Stolen from the Extrication Forum - Pedi immobilization in integrated child seats

[SilverCity4]

Okay, okay...so I stole it from the Extrication forums. Sue me!

Ron Moore bought up the fact that for MVAs where a pediatric patient is found secured in a child safety seat, EMS instructors teach their students to leave the patients in the carseat and immobilize around them. This is all fine and good but what about vehicles with integrated child safety seats--watcha gonna do?

I was taught the same thing--pad around the kiddo and transport with the car seat. However, I've got a 3 y/o and a 14 m/o that both sit in forward facing car seats. In the event of a crash, I have faith the the seats will keep my kids from being thrown around and ejected, but I don't think that they offer a whole lot of spinal immobilization.

Now, integrated child safety seats present a problem. You can't take them with you without cutting the seat out of the car (seems a little troublesome), so you've got to move the child from the seat.

How are you going to do this AND do you think we should consider removing children from all safety seats? Hmmmm?

[IAMedic]

Well............here we go folks;

As a certified NHTSA Child Safety Seat Technician, children under the age of 2 should be rear facing. In fact, you should keep all children in rear facing as long as possible, but the limit is 2 years/20 lbs in most seats.

But, back to the topic at hand. As a certified PHTLS Instructor/Coordinator, the NHTSA and PHTLS negate themselves. I take the new update on the 30th, so I may have to come back and correct myself. PHTLS teaches you to package around the patient that is in a car seat and load and go. However, NHTSA and carseat manufactures' state that once a car seat has been involved in a collision, the child should not be transported in the car seat.

What I do is determine what kind of injuries that patient may have sustained. If the patient may have suffered serious trauma, I will leave them in the carseat, package them with towel rolls, and transport. If there is little chance of injury to the child, I will take the child out of the car seat and immobolize them on our Peds board so that I can perform a more thorough assessment. However, these are not hard-and-fast rules that I follow. We don't have a specific protocol that we must follow, in fact, I don't know of any specific protocols regarding this topic.

If they are in the integrated car seats (safety seats integrated with the vehicle), I remove them from the carseat and immobilize them with the Peds board, if possible. Federal Child Safety Laws exclude Emergency Vehicles from mandated restraints.

Nice topic and thanks for bringing it here, SilverCity4.

[emstrainer]

I have a couple of observations on this topic. First of all the 5th Edition of PHTLS still teaches to secure the child in their own seat if it has not been damaged. I personally do not agree, but have not found concrete research that shows it is harmful.
We need to encourage providers to remove these kids from their car seats and perform a proper Patient Assessment. I suspect that we are missing alot of injuries because we are afraid to handle these kids and do proper assessments. I would hope you mis-spoke when you said major trauma patients would be kept in the car seat. Please get them supine on a proper backboard, and initiate proper trauma treatment. Our agency purchased the inflatable seats that seem to work well for the minor injury or minor illness. If the kids are sick we need to have access to them quickly ... Ferno markets a pedi-mate which seems like a good device. I would like to hear more opinions.

Stay Safe,

Jason Kinley, Lt./EMT-P

[IAMedic]

If the MOI shows serious trauma and I believe that if I may cause more harm by taking the baby out of the car seat, then the baby stays in. I will package and transport. Yes, we need to do a thorough assessment, I agree. I will do as good as a job as I can under those circumstances. I will make the best possible decision with the knowledge I have at that time.

I take the new PHTLS Instructor/Coordinator refresher course on the 30th of this month, so I will make I try and get some answers.

[ALSfirefighter]

If anyone read this post, nevermind I copy and pasted it as such below.

[ALSfirefighter]

Ron, your second pic is a little dark and I can't see well what that seat looks like. However there are a couple things I'd like to point out.

First, instructors go on the curriculum that is set by their state or follow national registry curriculum. Most curriculums are only evaluated every 3 to 5 years, so they are teaching what they know according to how it is spelled out in the curriculum they follow. If they sway and add something they haven't been authorized to teach and one of their students goes out and causes harm to a patient, it is them that will have to answer the subpeona to go infront of the grand jury.

Second, the seat you show in your first picture appears to me to be nothing more then a booster seat, not a car seat. In that situation you would provide spinal immoblization in the same fashion you would for anyone else in a car seat. It is proper procedure by most protocols/curriculums that if they are "in" a car seat, to pad the voids and transport. This is for basic spinal injuries, if their is A, or B, or C Compromise that goes out the window. The picture I can see, the patient would be sitting "on" a booster, and there is no sense in attempting to cut out the seat, it is not conforming, nor is it as rigid as a car seat.

______________________________
__
IACOJ Bureau of EMS Chairman

[MikeF25]

Wouldn't it be nice if little ones weren't involved in MVAs at all.

Anyway I would take it by incident. But, my fire Dept. doesn't run
medical and the medical I do do is at a foundry so, not to sure.

[IAMedic]

I should have just let it drop, but thought some might like this information.

I had my PHTLS Instructor/Coordinator update last night. The PHTLS Chair, Will Chapleau (http://www.phtls.org/chapleau.htm) , was the trainer. The question was asked to him about PHTLS's stand on Child Safety Seats since it was not talked about in the literature.

Will's comment was this "Paraphrasing". 'There are still a lot of talk about this with the PHTLS and the EMS-C. The recommendations for the Child Safety Seat by the manufacturers and NHTSA is that they should not be used after they have been in an collision. It is the understanding by all involved that NHTSA is referring to parents and guardians not using the CSS and makes no determination for Emergency Vehicles. So, unless airway is compromised and/or the child needs a more thorough assessment due to their injuries, they should be packaged in the child safety seat and transported.'

So the NAEMT's PHTLS Curriculum (http://www.phtls.org) is still suggesting that we package our infant patients in the car seats unless the have:

[list=1]
A risk of compromised airway
The apparent injuries to their body would necessitate the immediate removal of the patients for treatment.
[/list=1]

Otherwise, they should be packaged as they are with towel rolls and transported.

Just FYI. Comments??

[MedicMama]

includes that if the car seat is at all damaged, or we even suspect that it is, the child is removed. The PEPP course also taught us how to immobilize children in a modified KED, with padding, or for very small infants, on the KED insert. The little tricks they taught us were really valuable. Hope to never, ever have to put them to use.

Lisa