Instructional Archive

Proper Transport of the Non-Critical Pediatric Patient in an Ambulance (aka how to properly install a carseat on a stretcher/cot)

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On this warm, sunny, spring day – parents were obviously busy doing something other than coming to our check event. That left us techs with a little free time. At one point, some of the fabulous volunteers from the local ambulance corp showed up and the conversation quickly turned to transporting babies and young children in ambulances. I think I shocked a few of the local techs when I admitted that I had never actually installed a carseat on an ambulance cot (What? Something involving carseats that Kecia has never done??? Alert the presses! Lol.) Yes, I understand how it’s supposed to be done. I’ve read the research papers and I’ve seen several presentations on the subject at various CPS conferences over the years but I had never actually done it myself. Well, wouldn’t you know it – a short time later, an ambulance pulls up. Yes, boys and girls – it’s play time! 😀

It was actually a fairly simple install on this nice, new Stryker cot with this particular convertible (original model Cosco Scenera).  For the record, the only type of conventional carseat that should ever be installed on an ambulance stretcher/cot is a convertible. You need to be able to secure the carseat on the cot using two different beltpaths and this is only possible if the carseat has separate beltpaths for the rear-facing and forward-facing positions. Obviously, this setup is only going to work if the child actually fits in the convertible (and that will vary depending on the child and the specific convertible model being used) and if the child can tolerate being transported in the semi-upright position.

First we reclined the carseat into the position meant for a rear-facing installation. Then they showed me how to raise the head of the cot until we had it flush against the back of the convertible. Next we routed the straps nearest the rear-facing beltpath through that beltpath and routed the straps nearest the forward-facing beltpath through that beltpath. They helped me tighten everything up and Voila! Then we strapped in our “non-critical pediatric patient” for good measure (and for the photo op)! Finally, the guys showed me how to load this particular stretcher into the ambulance and secure it. I have to say, I was really impressed with this particular Stryker Powered Ambulance Cot. The hydraulic system was sweeet!

     

On this particular day, this exercise was all about learning something new in a relaxed and friendly environment. However, in reality, pediatric transport in an ambulance can range from “as safe as possible under difficult circumstances” to “downright scary for no good reason”. Why does it vary so much? Because currently there are no federal guidelines for  pediatric transport in an ambulance. Therefore,  EMS services are free to transport patients in any way they deem appropriate. Personally, I wouldn’t allow my kids to be transported to the hospital in an ambulance unless they really needed to be attended to by a medic on the way there. Unconscious? Not breathing? Massive head trauma? Get him into the ambulance fast and I’m not going to care or worry about how he’s restrained. Broken foot? Get in the car and I’m driving you to the hospital myself.

For more information on the subject see “Crash Protection for Children in Ambulances”: http://www.carseat.org/Resources/Bull_Ambulance.pdf

What Is An All-in-One / 3-in-1 / 4-in-1 Carseat?

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Graco 4Ever - StudioAll-in-One. 4-in-1. 3-in-1. Does it all. Last carseat you’ll ever need.

These promises sound exciting, don’t they? After all, you’ve probably shelled out over $100, maybe even close to $300 for a rear-facing only infant seat that only fit your child for about a year and now you have to buy another carseat already. Your kid keeps growing, wouldn’t it be nice to buy only one more carseat and be done with it all? Perhaps.

We need to get some basic terms out of the way since I’ll be addressing them frequently in this article. There are two types of carseats we’ll be discussing: convertible and combination. A convertible carseat is one that rear-faces or forward-faces, so it’s appropriate for newborns through preschoolers generally. A combination carseat is a forward-facing only carseat with a harness that can be removed to become a belt-positioning booster. Sometimes combo seats are called harnessed boosters. It’s all marketing, but the official class of seat is combination.

Let’s discuss what an all-in-one / 3-in-1 / 4-in-1 carseat is. These days it can be a convertible carseat or a combination carseat. An all-in-one carseat is one that “does it all.” This convertible carseat will go from infant to booster: rear-facing, forward-facing, and high-back booster. A 3-in-1 carseat does the same: rear-facing, forward-facing, and high-back booster. But a 3-in-1 carseat can also be a combination seat: forward-facing-only harness, high-back booster, and backless booster. Oh. That’s getting complicated. What about the 4-in-1 carseat? Well, that is a convertible carseat: rear-facing, forward-facing, high-back booster, AND backless booster.

What does one of these seats NOT do? It does NOT have a harness weight limit of 100 or 120 lbs. That’s a very common misconception. The carseat manufacturers are doing a much better job of labeling the boxes for their separate modes, but as you look at the pictures below, I think you’ll see why it’s easy to see why the harness might go to a super high weight limit. It doesn’t.

So we have the convertible vs. combination terminology out of the way and we know what an all-in-one vs. a 4-in-1 carseat is (er, basically the same thing, right?). Now let’s have some practice looking at these seats and their boxes so you know in the store *before* you buy if the carseat is appropriate for your 9 month old (of course, you could always consult our Recommended Carseats List and know which seats are appropriate right now and find one that will work for you!).

Questions to Ask Before You Shop

Does it have a rear-facing belt path? (Only if you are shopping for a rear-facing seat obviously.)

How long do I reasonably expect my child to use this seat?

Do I really want a carseat that I will be using for over 6 years? (Because really, what other piece of baby gear gets used for that long, let alone a safety device?)

All-in-One

The Evenflo Symphony LX is an all-in-one seat. It says so on the labels and on the box. Check out the label: 5-110 lbs. That’s misleading, because it makes you think the harness will take your child from 5-110 lbs., right? Wrong. It’s 5-40 lbs. rear-facing, 22-65 lbs. forward-facing, and 40-110 lbs. as a belt-positioning booster. There is a rear-facing belt path opening under where the child’s legs would sit, so you know it’s a convertible carseat. You could use this carseat from your child’s birth, provided he’s big enough.

Symphony LX box front Symphony LX box side

3-in-1

Are You Making These Carseat Mistakes?

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MaggieMargeDriveMost parents think, “I got this,” when they look at a carseat. I mean, really, it’s just some straps that go over your kid, right? Everyone who has a kid has to use a carseat, and we all know there are some parents out there barely qualified to have kids in the first place who are able to get from point A to point B and keep their offspring alive, so it’s not rocket science, right? Wrong. Sometimes we make mistakes that we look back on and say, “I can’t believe my child survived my parenting!” It’s a saying in our house that we’re not saving for college; we’re saving for the therapists’ bills, lol. Let’s look at some very common carseat mistakes and see their simple fixes so your offspring can ride safely enough to make it to college… or therapy sessions—whichever way your family sways.

Loose Installation

Whether using the lower LATCH connectors or the seat belt for installation, your carseat moves more than 1” when you give a tug at the belt path. Make sure you tug at the belt path only; that’s the only place where the carseat is connected to the vehicle. If you check for tightness anywhere else on the carseat, it’s going to move more than 1″. There’s nothing holding it to the car there, right?

Let’s define “tug”. A tug is like a firm handshake or a shake on a shoulder that doesn’t move someone’s head back and forth (heh, you don’t want to give them whiplash). You use your non-dominant hand to give this tug so you’re not tempted to shake the rivets out of the seat.

correct incorrect

Can’t Lock the Seat Belt (Loose Installation Corollary)

Sometimes your installation is loose because you can’t figure out how to lock your seat belt to keep it tight on the carseat. Seat belts lock either at the retractor or at the latchplate. All model year 1996 and newer vehicles must have locking seat belts and some vehicles manufactured before 1996 have them as well. The retractor spools up all the length of the belt and is hidden inside the wall of the vehicle or inside the vehicle seat back. At least 90% of all modern vehicles have switchable retractors that can lock the seatbelt to hold a carseat tightly in place.

This is how you test for a switchable retractor: Pull the shoulder belt portion of the seat belt out of the retractor slowly and smoothly until you reach the end and can’t pull it out any further. Then feed a few inches of the belt back into the retractor. You may hear a ratcheting sound as the seatbelt feeds back into the retractor in the locked mode (although some retractors are very quiet most will make a noticeable clicking sound once they are switched into locked mode). Stop after feeding a few inches of the belt back in and try to pull it back out again. If it won’t come back out, it’s locked and now you know that this seat belt has a switchable retractor that you must switch to the locked mode if you are installing a carseat in this seating position.

Other seat belts lock at the latchplate (male end of the seat belt). These are mostly found on Chrysler, Dodge and Jeep vehicles. To see if your seat belt locks in these vehicles, buckle the seat belt and pull up on the lap belt. If it holds tight, your latchplate locks.

lightweight locking latchplate

If you can’t get your seat belt to lock because your car was made before 1996, you have to use either a carseat with a built-in lockoff or a locking clip. If you want to read more about locking clips, you can click here. Lockoffs that are built into certain carseats are much easier to use than a locking clip and worth the extra price. Read about which carseats have lockoffs here.

Loose Harness

Yeah, you can’t just buckle the harness, it has to be snug on the kid or they’ll go flying out of the seat. If you can take a pinch of the harness above the chest clip, the harness is too loose so pull it tighter.

Pinch Test

Chest Clip or Belly Clip?

You know those plastic pieces that clip together across the kid’s middle? That’s called a chest clip. Some carseat manufacturers’ get all uppity and call it a harness retainer clip. Call it what does and where it goes and you’ll never forget! Chest clip. The top of the chest clip is placed at the armpits. Any higher and it’s at the kid’s throat, especially for babies. Any lower and it may not be able to do its job as a pre-crash positioner.

chest clips

Trusting Your Pediatrician for Carseat Advice

Do the initials “CPST” follow your pediatrician’s MD after his name? If not, he’s not qualified to give you carseat advice. Just like I’m not qualified to give you medical advice on your child’s rash (gee, that really does look like Ichthyosis en confetti—you should have that checked out), your ped is not qualified to give you advice on vehicle safety matters. Between charting, keeping up with ever-changing youth medicine, and making hospital rounds, most peds simply don’t have the time to keep up with the dynamic field of child passenger safety unless it’s a special interest. That’s why you come to us for answers on vehicle safety.

Turning Forward Too Soon

You may not admit it online, but turning your wee one forward before age 2 is really dangerous. I’ve heard all the arguments in my 14½ years of tech-ing: my child’s legs hurt because they’re scrunched, my best-friend’s-mother-in-law’s-phlebotomist’s-daughter’s-pediatrician told her to turn her son forward at 9 months because of a risk of hip injury, my child has to be able to see the DVD screen we spent top-dollar for, and so on. The truth is, if you turn your kid forward before age 2, *you’re* the one who is uncomfortable with the idea of rear-facing, not your child. Studies and years of rear-facing children have shown that rear-facing is not only safe, it’s loads safer for kids.

It’s so important to rear-face your toddler that two carseat manufacturers now mandate it, at least for some of their carseat models. Britax requires a 2-year and 25 lbs. minimum on all of their forward-facing harness-2-booster seats. And Dorel, parent company of Cosco, Safety 1st, and Eddie Bauer, says that your kids must be 2 before they can be turned forward-facing in several of their new convertible seats. I’m not pulling your leg—it’s right there in the manual.

NEXT manual

Commercials on TV claim that the best way to start your baby’s life is to use the best diapers or best formula (if you can’t breastfeed, of course). We feel the very best thing you can do for your kid in the child passenger safety world is to use an appropriate carseat or booster on every single ride. After the infant seat is outgrown, continue to rear-face your child until they reach the rear-facing height or weight limit of their convertible carseat. And install the seat tightly. And tighten the harness appropriately. And make sure the chest clip is properly placed. The crazy thing about kids and carseats is that there are so many things that can go wrong with them that we need an entire profession to help parents get it right! I remember making some of these mistakes—and more. Aye yi yi. It’s amazing we’re all still here.

Bicycle Helmets: They’re Not Just for Littles

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SchwinnMergeWearing a helmet is a lot like wearing a seatbelt.  It can be inconvenient and even uncomfortable, especially to adults.  According to the Centers for Disease Control, 800 cyclists were killed and half a million had injuries severe enough to go to the emergency room in 2010.  Fortunately, according to the IIHS, helmet use has been estimated to reduce the odds of head injury by 50 percent, but Safe Kids USA estimates that less than half of children 14 and under even wear a helmet.

Bicycle related head injuries send more people to the emergency room than any other sport, more than football, baseball and softball combined!  And it’s not just kids being injured.  The IIHS states, “Eighty-four percent of bicycle deaths are persons 20 and older. During the past few years, no more than 17 percent of fatally injured bicyclists were wearing helmets.”

So, yes, make sure your kids wear a good helmet and make sure it fits them.  And the same goes for football, baseball, softball and skateboards.  The NHTSA has a great page on bicycle safety education with tips and facts. Safe Kids USA has an excellent video on helmet fit for kids, but it applies to adults as well:

 

Take it from me, the cost of NOT wearing a helmet can be unimaginable.  Based on the statistics, it is just as important to wear one yourself!  This not only sets a good example, but adults in their 40s and 50s are most at risk of dying from head injuries sustained in a bicycle crash.

I’m a survivor of a life threatening sports-related head injury.  When I was 10 years old, I was struck by a thrown baseball that hit me above the eye while running to first base in a back yard game. There was literally a big dent in my head, and the depressed skull fracture required immediate surgery.  I was told that had it struck me an inch in any other direction, I’d probably have died.  A batting helmet would have prevented the injury and the long scar that remains on my forehead, too.  So, it’s not too hard for me to imagine what could happen to my 10-year old son or to me if we don’t wear our bike helmets.

In our next segment, I’ll review a few reasonably priced bike helmets that provide good protection for adults and older kids.  There are also some new options in helmets that may help prevent concussions as well as other traumatic brain injuries.