Pediatric restraints

[chimichanga]

Curious...

How do your ambulance companies, private and municipal, secure (if at all) toddlers/infants to the gurney (non c-spine precautions)

In my area (Arizona) at least 50% are not properly restrained (Ever seen a kiddo after being thrown around the back of an ambo? NOT pretty...Mom was fine, as she was strapped to the gurney, kiddo had internal decap as he was being "secured" in mom's arms)...

What are their lame excuses for not using a car seat or a "Pedi-mate?"

I believe it's likely an ignorance issue...Though I see a lot of apathy...Even from the EMS Medical director...

Would you secure YOUR 18 month old with a loose lap belt?

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[EMT2RN2MD]

Our local ambulance used Papoose boards "borrowed" from our ED.

"We weren't going that far." was the typical excuse that I heard.

 

[chimichanga]

when you see sub-standard EMS/interfacility child safety restraints come in your ER, please speak up...

 

[EMT2RN2MD]

My bad. The above was the lame excuse used by parents/guardians s/p MVC. The EMT's always secured the infants/pedi patients either w/ a car seat or the Papoose. However, once they got their hands on a Papoose board, you had to call the supervisor to get it back.

 

[igcgnerd]

In the cal central valley we like to use the pedimate or carseats and we love to use the carseats for c spine if the kids in it it maked it so much easier although the ked is nice with the kids too because its full body

 

[FoughtFyr]

Part of the problem in this area is that there are no standards for the ambulances "boxes" so anything you secure it to is suspect. Look up "Dr. Nadine Levick". I was an RA on her project. It was an eye-opener. In one case a full car seat had been secured to the bench seat by a NHTSA certified tech. Which worked great except that when the truck broad-sided the ambulance, the bench seat itself was thrown out the back doors!

BTW - Q: Based on crash test data, what is the most dangerous part of an ambulance to the pediatric patient?

A: The unrestrained EMT.

- H

 

[chimichanga]

So why is there widespread apathy and ignorance on the importance of properly securing kiddos in rigs??

It seems no one (docs, nurses) in the ERs, and the ambo personnel seem to care...

 

[FoughtFyr]

So why is there widespread apathy and ignorance on the importance of properly securing kiddos in rigs??

It seems no one (docs, nurses) in the ERs, and the ambo personnel seem to care...

It is not widespread apathy, it is a question of is there a good way to secure them? There are NO crash tested devices - because there is not an agreement to what forces constitute a crash pulse for testing. The closest thing to "standards" are here:

http://www.nhtsa.dot.gov/people/injury/ems/childam.html

but they don't carry any regulatory force.

Here is a mini lit review:

1) “Biomechanics of the patient Compartment of Ambulance Vehicles under crash conditions: Testing countermeasures to mitigate injury,” Levick NR, Li G, Yannaccone J, Society of Automotive Engineers Technical Paper 2001-01-1173; www.sae.org/servlets/index (search by paper number)

2) “Development of a dynamic testing procedure to assess crashworthiness of the rear patient compartment of ambulance vehicles,” Levick NR, Li G, Yannaccone J, Enhanced Safety of Vehicles Technical Paper # 454, May 2001; http://www-nrd.nhtsa.dot.gov/pdf/nrd-01/esv/esv17/proceed/00053.pdf


3) “Ambulance crashworthiness and occupant dynamics in vehicle-to-vehicle crash tests: Preliminary report,” Levick NR, Donnelly BR, Blatt A, et al. Enhanced Safety of Vehicles, Technical Paper # 452, May 2001; http://www-nrd.nhtsa.dot.gov/pdf/nrd-01/esv/esv17/proceed/00012.pdf


4) “Crash Protection for Children in Ambulances,” Bull, MJ, Weber, K, Talty, J, Manary, M, 45th Annual Proceedings, Assoc. for the Advancement of Automotive Medicine, 2001; http://www.carseat.org/Resources/Bull_Ambulance.pdf


- H

 

[chimichanga]

I am distressed that I seem to be the only one who cares when a kiddo comes in to the ER sitting on a parent's lap...

That's the apathy that bothers me...

No one can defend that sitting on a parent's lap is "a good way to secure them."

Thanks for the info on Dr. Nadine Levick...

She has already emailed me back twice tonight...

Would she not say that there ARE good ways to restrain kiddos?

Using a carseat (properly secured to the gurney) is inarguably better than sitting on a lap...

Despite the lack of sufficient research, common sense tells us that trying to do the right thing (carseat, pedi-mate, etc) will likely produce a better outcome (in the event of a crash) than just plopping a 20 lb kiddo on the gurney w/ a loose lapbelt...

 

[FoughtFyr]

I am distressted that I seem to be the only one who cares when a kiddo comes in to the ER sitting on a parent's lap...

That's the apathy that bothers me...

No one can defend that sitting on a parent's lap is "a good way to secure them."

Thanks for the info on Dr. Nadine Levick...

She has already emailed me back twice tonight...

Would she not say that there ARE good ways to restrain kiddos?

Using a carseat (properly secured to the gurney) is inarguably better than sitting on a lap...

She would ABSOLUTELY agree with you. As would I. My point is not that this is not a problem - it IS. My point is that the problem is compounded by the current absence of a scientifically supported solution.

In the ideal setting, pediatric patients not critically ill or injured would be transported in an SUV with a properly fitted child safety seat. Next best is the solution you propose - child safety seat on the gurney. The problem with that is the unrestrained EMT impacting the child during a crash.

It is a problem, and there is NO REASON for a child to be transported in mom's arms on the gurney (with the possible single exception of epiglottitis in a child with separation anxiety - a very rare case to be sure).

Nadine is great, she'll be able to help you out.

- H

 

[chimichanga]

In all honesty, when I worked on the ambo, I sometimes undid my seatbelt to perform a task...You make a good point...

The lack of research is likely due to the ignorance on this subject...

Though certainly Phoenix Fire lets kids ride unsecured not d/t a lack of research, but laziness on their part...


But their engines and ambos sure are nice, new and shiny

 

[viostorm]

It is not widespread apathy, it is a question of is there a good way to secure them?

I 100% agree with FoughtFyr.

We have a pseudo carseat built into the jump seat.

Some of you are being way to zealous about this whole thing and should probably back off. I have no problem taking care of a sick kid unrestrained and it isn't because I'm lazy. I'm not wasting time putting a kid who is sick in a pedi-immobilizer just "in case" we get in a wreck on the way to the hospital.

Even the cot on the ambulance will come off if they vehicle flips, they are not designed to stay in place.


There is really no safe place in the back of an ambulance for anyone in a wreck.

 

[chimichanga]

Not talking about codes or C-spine immob.

Parents call 911 for a fever...Kiddo is laughing and standing on the gurney as they wheel in - LAZY medic

interfacility transport 5 miles down the road, medic puts lap belt around mom (not kiddo), mom holding kiddo - LAZY medic


I transported vented kids on gtts x 1 year in Phx...ALWAYS used a Pedi- mate...even for 2 minute transports...

To be fair, I am speaking mainly of BLS transports...LOTS of time to do the right thing...I would tend to agree w/ you in emergent cases...Though when I ran on adults code 3, found whatever emergent case, they are always safely secured...we wouldn't think of not strapping an adult securely to the gurney...


"There is really no safe place in the back of an ambulance for anyone in a wreck." - This logic holds no water then...Why strap anyone in? And why waste time strapping your monitor to the bench seat - Let's let it fly around w/ our patient...

If I had a dime evrytime we went over a pothole and I flew up off my seat...That's not a wreck...

 

[chimichanga]

I suspect that the lawmakers that passed the mandatory seatbelt laws and carseat laws were accused of being over zealous as well...

Ever seen a kiddo in the trauma room after being bounced around the back of an ambo?

I have - DOA

Oh BTW, mom was strapped down (holding her son) and walked away from the ambo accident...

Yea, that was a great day for EMS