A fastening system includes an energy absorbing or impact indicator and at least one or more of the following: (1) a fastening base for mounting in an emergency vehicle, (2) a patient support engageable with a base, (3) a patient securement mechanism for securing a patient on a patient support, (4) a patient securement mechanism for securing a patient to a vehicle, (5) a patient support securement mechanism operable to secure a patient support in an emergency vehicle, or (6) a patient support securement mechanism operable to secure a patient support to a base, wherein the energy absorbing or impact indicator is located (1) at the patient securement mechanism, or (2) at the patient support securement mechanism, or wherein the energy absorbing or impact indicator is between (1) the base and the vehicle, (2) the patient support and the base, (3) the patient securement mechanism and the patient support, (4) the patient support and the emergency vehicle, (5) the patient and the emergency vehicle, or (6) the patient securement mechanism and the emergency vehicle, wherein the energy absorbing device or impact indicator has at least an energy absorbing state and a rigid state or indicates a level of impact at or between any of the respective component or components.