Vehicle Extrication of Children in Safety-Seats

Each scene and scenario must be evaluated separately for the safety of everyone. There will be more room to maneuver if the child and child safety seat (CSS) are removed from the vehicle as a unit and then extricate the child from the CSS. This will also allow for rapid access when there are concerns about vehicle stability. It is also appropriate for the EMS provider to remove the child from the safety seat before removing the seat from the car.

1. Scene Safety
2. Observe body substance isolation procedures (standard precautions)
3. Manually stabilize the child's head and cervical spine.
4. Conduct a brief (5 second) ABC Assessment and establish an open airway.
5. Release or cut the strap (usually a seat belt) that secures the child safety-seat to the car.
6. Remove the child safety-seat from the car and set it on a firm surface (such as a spine board or ambulance cot).
7. Tilt the safety-seat so that the back of the seat rests on the work surface.
8. Gently slide a padded board split between the child and the CSS to assist with moving the child to the pediatric immobilization device or short board.
9. Position the safety-seat to overlap the bottom end of a short spine board or vest-style extrication device (such as a KED).
10. Cut the shoulder straps or chest straps that secure the child in the safety-seat.
11. Maintaining spinal stabilization, slide the child out of the seat and onto the extrication device.
12. Secure the child to the extrication device.
13. Proceed with initial assessment and interventions following the General Patient Care protocol.

1. Scene Safety
2. Observe body substance isolation procedures (standard precautions)
3. Manually stabilize the child's head and cervical spine.
4. Conduct a brief (5 second) ABC Assessment and establish an open airway.
5. Tilt the safety-seat back and release or cut the strap (usually a seat belt) that secures the safety-seat to the car.
6. Turn the safety-seat so that the back of the seat faces the vehicle opening through which the child will be extricated.
7. Tilt the safety-seat so that the back of the safety-seat rests on the car seat cushion.
8. Gently slide a padded board split between the child and the CSS to assist with moving the child to the pediatric immobilization device or short board.
9. Position the safety-seat to overlap the bottom end of a short spine board or vest-style extrication device (such as a KED).
10. Cut the shoulder straps or chest straps that secure the child in the safety-seat.
11. Maintaining spinal stabilization, slide the child out of the seat and onto the extrication device.
12. Secure the child to the extrication device and carefully remove child from car.
13. Proceed with initial assessment and interventions following the General Patient Care protocol.

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