title: Child and provider restraints in ambulances: knowledge, opinions, and behaviors of emergency medical services providers.
abstract: BACKGROUND
  Approximately 16,000 children are transported by ambulances each day, and there are an estimated 4,500 ambulance crashes each year. Information about emergency medical services (EMS) provider knowledge, opinions, and behaviors regarding occupant restraint is lacking.
  
  
  OBJECTIVE
  To measure the knowledge, opinions, and behaviors of EMS personnel regarding child and provider restraint use in ambulances.
  
  
  METHODS
  A survey was given to all EMS providers in two large ambulance-service organizations and in a hospital-based pediatric ambulance service in a midsized urban area.
  
  
  RESULTS
  A total of 302 EMS providers were surveyed, for a return rate of 67.7%. Nearly half were involved in an ambulance crash at least once; of those, 7.6% were injured and 1% had patients in their care injured. The majority (91%) reported some training in child-restraint use in ambulances, and half reported that they know a lot or very much about securing a critically ill child for transport. However, 30% did not identify the correct method of transport for a stable 2-year-old, and 40% did not choose the correct method of securing a child seat to the ambulance cot. Securing a child seat to the cot was viewed by 81% to not take too much time from patient care, and 63% did not view caring for a child in a car seat as difficult. Although 80% of providers regularly transported children in a car seat, 23% transported them on an adult's lap at least sometimes. Specialized pediatric-transport providers were more likely to report safe pediatric and occupant restraint practices than were community EMS providers. Pediatric restraint behaviors were not associated with years of service or history of a crash. Two thirds of respondents reported not wearing their seatbelt on the squad bench while treating patients, and half believe that wearing a seatbelt interferes with patient care. A total of 95% report wearing seatbelts in the front seat of the ambulance. Provider seatbelt use in the patient compartment was not associated with years of service, with number of crashes, or with reporting correct use of pediatric restraints.
  
  
  CONCLUSIONS
  This study indicates that the frequency of crashes in ambulances, and therefore the potential for injury, may be underappreciated. Current restraint practices of some of the study group are outside recommendations and may be placing at risk some children who are being transported by ambulances. This problem is complicated by the relative infrequency of pediatric ambulance transports compared with adults. Improved equipment and education may help providers safely transport pediatric patients. In addition, providers are risking their own safety by not wearing seatbelts in the rear ambulance compartment. Improved equipment may help alleviate this risk and allow providers to take care of patients safely.
authors.affiliation: Division of Emergency Medicine, Children's Mercy Hospital, Kansas City, MO 64108, USA. tdjohnson@cmh.edu
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Johnson
authors.forename: Daniel
authors.initials: D
authors.lastname: Lindholm
authors.forename: M Denise
authors.initials: MD
authors.lastname: Dowd
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000552:Ambulances / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D015370:Infant Equipment / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008923:Missouri; D017410:Practice Guidelines as Topic; D012622:Seat Belts / Q000592:standards / Q000706:statistics & numerical data*