Sometimes, it’s the upside of a slow carseat check event – the opportunity to “play” with something new. On this particular warm, sunny, spring day – parents were obviously busy doing something other than coming to the well-publicized 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 transport of pediatric patients 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 (Cosco Scenera). For the record, the only type of conventional carseat that should be installed on an ambulance stretcher/cot is a convertible. You really 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 specific convertible model being used) and if the child can tolerate being transported in the semi-upright position.
First they showed me how to raise the head of the cot until we had it flush against the back of the reclined Scenera. Then we routed the straps nearest the rear-facing beltpath thru that beltpath and routed the straps nearest the forward-facing beltpath thru that beltpath. They helped me tighten everything up and Voila! Next one of our local CPS techs 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 sweeeeet!
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 probably wouldn’t allow either of my boys 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 and not breathing? Massive head trauma? Aortic Rupture? 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
Any ideas how you can install a car seat on the squad bench of an ambulance. This is especially important if you are transporting a parent and child and want to be able to observe both. How about after a childbirth when we need to transport both w/o separating the parent and child? Can we mount brackets that would make this possible .
Great questions but there are no easy answers here. There is no known acceptable way to secure any type of carseat on a side-facing bench in an ambulance. Well, you could try to secure it there but it wouldn’t be crash-worthy, therefore it’s not “acceptable”. The whole point of securing occupants in any type of moving vehicle is to reduce the risk of injury in a crash or during emergency manuvering. For mother and newborn, the ideal way to transport would be having the newborn secured in a convertible carseat as shown in the article (NOT an infant bucket seat) with the carseat installed on the rear-facing EMS provider seat using the forward-facing beltpath on the carseat, leaving the cot for the mother. The convertible carseat would need to be installed in a reclined position to keep the newborn’s airway open and the baby would be facing the rear of the ambulance. I understand that strapping a just-born baby into a carseat isn’t the most convenient thing to do but transporting a newborn in their mother’s arms could end in tragedy if the ambulance were to crash on the way to the hospital. For a non-critcal pediatric patient, it’s not worth the risk. Hopefully this scenario doesn’t happen too often and when it does, hopefully you’re not traveling a great distance to get to the hospital.
You cannot properly and safely secure a carseat to a gurney. Stryker makes specialty seats I.e. the pedi-mate. It’s not about hot you can secure the seat to the gurney. It’s about the mechanism of crash and how the baby rides the crash. They are installing a forward facing with ends up rear facing with two sets of straps. Completely unsafe. Carseat are just plastic. More than one belt can cause stress in to many places at once and fracture the seat. Not safe.
My oldest when six months old was left in her seat for transport but they only put it on the floor or the side bench but that was before I knew better. She was in a convertible at 9 mon old so it was possible. She was having a seizure. I tried to take her myself due to her issues she was having and less then a mile down the road she started having a seizure and I called for an ambulance.
NICOLECPST – it sounds like she may have been transported in a FERNO Pedi-Mate. You can google some images and see if it looks like what they used. I have zero experience with that particular product so I can’t comment on it. However,here is a quote from the “Crash Protection for Children in Ambulances” paper that I linked to at the end of the blog:
“….Even with these recommendations, it is recognized that the very nature of emergency circumstances may require some compromises of best practice. For instance, it is recommended that child restraints not be used again, once they have been in a crash. If a child is found in a convertible child restraint that is still visually intact, however, it may be better to move the child in that restraint to the ambulance for transport than to transfer the child to a different restraint.”
I’m just curious, but Bella was transported in a papoose thing strapped to the stretcher after a car accident at 8 mo, how “safe” or “approved” is that? Looking back, her crashed seat was an MA, but the crash was bad enough that it was trashed, so I didnt even consider using it.
interesting timing.
we just had to take our 1 year old to the ER by ambulance after a seizure. we used our own scenera, installed exactly as described. One of the EMTs knew what he was doing and the other was clueless, but this was covered in my special needs class and it actually helped calm me down a bit to help install the seat.
thanks for an awesomeblog post!
Although I’m not a tech,yet, I learned about this last summer when my daughter had to be transferred to a larger childrens hospital due to epiglotitis and croup. It was really interesting because at the time my daughter had a First Years True Fit and ambulance tech had never seen one before. So we got to talking and he showed me how to install the seat on the stretcher and we talked about ERFing and he was so impressed that he said he would be getting one for his 5 month old. Its very interesting to see it done for sure and I’m glad to see more care about car seat safety in ambulances.
There were a few newborns. ONe was a homebirth that wasn’t supposed to be a home birth.
The other two were babies with respiratory illnesses that were only a few weeks old. In those cases we couldn’t get the Scenera reclined enough and the straps were too high but we made do. Once we used an infant carrier and it seemed secured until we realized that technically it was forward facing. So we didn’t do that again!
I wish there were better options for little ones. However, built in seats are too expensive for departments with budget cuts lately, and the cot attachment ones by Ferno and such don’t fit teeny ones either.
Not great, but we make do.
Great post Kecia, and very interesting! I’ve never had quite such an interesting “down time” at a seat check, but I do find that as a tech, downtime with the right other techs can be almost as worthwhile as checking seats. 😉
JENNIFER – good guess but no, it wasn’t Alamo. 😉 This check event was in Goshen and the cot and ambulance were from Goshen VAC.
FYRFIGHTERMOMMA – have you run into many issues with babies that don’t fit in the Scenera? I know the Evenflo Titan has lower bottom harness slots than the Scenera but both are rated from 5 lbs up. The Bull report has some recommendations for securing a carbed on the cot but obviously I have zero experience with that so I can’t even comment on whether or not that would be a better option for little babies that didn’t fit well in the convertible. Glad to hear your dept has some of those awesome new cots too!
Great post! That is how we teach our firefighters as well on our department and all surrounding departments. We’ve always gone by the Bull report which I believe is one of the few actual papers and testing done on this type of transport. Works well when needed. But like you said, if there’s an alternate way, it should be used if the patient is stable. This method is not easy for infants though. We have yet to find a suitable way for a newborn/young infant that doesn’t fit in our Scenera yet (and funny enough, we have the same one on our FD!). Thanks for the great post!
Oh yeah, aren’t those cots the best? We got them 6 months ago on our department and I just love them! Nothing like not having to lift a 400 pound patient with only two people 🙂
Cool, Kecia. Umm, where was this well-publicized check? But, this is how dh was taught/told/did install a seat on an ambulance cot. Through both belt paths! Umm, Alamo, by any chance?