As you and your partner stop at a red light, you notice two children in the vehicle next to you--the youngest being held by an adult in the front seat. As you pull away, you discuss how dangerous this is and wonder, if the general public could see what you see, would they do things differently?

Yet, we do the same thing when we have a pediatric patient. We don't want the child to cry or be scared, so we transport them with a parent/caregiver holding them on the stretcher!

This practice needs to stop. According to statistics, ambulance crashes result in an estimated 50 fatalities per year; the injury rates are 60-fold higher. If you get in a crash or make a sudden unexpected move, a child is at risk of being thrown from the arms of whoever is holding him.

Ambulance crash-testing was first started three years ago. Using a convertible car seat (one that can be used either rear- or front-facing), two stretcher straps were attached to the two belt paths and the harness was put in the correct position. After the ambulance was crashed at 34 mph, the car seat and child dummy were both found in approximately the same position, although a fluorescent light fixture had separated and struck the child's head during the test.

So, what can we do to protect our smallest cargo and ourselves? First and foremost, use your seat belts, positioning the lap belt low over your hips, and secure any loose objects (monitors, O2 cylinders, kits). Always use a child restraint device when transporting a child--either the child's car seat or one that is made specifically for ambulance use. The stretcher straps will probably not hold a child on the stretcher during a crash (since children are so small, usually only one strap secures the child to the stretcher). Learn about the different types of car seats and how to use them. Never allow anyone to hold the child on the stretcher for transport. If your service does not already have existing policies on transporting children, now is the time to create them!

Here are some other tips to follow when transporting children: