Ambulance car seat misuse (long)

I am so irritated. You would Think that an ambulance company would know how to safely transport clients and children....I am a case manager for children in psychiatric hospitals and residentials. I had to go with one of my "kids" (14 yo) to the other side of the state for an interview with a residential placement. My boss would not allow me to drive myself with a coworker, but decided we would pay for an ambulance transport instead, as he was worried about liability if anything had happened. We got an ambulance van to transport us. In the van there was one half of a bench type seat, no headrests and the rest of the van had the seats removed... I suppose to transport those in wheelchairs. The bench was directly behind the driver. There was literally 5 inches of leg space as the driver's seat was so far back. There was one shoulder/lap belt by the window. The shoulder belt was being used to keep a wheelchair that was behind the bench from moving around in the van. It was wrapped around this folded up wheelchair, so it couldn't be used. That left one lap belt for my client to ride in. She was unable to sit strait forward due to no leg room, so she sat kind of sideways. I just imagined a crash and her flying into the drivers seat face first....
So, there was a convertible car seat in the back also. It was a 1997 Overhead Shield Touriva!!!! No stickers on it anywhere.. The only way I knew the year was because on the harness it has a tag that said 1997. The harness was twisted and routed through the un-reinforced middle slots (I am sure they use it forward facing that way). I could not believe it.
I was asking the driver how they transport little kids... He said "well a lot of them are scared and so we just tell the parents to hold them on their laps!!!"
WOW, how clueless. I am definately calling the ambulance company tomorrow. I am trying to figure out how to present it all and offer my help in selecting new seats to use. The driver says they have 10-12 vans like the one we were in that they use...
My Boss was worried about liability in her driving with me!! At least she would have been in a shoulder/lap belt! I can't even believe it.

That's horrible! I know AJ needed to go to another hospital when he was 4 mos old and I just sat on the gurney and they strapped him in the seatbelt on my lap. It was scary and had I been thinking, I would've asked to take him myself to the hospital since he had no IVs (they had come out) and he didn't really needed monitored, just needed a pediatric unit.

I have to call the company today. I hope they are receptive to listening to my concerns. Do you think I am overreacting? I would have felt much safer just driving her myself, as I know she would at least be buckled safely then...

I would've been bothered too. I thought the purpose of riding in an ambulance was to arrive safely?? On a side note, we rode in an ambulance once, because my son had RSV and was on oxygen during the transport. I brought his car seat, but they nowhere to put it, so they had me lay down on the gurney with him on my chest.

I'd be upset too!

Wow.... I wish we could've had more time to cover emergency rescue carseat stuff in my class -- I remember the guy next to me was an EMT & he said they have "inflatable" carseats for kids & the only space to use them are on the RF flip down seats.... The only other thing I remember is that they're supposed to call for another vehicle to safely transport uninjurred kids -- is this only NY

No, they said that in my class too. Only people who are too injured to ride safely in a car should be in an ambulance (or have IVs, etc).

The ambulance I was in was a van transport. It was driven by a EMT, but that is where the "ambulance" part of it ended. The company who also has regular ambulances is used to transport psychiatric patients between hospitals and residentials. I was very concerned that these vans they are using, don't have headrests, have expired car seats which are overhead shield seats to use for transporting the children, the straps are routed all wrong, and there was only a lap belt for the psychiatric passenger to ride in. The lap shoulder belt that could have been used was being used as a "bungie" to tie down a wheel chair that was placed behind the passenger seat. I know there are issues with how to transport medical patients. I don't know why this company was so unsafe about how it transports it psychiatric patients... I am going to call on Monday, I want to make sure I come off right and today was a horrible day... so I know I would have sounded too *****y had I tried to call today. Anyone have suggestions on how to approach them regarding the above mentioned problems? I was thinking of introducing myself and complimenting the driver we had, as he was very nice and pleasant. I want to tell them that I am a CPST, and I noticed a few things while on the transport about the child safety seat the van I was in had, and the lack of a shoulder belt for the 14 yo we were with to use... I don't know.. I really don't want to be blown off, but also don't want to come off the wrong way. Any advice???

My neice has been transported to DuPont in De. DuPont is a TOP childrens hospital. When she first started going she was still in the baby bucket. It was a graco snugride. They put her in the carseat, the carseat on the gurney and then they strapped her carseat to the gurney.

I also have a cousin who is an EMT...and we live in a rural area....For when kids are no longer in a bucket. They have some kind of positioning device they use to secure them.

Susan

I would call them and explain to them you are not only an employee of wherever and that you have to use these vehicles for transporting patients, but that you are also a CPST and mention your concerns. I would also talk to your employer as well and explain the situation and how much of a liability it is to have their patients riding around unsafely.

Ambulances are one of the least safe ways to transport anyone. Never ride in an ambulance unless you need the life support systems they have. I work with many EMT's who have themselves been injured in an ambulance while working on a patient. The inflatable carseat? It doesn't meet FMVSS safety standards. I don't think the ambulance did anything wrong here (with the exception of the too old, twisty seat); that's pretty much the norm for ambulance transport. Most ambulances don't have a suitable space to install a carseat. Most of the seats face the side. Some of the never ambulances have a designated spot for carseats, but they are the exception right now.

It is a pretty bad way to transport uninjured children. I hope you and your boss can figure out a better way to transport physically uninjured children in the future.

Jen, that is awful. I would definitely call and let someone know your concerns. Hopefully, they will being willing and able to make some changes.

Working for an ambulance service, I feel that I have to stick up for the profession in general. Making blanket statements about ambulances being unsafe is very unfair as safety practices vary greatly from service to service. At our service, we pride ourselves on being very safety conscious. We actually do have a carseat for transporting uninjured children. The truth of the matter is that many ambulance services are very, very underfunded (luckily ours is not one of them). Many services have very old ambulances with very improper restraint systems. It is quite sad to think of how much money the government spends on items that are far less important than lifesaving equipment. But that is a whole other topic and board!!

My son and I rode in an ambulance in February (he was okay, but under watch for a repeat anaphylactic reaction). He is 3 1/2.

He and I both sat on the side-ways facing bench seat with only lap belts.

At the time, under the circumstances, it didn't occur to me to worry about it. Now, it seems very unsafe !

I'm not trying to make unfounded blanket statements about ambulances being unsafe. I'm just echoing what is in the curriculum. Ambulances are crucial to transporting people who are seriously injured or ill. At that point, one needs the services an ambulance provides. My point is that if you have someone uninjured they shouldn't ride in an ambulance.

There are real trade offs with safety in ambulances. There is a lot of equipment and other stuff you don't have in a car. If you need it, you need it. If you don't need it, you should consider another means of transportation. The safety of children riding in ambulances has been questioned for years. Ambulances often don't have an appropriate seating area for a child in a car seat. If the child is uninjured, call someone else for transport. Some of the newer ambulances do a designated spot for child restraints.

Ambulances are enormously expensive. They don't have a high turnover rate which means they may not have the latest safety equipment. I work for fire & rescue in my county and I am very proud of the ambulance services the county provides. They do an extraordinary job, often in difficult circumstances.

My point, which apparently was missed, was that ambulances are not the safety cocoons many people think of them as. They come with equipment critically ill and injured people need. But there are overall tradeoffs in terms of riding safely in the vehicle. Ask any of the EMT's I work with, most of them have been hit by something in the vehicle while the ambulance was going lights and sirens.

As a full-time Paramedic I feel the need to reply.

First and formost, the "ambulance" you described is in no way, shape or form an "ambulance". It sounds like it is used to do non-emergency, barely medically necessary people between facilities, to doctor's appts, etc. I would absolutely complain to the company about the lack of sufficient restraints and the old carseat. But I would also speak with your employer about their transport methods. I understand the liability of you transporting completely, but I don't think they are using the best mode available. We do psychiatric facility transfers and those patients go on a real ambulance where they are strapped onto the gurney using leg straps, hip straps and shoulder harness with chest clip in place.

I have to agree with one of the other posters, ambulances in general are NOT safe modes of transportation and shouldn't be used unless medically necesarry. I don't care how safety-conscious a particular company is, ambulance themselves just are not that safe. Yes some of the newer models actually come in with those built-in carseats (like in some of the vans, where the back of the seat folds down to reveal a carseat), but these ambulances are very new and very expensive and you're just not going to see that many of them for a while.

But, when I work, if I need to transport a pediatric patient, I always ask the parents to retrieve the patient's own carseat and I secure it to the gurney in our ambulance. Unfortunately my company does not provide carseats for transport use because it's assumed the patient will have their own and carseats are too expensive and there is nowhere on the ambulance to store them when not in use. So in the rare instance that there is not a carseat available then the patient gets secured to the gurney like an adult does, with the shoulder harness w/chest clip and at least one other strap lower (2 if the patient is tall enough). I NEVER allow the parent to sit on the gurney and hold the child. And honestly, I almost never allow a parent or family member of any patient sit in the back unless I have to because the seatbelts just aren't safe enough (only lap belts) so I make them sit in the front passenger seat where there is a lap/shoulder belt and an airbag.

Unfortunately I am not the norm when it comes to this issue. Many EMTs will allow the parent to sit on the gurney and hold the child, despite it being against company policy, because it's easier and many times because the parent is so worried about their child being scared that they insist and the EMT does it. (Frankly, I'd rather my son be scared and safe than not scared and dead when he gets thrown from my arms in an accident.) Being as I have been doing this a few years now I have very little problem with walking up to a crew that I see do this and explaining to them why they shouldn't do that again and what to do next time, but that doesn't mean they'll do it.

This is a serious issue, but nobody has pressed it, so nothing will be done about it. Maybe if you make a big enough stink about it with that company (and maybe even offer to teach them what to do and what not to do) it'll change.

Good luck.

Emily,

I certainly wasn't targeting anyone in my post. You are absolutely right!! Ambulances are for emergencies only...they are not a taxi. If only we could get that point across. Yes, ambulances are not generally known to be safety cocoons. There are ambulance accidents quite frequently. Many EMT's forget that they must follow all traffic laws even with their lights and sirens on. I just don't want people to feel as though they shouldn't call an ambulance because they have a better chance of making it to the hospital safely in their own vehicle. Our service has never had so much as a fender bender in its almost 40 year history.

I really hope that you didn't feel that I was attacking you, as that was not my intent. I just wanted to add additional info for anyone that might have been curious about why some ambulance services don't have the latest and greatest. Our service replaces its primary ambulance every two years. We have great funding from the residents that we serve but that is absolutely not the norm.

PP (rachel),

I have to disagree only with one line in your post. "I don't care how safety-conscious a particular company is, ambulance themselves just are not that safe." Yes, being in the back of an ambulance isn't that safe if you get into an accident because many medics aren't even belted in to begin with (the patient should be though). However, I find the first part to be a little harsh. How about if our service has never been in an accident? I would say that the safety policy of a company makes a big difference. With Fail Safe, all aspects of an employees driving habits are tracked. Any driver that takes corners too fast or accelerates too fast (just a couple of examples) are eliminated from the service. There is zero tolerance at our service for drivers that think they own the road. Just like cars and boats (for example), you are only as safe as your driver. Many ambulance accidents happen because the ambulance going lights and sirens fails to yield the right of way to another vehicle. I am not debating that if the ambulance gets into an accident the people in back are far more likely to be injured than if they were belted into the front compartment. However, from all the studies I have read, the patients properly restrained on the cot are actually quite unlikely to be hurt. That is why I believe that it does make a difference with regards to each services individual safety policy. If we have a properly restrained child in a car seat, the likelihood of that child being injured is less than another service that has the child sitting with mom or dad on the bench seat in a lap belt. Our service also frowns upon parents (or any family members) riding in the back at all. You are totally right...they are much safer up front.

There are still many services out there that use an ambulance like "clown cars". And there are still a lot of people that will take an ambulance after being in a car accident because they have a bump or bruise. Another service in our area picked up six people with very minor injuries from a car accident. They used one ambulance to transport all of those people. One on the cot and five others sitting in lap belt only seats. That is completely ridiculous!! But whose fault is that...the patient for not realizing that they would be feeling sore but did not need to ride by ambulance. Or the service for wanting to save money and keep their other cars in service. If that ambulance would have gotten in an accident, those people probably would have been wishing they would have gone home and taken some Motrin.

But that is just my own opinion. You made very good points. Thanks for sharing your perspective. If all services employed people like you that are actually thinking about safety and looking out for your patients, that would help the problem. You are completely right about this being a serious issue.

I will try to talk to them tomorrow, I was really busy at work today and didn't have the time. I know that it wasn't a real ambulance in the sense of the word, It is a ambulance Van used for transport only. The patients in it are psychiatric patients, not sick or injured patients. I was appauled that a company that should know something about safety in transporting people would be so clueless. I will call and suggest they not use the only shoulder/ lap belt to restrain a wheelchair, instead of it being able to be used by the client that needs it. I will also see if they will consider getting up to date seats and offer to help them with that.
Thanks for the info everyone, sorry it turned into a debate. I will let you know how they respond when I get a chance to call them, hopefully tomorrow.. if anyone is interested. Thanks