programs with formalized dispatch procedures to include up-to-date weather information and assistance in flight risk-assessment decisions Although there is not a singular intervention or assessment tool that will guarantee risk-free air transport, accreditation by the CAMTS demonstrates adherence to the safety standards proposed for the air medical transport industry Vehicle Safety Accidents involving ground ambulances are tragically common In these accidents, the rear compartment of the vehicle is an extremely dangerous place Every patient must be safely restrained in the vehicle with shoulder and body straps, in a position that minimizes further injury and protects the airway; however, this can pose a significant challenge with pediatric patients Current guidelines for the safe transport of children in ground ambulances have been published by the National Highway and Traffic Safety Administration (https://www.nhtsa.gov/staticfiles/nti/pdf/811677.pdf ) Every ambulance should have the capacity to secure a child or infant safely If the patient is an infant and his or her medical condition permits, the use of an approved child safety seat (CSS) should be encouraged in a forward facing seat without an airbag However, these are not available in most ambulances and not allow for ease of continuous monitoring In some ambulances, there is a seat in the rear of the vehicle that can be opened into a CSS that may be appropriate For infants and small children who are to be secured on the ambulance cot, there are techniques that can be used to make this practice as safe as possible to reduce the chance of another injury if the vehicle is involved in an accident either using a commercial car seat in accordance with manufacturer guidelines or a commercial device approved for medical transport ( Fig 11.9 ) New products are available, many of which have been crash tested to establish their safety capabilities, that can safely secure a child to the ambulance cot, such as a restraint developed by Ferno (Wilmington, Ohio) (https://www.fernoems.com/us/en-us/ems/pediatrictransport/pediatric-restraints/pedi-mate-plus-pediatric-restraint-system ) These devices can be used for children too large to fit in a CSS or as an alternative to a CSS The transport provider must take great care to ensure that the patient is properly attached to the cot, and that the child’s head, torso, and pelvis are appropriately secured to prevent injury in an accident It is important to keep in mind that many of these products may not have established crashworthiness, and the degree of protection they provide is unclear The family’s own car seat, if able to be secured properly in the ambulance, may be an excellent choice for noncritically ill patients without special needs This also encourages a safe