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Why is pediatric transport so difficult to define?

In September 2012, “Working Group Best-Practice Recommendations for the Safe Transportation of Child in Emergency Ground Ambulances” was released. The working group was the result of a recommendation by the National Highway Traffic Safety Administration (NHTSA) of the U.S. Department of Transportation following an earlier study completed in 2008, “Solutions to Safely Transport Children in Emergency Vehicles.”

So why the four-year gap?

According to the report, the biggest obstacle has been in “describing and defining the problem of the unsafe and inappropriate method of transporting children (injured, ill, or uninjured) from the scene of a crash or other incident in a ground ambulance id somewhat challenging due to the limited data involving such crashes.”


There has also been an issue of poor data which required an outside consultant to sort through related literature that could be used for research materials and discussion. That review was completed in May 2009. Over the next two years, the working group would teleconference to discuss what needed to be done, eventually settling on specific transport issues that included placement and restraint of the injured, ill, or uninjured child.

State and Local Legislation
The industry didn’t wait for recommendations. Several states adopted legislation looking to the (NHTSA)/Emergency Medical Services for Children (EMSC) “Do’s and Don’ts of Transporting Children in an Ambulance” for guidance. The checklist included recommendations for restraining all occupants in the emergency vehicle, but lacked specificity.


“I think the challenge is not in a commitment to safety and restraints,” says Jason Wender, Global Marketing Director of Ferno. “A child can be a 5 or 15. That weight and size disparity makes it difficult to define a “recognized standard.”

“There is a range of options here, and little consensus,” wrote researchers in the Working Group Best-Practice Recommendations for the Safe Transportation of Child in Emergency Ground Ambulances.” During the group’s July 2009 meeting, the “expert members of the working group,” were unable to agree on what they referred to as a “non-technical definition of a child.”

“The various definitions of a child or pediatric patient are inconsistent. The term ‘child’ may be used to denote all non-adult patients, OR it may be used to represent all non-adult, non-adolescent patients, OR it may be used to represent all non-adult, non-adolescent, non-neonatal, and non-infants.”

Ferno used the patient diversity as a guide, creating pediatric transport restraints that can be securely adjusted for the child of any size or length. The Neo Mate Pediatric Restraint System, is a fully-adjustable five-point harness system with three restraint straps that attach to the cot and a “Halo” Pad that keeps a newborn’s head stable when emergency transport is required. Additionally, the company developed a transport incubator for neonatal patients.

The company’s Pedi-Mate® Pediatric Restraint System adapts any ambulance cot for the safe transport of children ranging in size from 10 to 40 pounds, is fully adjustable with a five-point harness system.

Assessing Pediatric Transport Equipment
While the working group stopped short of advocating one type of pediatric restraint over another, “It is outside the purview of this project to conduct the vast amount of engineering research, crash testing, and field work that would be required to evaluate and determine the effectiveness of ambulance vehicles and child restraint and medical equipment currently available,” they did provide a list of six Considerations for Manufacturers:

  1. Develop child restraint systems that meet or exceed the injury criteria for FMVSS No. 213 to accommodate child patients of various heights and weights (or lengths including newborn/infant patients) for use on cots in ground ambulances.
  2. Develop an integrated cot restraint system that, when tested with child dummies in a dynamic sled test environment simulating a 30 mph ambulance frontal crash, results in dummy injury metrics that are equal to or lower than those specified in FMVSS No. 213.
  3. Develop products and provide instructions that improve correct and easier use of devices designed for ambulance use.
  4. Determine the need to develop crash-tested child restraint systems for use in rear- or forward-facing EMS provider’s seat of ground ambulances.
  5. Ensure all EMS personnel seats meet or exceed all applicable FMVSS requirments and can accommodate convertible or rear-facing-only child restraint systems (and adult passenger with three-point belt)
  6. Develop improved crashworthy methods of seating for all occupants in the rear of the emergency ground ambulance compartment.

Review The Pedi-Mate® Pediatric Restraint System