragic. It’s estimated that between 6,000 and 8,000 young people experience sudden cardiac arrest (or SCA) each year, and only about one in 10 survive. An AED can save their life, however today only 15 states require them on school campuses. Not all of those require them to be present on athletic fields. Parents that means its up to you. Be observant. During the sports season, look out for signs that your child may be struggling. And talk to your school about AED’s. Source: Nemours Children’s Hospital

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