hello class and welcome to chapter 8 lifting and moving patients of the emergency care and transportation of the sick and injured 12th edition after you complete this chapter in the related coursework you will understand the body mechanics of patient movement principles of safe reaching and pulling urgent and non-urgent moves how to move patients as a team types of patient packaging and moving equipment how to protect yourself from injury when moving patients and the use of medical restraints okay so let's get started in the course of a call you will have to move patients several times to provide emergency medical care and transport so at a minimum you will have to lift and carry the patient to the stretcher move the stretcher to the ambulance and load the stretcher into the patient compartment to move patients without injury to the patient yourself or your team you need to learn how to lift and carry a patient properly knowledge of proper body mechanics and a power grip is important okay so let's talk about the wheeled ambulance stretcher it's also called the stretcher or gurney and the device most commonly used to move and transport patients generally not taken up or downstairs or to other locations where the patient must be carried for any significant distance moving a patient by rolling using a stretcher or wheeled device is preferred when the situation allows and helps prevent injuries from carrying so some of the general features of the stretchers they have a specific head and and specific foot end and their strong rectangular their tubular metal main frame to which all other parts are attached the retractable guard rails are attached along the center portion of the main frame to prevent the patient from rolling off the stretcher the undercarriage frame allows the litter to be adjusted to any height and locked into place the stretcher remains locked at its present height when the controls are not activated so hinges at the center allow the head end to be elevated and the patient's back to be positioned at any desired angle the undercarriage is designed so that the litter can be adjusted to any height like i said and the mattress is fluid resistant so that it does not absorb potentially infectious materials and allows for easy cleaning and disinfecting and the patient is secured with straps and the straps protect the patient from further injury all right so once we move from backwards work or stretchers we're going to talk about backboards next and backboards are long flat boards made of rigid rectangular material they're used to carry and immobilize supine patients with suspected hip pelvic spinal and lower extremity injuries or other multi multiple trauma they can also be used to move patients out of awkward places parallel to the sides and ends of the board are long holes that serve as handles and that allows drops to be used to secure the patient to the board moving and positioning the patient so we're going to talk about that next and when you move the patient take care that injury does not occur to you your team or your patient so patient lifting and moving are technical skills that require repetitive training and practice so using proper body mechanics and maintaining physical fitness greatly reduce the chance of injuries moving a patient should be done in an orderly planned and unhurried manner you must master the skills necessary for the use of equipment and understand the advantages and limitations of each device before you use it in the field so let's talk about some body mechanics next and just a quick anatomy review so when you're standing upright the vertebrae are stacked on top of each other and aligned over the sacrum so the sacrum is both the mechanical weight-bearing base of the spinal column and the fused central posterior section of the pelvic girdle so when you talk about body mechanics that's the relationship between the body's autotomic structures and the physical forces associated with lifting moving and carrying so very little strain occurs when the spinal column remains in alignment okay so the lifting position you should have the shoulder girdle should be aligned over your pelvis your hands should be held close to the legs when this is happening force then goes essentially straight down your spinal cord and very little strain occurs this figure shows that the correct way to lift okay you may injure your back if you lift while leaning forward or if you lift while your back is straight but you're bent forward at the hips so lifting techniques so your legs should be spread about 15 inches apart or shoulder width you place um your feet so that they that your center of your gravity is properly balanced weight should be balanced on the balls of your feet not your toes with your back held upright bring your upper body down by bending at the legs grasp the patient or stretcher and make any necessary adjustments in the location of your feet we're gonna lift the patient by raising our upper body and arms and straightening our legs until we are in the standing position and then curling our arms up to waist height lifting by extending the properly placed flex legs is the safest and most powerful way to lift this is called the power lift do not lift a patient or heavy object with your arms outstretched avoid placing lateral force across the spine and sideways leverage against the low back keep your arms at a safe distance apart when when hanging your arms at the side of your body use the power grip to get maximum force from hands when you're lifting and so what the power grip is is the palms are up and the thumbs extend upward so hands are about 10 inches apart all fingers are at the same angle fingers and thumb are curled tightly over the top of the handle and fully support the handle with your curved palm not figure on the slide it shows a great photo of the power grip when directly lifting the patient tightly grip the patient in the place and manner that will ensure that you will not lose your grip on the patient all right so let's talk about some safe reaching and pulling principles so the same body mechanics and practices and principles apply to moving lifting and carrying a patient so let's talk about the body drag and when you do this you're going to keep your back locked in this slight curve created by tightening your abdominal muscles not curved or bent laterally kneel and extend your arms no more than 15 to 20 inches in front of you when you can pull no further because your hands have reached the front of your torso stop move back another 15 to 20 inches so alternate between pulling the patient by slowly flexing your arms and repositioning yourself this figure shows how to perform a body drag if you must drag a patient across the bed kneel on the bed to avoid reaching beyond the recommended distance drag the patient to within about 15 to 20 inches complete the drag while standing at the side of the bed use a sheet or blanket under the patient rather than dragging the patient by his or her clothing in the hospital when you're transferring the patients from the stretcher to the bed by a body drag the stretcher should be the same height or slightly higher than the bed you and your partner should kneel on the bed and drag in increments then there is the log roll so you can log rolling a patient onto his or her side to place the patient on the backboard you're going to kneel as close to the patient's side as possible and when you lean forward keep your back straight and lean solely from the hips roll the patient without stopping until the patient is resting on his or her side and braised against your thighs pulling towards you allows your legs to prevent the patient from rolling over completely and from rolling beyond the intended distance all right so let's talk a little bit more about safe lifting and carrying so whenever possible use a device that can be rolled to move the patient when a wheeled device is not available make sure that you can understand and follow the proper guidelines for carrying a patient to the stretcher so a patient's weight so you need to estimate the patient's weight before lifting adults often weigh between 120 to 220 pounds so two emts should be able to safely lift this weight use for providers to lift though when possible do not attempt to lift a patient who weighs more than 250 pounds with fewer than four providers know the weight limitations of the equipment and how to handle the patient who exceeds the weight limitations special bariatric techniques equipment and resources are generally required to move patients weighing more than 350 pounds lifting and carrying a patient on the backboard or stretcher so more of the patient's weight rests at the head of the stretcher than um half of the device than on the foot half the diamond carriers use uses one emt at the head and one emt at the foot of the backboard and one on each side of the torso and then the one-handed carry includes four or more rescuers each using one hand to support the backboard so that they are able to face forward as they're walking and these can be found in the skill drills in chapter eight right and then there's also a figure so the this figure shows the diamond carry for the stretcher when the stretcher must be carried it is best if four providers are available to carry it one provider should be positioned at each corner of the stretcher to provide an even lift and when you're rolling the wheeled ambulance stretcher make sure it is in the fully elevated position next we're going to talk about the stair chair so moving a patient with a stair chair use a stair chair to carry a patient up or down the flight of stairs or other significant incline if the patient is conscious and the patient's condition allows for him or her to be placed in a seated position so a stair chair is a lightweight folding chair with a molded seat adjustable safety straps and fold out handles at both the head and the feet most models have rubber wheels on the back with casters in the front so that they can roll along the floor and make turns you they're used to bring a conscious patient down to the stretcher and you could see this in the skill drill in chapter 8-4 okay moving a patient on stairs with a stretcher so a backboard should be used for a patient who is unresponsive or must be moved in a supine position so um also a patient who must be immobilized needs to be on the backboard so carry the patient on the backboard down the stairs to the prepared stretcher place the strongest emts at the head and foot ends of the board the taller person should be at the foot end of course and once you reach the stretcher place both of the backboard and the patient on the stretcher secure both the stretcher with additional straps to carry a patient on the stairs on a backboard follow the skill drills in 8-5 okay loading a wheeled stretcher into the ambulance so ensure the frame is held firmly between two hands so it does not tip newer models are self-loading so extra wheels at the end of the stretcher allow you to push the stretcher into the back of the ambulance models that are not self-loading need to be lowered and then lifted to the height of the floor of the ambulance clamps inside the ambulance will hold the stretcher in place during transport and then there's a skill drill it's 8-6 okay so directions and commands so team actions must be coordinated and we talk about having a team leader and this team leader indicates where each team member should be and rapidly describes the sequence of steps to perform before lifting they are preparatory commands and countdowns that they will use and so for example stop or all ready to stop you know countdowns are used okay and then carefully plan ahead so select the methods that you will involve the least amount of lifting and carrying consider whether there is an option that will cause some type of strain so emergency moves okay so what are emergency moves emergency moves are used when there is a potential for danger before assessment can and care can be provided so use emergency moves when you cannot properly assess the patient or provide immediate care because of the patient's position so techniques to prevent an aggregation of the patient's spinal cord injury if there is one present we use a closed drag and this we could pull on the patient's clothing in the neck and shoulder area we could use a blanket drag and this is we place the patient on a blanket coat or other item that can be pulled we could use an arm drag rotate the patient's arm so that they are extended on the ground above his head and grasp the wrist and drag the patient or you could do the arm to arm drag and basically you're placing the arms under the patient's shoulders and through the armpits and what you're while you're grasping the opposite wrist and you're dragging the patient backwards and this these figures show the different types of drag so you have the close drag the blanket drag the arm drag and then the armpit drag removing an unconscious patient from a vehicle alone you need to move the patient's legs clear the petals rotate the patient so that his or her feet or back or towards an open door then place the arms under the patient's shoulders and through the patient's armpits and support the patient's head against your body if the legs and feet clear the car rapidly drag the patient from the seat to a safe location and this figure shows the steps to remove an unconscious patient from the vehicle so urgent moves an urgent move may be necessary when we have a patient with an altered loss of altered level of consciousness or with inadequate ventilation in shock or in extreme weather conditions also a rapid extrication technique should be used when the patient is sitting in a vehicle and must be urgently moved whether a backboard is used for the skill will depend on your local protocols this technique should only be used if urgency exists so these special circumstances could be if the vehicle or scene is unsafe if explosives or other hazards are unseen maybe the car is on fire or is um there's a danger of that or the patient could not be properly assessed prior to the removal of the vehicle the patient needs immediate intervention that requires the supine position or if the patient has a life-threatening condition requiring immediate transport or the patient blocks your access to other serious injured patients so using the rapid extrication technique a patient can be moved from the sitting position in the vehicle to a supine on the backboard in one minute or less okay so because of its rapid nature this technique increases the risk of damage if the patient has a spinal cord injury so look at all available options before using this technique once a patient has been moved on to the backboard move the patient away from the hazard to begin life-saving treatment all right so some non-urgent moves and we can use these when both the scene and the patient are stable and we're going to carefully plan how to move the patient so methods for lifting and carrying we could use the direct ground lift and this is used for patients with no suspected spinal cord who are found on the ground we use the direct ground lift when the patient will need to be carried a distance to the stretcher so emt stand side by side to lift the patient and carry the patient then there's the extremity lift and this is used for patients with no suspected or extremity or spinal cord injury they may be helpful when the patient is in a small space because it does not require emts to stand side by side one emt is positioned at the head and the other is positioned at the feet and you're going to coordinate the movements by using direct verbal commands okay then there's transfer moves transfer moves include direct carry draw sheet method or using a scoop stretcher or other carries okay so direct carry is with two or more rescuers we're going to move supine patient from the bed to the stretcher we're using a direct carry okay a draw sheet method we're using two or more rescuers we're moving the patient from the bed to the stretcher using a sheet or blanket using a scoop stretcher we're going to insert the halves of the scoop stretcher under the patient and we're going to fasten the sides other carries are the log roll or slide to move the patient to the backboard okay okay when it comes to geriatrics most patients transported by ems are geriatric patients and there are some skeletal changes okay so we need to be careful of those uh changes in older people may cause brittle bones rigidity or spinal curvatures and these patients cannot lie supine on the backboard or scoop stretcher without causing further injuries so consider using geriatric specific mobilization devices such as vacuum mattresses this figure is going to show the skeletal changes so this is kyphosis all right and then bariatrics so the management of or prevention of obesity or diseases and bariatrics okay bariatric patients are taking an increasing toll on the health of emts back injuries account for the largest number of missed days with emts so stretchers and equipment are being produced with over higher cap with ever higher capacity so increased capacity does not address the danger of users of that equipment so mechanical ambulance lifts are used in europe but are uncommon in the united states so some additional um devices so this is a on the figure you could see the bariatric stretcher it's a specialized wheel stretcher for overweight or obese patients um they have a higher or wider patient surface area and a wider wheelbase allowing for increased stability the most important feature is an increased weight lifting capacity and then the mnemonic or electric powered wheel stretchers so these are battery or air operated with electric controls to raise and lower the undercarriage devices limit the risk of injury to the providers and to the patients okay then there's portable or folding stretchers so these stretchers with long rectangular um tubular frame with rigid fabric stretched across it so they're used in areas where it's difficult to read they weigh much less than wheeled stretchers all right and then you have flexible stretchers and these can be rolled up across the stretcher's width or length so that the stretcher becomes a smaller tubular package and it conforms around the patient's sides and does not extend beyond them when extended useful when removing patients from or through a confined space and then there's short boards short backboards and these are used to immobilize the head torso and neck of a seated patient with a suspected spinal cord injury until the patient can be moved to a long backboard short wooden backboards have mostly been replaced with this vest style type device that you see in the photo it's a ked and what that stands for is kendrick extrication device and you can see a photo of that on the slide then you have the vacuum mattresses this is an alternative to a backboard for mobilizing geriatric and pediatric patients the patient is placed on the mattress and the air is removed from the device allowing it to mold to the patient it provides a high degree of immobilization comfort and thermal insulation then you have basket stretchers so these are rigid and they're used to carry patients across an even terrain from a remote location that is inaccessible to an ambulance or another vehicle okay so if the patient has suspected spinal injury secure the patient to a backboard and secure the backboard inside the stretcher so when you return to the ambulance if the backboard lift the backboard out of the basket structure and place it on the ambulance stretcher so these are used for technical rope rescues and some types of water rescues okay these are designed to split into two or two or more pieces so this is the scoop stretcher and the pieces are fitted around the patient who's lying on the ground are on some other flat surface so the parts are then reconnected and the patient is lifted and put onto the backboard both sides of the patient must be accessible to use the scoop stretcher and you must fully immobilize and secure the patient onto the scoop stretcher so it's almost just like putting spatulas underneath them scooping them up and then there's a neonatal isolette and this is for the neonatal patient so birth to 30 days the first 30 days of that neonatal period it cannot be transported on the wheeled stretcher it keeps the neonatal patient warm with moistened air in a clean environment it protects from noise drafts infection and excessive handling this isolette can be placed directly on the wheeled stretcher and secured with seat belts and uh it's freestanding and secured onto the back of the ambulance in place or of where the stretcher could be then there's decon so it's essential that you decontaminate the equipment after we use it and that's for our safety and the safety of the crew and then the safety of the patients of course and then preventing the spread of disease so know and follow your local standard operating procedures for disinfecting the equipment let's talk about patient positioning okay so the patients must be properly positioned based on their chief complaint so when we talk about this if we have a patient who has no suspected injury reporting of chest pain or respiratory distress we should place the patient in the position of comfort and that's typically the fowler or semi-fowler position so patients who are in shock should be packaged in place in the supine position patients in late stages of pregnancy they should be positioned and transported on their left side if if they are uncomfortable or hypotensive supine exists okay so an unresponsive patient with no suspected injury hip or pelvic injury should be placed in the recovery position and a patient who is nauseated or vomited vomiting should be transported in the position of comfort now let's talk about medical restraints so first evaluate as a patient for correctable causes of combativeness such as a head injury or hypoxia or hypoglycemia and follow your local protocols or obtain medical authorization if necessary you're going to require restraints require a minimum of five people so one for each extremity and one for the head one emt should be the established team leader the patient should be in the supine position and the patient in a prone position can develop some type of asphyxia so we want to keep them in the supine position each extremity should have a restraint applied to it the patient should be restrained to the backboard with one arm above his or her head and the other arm down by its side assess the abc's mental status and circulation um after endurance and um often okay and then document all that information personal consideration so ask yourself these questions before moving the patient am i physically strong enough is there adequate room for me to get the proper stance to lift the patient and do i need personal for lifting assistance do i need additional personnel so injured emts cannot help anymore all right so that concludes chapter eight lifting moving patients let's just go through the review questions see what how much we've learned so what is the first rule of lifting what do we know are we going to use our arms to do most of the lifting no we're going to always keep our back in the straight upright position it's the best use okay when lifting a stretcher using a power lift you should what should we do we should have our hands should be facing palms up this is a better power lift and it is not as stressful on the wrist okay so see place your hands palms up on the leader handle it is important to apply a vest type extrication device on a critically injured patient to remove him or her from a wreck because it oh it is impractical yes because it takes too long hey it takes too long proper guidelines for correct reaching include all of the following except all right which one does not include reaching no more than 30 inches in front of your body all right that's right we don't want to reach no more than 30 inches in front of our body okay an injured hand glider is trapped at the top of a large mountain and must be evacuated to the ground the terrain is very rough and even which of the following devices would be the safest and most appropriate i think it would probably be the stokes basket all right and what the stokes basket is it's a basket stretcher so i think that we went over it in it being called a basket stretcher when two emts are lifting a patient on a long backboard they should they should since there is more than half of the patient's weight is distributed to the head end of the backboard or stretcher you should always ensure that the strongest emt is in that position okay so position the strongest emt at the head of the board which of the following techniques is considered to be an emergency move the firefighter's drag is a one-person technique that's used when the patient must be removed from a life-threatening situation so that would be the firefighter's drug to extricate a patient from the basement of a building you must transport the patient up a flight of stairs in doing this you must ensure that we don't want the feet to go first we know that so we know that if we're going on up on an incline we want to ensure that the head the head goes first not the feet if an injured patient must be moved but is not in immediate danger from a fire or building collapse you should first of course the only time your attention should be directed away from the primary assessment is if there's a life immediate danger life threat so the first thing we should do is check the airway breathing and circulation the rapid extrication technique is to the rapid extrication technique is to remove a person rapidly from a vehicle to a supine position onto a backboard so that was d all right and thank you for joining us uh chapter eight uh lifting and moving patients