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Safe Pediatric Ground Ambulance Transport: A Systematic Review
Anne R Stoklosa1, Michelle L Zafron1, Brittany L. Cantor1, *Denise F. Lillvis2, *Kathryn D. Bass2
1University at Buffalo, Buffalo, NY;2John R. Oishei Children's Hospital, Buffalo, NY

Background: Ambulance crashes resulting in child injury or death are rare and preventable with the use of proper restraints. This systematic review assesses the uptake of proper use of pediatric restraints and identifies barriers to using restraints.
Methods: PubMed and Web of Science were searched between the years 2000 and 2020. Inclusion criteria included pediatric population, ambulance transportation, and English-language peer-reviewed articles. After initial screening, a snowball methodology was used to further screen potential articles of relevance (Figure 1). The methodology was carried out by two independent reviewers.
Results: The original search yielded 80 publications after de-duplication, and two additional articles were identified through the snowball methodology. Four publications met inclusion criteria for final analysis. Two studies employed surveys of EMS personnel to identify knowledge, behaviors, and barriers to child transport. One study used qualitative interviews of ambulance personnel. The final study combined survey and observational data. Lack of knowledge/training about and access to appropriate restraints were identified as barriers to the use of pediatric restraints in ground ambulances. Of note, there were no studies that evaluated an intervention.
Conclusions: Based on this review, there is a lack of safe pediatric ambulance transport research. There is a need for quality improvement studies to address the identified barriers to improve the overall safety and compliance of pediatric safety restraints during transportation to the hospital.


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