Training Day: 3 Options for Safely Transporting Your Pediatric Patient

Tim Nowak // August 5, 2020

You’ve likely read how "mom holding onto baby" is not an acceptable transport option. That’s because it’s not safe. Just like it’s illegal to hold children and infants in your lap in your personal vehicle while it’s traveling, the same is true in an ambulance.

Securing a pediatric patient to your standard EMS cot/stretcher using restraints specially designed for children may be your best option. (image/Bound Tree)

Securing a pediatric patient to your standard EMS cot/stretcher using restraints specially designed for children may be your best option. (image/Bound Tree)

So let’s break down what is acceptable for transporting patients of a younger age (and smaller size).

1. Start with their own car seat

Ideally, the child’s parents have kept up with their child’s growth and have them secured in a properly-sized seat. If this is the case – and if you have the time (i.e., your patient is in a stable condition) – lobby for taking the child’s own car seat along for the ride in your ambulance.

If the child’s seat was inside of a vehicle that was involved in a collision, that doesn’t automatically discard its use from further transport use, according to a 2012 NHTSA document. Along with some additional criteria, if the car seat has no visible damage, it may be safe for further use.

Your airway/captain’s seat will likely be your best place to buckle it into place. An alternative option could be appropriately securing it in a forward-facing bucket seat (in place of your traditional bench seat) – but remember that having the car seat facing the side of any ambulance is unacceptable, no matter how you try to justify it.

On top of that, securing a rearward-facing car seat to an already rearward-facing seat (like the captain’s seat) does not equate to the patient facing forward. In this instance, two “negatives” don’t equal a “positive.” If the patient is supposed to be rearward-facing in a personal vehicle, they should also be rearward-facing in an ambulance, no matter what you need to do to accomplish that.

Why is the patient’s own seat the first option? Because they’re already familiar with the look, smell and contour of it. Providing this familiarity – again, if it’s the proper size – can go a long way toward promoting the patient’s safety and comfort.

2. Commercial devices offer plenty of options

It’s not expected that every ambulance carries a variety of full-size car seats to accommodate a one-day-old, a 1-year-old or even an 8-year-old. If this were the case, we would either have to add a hitch to the back of our ambulances or convert all of our fleets into super-sized, mega-ambulances with enough cargo space to make a heavy-duty rescue unit look like a Geo Metro (for those that remember those classics).

Innovative minds and companies have paved the way for multiple commercial options in this market space, including:

It’s hard to find a one-size-fits-all option because of the wide variance in pediatric patient sizes – after all, both a 2-year-old and a 9-year-old are considered pediatric, but their sizes are not comparable. Sometimes, relying on your standard EMS cot is your best (and only) option.

3. Four-point shoulder/chest restraints

Sometimes, simply securing your pediatric patient to your standard EMS cot/stretcher may be your best – or even only – option. In this case, reverting back to your training with backboards comes in handy, particularly when it comes to "padding the voids." As outlined by NHTSA, using your four-point straps in this situation is a must.

A three-point restraint specially designed for children is also a good option and may provide greater access to the torso without the need to loosen or remove the restraint during transport.

Many states require that ambulances carry some form of child protective restraint system, like Colorado’s Rules Pertaining to Licensure of Ground Ambulance Services (Chapter 4 of the state’s code of regulations for EMS, which I took part in updating). In the stable condition environment, time should be taken to properly secure patients using some form of approved commercial device.

In instances where true emergent transport is necessary, or where a seated position is not conducive toward the needs of your pediatric patient’s care, then semi-Fowler or supine transport of the patient on your cot may be the best bet – with adequate padding and shoulder/chest restraints, of course.

No one in the ambulance – including parents, caregivers, medics or other passengers – should be unrestrained during transport. Consider your options and plan ahead so that you’re prepared when faced with a pediatric patient.


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