Child Safety Seats and the Emergency Responder

As you and your partner stop at a red light, you notice two children in the vehicle next to you--the youngest being held by an adult in the front seat. As you pull away, you discuss how dangerous this is and wonder, if the general public could see what you see, would they do things differently?

Yet, we do the same thing when we have a pediatric patient. We don't want the child to cry or be scared, so we transport them with a parent/caregiver holding them on the stretcher!

This practice needs to stop. According to statistics, ambulance crashes result in an estimated 50 fatalities per year; the injury rates are 60-fold higher. If you get in a crash or make a sudden unexpected move, a child is at risk of being thrown from the arms of whoever is holding him.

Ambulance crash-testing was first started three years ago. Using a convertible car seat (one that can be used either rear- or front-facing), two stretcher straps were attached to the two belt paths and the harness was put in the correct position. After the ambulance was crashed at 34 mph, the car seat and child dummy were both found in approximately the same position, although a fluorescent light fixture had separated and struck the child's head during the test.

So, what can we do to protect our smallest cargo and ourselves? First and foremost, use your seat belts, positioning the lap belt low over your hips, and secure any loose objects (monitors, O2 cylinders, kits). Always use a child restraint device when transporting a child--either the child's car seat or one that is made specifically for ambulance use. The stretcher straps will probably not hold a child on the stretcher during a crash (since children are so small, usually only one strap secures the child to the stretcher). Learn about the different types of car seats and how to use them. Never allow anyone to hold the child on the stretcher for transport. If your service does not already have existing policies on transporting children, now is the time to create them!

Here are some other tips to follow when transporting children:

• Don't use side-facing seats. Car seats are crash-tested in a forward position, so we are not sure how they will hold up in the side-facing position.
• You cannot use a belt-positioning booster seat in the back unless you have lap/shoulder belts.
• When putting the seat in a rear-facing position, raise the head of the stretcher to an upright position and secure the seat with the stretcher straps: one strap for an infant seat and two straps for a convertible type. If the child is in a high-back booster with a harness, raise the head of the stretcher to the upright position and use the stretcher strap to secure. With either the infant seat or the booster seat, you could also use the captain's seat.
• Be sure the harness is tight. No more than two fingers should fit under the harness at the shoulder. The retainer clip (plastic clip that holds the harness together) should be at armpit level.
• If the child is a rider, not a patient, he/she could ride up front, but remember to turn off the airbag and use a car seat! If possible, the child should go with an alternate source.
• Learn how to secure the seat in the ambulance. To do this, you will need to be familiar with your seat belts and the type of retractors they have. The seat should not move more than an inch in any direction. Once you learn how to do this, it does not take long!

If you work a car crash involving children, do not assume they are OK because they were in a car seat. (The same goes for adults wearing a seat belt.) More than 90% of car seats are installed incorrectly! The smallest error in car seat use could mean the difference between life or death for a child.

Remember, we should set an example for others. If you are not already involved with injury prevention, get involved now! A good place to start is with a child passenger safety tech class. This 32-hour class will teach you how to use a car seat correctly and what to look for when you respond to a crash with children involved. This is a great way to serve your community. To find a class near you, visit www.nhtsa.dot.gov.

Bibliography

• Levick N. Biomechanics of the patient compartment of ambulance vehicles under crash conditions: Testing countermeasures to mitigate injury. SAE Technical Paper Series 2001-01-1173.