A method and cot fastening system for a patient transport vehicle having a rearwardly located patient access which meet the pull requirements for vertical and lateral movement are disclosed. The system comprises a rear mounting part, which mounts on the floor of the transport vehicle adjacent the patient access; a forward mounting part which mounts on the floor forward of the access, rails connecting the rear mounting part to the forward mounting part, and a release mechanism. The rails of the cot fastening system help guide the cot into the vehicle and to the forward mounting part. When the cot has reached the forward mounting part, a cross-member which forms part of the cot undercarriage, is urged against a pair of automatically locking securing mechanisms of the forward mounting part which secures the cot thereto as well as to the rear mounting part via catches.