National safety protocols near for child transport in ambulance

The federal government is attempting to write the first national recommendations on how children should be restrained in ambulances, whether they are ill or injured or they simply need to be transported along with family members or other people.

The draft, "Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances," states, for example, that an ill or injured child who does not require continuous or intensive medical monitoring or intervention ideally should be transported in a size-appropriate child restraint system that complies with the federal standards for such systems in cars and other vehicles, secured appropriately to the ambulance cot. This means a standard child seat, according to a federal official.

National Highway Traffic Safety Administration (NHTSA) officials say that there are limited data on crashes involving children in ambulances, but it is estimated that up to 1,000 such crashes occur each year. The laws, guidelines, and protocols on the issue vary widely among states, localities, associations, and EMS providers, "and often provide limited, or in some cases, inappropriate guidance," says the agency.

The draft report says that the ultimate goal is to "prevent forward motion/ejection, secure the torso and protect the head, neck, and spine of all children transported in emergency ground ambulances." The recommendations list both ideal restraint situations and alternatives for when the ideal is not practical.

Marilyn Bull, MD, FAAP, the AAP representative to the working group, said that members believe the recommendations are only a first step to improving the safe transport of children. She said that there is much to be learned about the safety of children in ambulances. In addition, there are other ambulance standards now under development that she said she hopes will eventually affect the child safety recommendations.

Bull explained that, currently, the ambulance driver and the first passenger in the front part of the vehicle are afforded the same safety standards for vehicle structure and restraints as in other vehicles; however, there are no such standards for patients or professionals in the back. That's something that surprises many physicians who think ambulances are the safest vehicles on the road, she noted. There currently are efforts through the National Institute of Occupational Safety and Health and the National Fire Protection Association to write recommendations on how ambulances are constructed.

In regard to the child transport standards, an NHTSA official said that many local communities have gathered a variety of stakeholders to decide on best practices for child transport. However, some communities also have asked the agency to bring together experts to make recommendations that will serve as a starting point for discussions at the local level. He said that these recommendations were not expected to evolve into regulations.

At an August 5 public meeting, NHTSA officials said that the project is not designed to evaluate the efficacy of one restraint over another; to do field tests on equipment and solutions; evaluate the crashworthiness of emergency vehicles; or assess ambulance design.

The draft report calls for government agencies to take steps to find out more about what is safe, including enhancing the National EMS Information System (NEMSIS) that is now under development so that it will collect detailed data on ambulance crashes and their effects on patients of all ages. The report also encourages state EMS agencies to share data with state highway safety offices and with NEMSIS, including obtaining modifications or exemptions to the Health Insurance Portability and Accountability Act (HIPAA) so that information transfer will be allowed.

Bull said there have been some clarifications to the recommendations since the public meeting on the issue in August. NHTSA plans to make the revised draft recommendations public on its contractor's Web site and finalize them before the end of the year, according to the official.