Cot fastening systems which fix and hold an emergency cot to a crash stable, cot fastener track included in the system and provided within an emergency vehicle and methods of affixing the emergency cot thereto are disclosed. The track has a longitudinal length with first and second ends, open side rails longitudinally extending between the ends, and a channel centrally located between the rails. The side rails align, accommodate and guide a first fixture of the cot towards the first end as the cot is rolled within the vehicle and to retain the first fixture adjacent the first end at least vertically and laterally therein. The channel accommodates therein and retains a second fixture adjacent the second end at least vertically and laterally therein. A securing mechanism releasably prevents removal of the first fixture from the open side rails and removal of the second fixture from the channel.