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  1. #1
    CPS Technician CPS_obsessed_EMT's Avatar
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    Carseat for an Ambulance?

    Recently our ambulance service was part of the rescue on a large multi-vehicle pile-up on interstate. Our rig was assigned 3 "yellow tags"- 2 adults and a 2 yr old. The 2 yr old's carseat had been damaged beyond re-use in the ambulance (and his mom had taken him out of his carseat right away anyway, otherwise normally we keep kids in their seats and immobilize them that way) So anyway, the child was put into a carseat that the ambulance stores on hand for when we transport a child (if their parent is being treated, etc)

    Well, when the child was brought into the ER, and we told the ER doc that we had moved the child from his seat to our seat, he took one look at our seat and said "Throw that thing in the garbage and get one without the death bar on it!" (the OHS....lol)

    I was so happy he said that. I hated that we carried an OHS seat, but being we hardly ever transport children and this is a rural ambulance squad with extremely limited funds, I knew there was no way I myself would talk them into getting something different.

    So anyway, when this was brought up at the squad meeting, I volunteered to bring the OHS into BRU for the Trade-In thing and get a new one. When they asked how much it would be...I told them around $40 (knowing how limited our funds are and this would be a rarely used thing, I wasn't going to tell them $150 or something like that)


    Anyway, is it the consensus to go with a Scenera? It has to be fairly cheap, and also not big and bulky because we have limited space on the rig.
    But, I'd also like to know if there are any other ideas. This is honestly something I've never thought about.
    Most of the EMTs are completely clueless about carseats, and could probably figure out how to strap it in with a seatbelt and buckle the straps...and that's it.

    I'm thinking a Scenera is going to be the best bet....but does anyone have any info about like, which seat in an ambulance is the best to install a carseat on? None of the seats are "allowable". They are either side facing bench seats, or a rearfacing captain chair. I'm assuming just strap it into the rearfacing captain (so like, how a FFing install would be, except the entire thing is facing the rear)
    and also, am I right to assume to set the harness straps on the tallest setting do you think? (since I'm not going to expect everyone else to know how to adjust the strap height when I'm not there) I think I'd rather have the straps too high on say, a 2 yr old than way too low of straps on a 4 yr old. Usually if it's a baby we are transporting, they have their infant carrier along so we'd be using that for the tiny babies.

    Sorry for how clueless I sound....carseat use on an ambulance is kind of new territory for me. I've "installed" infant seats for babies onto the cot itself (when the infant is the actual patient) but until recently I've never come across having to transport a between 1-5 yr old not on the cot.

    If there are any other EMTs out there, I'd love to know how you handle this issue on your squad!

    Thanks!

    Oh, and I'm going to BRU tomorrow with the new seat, I should have posted sooner but I had just assumed to "at least get a 5 pt seat" and hadn't thought more deeply into it until now. (But even after I buy the seat, I'd still like input about this particular issue afterwards)





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  3. #2
    CPS Technician mamajava's Avatar
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    Re: Carseat for an Ambulance?

    When we were in our very bad rollover 4 times accident, my daughter was in a OHS in our truck. I swear by that seat...lol...just cause she came out without a bruise on her and LAUGHING! Anyways, when they put her in the ambulance, they had a Scenera. They hooked it to a box that was right above my head with the Lower Anchors! I dunno what it was, but they said thats where they have to put the carseat! Only bad part about it, my daughter saw me at my worse and screaming and them poking me! She was only 15 months old, but she still asks about it!

    Sorry can't be much help...but just thought I would tune in and say that I have seen alot of Scenera's in ambulances! Heck, I bought one for the ambulance thats in the town where I grew up! They responded on the call also along with 3 other ambulances and they were gonna take my daugher...I said absolutely NOT!!! They had a 1979 Fisher Price seat that had the t-bar (don't know exactly what its called, but I am sure most will know)! But then come to find out...they gave it to my parents to use to take my daughter home! UGHH!!!

    Bella: 3/17/05, 110lbs, 5 stepping!!
    Miley: 7/17/08, 70lbs, Diono Cambria
    Baby Levi: 3/15/16, Nuna Pipa

  4. #3
    Admin - CPST Instructor wendytthomas's Avatar
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    Re: Carseat for an Ambulance?

    A Scenera will be fine. When I was riding we carried backless boosters (with no shoulder belts in the back). We never used it.

    I've also heard of inflatable seats for ambulances, but I don't know if they're FMVSS213 compliant or not, and I'd be willing to be they're far more than $40.

    Course, we also had a volunteer rural squad and a multivehicle collision would get a TON of people out of bed. We're talking five or six to a rig. And we had three rigs. So we'd rarely take more than one person, since there were a dozen other squad members sitting around doing nothing. hehe Course, I don't think we ever had so many as to triage them to colors.

    Wendy
    wendy, cpst-i mom to
    piper, 7/26/02, 62", 108#, seatbelt, driving her own car
    laine 9/16/09, 54", 96#, Nuna Aaces, Diono Solana 2
    in my husband's 2018 Toyota Land Cruiser, my 2017 Volvo XC90, and big sister's 2016 Honda Civic
    https://www.car-seat.org/image.php?type=sigpic&userid=1353&dateline=1552329  785

  5. #4
    Senior Community Member KaysKidz's Avatar
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    Re: Carseat for an Ambulance?

    When they transported my DFS...the used my seat (not in a wreck) and strapped the seat w/him in it right onto the gurny.
    Kay... Former CPST, Working Mom to SIX!
    27, 26, 20, 9, 9 and 7!
    'Grammy' to Sophia, Kyra,...and Elijah James

  6. #5
    CPS Technician CPS_obsessed_EMT's Avatar
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    Re: Carseat for an Ambulance?

    Quote Originally Posted by wendytthomas View Post
    A Scenera will be fine. When I was riding we carried backless boosters (with no shoulder belts in the back). We never used it.

    I've also heard of inflatable seats for ambulances, but I don't know if they're FMVSS213 compliant or not, and I'd be willing to be they're far more than $40.

    Course, we also had a volunteer rural squad and a multivehicle collision would get a TON of people out of bed. We're talking five or six to a rig. And we had three rigs. So we'd rarely take more than one person, since there were a dozen other squad members sitting around doing nothing. hehe Course, I don't think we ever had so many as to triage them to colors.

    Wendy
    The inflatable ones are not FMVSS compliant, unfortunately.

    We are a very small squad, we only have one rig. This accident was actually way out of our service area, but since it was a MCI (ok maybe not mass casualty, mass injury though) there were about 5 different services called out to it. And yea, there were about 5 EMTs packed into that rig We really had not much information on the wreck(s), so even though it was crowded, it was decided to all go in case the resources were needed.





  7. #6
    CPS Technician CPS_obsessed_EMT's Avatar
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    Re: Carseat for an Ambulance?

    Quote Originally Posted by KaysKidz View Post
    When they transported my DFS...the used my seat (not in a wreck) and strapped the seat w/him in it right onto the gurny.
    That's what would normally happen, if the child was the patient. The child would either get strapped right to the cot, or they would be in their carseat and the carseat strapped to the cot.

    However, in this situation, there were 2 adults in backboards also being transported. One had to go on the cot and the other on the bench seat.

    And also, we need a carseat not only for a child patient, but for when the parent is the patient (thus taking up the cot) and the child has to ride along with us (and their own seat isn't readily available)


    How do you guys feel about putting a non-patient child up in the front passenger seat, front facing in a Scenera 5pt even though there is an airbag there? Is a harnessed child in a "proper" seat that has an airbag safer or less safe than putting them in the back, on a side facing bench seat or rearfacing captain seat? The RFing captain chair might not even be an option....if the patient is critical and needs to be ventilated, an EMT will need to sit in that seat. And also, if the parent is very badly injured I don't know if I'd want the kid back there sitting so close and facing their injured parent....





  8. #7
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    Re: Carseat for an Ambulance?

    I would not recommend a Scenera. There is no where in the back of an ambulance that it can be safely or properly secured. You can't put it on the stretcher. You can't put it on the side bench. The only seat that MIGHT have a seatbelt that works with a child restraint is a rear facing jump seat.

    A traditional child restraint is not an appropriate choice for ambulance transport.

    It's been a few years since I've worked at a (full-time, professional) service, so I know the technology has improved.

    However, there are multiple systems designed by various transport systems including IMMI that are meant to safely restrain a child passenger to a stretcher.

    Depending on your state regs, your ambulance may be operating outside service provider protocol (and thus illegally) if you don't have an appropriate child restraint. That means a restraint that can be correctly fitted to the patient stretcher.

    My recommendation is to call the nearest full-time, professional service and ask what system they recommend, then go from there.

    Edited to add: I see you're also looking for something when you're simply transporting the child. Your jump seat needs to come with a modified pull-down restraint attaching directly to the seat and not required to be strapped into the belt.

  9. #8
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    Re: Carseat for an Ambulance?

    Quote Originally Posted by CPS_obsessed_EMT View Post
    The inflatable ones are not FMVSS compliant, unfortunately.

    We are a very small squad, we only have one rig. This accident was actually way out of our service area, but since it was a MCI (ok maybe not mass casualty, mass injury though) there were about 5 different services called out to it. And yea, there were about 5 EMTs packed into that rig We really had not much information on the wreck(s), so even though it was crowded, it was decided to all go in case the resources were needed.
    Hello!
    I am not an EMT but my almost 2 year old son was taken to the hospital this past fall the day before his birthday (October 09) in an ambulance and I had also just taken him out of our car so that I could wave down the ambulance. They didn't have any car seats in the ambulance they had him on the bed (with wheels, I am not sure what it's called) and had the back raised. They added a harness attachment to it (the kind I see some people use with their boosters) and he rode facing the back of the vehicle (raising hell of course because he couldn't see me since the only other chair with a seat belt was behind him, also rear facing).
    HTH!!!

  10. #9
    Admin - CPST Instructor wendytthomas's Avatar
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    Re: Carseat for an Ambulance?

    Six of one half dozen of another there. No carseat is approved for a rear facing seat or side facing seat installation. So forward facing as far back as possible in front of an airbag becomes the next best thing. But I don't know. Rear facing against instructions (forward facing on the rear facing seat) may not fail, and may end up safer. OTOH, especially if you're working and you have a bunch of stuff out, in the back may not be safe as it's full of needles, equipment, and full grown adult projectiles. OTOH, the back may be further from an impact point than a front seat is.

    The consensus in the past is that there's no good way to transport a kid in an ambulance. A five point harness on the gurney may be the best way, with the child partially upright as allowed. The first time Piper was transported she was on a backboard and on the gurney and just strapped in. The second time was a non emergency transport (they were worried about her respiration so we got a respiratory crew do a transfer to another hospital) and so they took the time to set up the five point harness on the gurney for her, and she sat more upright.

    Wendy
    wendy, cpst-i mom to
    piper, 7/26/02, 62", 108#, seatbelt, driving her own car
    laine 9/16/09, 54", 96#, Nuna Aaces, Diono Solana 2
    in my husband's 2018 Toyota Land Cruiser, my 2017 Volvo XC90, and big sister's 2016 Honda Civic
    https://www.car-seat.org/image.php?type=sigpic&userid=1353&dateline=1552329  785

  11. #10
    CPS Technician Pixels's Avatar
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    Re: Carseat for an Ambulance?

    In tech class, we had several EMTs, so they spent some time discussing child restraints in ambulances. I'm going to speak all in ideals, of course you need to adapt based on the medical needs. Assuming the child is the patient, put the gurney is sitting-up mode. Place the child restraint on the gurney, facing the back of the ambulance. Use two of the belts from the gurney through the belt path of the child restraint (convertibles, use both belt paths).

    If it's a transport-only situation (for example the parent is the patient and the child can't be left home alone), the carseat gets strapped into the seat that the EMT would be using if the EMT wasn't working on the patient. Carseat in upright mode, using FF belt path (if it's a convertible and depending on child's age, obviously a newborn can't be that upright).
    Melissa, CPST and Mom to three

  12. #11
    CPS Technician fyrfightermomma's Avatar
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    Re: Carseat for an Ambulance?

    My job was to get rid of our 1988 fisher price T shields

    We had no money so we just got two sceneras for our two rigs

    We didnt want a ferno one that attaches to the cot or anything cause what do you do if mom is the patient and needs the cot? So we just did the sceneras. Plus we had no funds for the Ferno cot ones

    It doesnt fit the best range of kids but we make it work. Since "technically" its always rear facing, we do put kids in it with their shoulders above the top slots. Plus the cot and jump seat go so far above their heads we dont worry about ramping with tall kids. We just do the best we can.

    It sucks that no matter what you are using them against the rules, but thats life. Just gotta make it as safe as you can and hope for the best

    If we had money, i'd like a ferno pedimate for the cot since you'd be following the rules wih it and then a spare actual car seat for times when the cot is used by someone else. But i guess i'd rather be employed than have nice things gotta love budget cuts!
    Last edited by fyrfightermomma; 02-05-2010 at 02:09 PM.

    E 8y 43 lbs 58" Harmony NBB
    S 7y 52 lbs 54" Harmony NBB
    J-4y 38 lbs Graco Headwise 70 Britax Roundabout 50

  13. #12
    CPS Technician fyrfightermomma's Avatar
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    Re: Carseat for an Ambulance?

    We go by the Bull report in our County. Milwaukee County Protocol (one of the largest service areas in the State of Wisconsin-composed of Milwaukee Fire Dept, I think over 10-12 regular full time fire depts and 1 paid on call dept as well as 4 private ambulance services) approves us to use "normal" child restraints in the ambulance according to this report.

    So that's what we go by
    http://www.luhs.org/depts/emsc/crash..._ambulance.pdf

    http://www.saems.com/downloads/pedsransport.pdf


    All Milwaukee County Fire depts either carry a cot version (like the Ferno pedimate) or an actual car seat. I'd say 80% carry a normal lightweight 40 lb seat. One department has a built in seat in the jump seat. These are all full time professional very busy departments. My husband's dept is the only one with a built in car seat in their jump seat on their two newer rigs. The rest of the FD's have a car seat like a Scenera or Tribute. The private ambulances use the cot versions.

    Our protocols dictate that if the child is the patient the child is secured in their own carseat or our car seat on the cot if at all possible since that's what the report tested. If you have the cot versions like inflatables or the pedimate, that is used.

    If the child is not the patient, you look for alternate transportation. If that's not possible, then the child is secured to the jump seat facing the rear with the car seat.

    The car seat is never allowed in the front seat or on the side facing seats.

    We secure the seat according to the Bull report. Back of the cot slightly reclined, one belt through the RFing path, one through the FFing path (facing the rear) and tightened. The straps go below the child's shoulders.

    On the jump seat the seat is secured facing the real through the forward facing belt path (against manufacturers instructions so that's why we try not to use the jump seat, but if we have to, we do).

    Thankfully ambulance have a decent safety record. They are big and bright and we have a very strict no lights and sirens policy for many calls (in fact, we were just part of a national study our county is currently doing regarding no longer using lights and sirens for many calls. It was in the national EMS magazine recently and is done in the East frequently and they think will soon be protocol in other areas) so that cuts down on crashes.


    Unfortuantely with budgets now a days, we have to choose carefully. Ideally all children would be transported in cot approved restraints (like the pedimate or IMMI ones) but that's not practical in most areas. So going by the Bull report (if your County protocols allow) is the next best thing. We aren't getting the cot restraints anytime soon so that's what we have to work with. So the next best is a regular child restraint used according to the Bull report on the Cot if possible and if no other choice on the jump seat (never the front or side facing seats). It's against the car seat manufacturers rules, but again, you have to do what you have to do.

    Our biggest thing we teach our firefighters is that you MUST be able to defend yourself in court if a child is injured. Strapping a child to a cot or side facing seat and there is a crash, you are gonna have a hard time justifying that in court unless they were critical. Strapping them to a rear facing car seat according to the report is a little easier to defend in court

    So first, check your county protocols. A child in a newer restraint attached to the cot according to the Bull report is safer than an ancient OHS not really attached real well during a crash, even though both are not "right." If those are your choices, those are your choices


    #1 choice-transport with parents/other person if stable
    #2 choice-cot approved restraint if you have it
    #3 choice-car seat on cot facing the rear
    #4 choice-car seat on the jump seat facing the rear
    #5 choice-child restrained on the cot only (only if critical)

    Those are the 5 choices we give our members. There are exceptions but we try to go by that. For example, in a mass casualty incident, most "rules" go out the window once you enter the START triage mode. So then children would just be transported any which way (just like you would never abandon a patient with severe injuries who was breathing 4 breaths a minute on a normal call, you'd do everything to save them. But in a mass casualty, that same patient is tagged black or grey and they are abandoned to die. Sad, but true. So in mass casualty things change. That's one exception we bring up)

    However you MUST train your personnel to use the child restraint properly and practice.

    I run the car seat training program for our firefighters so lemme know if you need to know anything else.

    E 8y 43 lbs 58" Harmony NBB
    S 7y 52 lbs 54" Harmony NBB
    J-4y 38 lbs Graco Headwise 70 Britax Roundabout 50

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  15. #13
    CPS Technician fyrfightermomma's Avatar
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    Re: Carseat for an Ambulance?

    I forgot to add why we dont allow a restraint in the front. In most ambulances the front seats dont really move back cause the wall behind you. On ours (98 ford and 08 ford chassis) once the restraint was installed in the front, the child was only about 8-10 inches from the airbag and with no top tether we decided not to allow it

    E 8y 43 lbs 58" Harmony NBB
    S 7y 52 lbs 54" Harmony NBB
    J-4y 38 lbs Graco Headwise 70 Britax Roundabout 50

  16. #14
    CPS Technician mommy-medic's Avatar
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    Re: Carseat for an Ambulance?

    The only way to 100% correctly transport a child in a car seat in an ambulance is IF the captain's seat swivels to become a FFing vehicle seat. Ours do, but not all do. Our has a built in 5 pt harness in the captains chair that harnesses to 50 lbs, so we use that when mom is the pt, (and just strap the childs car seat in an empty bench seat or CPR seat for transport for parent's to use later).

    If transporting the child and we can't use their car seat due to damage from an MVC or other trauma, we put the child on a pedi board with c-spine protection.

    We looked into this seat http://www.med-worldwide.com/respond...l-epr-96-p2444 but it's "tested" not "approved" through FMVSS213. It's also FFing only. It also only goes to 40 lbs. It's a decent idea, but just not practical, expecially at that price.

    I would look into maybe an evenflo titan? I think they run just a little more than a scenera (around $75), but it harnesses to 50 lbs and would be able to restrain a larger percentage of kids. Kmart has sceneras for $35 now though.

    Does your stretcher had shoulder straps to it? That may be the most cost effective way of safely transporting a larger or older child. (IMO kids have to be about 8 or older to have the 4 pt cot straps fit them well).

  17. #15
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    Re: Carseat for an Ambulance?

    My hubby is a volunteer firefighter/EMT. Last year his department bought Evenflo Truimph Advance seats to go in all the ambulances. They choose this seat because it fits children of different sizes well and the harness hight is easy to adjust.

    Ideally of course, they transport in the child's own carseat, but that is not always possible.
    Gena

  18. #16
    Moderator - CPST Instructor mom2acrew's Avatar
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    Re: Carseat for an Ambulance?

    A local CPS Instructor here has a course she worked on for ambulance transports, they used Sceneras/Tourivas...I don't know all the details except my DS modeled for her strapped to a stretcher

    You could try contacting her to see if she has any info?

    http://www.town.falmouth.me.us/Pages...E_Fire/carseat
    Jodi CPST Mom to 5

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