Cot fastening systems (2) which fix and hold an emergency cot (14) to a crash stable cot fastener track (12) provided within an emergency vehicle (8). The track (12) has a longitudinal length with front (85) and back ends (80), open side rails (28, 30) longitudinally extending between the ends, and a channel (86, 88) centrally located between the rails. The side rails (28, 30) align, accommodate and guide a forward fixture (4) of the cot towards the front end (85) as the cot (14) is rolled within the vehicle to retain the forward fixture (4) adjacent the front end (85) at least vertically and laterally. The channel (86, 88) accommodates and retains a rearward fixture (6) adjacent the back end (80) at least vertically and laterally. A securing mechanism (70,102) releasably prevents removal of the forward fixture (4) from the open side rails and removal of the rearward fixture (6) from the channel (86, 88).