A Survey of Restraint Methods for the Safe Transport of Children in Ground Ambulances

Pediatr Emerg Care. 2018 Mar;34(3):149-153. doi: 10.1097/PEC.0000000000001280.


Objectives: The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers.

Methods: We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed.

Results: Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment.

Conclusions: Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.

MeSH terms

  • Ambulances / standards
  • Ambulances / statistics & numerical data*
  • Awareness
  • Child
  • Cross-Sectional Studies
  • Databases, Factual
  • Emergency Responders / statistics & numerical data
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Patient Safety / standards
  • Patient Safety / statistics & numerical data*
  • Practice Guidelines as Topic
  • Surveys and Questionnaires
  • Texas