EMERGENCY RESPONSE: CAN WE BETTER SERVE CHILDREN IN CAR CRASHES?
When a car crash happens, time is everything. The faster help arrives and emergency treatment begins, the better the chances someone survives. Emergency services play a crucial role in saving lives. When a child is injured, we trust those first on the scene to do all they can.
Emergency responders have saved countless lives, both young and old. But there is an oversight when it comes to children. The way emergency systems are set up – from the equipment in ambulances to the protocols – is built with adults in mind. As a result, children helped by these services are not always getting the care for their child-specific needs.
This gap in design and readiness matters. Car crashes remain the leading cause of death for children globally. And while many efforts focus on prevention, we also need to take a hard look at how we respond when tragedy strikes. If emergency services were better adapted for children, we could save more young lives.
CHILDREN ARE NOT “SMALL ADULTS”
Children are often thought of as miniature versions of adults. But in reality, their bodies and minds work differently and have different needs. Children have different physical proportions. They have smaller airways, more delicate bones, and different responses to trauma. They also experience fear and pain in ways that are not always obvious.
According to the National Highway Traffic Safety Administration (NHTSA) in the U.S., more than half of the children who die in crashes are still alive when help arrives. That means there is a critical window to save them. If emergency responders have pediatric-specific equipment and training, the chance of saving a child would increase. With the right approach, the mortality rate for injured children could drop by as much as 60%.
Almost everything about using roads – roads themselves, vehicle design, safety rules – is built around adult thinking and physiology. Think about something as simple as a seat belt. Seat belts are designed to save lives in a crash, but can actually harm a child if used incorrectly. That’s why we use car seats and boosters to make up for the differences in size, weight and body development between a child and an adult. But similar adjustments are not widely adopted in emergency care. Ambulances still rely on equipment designed around the needs of adults. And emergency systems, by and large, are still operating under a “one-size-fits-all” mindset that does not account for a child’s unique needs.
PEDIATRIC AMBULANCES
Inside most ambulances, you will find everything designed around the average adult patient – stretchers, restraints, oxygen masks, and IV setups. In most cases, nothing has been adjusted for younger, smaller bodies.
Stretchers and restraints in ambulances are not designed around child bodies. Much like seat belts being inadequate for children, incorrectly sized restraints can increase the risk of injury to children during transport. Child-appropriate emergency harnesses exist that would solve this problem. Unfortunately, they are not widely used.
In South Africa, Netcare, a major private healthcare provider, launched the country’s first pediatric intensive care ambulance in 2018. It is fully equipped to handle critically ill or injured children with the care and expertise they need. This is a fantastic step in the right direction, but an emergency vehicle specific to children is still a rarity.
If one specialised ambulance is seen as a groundbreaking innovation, we still have a long way to go. These features should be the standard, not the exception. Especially given the high rate of child fatalities related to our roads.
Specialised ambulances also come at a very steep cost. Often, only a feature of private healthcare providers, children from low-income families must rely on government emergency services. State ambulances are not equipped with the specialised equipment of a pediatric ambulance. Additionally, state paramedics receive little to no pediatric training. In the event of a car crash where child-specific equipment is required, paramedics must wait for an Advanced Life Support vehicle to arrive. Minutes spent waiting for these vehicles to arrive increases the chance of a child’s fatality.
Children from low-income families are more likely to be involved in a life-threatening crash. With no option but to rely on government services that are sub-optimal for their needs, the roads become that much more dangerous for them.
TRAINING & PROTOCOLS TO BEST SERVE CHILDREN
Even the best equipment is only as good as the person using it. And here, too, there’s a shortfall. Most first responders receive only limited training in pediatric care, if any at all. They may not have specialised expertise in assessing a child’s vital signs, calculating medicine dosages based on weight, or calming a frightened toddler at the scene of a crash.
Guidelines on how to transport or treat children in emergencies differ from one place to another. Some EMTs may be unsure of the safest way to restrain a child in the back of an ambulance, and others might not have access to child-sized equipment at all.
More consistent, hands-on training in pediatric emergencies could change that. Emergency workers need to feel prepared. Not just for adult trauma, but for the unique challenges children present in emergencies. When we put children first in our emergency response systems, we are also positioning people to better advocate for the most appropriate care for children when they need it the most.
EMOTIONAL FIRST AID MATTERS TOO
A child involved in a car crash is not only physically injured. They are likely also scared, disoriented, and overwhelmed. Sirens, flashing lights, and unfamiliar faces can be terrifying, especially if a caregiver is not nearby.
Often, psychological care in emergencies is treated as an afterthought. But for children, the way they’re spoken to can make a big difference in how they cope, both in the moment and long after. Even just having someone explain to them what is happening to help them make sense of what is going on can ease some of the trauma.
Most emergency personnel are not trained in child psychology or trauma communication. Even a few basic techniques – like using calm tones, distraction tools, or child-friendly explanations – can reduce fear and make treatment easier. An ambulance that has a more child-friendly atmosphere, such as cartoon characters, warmer lighting, personnel with an affinity for working with children, and a seat for a parent to go with them to the hospital can provide some degree of comfort.
RETHINKING EMERGENCY CARE FOR CHILDREN
To reduce the number of children lost to road-related crises, we need to rethink how we handle emergency care for them. That means going beyond “good enough” and investing in emergency systems that are designed with children in mind.
Here’s what that could look like:
- Ambulances equipped with child-sized restraints and medical tools
- Specialised pediatric emergency vehicles or modular designs for mixed use
- Standardised protocols across all emergency service systems
- Mandatory pediatric training for all emergency responders
- Better emotional care during transport and treatment.
These changes do not need us to reinvent emergency care. They just need us to expand it thoughtfully. Children deserve systems that recognise their needs from the moment help arrives.
We count on emergency services to show up when things go wrong. They do heroic work every day. But it is time to ask more of the system itself. Children are not just small passengers in an adult-sized world. They are individuals with different risks, responses, and needs.
If we want to save more young lives, we have to build emergency systems that are ready for them.
