An EMT's Story

Below is a story told to me by a young EMT back in 1995 - what is truly amazing is how little has changed:

“On Tuesday, September 19, 1995 at approx. 4:00pm, while working on an ambulance, my partner and I were called to do a routine transport at Hugh Spalding Children’s Hospital, an affiliate of Grady Memorial Hospital in Atlanta, Georgia. We were dispatched to pick up a mother and her infant and bring them back to their residence. I informed my dispatcher that we were not equipped with an infant seat on the truck. I was told to follow usual procedures (strap the mother to the stretcher and have her hold the baby on her lap) and to transport them . I felt this was wrong, but did as I was advised. When I returned to the station I sat down with my supervisor and told him that what I had just done went against everything I believed in. My supervisor respected how I felt and said that what he could try to do was get an infant and toddler seat and keep it in his car and first respond to the scene with us from now on. While I appreciated his efforts, I still felt that this was not enough.

I thought about when I had worked at Egleston’s Children’s Hospital in Atlanta. We used infant and child seats for transport but they were always so difficult to attach to the stretcher. The seat is shaped to fit a car’s seat belts. To attach it to a stretcher meant adjusting the stretcher to an upright position and strapping it in. In doing so, the bottom of the child seat was suspended mid-air and needed to be held in place by sheets and blankets propped up underneath it. No matter how we attempted to manipulate it, it was still unsteady.

And attaching the child to the stretcher was simply not an option. The reality is they are just too small: the straps cover half of their body and can’t restrain them. The straps can’t be tied tight enough to keep them in place or it will hurt them, and when the straps are loose, the child slides all over the stretcher. This makes for a miserable trip for all involved: crying child, stressed parent and helpless crew.

Which brings to mind the dangers of the everyday baby seat being strapped to a stretcher. While working on the ambulance at Egleston’s Children’s Hospital, 9 out of 10 children transported were going from one hospital’s emergency room to the PICU (Pediatric Intensive Care Unit) at another because they were in severe danger (they were having seizures, their airways were compromised, they had head injuries or were intubated). If any of those children went into arrest along the way, there were approximately 6 time consuming steps that had to be taken before CPR could even begin:

1. The safety seat shoulder straps had to be removed from the infant/child
2. The infant/child had to be removed from the seat. (Remember that at this point in time, someone is standing up in a fast moving ambulance, holding a non-breathing infant in their arms, trying to support themselves and the child without falling over)
3. All of the sheets and blankets that were previously holding the seat in place on the stretcher have to be removed. (These get tossed on the floor and everyone involved keeps kicking them out of the way so that they can help during the trauma…in effect more time wasted).
4. The straps holding the child seat in place have to be found (under the bar of the seat) and released, and the seat has to be removed from the stretcher.
5. A short back-board must be placed on the stretcher so that heart compressions may begin
6. The baby is positioned on the board, and resuscitation can begin.

But that is not the end to this emergency. The infant/child is still sliding all over the place. The technician’s hands can easily be misplaced while doing compressions and there are many other dangers that can occur to this un-restrained child while racing to the hospital.

My partner and I conducted a run-through of this procedure using a doll as a prop Going as fast as we could, it took us 2 minutes and 4 seconds. According to the “Brady Emergency Care” book, “all cells in the body need oxygen for survival. Lethal changes will begin to take place in the brain within 4-6 minutes without a constant and adequate supply of oxygen. Brain cells begin to die within 10 minutes.” It’s clear that two minutes without air for an infant or child is way too long!"

The EMT went home and drew what she believed was needed to solve this problem. It is my hope that somehow, someday, I will help her do that.