Review of: Timothy D. Johnson, DO, Daniel Lindholm, NREMT-P and M. Denise Dowd, MD, MPH: Child and Provider Restraints in Ambulances: Knowledge, Opinions, and Behaviors of Emergency Medical Services Providers. Academy of Emergency Medicine. 2006. 13: 886–892.
This study was conducted by surveying EMS providers in two large ambulance services in a Midwest urban system, as well those in a hospital-based pediatric transport service. The purpose of the survey was to measure the knowledge, opinions, and behaviors of EMS providers regarding pediatric and provider restraint use in ambulances.
They surveyed 302 EMS providers, of which 69.8% were paramedics, 22.3% were EMT-Basics, and 4.6% were RNs. Ninety-one percent reported some training in child-restraint use in the ambulance, and half reported that they knew a lot or very much about securing a critically ill child for transport. However, when they gave these same individuals various scenarios for transporting a stable 2-year-old, 40% did not choose the correct method of securing a child seat to the ambulance cot. Although 80% of the providers regularly transported children in a car seat, 23% transported them on an adult s lap at least sometimes.
Interestingly, nearly half of the respondents reported having been involved in at least one ambulance crash and 7.6% having been injured in an ambulance crash. Two thirds of respondents reported not wearing their seatbelt while caring for patients in the back of the ambulance, and half stated that wearing seatbelts interfered with providing patient care.
The providers working for a pediatric transport service were significantly more likely to report safe pediatric and occupant restraint practices. There was no correlation between years of service and number of crashes with reported correct use of pediatric restraint.
The authors admit that the major limitation of this study is that it is based on self-reported opinions of restraint use frequency. It is certainly possible that the respondents answered questions in a manner that they believed was consistent with the desires of the authors. However, the fact that their perspective of how well they were doing did not match their ability to correctly identify proper pediatric restraint use would indicate that the disparity between what they believe and what they practice may vary even more significantly than what was reported.
Further compounding the issue is the fact that the vast majority do not wear their own seatbelt while caring for patients, justified by most with the belief that doing so would inhibit their ability to care for their patients. Other studies indicate that unrestrained rescuers may represent a significant source of injury to the patient when, during a crash, they are thrown about the ambulance, causing further harm to the patient.
It would have been interesting to compare their service s policy on the subject to their actual performance by documenting it with first-hand observation. However, such a study would introduce the bias that occurs whenever behavior is directly observed. To avoid this bias, the study would either need to utilize hidden cameras to record the behavior or have an observer present whose objective the rescuers were not aware of.
The bottom line is that this study further confirms the lack of understanding EMS providers have of the issues surrounding proper restraint use by both their patients and themselves. As the issue of patient safety during transport continues to garner greater interest by special interest groups and lawmakers, it is vital that the EMS industry address these concerns before some form of compliance is mandated by persons without the expertise to understand the complexity of matching quality patient care with optimal safety.