Car seats in an ambulance

[mommy-medic]

***Disclaimer- because there is NO "approved" way to secure a car seat in the back of an ambulance, this is what I do. After 8 years of trial and error this is what we have found to be the most secure.***

If the child is uninjured and NOT the patient (i.e. if you are transporting a child because the parent or caregiver has no alternative choice) then make sure you bring the child's car seat along for the ride back home, and we put them in the built in seat. Our built in seat is VERY specific that it is to be used REAR FACING only. (Our captain's chair pivots forward facing, though not all captain's chairs offer this feature).

For the sake of pictures I used a Sunshine Kids Radian. I will be editing this post later to also include a Britax Boulevard, a Graco Snugride, and either a Cosco Scenera or Evenflo Titan when those seats become available to me.

For the Radian I found it best to keep the recline boot attached. The stretcher will not sit at a complete 90 degree upright angle, and you can see from the pics that even with the boot attached the seat is VERY upright. I have simply adjusted the back of the stretcher to meet the angle of the seat (securely, not just touching).

Start by unbuclking the top two straps on the stretcher. If yours is equipped with shoulder straps, remove and secure those.

Don't ya just love the mauve sheets the hospital gives out for EMS use? (They match the seat well, lol).

I have found for whatever reason, it is easier to install the top strap first. I route this one through the forward facing belt path. Depending on the length of your straps, it may be easier to send the male end completely through the belt path, bucle it, then pull the slack back through. (opposed to sending the female end into the back of the car seat and attempting to buckle them blindly).

Repeat with the middle stretcher strap in the rear facing belt path:

Then secure both of them, removing the slack.

If your female end is long enough, it will clear the back of the car seat, like so:

If it is too short, it will be inside the belt path of the car seat somewhere, like so:

IF THIS HAPPENS, KEEP IN MIND THAT IT IS GOING TO BE EXTREMELY DIFFICULT TO UNDO. I suggest making your female end longer, especially if you have small beltpath routes as the radian does.

Personal preference here, but I carry D-ring anchors to secure here for top tether attachment (not pictured):

This is the most secure way I have found to transport an infant/toddler/small child. If a child is in their own seat they have less room to squirm around (and it's a little "familiar" to them), allowing you to apply oxygen, pulse oximetry, monitor leads, establish IV's, suction, or do other necessary interventions safely.

I am certainly open to other ideas or suggestions. Thanks.

 

[Pixels]

This is pretty much exactly the way we were taught to do it in CPST class.

The only thing I have to add is for situations when the child is not the patient and is riding in the captain's chair (if you don't have integrated seats), use the child's seat, set up in forward facing mode. No, it's not approved to be used that way, but it's better than nothing and there aren't really alternatives in certain situations. It would be preferable to find alternate transportation whenever possible.

 

[SavsMom]

My daughter got sick after Christmas and on New Years Eve had to be transferred via ambulance from the ER closest to our house to the childrens hospital (a 15 mile trip) - I was so glad when the medics installed her seat on the stretcher (not that I wouldn't have made them myself) - their stretcher only had the straps that go over your legs and the set that goes near your chest, so they installed her Boulevard with the top set of straps through the ff belt path - they did have to recline the back of the stretcher on the way to maintain some of the lines they had attached to her - but the BV was on the stretcher rock solid.....

[/IMG]

 

[jenrose]

This is so brilliant. The many times I've taken Shiny to the hospital by ambulance, no one ever suggested this, I just strapped her on me with a baby carrier on the front, and then they strapped me to the stretcher (far safer than the same arrangement would be in a car, but still awfully precarious compared to these setups. Then again, can you do this fast enough when there is a breathing emergency?

 

[TeacherAmy]

I went through this in December with DD2, who was then five weeks old. She had to be transported to the naval medical center from the emergency room at another hospital, and the EMTs strapped her infant seat right onto the stretcher. I took a picture of it with my cell phone (don't know how to get it uploaded at this point) because it was just so pitiful. (I knew that, if everything turned out all right, it would be funny someday.)

 

[agurlsride]

Wow, thats awesome. You should see some of the medics try to install car seats on their stretchers...they act like they've never touched a car seat before!

 

[Jennifer mom to my 7]

This is so brilliant. The many times I've taken Shiny to the hospital by ambulance, no one ever suggested this, I just strapped her on me with a baby carrier on the front, and then they strapped me to the stretcher (far safer than the same arrangement would be in a car, but still awfully precarious compared to these setups. Then again, can you do this fast enough when there is a breathing emergency?

If you have a crew arrive prepared for the emergency, then no problem. Remember, basically having a paramedic on board and respond is actually like bringing the ER to you in most places.

 

[iputfiresout]

Thanks for sharing. I am always amused at drills when people with out kids are trying to figure out what do with the seat and install it. I am going to have to share the pictures at the next drill with the ambulances and bring my seat so that can try it out.

 

[Leche Mami]

I'm really frustrated reading this seeing that the car-seats can be installed RF on the stretcher. My son's carseat was installed on the stretcher so that he was FF even though he was 8.5 months old. They said they HAVE to for accesibility reasons for treating the patient. It was a stressful ride for many reasons including that and the car-seat nearly toppling over every time we went around a corner. Ugh. Hope to never repeat that again!

 

[finleysmommy]

This is exactly what they did with my daughter, also riding in a blvd. I was very grateful to not have to worry about it!

 

[zebracrazy]

Just a few days after my son was born he had to be transferred to a better hospital. I was so grateful to see the EMT's buckling him into an infant seat, then strapping it to the stretcher. I later found out the one EMT was a car seat tech and she was studying to become a nurse in the PICU.

 

[piggymama]

One of my CPST recertification courses was a SafeKids webinar "transporting children in vehicles other than vehicles" (a large part of it was about amulance transport). While there are not formally approved methods for this type of transport, Riley Children's Hospital (experts in special needs tranportation) has tested various methods - and they made these recommendations that apply to this thread:

1. Use a car bed that can be secured with two cot/stretcher belts - or -
2. Use a convertible car seat for children 5-40 pounds with head control.
*Infant seats should NOT be used on a cot, as they only have one belt path
**The cot should be rear-facing, but the seat itself should be installed FF (again due to using both cot belts).
3. NEVER place a child restraint on the captian's chair, sqad bench or side-facing attendant seat.

Obviously all emergency situations are different, and I would wager that many paramedics are not familiar with the correct methods.

 

[whitejerabias]

Why not transport the child on the cot alone? I would have thought that ambulances would be akin to buses in safety. Also, in the first picture the car seat is installed on the cot. What if the adult is on the cot, where does the child go? Lastly what about when you are transporting the adult from home, and the child has no option but to go with and there is no car seat? For that matter, what happens to that poor child once you get to the hospital?

 

[fyrfightermomma]

Why not transport the child on the cot alone? I would have thought that ambulances would be akin to buses in safety. Also, in the first picture the car seat is installed on the cot. What if the adult is on the cot, where does the child go? Lastly what about when you are transporting the adult from home, and the child has no option but to go with and there is no car seat? For that matter, what happens to that poor child once you get to the hospital?

The straps are not properly sized to fit a small child. The child would slide right out. They are only made to fit larger children (maybe over age 6-8). Small children would have a strap across their head or neck, and one somewhere over their legs. So it doesn't work for newbies.

Ambulances are not akin to buses. They don't have the aspect of compartmentilization (where you hit the seat in front of you to protect you). If you fly around in an ambulance you hit sharp metal cabinet corners, windows, or the back metal door, other people, or heavy equipment like EKG monitors.

If the adult is on the cot, our protocol is that the child seat gets secured to the rear facing "jump" seat .In Mommy medic's picture, they have a built in seat in that spot. For those that don't a car seat, set up for rear facing is belted in that position. But that takes away the safest place for the medic so it's done often in our service.

If it's a parent being transported and no where for the child to go, most times we will have a police officer stay with the child until someone can come. If there is no one, the child would get secured with the ambulances child seat (most services have some type of child restraint). It would go in the jump seat like the previous scenerio. We avoided transporting non patients most of the time. If the kid doesn't need to be there, he doesn't go with us. He follows some other way or stays back with a cop.

As for the ER, I work there too We have a secretary or ER tech "sit" with the child until someone can come and stay with the child. It's very rare that you never ever have *someone* who can stay with the child.

Hope that helps!

 

[Keeanh]

. We avoided transporting non patients most of the time. If the kid doesn't need to be there, he doesn't go with us. He follows some other way or stays back with a cop.

As for the ER, I work there too We have a secretary or ER tech "sit" with the child until someone can come and stay with the child. It's very rare that you never ever have *someone* who can stay with the child.

Hope that helps!

Just seeing this thread now. My mom, brother, & I were in a crash when I was 7, lil bro was 4. This is how I remember it: I sat in the front passenger seat of the ambulance, wearing a regular seatbelt. I remember a sticker or pamphlet or something about buckling up and giggled to myself because the driver wasn't wearing his. My mom was on the gurney (smashed hip), my bro was being held by someone, and the lady who T-boned us was sitting in the jump seat. So, how many frickin people did they have in that ambulance??

Somehow my Nana showed up at the hospital. I guess my mom came to enough to give them Nana's phone # because my Dad was out of town.

My brother & I told my mom years later that the person who hit us had been in the ambulance. My mom got all pissed off and said "No WAY was THAT woman in MY ambulance." LOL. She finally had to agree that if we both remembered it, it was likely true .