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Ambulance transport: Protecting our kids

A working group made up of representatives from various agencies is looking to improve safety levels for children being taken to the hospital

By Jim Love

About 620,000 transports involving children take place each year in the United States in ground ambulances. As many as 1,000 of these are involved in a collision during transport.

It’s statistics like these that warrant our attention. In Washington D.C. last Thursday, a meeting took place to discuss the safe transportation of children in ground ambulances.

Hosted by the National Highway Traffic Safety Administration (NHTSA), representatives were present from and NHTSA’s Occupant Protection Division.

In addition, the working group that has emerged to look into this issue is also comprised of representatives from the medical community, volunteer and paid fire services, NAEMT, Emergency Medical Services for Children and others. The group has identified and listed five categories of children transports based on needs.

These categories are:

1. Child who is uninjured/not ill;

2. Child who is ill and/or injured and whose condition does not require continuous and/or intensive medical monitoring and/or interventions;

3. Child whose condition requires continuous and/or intensive medical monitoring and/or interventions;

4. Child whose condition requires spinal immobilization and/or lying flat; and

5. Child or children who require transport as part of a multiple patient transport (newborn with mother, multiple children, etc.)

From these categories, transport recommendations were outlined during the meeting. For each category there is a defined ideal method of transport as well as alternatives when the ideal is not possible.

The group also suggests that all transport agencies engage in preplanning activities – specifically, “what if…"

What if we are called to a scene where an adult requires immediate transport but there is a child on scene that may not be left alone on scene?

What if we respond to a motor vehicle collision where several children of various sizes and needs require transport? What if a response finds a child who requires spinal immobilization and transport?

The answers to these “what if” scenarios may seem obvious but vary across the country depending on several factors including available resources, equipment, rural or urban. The questions above suggest additional questions and actions including:

  • Do we have a variety of the right equipment to transport children?
  • Will we require additional equipment to meet these recommendations?
  • Are we practiced in using the equipment?
  • Can we call/use the police or other allied agencies to transport non- sick, non- injured children so we may focus on the person needing help?
  • What other resources exist that we may tap into?

The working group also recognizes that there should be work on ambulance design, care giver seating and response determinants, but that these areas were outside the scope of the group.

One purpose of this group is to build consensus on the right way to transport our kids when the need and the time arises. Another goal is the creation of a national document as none currently exists.

Public comment was sought and allowed by people not part of the working group; one comment was that we do not ask automotive engineers to make medical protocols and we should not ask medical doctors and the EMS community to make vehicle design and transport location recommendations.

Another who commented stated that sometimes the correct approach to a challenge is a carrot, other times it is a stick. In this case, where the lives and welfare of our children is concerned, he suggested the stick approach to make sure that meaningful change takes place. Both arguments have merit and caused thoughtful discussion.

Once finalized, the document will be recommendations only — not a rule, not law. States are then expected to decide how they will enact these transport guidelines.

For more information go to Type 2010-0089 into the internal search engine. This will bring you to the discussion and comments regarding this topic. In addition, you’ll find a document that offers an unbiased look at the various transport equipment available and how they may fit into the five transport categories.

The working group does not recommend any particular product. Their complete document includes an appendix that suggests what buyers should look for when buying ground ambulance child transport equipment.


About the author

Jim Love began his EMS career in 1974. Since that time he has worked providing direct patient care, has been an FTO and has been an EMT instructor. He transitioned to management and has held many positions over the years including operations, later focusing on training, safety and risk management. He was the National Director of Safety and Risk for AMR. He worked extensively on the development of all three Safety Concept Vehicles co-built by AMR and AEV. Jim is currently enjoying consulting on EMS safety. He maintains an EMS Safety site and blog,, and can be contacted at