Ambulance crash

[Brigala]

http://koin.com/2014/04/21/ambulance-crashes-transporting-3-year-old/

This just got me thinking about how many of us aren't quite sure what the proper way to transport a (non-critical) child in an ambulance is. Obviously if the child is in really bad shape, restraint is secondary to just keeping the child breathing en route to the hospital. But how many of us know how to install a car seat on an ambulance gurney? This is something that even confuses a lot of techs... let alone parents who are stuck trying to figure out how to safely transport kiddo to the hospital. It's not as if ambulance rides are something most parents plan for.

Around here, a lot of our techs are AMR employees, so I'm going to make a wild guess that this child was being transported pretty safely since no additional injuries were reported at the scene of the crash.

 

[seb3244]

Glad the child is okay.

My sis is a nurse on an ambulance and after visiting her in Seattle in feb with my then 19 month old dd who was rf in her britax advocate she told her boss they need car seats for the ambulance and went out and bought some convertible car seats that are good from NB to 40lbs rf and 65lb ff.

She even told me that a mother was very excited that they had a car seat for her tiny 8 month old & the mother told her to thank me for educating them on car seat safety

I feel pretty great about this!

 

[seb3244]

http://koin.com/2014/04/21/ambulance-crashes-transporting-3-year-old/ This just got me thinking about how many of us aren't quite sure what the proper way to transport a (non-critical) child in an ambulance is. Obviously if the child is in really bad shape, restraint is secondary to just keeping the child breathing en route to the hospital. But how many of us know how to install a car seat on an ambulance gurney? This is something that even confuses a lot of techs... let alone parents who are stuck trying to figure out how to safely transport kiddo to the hospital. It's not as if ambulance rides are something most parents plan for. Around here, a lot of our techs are AMR employees, so I'm going to make a wild guess that this child was being transported pretty safely since no additional injuries were reported at the scene of the crash.

Also I am not sure how to strap a car seat in an ambulance

 

[Dillipop]

Also I am not sure how to strap a car seat in an ambulance

From previous threads, you attach it to the rearfacing gurney, using both belt paths with the back of the car seat aling the back if the gurney. So installed forward facing in the gurney, but since the gurney is rearfacing, all children are rearfacing. You need a convertible seat with 2 belt paths to make it secure.

 

[abigaylebelle]

Poor little guy to fall out a window and then get in an ambulance crash. I'd guess he was strapped in somehow since he didn't sustain any additional injuries thank goodness.

When my dd was 12 months she broke her arm. She used her own convertible carseat rear facing in the ambulance.

 

[Brigala]

Interesting... they've updated the story and they talked to Lucie Drum of AMR. She is one of the prominent CPSTIs in our area. I bet we'll be hearing more about this crash in the CPS circles... if I hear anything interesting to pass on I'll let people know.

 

[bubbaray]

My DD2 rode in her first ambulance at almost 12m (for severe anaphylaxis). Transport was via specialized infant transport ambulance (2 ambulances and a fire truck responded). They installed her MA on the gurney. She was barely conscious and had O2 and IV. That ride was lights and sirens to ER

Her second ride was at age 3 for a HI after a bike fall. Regular ambulance and they used a harness that looked similar to a CARES harness, installed on the gurney. Transport to ER was via regular speeds.

Honestly in the first case, they could have transported her any way they wanted, we were told later that it was lucky she didn't die that night. In the second, they has time as her condition wasn't critical.

 

[Brigala]

What scary experiences, Melissa.

My only kid-transport was with a 4th grader, and it was non-critical transport from one hospital to another over ice and snow with chains. We had taken him to the ER in the first place without calling an ambulance because with the road conditions it would have taken twice as long for the ambulance to crawl to our house; so we loaded up in the 4wd and headed for the nearest ER.

And yeah, when they have to work to keep the child alive until they get to the ER, sometimes you just do whatever you have to do and hope nobody hits you.

Now that the article has been updated, it sounds like the child in question was NOT in a critical condition from the fall; sounds more like transport was a precaution. And I suspect they took the time to transport him in a restraint.

 

[jjordan]

My ds was transported in an ambulance just after his 4th birthday with a broken arm. He was strapped onto the gurney just using the gurney straps. I'm not sure we would have been able to get his arm into a car seat strap... His arm was all bent out of shape (I think they call it a displaced fracture?). Meanwhile, me and two paramedics were riding in the back and I don't recall if we had anything to strap us in. One of the paramedics was regularly taking vital signs so if he *had* been strapped in, he wouldn't have been able to reach ds to do the vital signs, so at least he was unsecured for portions of the trip.

All that to say - I suspect there is probably a lot of ignorance (in the CPS community and in the paramedic community) about best practice when transporting in an ambulance. I guess that since they rarely get into crashes, it usually works out just fine, which is great on the one hand, but on the other hand it would be nice if there was more attention paid to the issue.

 

[bubbaray]

This is what the restraint looked like that the crew used in DDs second ride.

http://www.lifenetems.org/EMSNews/preview.aspx?id=150

It was burgundy. I don't know how they set it up because they had it installed by the time we got her to the gurney.

 

[jaemom]

My ods rode in an ambulance twice foe seizures ( he started turning blue from extended seizing) once age 3 and once age 2. Both times they strapped our convertible car seat to the gurney and he rode rear facing. YDS was 9 months, and it was after a car accident. We/they never removed him from the infant bucket. They strapped that right onto the gurney also.

 

[kathysr98]

Dd was transported by ambulance once at 12m. It was a hospital transfer, and a 110 mile trip. We were at normal speeds except for a while when the driver sped up to make up for being late leaving. Dd rode in her Recaro convertible, installed on the gurney with two straps, one in each belt path. I was in a lap belt on a side facing bench and the paramedic was in a rear facing seat with a three point belt. Dd slept the entire trip and had no need for monitoring. (We were sent by ambulance because the pediatric hospitalist at the first hospital is an idiot.) I had a nice talk with the paramedic & learned the difference between a paramedic and EMT, and prayed a lot. Thankfully dd's illness was figured out in a few days and we drove ourselves home.

 

[jacqui276]

From previous threads, you attach it to the rearfacing gurney, using both belt paths with the back of the car seat aling the back if the gurney. So installed forward facing in the gurney, but since the gurney is rearfacing, all children are rearfacing. You need a convertible seat with 2 belt paths to make it secure.

This is how I find that most of our paramedics/EMTs buckle convertible car seats in. I've had to help with a few and this is how I've always done it (glad that it is apparently right). Thankfully probably 95% of the kids we get via ambulance come in their car seats (the paramedics are supposed to get the parents to pull their seats out of their car for the trip unless it is absolutely emergent and there is no time to do so).

Is there a proper way to install infant seats? Can infant seats be installed properly? I've also assisted in a fair number of infant seat installations on a gurney when kids are being transported out to other sites. We always install them so that they are "forward facing" on the gurney but end up rear-facing in the ambulance, threading the belt throw the belt guides and using lock offs if they have them. Is there a right or wrong way to be putting these ones in? A lot of the little ones that we transport to another site are less than a month old (since the peds unit at the other site largely takes this population) so they almost always come with infant seats. It's nice though, when booking transport, they ALWAYS ask if the baby/child has a car seat!

 

[Suzibeck]

An ambulance near here slid off the road in snow and ice this winter. I was pleased to hear the toddler on board was restrained in a rearfacing seat. No one was injured, thankfully. I have been lucky enough to never need an ambulance transport for one of my kids.

 

[CTPDMom]

This graphic might help those of you needing a visual for proper install on an ambulance cot/stretcher.



Also, the link provided above with the restraint used...it's called a PediMate. It's the most popular ambulance specific child restraint used around here, it only goes to 40lbs though.

My preference for ambulance specific child restraints is the Safe Guard Transport. It has a much larger weight range, up to 100lbs. It is less bulky than storing a convertible car seat, and is better for rapid changes in patient status...it can go from sitting up to laying down flat in second.

http://www.imminet.com/products/safeguard-transport/

(I have taught the 'Safe Transportation of Children in Ambulances' several times now. It's always eye-opening for the EMTs and Paramedics!)

 

[Dillipop]

Is there a proper way to install infant seats? Can infant seats be installed properly? I've also assisted in a fair number of infant seat installations on a gurney when kids are being transported out to other sites. We always install them so that they are "forward facing" on the gurney but end up rear-facing in the ambulance, threading the belt throw the belt guides and using lock offs if they have them. Is there a right or wrong way to be putting these ones in? A lot of the little ones that we transport to another site are less than a month old (since the peds unit at the other site largely takes this population) so they almost always come with infant seats. It's nice though, when booking transport, they ALWAYS ask if the baby/child has a car seat!

I don't think there is a way to safely install an infant seat. You really need the 2 belt paths that the convertible has to install it on the gurney.

 

[CTPDMom]

I don't think there is a way to safely install an infant seat. You really need the 2 belt paths that the convertible has to install it on the gurney.

This is true. And what the 'official' curriculum says (the safe transportation in ambulances one).

However, sometimes we have to make tough choices since not all ambulances carry something to properly restrain a child.

If I had an infant carrier that allowed for baseless install, I'd use it on the stretcher in a heartbeat for my own child. I'd put the carrier facing the rear of the ambulance, with the head of the stretcher up for support and the belly strap across it (as you would for a baseless install in the car). Then put the handle in the B/C position (up near the head) and loop the chest strap through it for additional support. FOR ME, this would be a better choice than no seat at all.

 

[jacqui276]

This is true. And what the 'official' curriculum says (the safe transportation in ambulances one). However, sometimes we have to make tough choices since not all ambulances carry something to properly restrain a child. If I had an infant carrier that allowed for baseless install, I'd use it on the stretcher in a heartbeat for my own child. I'd put the carrier facing the rear of the ambulance, with the head of the stretcher up for support and the belly strap across it (as you would for a baseless install in the car). Then put the handle in the B/C position (up near the head) and loop the chest strap through it for additional support. FOR ME, this would be a better choice than no seat at all.

That's essentially what we do. I've never seen our ambulances have any sort of child restraint and when I'm sending a 5lbs baby out to another site, the infant seat is definitely a better choice than nothing at all.

 

[jaemom]

This is true. And what the 'official' curriculum says (the safe transportation in ambulances one).

However, sometimes we have to make tough choices since not all ambulances carry something to properly restrain a child.

If I had an infant carrier that allowed for baseless install, I'd use it on the stretcher in a heartbeat for my own child. I'd put the carrier facing the rear of the ambulance, with the head of the stretcher up for support and the belly strap across it (as you would for a baseless install in the car). Then put the handle in the B/C position (up near the head) and loop the chest strap through it for additional support. FOR ME, this would be a better choice than no seat at all.

That is how ours was installed, except it was FP with a shoulder style carry strap instead of a handle.

 

[unityco]

DD was transferred loose in an incubator (non-emergent transfer to a step-down nursery.) I've seen other babies arrive here in similar circumstances at least velcroed into their incubators. Our trip wasn't long.