It is critical that the pram move in a linear fashion, and never laterally. Given the high center of gravity, lateral movement of the pram can easily lead to tipping.

Any time the pram is moved with a patient onboard, two people must have hands on it at either end or on either side.

SECURING PATIENT ON PRAM

When securing a patient on the pram without a flight stretcher, the following shall apply:

• All seat belts shall be used, including shoulder straps.

• Ensure the shoulder straps cross the shoulders as close as possible. Do not put them over a pillow.

• Ensure all belts are snug, but not tight.

• A belt extender may be used if needed. (usually on the chest strap).

• Ensure that vent/IV tubing is not crushed by belts.

• Siderails must be in the up position during movement.

RESTRAINED PATIENTS

Restraints are to be used only when necessary in situations where the patient is potentially violent and is exhibiting behavior that is dangerous to self or others. Pre-hospital personnel must consider that aggressive or violent behavior may be a symptom of medical conditions such as head trauma, alcohol, drug-related problems, metabolic disorders, stress, or psychiatric disorders.

The method of restraint used shall allow for adequate monitoring of vital signs and shall not restrict the ability to protect the patient’s airway or compromise neurological or vascular status.

Restraint equipment applied by pre-hospital personnel must be either padded leather restraints or soft restraints. All methods must allow for quick release.

If a patient is an immediate danger to self or others a Mental Health Hold (“M1”) is not required for you to restrain them.

Restraint devices applied by law enforcement require the officer’s continued presence to ensure patient and scene management safety. The officer shall accompany the patient in the ambulance. It is not acceptable for the officer to follow the ambulance.

iCare Ambulance personnel shall not apply any of the following forms of restraint:

• Hard plastic ties or any restraint device requiring a key to remove.

• Backboard or scoop pram as a “sandwich” restraint.

• Restraining a patient’s hands and feet behind the patient, i.e., hog-tying.

• Methods or other materials applied in a manner that could cause vascular, neurological, or airway compromise.

• Covering of the eyes.

A restrained patient shall never be left alone.

PEDIATRIC PATIENTS

PROHIBITED SITUATIONS:

Transportation of a child in any of the following ways is NEVER appropriate:

• Unrestrained

• On a parent/guardian/other caregiver’s lap or held in their arms

• Using only horizontal pram straps.

• On the bench seat or any seat parallel to the forward motion of the vehicle, even if the child is in a child safety seat.

• In the front seat of the ambulance if the child is under the age of 12

CHILDREN WEIGHING 5-100 POUNDS:

Children with a weight between 5-100lbs (2.3-45.3kg) shall be secured in the pediatric restraint device. The device shall be attached to the pram according to  APPENDIX C- Child Safety Seat Installation.

TRANSPORT OF CHILDREN IN PERSONAL CAR SEAT:

When clinically appropriate, personal car seats or boosters may be used and should be secured to the ambulance pram.

REMOVING A CHILD FROM RESTRAINT DURING TRANSPORT:

If life-saving interventions require a child to be left unrestrained for any portion of transport, such incident shall be documented outlining the need and reasons in the patient care report.

In such instances, restraints should be reapplied as soon as possible following interventions to minimize the amount of time the child is unrestrained.

Lift Assists:

Additional personnel are required for list assist in the following situations:

• Any patient weighing more than 250 lbs.

• Isolette.

• Patient on IABP, ECMO, or Impella.