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bkelley

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bkelley last won the day on April 14 2017

bkelley had the most liked content!

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    Male
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    Cheyenne, Wyoming
  • Interests
    Pediatrics, Fishing, gardening, Hockey

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    State Office of EMS, Paramedic

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  1. Every new person thinking and talking, is one more than there was yesterday.
  2. Lets solve a problem. What does a pediatric patient need, to be safe in our ambulances? For arguments sake... lets call a pediatric patient a child between 5 and 99 pounds. Parts to discuss: 1. Ambulance environment (e.g. the equipment we carry, how we carry and secure it, our own bodies not restrained while we transport) 2. What do we do, or not do to make sure that a kid is as safe as possible in our ambulances (what if we wreck while transporting them?) 3. What does the kid expect from us? Do they consider their own safety or is that our job? 4. How can we meet their safety needs better?
  3. You can read about the make up of the group here: https://www.nasemso.org/Committees/STC/index.asp I hear what you are saying. Until I moved out of the field, I lacked perspective on how big the EMS picture really is. For example: Your own field impression of the situation: "Without the proper tools and when we are forced to improvise, when something goes wrong, we are the ones who are hung out to dry because we are not given the tools to properly do our jobs" So lets break that into a simple (not perfect) problem statement: The EMS workforce lacks the proper training, policies/protocols, and equipment to always provide the safest transport of pediatric patients in ambulances. Agree? So in order to solve the problem we first have to break the problem into its respective parts. Basically the main parts of it are: 1. Pediatric patient safety needs in ambulances; 2. EMS workforce needs regarding the care they must provide to pediatric patients; 3. Equipment options that satisfy both of the above; 4. Policies and procedures that reflect all of the above, adjusted based on local needs and resources; 5. Training that encompases all of the above, tailered to fit the local agency having the responsibility; and 6. Finally, Laws and regulation that ensures and measures compliance with the now prevailing standard of care. It is only by looking at the problem and its respective moving parts individually that you can see the scope, and consequently the players who need to be at the table for the various parts of solving the problem. The field provider has a critical role, absolutely in every single part of the problem. The group I am currently working with is also equally and vitally important. We represent the regulators, standard writers, and researcher component. Think of us as the folks who plan the road that you are going to build and drive on. Our role is to select the path (based on science and fact), secure the land the road is built on, and then lay out the foundations of the road bed. The manufacturers of pediatric ambulance safety products will be the ones that make the material for the road (asphalt, concrete, whatever). Guess who has to pave it and then drive on it, refine it, smooth it, make it pretty, functional, and the favored path to take? When its ready, we come back and put up the signs along the way for speed limits, hazards, and mapping. I don't remember if I shared this already, but: https://www.nasemso.org/Committees/STC/documents/WY_ChildTransportProtocol.pdf Additionally: There has been tons of effort on this issue already, has your agency administrator read it? Have you? check this out: https://www.nasemso.org/Committees/STC/Resources.asp There is so much out there to build the road map, you have the patient. I drive a desk in Cheyenne Wyoming. What are you doing to make YOUR world right? If your not go do it... take this material, teach your peers, change the world one EMT at a time. That is the same thing I am trying to do. Help me. As a matter of fact my friend, you have inspired me.... We can use this forum to beat each part of that problem statement up. Then the field, the docs, the regulators all have a place to talk. I am gonna start a new thread for part 1: Pediatric patient safety needs in ambulances Come play everyone
  4. That is the exact problem we are working to solve at the national level. There are tools available, they haven't been tested in the way we want, but that isn't the fault of the manufacturers who make them. There isn't a test, it simply doesn't exist. My group at NASEMSO is almost done with a guidance chart that will help EMS agencies make these decisions while a standard is developed. We want to prevent these injuries that occur in ambulances due to no equipment, poorly utilized equipment, and lack of policies and training.
  5. bkelley

    Hello

    I appreciate it. This particular subject is one that isn't discussed nearly enough. Come see me at EMS World in October. I will be with a panel of folks for a general session on the 18th.
  6. So the integrated seats actually have testing behind them. You just have to be careful about weight ranges. There is a tag on the pull out portion that tells you the weight ranges for the patient. The downside is that if you really need to work a patient, that seat is less than ideal. As far as removed versus non removed, wrecked seat vs. non-wrecked.... Agree with Mike here, as the removal of a patient doesn't really make a difference. If you took them out you can put them back in, no problem. Is a seat that has been in an MVA safe, well it depends. If you have another option, that other option is most likely safer. If that seat is all you have, then that seat is better than no seat. Does that make sense?
  7. It could be because they actually didn't. The pedimate is only for kids 4.5kg to 18 kg. It also is only supposed to be used on the Ferno cots listed in the operators manual for the pedimate. It is possible that on a different cot, you weren't able to snug up the pedimate because the cot wasn't designed for it. I bet that car seat got pretty dirty, lol!
  8. How does your agency deal with the topic of safely transporting children (5-99lbs) in your ambulances? Do you have policies in place (share them)? Do you do training over equipment for this purpose? Do you even think about it?
  9. That is a two part answer. So yes, by putting a car seat on a stretcher you have indeed provided a car seat in the ambulance. There are some catches to that though: 1. There has been some testing done on this set up see: http://www.carseat.org/Resources/Bull_Ambulance.pdf. The problem is that this test was done using a modified stretcher. In testing, the model they were using would not maintain an upright back, so they welded a piece of steel to it to make it stay upright during testing. You do not have a piece of steel on your stretcher so the same results may not appear in your realistic scenario as occured during these tests. 2. FMVSS-213 (the standard for car seat designs) does not test for the conditions that are present in an ambulance patient compartment. So a car seat is no more of a "sure thing" solution that any other devices out there for this purpose. All of that said, using a car seat is absolutely better than using adult straps on a child; allowing them to be unrestrained (held by caregiver, mother, etc); or putting them on a bench seat. Your second question "Do you provide the same level of securitysafe transport to that pediatric patient compared to a properly secured/installed car seat in a automobile?" Absolutely not! The only place in an ambulance that has supporting science that compares to the testing that car seat design has had is in the passenger seat, properly positioned, with the airbags off. This placement is not out of line for an uninjured/ not ill child who is a passenger with an injured/ill adult for example. The sad truth is that the safest place for a kid in an ambulance... is to not be in the ambulance at all.
  10. Hello folks I wanted to start a discussion about ambulance safety, specifically about transporting pediatric patients in ambulances. This should be a safe space for EMS workers to discuss this topic and be free to admit what you do not know. I have learned so much in the past 3 years on the topic, from US ambulance operations to similar issues in other countries. I have access to the top experts on the subject from NIOSH, NHTSA, Pediatrics researchers and professors, equipment manufacturers like Ferno, Quantum, and IMMI. Lets talk! I will start with something I didn't know, that I know now. 1. There is no "standard" in the United States that measures whether or not a product designed to restrain a child in an ambulance actually works as intended. The only thing close is FMVSS-213 which sets requirements for car seats in passenger vehicles.... which does NOT include ambulances. This means that no device on your ambulance has ever been scientifically proven to reduce death and disability in a similar way to how car seats have been tested.... scary huh? I attached some guidance from NASEMSO on the topic (I was one of the authors). Safe Transport of Children by EMS- Interim Guidance 3-8-17 final.pdf
  11. bkelley

    Hello

    Hello, I am Brandon with the Wyoming Office of Emergency Medical Services. I stumbled across a post about pediatric transport concerns and I thought I may be able to help answer some questions. I am active with NASEMSO, particularly regarding pediatric safety in ambulances, serve the AAP on the PEPP steering committee, and am very active in many aspects of national level EMS topics. See ya around!
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