Chapter 8. Lifting and Moving Patients. Introduction. In the course of a typical call, you will have to move the patient several times to provide emergency medical care and transport. Once you have assessed the patient and provided emergency care, the patient is generally moved onto a stretcher. In most cases, 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.
Upon arrival at the hospital, the patient must be removed from the ambulance, wheeled into the emergency department, and transferred to the emergency department bed. To avoid injury to the patient, yourself, or your team, you need to learn how to lift and carry a patient properly, using proper body mechanics, and a power grip. To move a patient safely in the various situations that you may encounter in the field, it is necessary to learn how to perform emergency body drags and lifts. rapidly extricate a patient from a vehicle onto the stretcher, assist a patient from a chair or bed onto the stretcher, lift a patient from the floor onto the stretcher, and manually carry a patient up or downstairs.
You and your team should know how to place a patient with a suspected spinal injury onto an immobilization device, and how to package patients with and without suspected spinal injury. At times, You and your team may need to move a patient who is very heavy or carry a patient on a trail or across rugged terrain. Special techniques for loading and unloading the stretcher and transferring the patient from the stretcher to a bed in the emergency department are necessary.
Lifting and carrying are dynamic processes. Back injuries are the leading cause of injury that forces emergency medical technicians and paramedics to leave the profession. Learning the proper way to lift and move patients will help prevent you from suffering injury. You also need to know how to properly use patient moving devices, such as a stretcher, stair chair, back board, scoop stretcher, flexible stretcher, and any other equipment your service may carry.
You must also know which device or combination of devices is appropriate for the current situation. This chapter will cover lifting, carrying, and reaching techniques as well as principles of moving patients, including emergency, urgent, and non-urgent moves, and the use of physical restraints to protect the patient and your team from further harm. In addition, different types of equipment and patient positioning will be discussed in detail.
The wheeled ambulance stretcher The wheeled ambulance stretcher, also called an ambulance stretcher, gurney, litter, or cot. is the most commonly used device to transport patients. The wheeled ambulance stretcher is a specially designed stretcher that can be rolled along the ground and weighs between 40 and 145 pounds, 18 and 66 kilograms, depending on its design and features. Because of its weight, it is 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 other wheeled device is preferred when the situation helps prevent injuries. The modern stretcher is available in a number of different models, which may include different features. During your training, familiarize yourself with the specific features of the stretcher that your ambulance carries. You must know where to locate the controls to adjust and lock each feature and how each works. The stretcher has a specific head end and foot end.
The stretcher has a strong, rectangular, tubular metal mainframe to which all of its other parts are attached. The stretcher should be pulled, pushed, and lifted only by its mainframe or handles, which are attached to the frame specifically for this purpose. A retractable guardrail is attached along the central portion of the mainframe of the stretcher at each side, and is lowered out of the way when a patient is being loaded onto the stretcher.
Once the patient has been properly placed on the stretcher, the handle is drawn up and locked in an elevated position perpendicular to the surface of the stretcher. The guardrail is not a restraint device, and will not prevent the patient from falling off of the stretcher. The guardrail at each side can be lowered only if its locking handle is released. The underside of the main frame of the stretcher is supported on a folding undercarriage that has a smaller, horizontal rectangular frame and four large rubber casters at its bottom end. The folding undercarriage is designed so that the litter can be adjusted to any height from about 12 inches above the ground, which is the desired height when the stretcher is secured in the ambulance, to 32 to 36 inches above the ground, which is the desired height when the stretcher is being rolled.
Because you are able to lock the stretcher at any height between its lowest height and its fully extended height, it can be locked at the same height as any bed or examining table to allow the patient to sit or be slid from one to the other. This permits you to transfer the patient without the need for any additional lifting. The controls for folding the undercarriage are designed so that the stretcher remains locked at its current height when the controls are not being activated. As an additional safety feature on most stretchers, The main frame must be slightly lifted to remove all weight from the undercarriage before it will fold, even if the control is pulled.
Therefore, if the handle is accidentally pulled, the elevated stretcher will not suddenly drop. Controls for elevating and lowering most stretchers are located at the foot end. You and your partner must use the proper lifting mechanics to lift the wheeled ambulance stretcher.
The mattress on a stretcher is fluid resistant so that it does not absorb any type of potentially infectious material, including water, blood, or other body fluid. This also allows for easy cleaning and disinfecting. Patients must always be secured with the straps on the stretcher. In the event of a crash while en route to the hospital, the straps help to protect the patient from further injury.
Secure the patient to the wheeled ambulance stretcher as follows. 1. Secure the stretcher's safety belts over the patient's shoulders, and around the patient's chest in a four-point harness fashion. They should be tight enough to keep the patient secure and on the stretcher but not limit breathing. 2. Secure the stretcher's safety belt over the patient's abdomen.
3. Secure the stretcher's safety belt over the patient's thighs. 4. Secure the stretcher's safety belt over the patient's ankles. Backboards. A backboard is a long, flat board made of rigid, rectangular material. Backboards are also called long backboards, spine boards, trauma boards, or long boards.
A backboard is used to temporarily restrict spinal motion in supine patients with potential neck and back injuries. Backboards can also be used to move patients out of awkward places. Backboards are 6 to 7 feet long. approximately 2 meter and are commonly used for patients who are found lying down. Parallel to the sides and ends of the back board are a number of long holes that are about 0.5 to 1 inch from the outer edge.
These holes form handles and handholds so that the board can be easily grasped, lifted, and carried. The handles and adjacent holes also allow the patient to be secured to the board using straps located at each side and end of the backboard. For many years, backboards were made of thick marine plywood whose surface was sealed with polyurethane or marine varnish. Newer backboards are made of lighter plastic materials that will not absorb blood or other infectious substances.
Some services are moving away from backboard use due to injuries patients can receive after being secured to them for long periods, and are instead using other devices, such as vacuum mattresses. Moving and positioning the patient. Every time you have to move a patient, special care must be taken so that neither you, your team, nor the patient is injured.
Patient packaging and handling are technical skills that you will learn and perfect through repeated training and practice. Every year, a significant number of emergency medical technicians are injured when they attempt to lift and move patients. Even when you are lifting, moving, or transferring relatively lightweight patients, the need for proper body mechanics should remain paramount. Occasionally injuries occur when proper lifting techniques are used.
However, using proper body mechanics and maintaining physical fitness greatly reduces the chance of injury. Moving a patient should be done in an orderly. planned, and unhurried manner. This approach will protect you and the patient from further injury, and reduce the risk of worsening the patient's condition when he or she is moved. Therefore, practice each technique with your team often so that when you must move a patient, you can perform the move quickly, safely, and efficiently.
You must also master the skills necessary for the use of all equipment. understand the advantages and limitations of each device before you use it in the field. After each patient transfer, you and your team should evaluate the appropriateness of the technique that you used, as well as your technical skill in completing the transfer.
You must also be sure to maintain your equipment according to the manufacturer's instructions. Using clean, well-maintained equipment is a critical part of providing high-quality patient care. After delivering the patient to the emergency department, you and your team must begin preparation for your next call by reviewing the positive points about the transport and discussing changes that would improve the next run. This process of evaluation should help you identify the following.
Procedures that need more practice. Equipment that needs to be cleaned or serviced. Skills that you need to review or acquire.
Body mechanics. Anatomy review. The shoulder girdle rests on the rib cage, and is supported by the vertebrae that lie inferior to it.
The arms are connected to and hang from the shoulder girdle. When a person stands upright, the individual weight-bearing vertebrae are stacked on top of each other and aligned over the sacrum. The sacrum is both the mechanical weight-bearing base of the spinal column, and the fuse central posterior section of the pelvic girdle.
Body mechanics is the relationship between the body's anatomic structures. and the physical forces associated with lifting, moving, and carrying. In other words, the ways in which the body moves to achieve a specific action.
Maintaining proper posture and body movement during daily activities is applying the use of body mechanics. Using good body mechanics while lifting and moving patients reduces your risk of injury. When a person stands upright, the weight of anything being lifted and carried in the hands is reflected onto the shoulder girdle.
the spinal column inferior to it, the pelvis, and then the legs. In lifting, if the shoulder girdle is aligned over the pelvis, and the hands are held close to the legs, the force that is exerted against the spine occurs in an essentially straight line down the vertebrae in the spinal column. Therefore, with the back properly maintained in an upright position, little strain occurs against the muscles and ligaments that keep the spinal column in alignment.
significant weight can be lifted and carried without injury to the back. However, you may injure your back if you lift while leaning forward, or even if you lift while the back is straight, while you are bent significantly forward at the hips. With the back in either of these positions, the shoulder girdle lies significantly anterior to the pelvis, and the force of lifting is exerted primarily across, rather than down, the spinal column.
When this occurs, The weight is supported by the muscles of the back and ligaments that run from the base of the skull to the pelvis, keeping the spinal column in alignment, rather than by each vertebral body and disc resting on those aligned below it. In addition, the upper spine and torso serve as a lever so that the force that is exerted against the muscles and ligaments in the lumbar and sacral regions, as a result of the mechanical advantage produced, is many times that of the combined weight of your upper body, and the object you are lifting. Therefore, the first key rule of lifting is to always keep your back in a straight, upright, vertical, position, and lift without twisting.
Always face the patient and point your feet in the same direction. After lifting the patient, change the direction of your feet as opposed to twisting or turning from the waist. When lifting, spread your legs approximately shoulder width apart, and place your feet so that your center of gravity is properly balanced between them. Your weight should be balanced on the balls of your feet, not your toes.
Then, with the back held upright, bring your upper body down by bending the legs. Once you have properly grasped the patient or stretcher, and made any necessary adjustments in the location of your feet, lift the patient by straightening your legs until you are in a standing position, and then curling your arms up to waist height. If you still have not reached the desired height, Reposition your legs so they are closer together and repeat the process. Because the leg muscles are regularly exercised by walking, climbing stairs, or running, they are well developed, and strong. Therefore, as well as being the safest method, lifting by extending the properly placed flexed legs is also the most powerful way to lift.
This method is appropriately called a power lift. One mistake to avoid while performing a lift is lifting a patient or other heavy object with your arms outstretched. Even if your back is held properly upright, adverse forces across the spinal column and leverage against the low back will occur if your hands are significantly anterior to the plane described by the front of the torso.
The plane consists of the anterior torso, and imaginary lines extend vertically above and below it. Whenever you lift or carry a patient, Be sure to hold your arms so that your hands are almost adjacent to the plane described by your anterior torso, and always keep the weight that you are lifting as close to your body as possible. Another rule to remember when lifting is to avoid placing lateral force across the spine, and sideways leverage against the low back.
If you lift with only one arm or with the arms extended more to one side than the other, more force will be exerted against one side of the shoulder girdle than the other, causing lateral force to be exerted across the spinal column. To prevent this, keep your arms approximately the same distance apart as when hanging at each side of the body, with the weight distributed equally and properly centered between them. If the weight is not balanced between both arms or properly centered between the shoulders when you are preparing to lift, turn and or move to the left or right until the weight is properly balanced and centered. To lift safely and produce the maximal power lift, take the following steps. 1. Tighten your back in its normal upright position, and use your abdominal core muscles to lock it in a slight curve.
2. Spread your legs apart about 15 inches. 38 centimeters and bend your legs to lower your torso and arms 3 with arms extended down each side of the body grasp the stretcher or back board with your hands held palm up and just in front of the plane described by the anterior torso and imaginary lines extending vertically from it to the ground 4 adjust your orientation and position until the weight is balanced and centered between both arms step 1 5 Reposition your feet as necessary so that they're about 15 inches apart with one slightly farther forward and rotated so that you and your center of gravity will be properly balanced between them. Be sure to straddle the object, keep your feet flat, and distribute your weight to the balls of the feet or just behind them.
The knees should not bend more than 90 degrees, nor extend past the toes. 6. With the arms extended downward, Lift by straightening your legs until you are fully standing. Make sure your back is held upright and that your upper body comes up before your hips.
Step 2. Skill Drill 8-1 Performing the Power Lift Step 1. Lock your back in a slight curve, spread and bend your legs. Grasp the back board, palms up and just in front of you. Balance and center the weight between your arms.
Step 2. Position your feet. Straddle the object and distribute your weight evenly lift by straightening your legs keeping your back locked in Reverse these steps whenever you are lowering the stretcher Always remember to avoid bending at the waist or twisting as you stand your safety as well as that of the other emergency medical technicians and the patient depends on the use of proper lifting techniques and Maintaining a proper hold when lifting or carrying a patient If you do not have proper hold of the stretcher or of the patient in a body lift, you will not be able to bear a proper share of the weight, and there is an increased chance that you might suddenly lose your grasp with one or both hands. If you temporarily lose your grasp, the position and weight distribution of the stretcher will change suddenly, and the other team members must quickly overextend beyond a safe distance to avoid dropping the patient.
As a result, Sudden excessive force may be placed across each one's spine, causing low back injury. You should use the power grip to get the maximum force from your hands and arms whenever you are lifting a patient. The arm and hand have their greatest lifting strength when facing palm up. Whenever you grasp a stretcher or backboard, your hands should be at least 10 inches, 25 centimeters, apart. Each hand should be inserted under the handle with the palm facing up and the thumb extended upward.
Next, advance the hand until the thumb prevents further insertion, and the cylindrical handle lies firmly in the crease of your curved palm. Curl your fingers and thumb tightly over the top of the handle. All your fingers should be at the same angle. To have the proper power grip, make sure that the underside of the handle is fully supported on your curved palm.
palm with only the fingers and thumb preventing it from being pulled sideways or upward out of the palm. If you must lift the object higher once you have lifted by extending your legs, you will be able to curl the object higher by using your biceps to flex the arms while maintaining the power grip and weight supported in the palms. Never grasp a stretcher or backboard with the hand placed palm down over the handle.
When you are lifting with the palm down, the weight is supported by the fingers rather than the palm. This hand orientation places the tips of the fingers and thumb under the handle. If the weight forces them apart, your grasp on the handle will be lost. Principles of safe reaching and pulling.
The same basic body mechanics and principles apply to moving, lifting, and carrying a patient. When you use a body drag to move a patient, your back should always be locked in a slight curve created by tightening your abdominal muscles, not curved laterally or bent laterally. It should be held in its normal upright position.
Avoid any twisting so that the vertebrae remain in their normal alignment. When you reach overhead, avoid hyperextending your back. When you pull a patient who is on the ground, always kneel to minimize the distance that you will have to lean over.
Figure 8-6a. To keep your reach within the recommended distance, reach forward and grasp the patient so that your elbows are just beyond the anterior torso. Figure 8-6b. When you pull a patient who is at a different height from you, bend your knees until your hips are just below the height of the plane across which you will be pulling the patient. During pulling, extend your arms no more than about 15 to 20 inches, 38 to 50 centimeters.
in front of your torso. Reposition your feet or knees if kneeling so that the force of pull will be balanced equally between both arms and the line of pull will be centered between them. Pull the patient by slowly flexing your arms. When you can pull no farther because your hands have reached the front of your torso stop and move back another 15 to 20 inches 38 to 50 centimeters.
Then when properly position Repeat the steps. Alternate between pulling the patient by flexing your arms, and then repositioning yourself so that your arms are again extended with your hands about 15 inches in front of your torso. By not moving yourself and the patient simultaneously, you will prevent undesirable jostling of the patient, and the chance that sudden force will occur across your spine. You should also try to prevent injury to yourself by avoiding situations that involve strenuous effort lasting more than one minute.
If you must drag a patient across a bed, kneel on the bed to avoid reaching beyond the recommended distance. Then follow the steps described previously until the patient is within 15 to 20 inches, 38 to 50 centimeters, of the bed's edge. See Figure 8-6.
You can then complete the drag while standing at the side of the bed. Rather than dragging the patient by his or her clothing, use the sheet or blanket under the patient for this purpose. You can roll the bedding under the patient until it is about 6 inches, 15 centimeters, wider than the patient.
Pull on the rolled bedding smoothly and evenly to glide the patient to the bedside. Transfer the patient from the stretcher to a bed in the emergency department or the patient's hospital room with a body drag. With the stretcher at the same height as the bed or slightly higher and held firmly against the bed's side, you and another emergency medical technician should kneel on the hospital bed and, in the manner previously described, drag the patient in increments until he or she is properly centered on the bed. A third person may need to take both sides of the head to move the patient safely, sometimes during a body drag. You and another emergency medical technician may have to pull the patient with one of you on either side of the patient.
You will have to alter the pulling technique to prevent pulling sideways and producing adverse lateral leverage against your lower back. Position yourself by kneeling just beyond the patient's shoulder, and facing toward his or her groin. By extending one arm across and in front of your chest, you can grasp the armpit and, with your other arm extended in front, and to the side of the patient's torso, the patient's belt. Then, by raising your elbows and flexing your arms, you can pull the patient with the line of force at the minimum angle possible.
Generally, when log rolling a patient onto his or her side, you will initially have to reach farther than 18 inches . To minimize this distance, kneel as close to the patient's side as possible. leaving only enough room so that your knees will not prevent the patient from being rolled. When you lean forward, keep your back straight and lean solely from the hips.
Be sure to use your shoulder muscles to help with the roll. To minimize the amount of time you are extended like this and to support the patient's weight, roll the patient without stopping until the patient is resting on his or her side, and braced against your thighs. Pulling toward you allows your legs to prevent the patient from rolling over completely and from rolling beyond the intended distance. Principles of safe lifting and carrying. Whenever possible, use a device that can be rolled to move a patient.
However, in a situation where a wheel device is not available, you must make sure that you understand and follow certain guidelines for carrying a patient on a stretcher. Table 8-1 presents the guidelines. Patient weight. You should estimate how much the patient weighs before you attempt to lift. Commonly, adult patients weigh between 120 and 220 pounds, 54 and 100 kilograms.
Depending on your individual strength, you and another emergency medical technician may be able to safely lift an even heavier patient. However, due to safety concerns, consider using four providers to lift when possible. There is more stability with a four-person carry, and the carry requires less strength. You should know how much you can comfortably and safely lift, and do not attempt to lift a proportional weight, the share of the weight that you will bear, that exceeds this amount. If you find that lifting the patient places a strain on you, stop the lift and lower the patient.
You should then obtain additional help before again attempting to lift the patient. Be sure to communicate clearly and frequently with your partner. and other providers whenever you are lifting a patient.
Protocols should include a method to rapidly summon additional help to lift and carry a heavy patient or, as in the case of a cardiac arrest, provide and maintain the necessary care in the field. In addition, you must know, or be able to find out, the weight limitations of the equipment you are using, and how to handle patients who exceed those weight limitations. Special Bariatric Techniques Equipment and resources are generally required to move any patient who weighs more than 350 pounds 159 kilograms to the ambulance discussed later in the chapter. These resources should be called on when you arrive on scene and have assessed the situation.
Lifting and carrying a patient on a backboard or stretcher. If a patient is supine on a backboard or is lying in a semi-fowler position on the stretcher, His or her weight is not equally distributed between the two ends of the device. Between 68% and 78% of the body weight of a patient in a horizontal position is in the torso.
Therefore, more of the patient's weight rests on the head half of the device than on the foot half. A patient on a backboard or stretcher can be lifted and carried by four providers in a diamond carry, with one provider at the head end of the device, one at the foot end, one at each side of the patient's torso. Follow these steps to perform the diamond carry.
1. To best balance the weight, the providers at each side should be located so that they are able to grasp the backboard or stretcher with one hand adjacent to the distal edge of the patient's pelvis, and the other hand located mid-thorax. All four providers lift the device while facing toward the patient. Step 1. 2. The provider at each side should grasp the backboard or stretcher with the head and hands.
Step 2. 3. The providers at each side turn toward the patient's feet. The provider at the foot end turns to face forward. All four providers should face the same direction and walk forward when carrying the patient.
Step 3. Skill Drill 8-2 Performing the Diamond Carry Step 1. Position yourselves facing the patient. Step 2. The providers at each side turn the head and hand palm down and release the other hand. Step 3. The providers at each side turn toward the foot end.
The provider at the foot end turns to face forward. A patient on a backboard or stretcher should be carried feet first to place the lightest load on the provider at the patient's feet, who, to walk forward, must turn and grasp the handles with his or her back to the device. Carrying the patient feet first will also allow a conscious patient to see in the direction of movement, which may reduce anxiety.
It is important that you and your team use the correct lifting techniques to lift the stretcher. One method of lifting and carrying a patient on a backboard is the one-handed carry. With this method, four or more providers each use one hand to support the backboard so that they are able to face forward as they are walking. To perform the one-handed carry, follow the steps in Skill Drill 8-3.
1. Before lifting the backboard Be sure that at least two providers are on each side of the backboard facing across from each other and using both hands. Step 1. 2. Lift the backboard to carrying height using correct lifting techniques, including a locked-in back. Step 2. 3. Once you have lifted the backboard to carrying height, you and your partners turn in the direction you will be walking and switch to using one hand. Step 3. Skill Drill 8-3.
Performing the one-handed carry. Step 1. Face each other and use both hands. Step 2. Lift the backboard to carrying height. Step 3. Turn in the direction you will walk, and switch to using one hand.
Be sure to pick up and carry the backboard with your back in the upright position. If you need to lean to either side to compensate for a weight imbalance, you have probably exceeded your weight limitation. If this occurs, re-evaluate the carry, you may need additional providers or else you might injure yourself or drop the patient.
In most instances. It is best if you push the head of the stretcher while your partner guides the foot of 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. If only two providers are available, or if limited space allows room for only two providers to carry the stretcher, there is a risk that the stretcher will become unbalanced. In a two-person carry, The two providers should stand facing each other, with one person at the head end of the stretcher, and the other at the foot end. With this type of carry, one provider will have to walk backward.
When you are rolling the wheeled ambulance stretcher, make sure that it is in the fully elevated position. If you are guiding the stretcher from the foot end, make sure your arms are held close to your body, and be careful to avoid reaching significantly behind you or hyperextending your back. Recall that your back should be locked, straight, and untwisted.
While you are walking and guiding the stretcher, bend slightly forward at the hips. As you walk, your legs are pulled back with your feet on the ground, your pelvis is moved forward, and the movement of the pelvis is transferred to the stretcher through your straight torso, and firmly held arms. Try to keep the line of the pull through the center of your body by bending your knees. Your partner should control the head and and assist you by pushing with his or her arms held with the elbows bent so that the hands are about 12 to 15 inches in front of the torso. To protect your elbows from injury, never push an object with your arms fully extended in a straight line, and the elbows locked.
When you push with the elbow bent but firmly held from bending further, The strong muscles of the arm serve as a shock absorber if the wheels or foot end of the stretcher strikes an obstacle that causes its progress to be suddenly slowed or stopped. Be sure that you push from the area of your body that is between the waist and shoulder. If the weight you are pushing is lower than your waist, push from a kneeling position. Remember not to push or pull from an overhead position. Moving a patient with a stair chair.
When you must carry a conscious patient up or down a flight of stairs or other significant incline, use a stair chair if the patient's condition allows him or her to be placed in a sitting position. A stair chair is a lightweight folding chair with a molded seat, adjustable safety straps, and fold-out handles at both the head and feet. Most models have rubber wheels in the back with casters in front so that they can roll along the floor and make turns. Some have a specially designed track to facilitate movement down steps with little lifting required. Stair chairs serve as an adjunct for moving a patient up or down stairs to the ground floor, where the prepared wheeled ambulance stretcher is waiting.
You can roll the stair chair on the floor until you reach the stairwell, and then both providers carry it, rather than roll and bump it, up or down the stairs. You will find this is one of the most useful tools in moving a patient. When the patient is upstairs, you should take the wheeled ambulance stretcher to the ground floor landing, and prepare it for the patient. Place it at the proper height, lower the side rails, turn down the cover sheet, and remove any equipment that you may have secured on the top. You should then take the stair chair upstairs and load the patient into it.
Once reaching the bottom of the stairs, transfer the patient from the stair chair onto the stretcher. Follow these steps to use a stair chair. 1. Secure the patient to the stair chair with straps. At a minimum, use a lap belt at the hips, and two straps around the chest. You will need to coach the patient to hold on to the chest straps tightly as to prevent the patient from grabbing onto the stairwell or rails, and throwing the team off balance.
2. Take your places around the patient seated on the chair, one provider at the head end, and one at the foot end. Step 1. The provider at the head will give directions to coordinate the lift and movement. If a third provider is on scene, he or she may precede you and your partner, keeping his or her hand on the back of the second provider who is at the feet. The third provider can assist by opening doors and providing guidance and support. For lengthy carries, a third provider can also rotate into the carrying team to provide breaks for the other two.
3. When reaching landings, and other flat intervals in the move, lower the chair to the ground and roll the chair to the next position. Upon reaching the ground level where the stretcher awaits, roll the chair into position next to the stretcher in preparation for transferring the patient. Step 2. Skill Drill 8-4.
Using a Stair Chair. Step 1. Position and secure the patient on the chair with straps. Take your places at the head and foot of the chair. Step 2. Lower the chair to roll on landings, and for transfer to the stretcher. As with other carries, always remember to keep your back in a locked in position, and to flex at the hips, not the waist.
Bend at the knees, and keep the patient's weight, and your arms as close to your body as possible. Twisting while carrying or moving a patient will increase your risk of injury. Try to avoid any unnecessary lifting and carrying of the patient.
You may find that a log roll or a body drag will aid you in moving your patient onto the backboard or the stretcher. If these techniques will not harm or jeopardize your patient's condition, use one of these moves. Moving a patient on stairs with a stretcher.
When a patient is unresponsive, must be moved in a supine position. or must be immobilized, secure the patient onto a soft stretcher backboard or vacuum mattress. Be sure that the patient is anatomically secured to the device so that he or she cannot slide significantly.
Carry the patient on the backboard down the stairs to the prepared stretcher. When moving on stairs, more than half of a patient's weight is distributed to the head end of the device, so make sure the strongest provider is positioned at the head end. Even with four or more providers carrying the patient, the strain on the provider at the head end will be increased when you must negotiate a narrow flight of stairs. In carrying a patient up or down a flight of stairs, proportionally greater weight will also be distributed to the provider who carries the foot end when the device becomes angled because of the incline or decline. You should anticipate this and, in such cases, make sure the two strongest providers are positioned at the head and foot ends of the device.
Because of the incline of the stairway, if one of the two strongest providers is considerably taller than the other, it will be easier if the shorter provider is at the head end, and the taller provider is at the foot end. This minimizes bending while lifting and moving the patient. Once you reach the stretcher, place both the device, and the patient on the stretcher, then secure both to the stretcher with additional straps. To carry a patient on stairs on a backboard or vacuum mattress, Follow the steps in skill drill 8-5.
1. Apply the straps to pass tightly across the upper torso over the shoulder, and across the patient's chest, but not over the arms, to hold the patient in place while leaving the arms free. The strap is secured to the handles at both sides of the backboard or vacuum mattress so that it cannot slide toward the foot end of the device. Strap the patient securely to the device.
Step 1. 2. When you carry the patient downstairs or an incline, make sure the backboard or vacuum mattress is carried with the foot end first so that the head end is elevated higher than the foot end. The straps will prevent the patient from sliding down or off the device. Step 2. Skill Drill 8-5.
Carrying a Patient on Stairs. Step 1. Strap the patient securely. Make sure one strap is tied across the upper torso, under the arms. and secured to the handles to prevent the patient from sliding. Step 2. Carry a patient downstairs with the foot in first, always keeping the head elevated.
Loading a wheeled stretcher into an ambulance. Whenever a patient has been placed onto the stretcher, one emergency medical technician must hold the mainframe to prevent movement. When the stretcher is elevated, the mainframe and the patient extend considerably beyond the wheels at both the head end and foot end of the stretcher. Therefore, whenever a patient is on an elevated stretcher, you must ensure that it is held firmly between two hands at all times so that even if the patient moves, the stretcher cannot tip. Inside the ambulance are strong clamps that fasten around the undercarriage when the stretcher is pushed into them.
The clamps are located in a rack on the floor or side of the patient compartment. or through a center mounted track system and will hold the stretcher in place until they're released at the hospital you can control and release the clamps with a single handle when standing on the ground at the open back doors of the ambulance when the stretcher is to be unloaded Stretcher is designed to be rolled on flat surfaces. Ensure the intended travel path is free from debris and potential obstacles. If the patient must be moved over a long or other irregular surface, you must lift and carry the stretcher over the terrain. A four-person carry is much safer if the stretcher must be moved over rough ground.
If the loaded stretcher must be carried down a short flight of steps, be sure to first retract or raise the undercarriage, however. This is not necessary when a stretcher must be lifted over a curb, a single step, or an obstacle of a similar height. When you reach the back of the ambulance, you and your partner will roll the front wheels onto the floor in the back of the ambulance, advancing the stretcher until the safety hook catches the stretcher.
The emergency medical technician at the foot of the stretcher lifts and releases the undercarriage. The second emergency medical technician lifts the undercarriage with the wheels up to the level of the ambulance floor. Both emergency medical technicians then guide the stretcher into the locking mechanism in the back of the ambulance. Often the raising and lowering of the stretcher is done with a battery-powered motor, however, it is still important for you to maintain a firm grip on the stretcher.
Newer automatically loading stretchers will manage the entire loading and unloading of the stretcher. and only require the provider to operate the buttons on the stretcher. An intravenous pole is attached to many stretchers. The intravenous pole can be unfolded or extended above the main frame to hold an intravenous bag above the patient while you move the stretcher to the ambulance.
Some wheeled ambulance stretchers even include a carrier to hold a cardiac monitor or automated external defibrillator and portable oxygen unit. If the model you use does not include these features, you will have to secure the portable oxygen unit and cardiac monitor or automated external defibrillator to the top surface of the stretcher mattress at the patient's legs if possible remove these items before lifting the stretcher to avoid the excess weight these items must be secured in the ambulance prior to departing the scene table 8-2 shows the guidelines that you must follow to load the stretcher into the ambulance follow these steps to load the stretcher into an ambulance. 1. Tilt the head end of the mainframe upward, and place it into the patient compartment with the wheels on the floor. The two additional wheels that extend just below the head end are attached to the mainframe, and will enable this movement.
Ensure that the safety bar under the head of the stretcher catches on the hook prior to lifting the stretcher. Step 1. 2. With the patient's weight supported by these two head end wheels, and the emergency medical technician at the foot end of the stretcher, Move to the side of the mainframe, and release the undercarriage lock to lift the undercarriage up to its fully retracted position. The wheels of the undercarriage, and the two on the head end of the mainframe will now be on the same level. Step 2. 3. Simply roll the stretcher the rest of the way into the back of the ambulance, where it will rest on all six wheels.
Step 3. 4. Secure the stretcher in the ambulance with the strong clamps that fasten around the undercarriage when the stretcher is pushed into them. The clamps are located in a rack on the floor or side of the patient compartment. Step 4. Skill Drill 8-6. Loading a stretcher into an ambulance.
Step 1. Lift the stretcher into the load position, and place it into the patient compartment with the wheels on the floor, and the safety bar latched on the hook. Step 2. The second EMT on the side of the stretcher releases the undercarriage lock and lifts the undercarriage. Some newer powered stretchers lift the undercarriage with the push of a button. Step 3. Roll the stretcher into the back of the ambulance.
Step 4. Secure the stretcher to the clamps mounted in the ambulance. Directions and commands. To safely lift and carry a patient, you and your team must anticipate and understand every move. and each move must be executed in a coordinated manner. Before any lifting is initiated, the team leader should indicate where each team member is to be located, and rapidly describe the sequence of steps that will be performed to ensure the team knows what is expected.
If you must lift and move the patient through a number of separate stages, the team leader should first give an abbreviated overview of the stages, followed by a more detailed explanation of each stage just before it will occur. Orders that will initiate the actual lifting or moving or any significant changes in movement should be given in two parts, a preparatory command, and a command of execution. For example, if the team leader says, all ready to stop.
Stop. The phrase all ready to stop will get your attention, identify who should act, and prepare you to act. The declarative stop will indicate the exact moment of execution. Commands of execution should be delivered in a louder voice.
Often, a countdown is helpful when you need to lift a patient. To avoid confusion in using a countdown, the leader should always clarify whether 3 is to be a part of the preparatory command or whether it is to serve as the order to execute. He or she can say, we're going to lift on 3. 1, 2, 3, or I'm going to count to 3, and then we're going to lift. 1, 2, 3, lift.
You will often have to perform several additional steps to place the patient onto a backboard and or carry him or her down a flight of stairs. You will also have to add a stop at the top of the stairway so that everyone can reposition before carrying the patient down the stairs. Repositioning usually requires lowering the backboard to the ground, and lifting it again when all providers are in their proper places.
If you are carrying the patient in a stair chair, the additional step occurs after you have descended the stairs, and reached the stretcher. At that point, you will have to assist or lift the patient from the stair chair onto the stretcher. You should carefully plan ahead and select the methods that will involve the least amount of lifting and carrying.
Remember to always consider whether there is an option that will cause less strain to you and the other providers. Emergency Moves When there is a potential for danger to you or the patient, use an emergency move to drag or pull a patient to a safe place before assessment and care are provided. The risk of serious harm or death due to fire, explosives, or hazardous materials, your inability to protect the patient from other hazards, or your inability to gain access to others in a vehicle who need life-saving care all are situations in which you should use an emergency move. In such conditions, protecting the cervical spine is secondary to rapidly getting your patient to safety. The only other time you should use an emergency move is if you cannot properly assess the patient or provide critical emergency care because of the patient's location or position.
If you are alone and danger at the scene makes it necessary for you to use an emergency move, regardless of a patient's injuries, you should use a drag to pull the patient along the long axis of the body. Remember that it is impossible to remove a patient quickly from a vehicle while providing as much protection to the spine as would a spinal immobilization device such as a Kendrick extrication device. However, if you follow certain guidelines during the move, You can usually remove a patient from a life-threatening situation without causing further injury to the patient.
You can move a patient on his or her back along the floor or ground by using one of the following methods. Pull on the patient's clothing in the neck and shoulder area. If the shirt has buttons, the top two should be undone to prevent the patient from choking.
Place the patient onto a blanket, coat, or other item that can be pulled. Rotate the patient's arms so that they're extended straight on the ground beyond his or her head. Grasp the wrists, and, with the arms elevated above the ground, drag the patient. Place your arms under the patient's shoulders, and through the armpits, and, while grasping your opposite wrist, drag the patient backward.
If you are alone and must remove an unresponsive patient from a vehicle, first move the patient's legs so they are clear of the pedals, and are against the seat. Then rotate the patient so that his or her back is positioned toward the open vehicle door. Next, place your arms through the armpits and support the patient's head against your body.
While supporting the patient's weight, drag the patient from the seat. If the legs and feet clear the vehicle easily, you can rapidly drag the patient to a safe location by continuing this method. If the legs and feet do not clear the vehicle easily, You can slowly lower the patient until he or she is lying on his or her back next to the vehicle, clear the legs from the vehicle, and, as previously described, use a long-axis body drag to move the patient a safe distance from the vehicle. You should use one-person techniques to move a patient only if an immediately life-threatening danger exists, and you are alone or, because of the pressing nature of the danger, your partner is moving a second patient simultaneously.
Additional one provider drags, carries, and lifts are shown in Figure 8-16. Urgent Moves An urgent move may be necessary to move a patient with an altered level of consciousness, inadequate ventilation, or shock, hypoperfusion. An extreme weather condition may also make an urgent move necessary.
In some cases, patients must be urgently moved from the location or position in which they are found. When a patient who is sitting in a vehicle must be urgently moved, use the rapid extrication technique. Rapid extrication technique. The backboard, short backboard, and vest type devices are known as spinal immobilization devices.
Normally, you would use an extrication type vest or short backboard device to immobilize a seated patient with a suspected spinal injury before removing the patient from the vehicle see chapter 39 vehicle extrication and special rescue however proper placement of either of these devices on the patient usually requires between six and eight minutes and in some cases even longer by using the rapid extrication technique instead The patient can be moved from sitting in the vehicle to supine, on a backboard if required, in one minute or less. However, the rapid nature of this type of extrication can potentially increase the risk of damage if the patient has a spinal injury. Because of this possible patient injury, all available options need to be considered prior to performing a rapid extrication.
Table 8-3 describes the situations in which you should use the rapid extrication technique. In such cases, the delay that occurs in applying immobilization devices is a contraindication. However, the manual support and stabilization that you provide when using the rapid extrication technique produce a greater risk of spine movement.
Because of this increased risk, do not use the rapid extrication technique if no urgency exists. If the patient is able to stand and pivot to the stretcher, it is safer to have them do so. The rapid extrication technique requires a team of three providers who are knowledgeable and practiced in the procedure.
Take the following steps when using the rapid extrication technique. Whether a backboard is used for this skill will depend on your local protocols. Here, use of a backboard is included. 1. The first provider applies manual in-line support of the patient's head and cervical spine from behind. Support may be applied from the side, if necessary, by reaching through the driver's side doorway.
Step 1. 2. The second provider serves as team leader and, as such, gives the commands until the patient is supine on the back board. Because the second provider lifts and turns the patient's torso, he or she must be physically capable of moving the patient. The second provider works from the driver's side doorway. If the first provider is also working from that doorway, the second provider should stand closer to the door hinges toward the front of the vehicle. The second provider applies a cervical collar and may perform the primary assessment step 2. 3. The second provider provides continuous support of the patient's torso until the patient is supine on the backboard.
Once the second provider takes control of the patient's torso, usually in the form of a body hug, hug. He or she should not let go of the patient for any reason. Some type of cross chest shoulder hug usually works well, but you will have to decide what method works best for you on any given patient. You must remember that you cannot simply reach into the vehicle and grab the patient.
This will only twist the patient's torso. You must rotate the patient as a complete unit. 4. The third provider works from the front passenger seat.
and is responsible for rotating the patient's legs and feet as the torso is turned, ensuring that they're free of the pedals and any other obstruction. With care, the third provider should first move the patient's nearer leg laterally without rotating the patient's pelvis and lower spine. The pelvis and lower spine rotate only as the third provider moves the patient's second leg during the next step.
Moving the nearer leg early makes it much easier to move the second leg in concert with the rest of the body. After the third provider moves the legs together, they should be moved as a unit. Step 3. 5. These initial steps of the rapid extrication technique direct the team to its starting positions and responsibilities.
The first provider applies inline support and stabilization of the head and neck. The second provider gives orders and supports the torso. The third provider moves and supports the patient's legs. The team is now ready to move the patient.
6. The patient is rotated 90 degrees so that the patient's back is facing out the driver's door, and the feet are on the front passenger's seat. This coordinated movement is done in 3 or 4 short, quick 8 turns. The second provider directs each quick turn by saying, Ready, turn, or ready, move. Hand position changes should be made between moves. 7. In most cases, the first provider will be working from the back seat, and will have removed the headrest, if possible.
At some point, either because the door post is in the way or because he or she cannot reach farther from the back seat, the first provider will be unable to follow the torso rotation. At that time, the third provider should assume temporary in-line support of the head and neck until the first. provider can regain control of the head from outside the vehicle.
If a fourth provider is present, the fourth provider stands next to the second provider. The fourth provider takes control of the patient's head and neck from outside the vehicle without involving the third provider. As soon as the change has been made, the rotation can continue.
Step 4. 8. Once the patient has been fully rotated, the backboard should be placed against the patient's buttocks on the seat. Do not try to wedge the backboard under the patient. If only three providers are present, be sure to place the backboard within arm's reach of the driver's door before the move so that the backboard can be pulled into place when needed.
In such cases, the far end of the backboard can be left on the ground. When a fourth provider is available, the first provider exits the back seat of the vehicle, places the backboard against the patient's buttocks, Thanks. and maintains pressure toward the interior of the vehicle from the far end of the backboard. When the door opening allows, some providers prefer to insert the backboard onto the seat before the patient is rotated.
As soon as the patient has been rotated, and the backboard is in place, the second provider and the third provider lower the patient onto the backboard while supporting the head and torso so that neutral alignment is maintained. The first provider holds the backboard until the patient is secured. Step 5. 10. Next, the third provider must move across the front seat to be in position at the patient's hips.
If the third provider stays at the patient's knees or feet, he or she will be ineffective in helping to move the body's weight. The knees and feet follow the hips. 11. The fourth provider maintains manual in-line support of the head. and now takes over giving the commands. The second provider maintains the direction of the extrication.
The second provider stands with his or her back to the door, facing the rear of the vehicle. The backboard should be immediately in front of the third provider. The second provider grasps the patient's shoulders or armpits. Then, on command, the second provider and the third provider slide the patient 8 to 12 inches, 20 to 30 centimeters.
along the backboard, repeating this slide until the patient's hips are firmly on the backboard. Step 6. 12. At that time, the third provider gets out of the vehicle and moves to the opposite side of the backboard, across from the second provider. The third provider now takes control at the shoulders, and the second provider moves back to take control of the hips.
On command, these two providers move the patient along the back board in 8 to 12 inch 20 to 30 centimeters slides until the patient is placed fully on the backboard step 7 13 the first or fourth provider continues to maintain manual inline support of the patient's head the second provider and the third provider now grasp their side of the backboard and then carry it and the patient away from the vehicle onto the prepared stretcher nearby step 8. in some cases you will be able to rest the head end of the backboard on the stretcher while the patient is moved onto the backboard. In other situations, you will not be able to do this. Once the backboard and patient have been placed on the stretcher, begin life-saving treatment immediately. If you use the rapid extrication technique because the scene was dangerous, you and your team should immediately move the stretcher a safe distance away from the scene before you assess or treat the patient.
Skill Drill 8-7. Performing the Rapid Extrication Technique. Step 1. The first provider provides in-line manual support of the head and cervical spine.
Step 2. The second provider gives commands, applies a cervical collar, and performs the primary assessment. Step 3. The second provider supports the torso. The third provider frees the patient's legs from the pedals.
and moves the legs together without moving the pelvis or spine. Step 4. The second provider and the third provider rotate the patient as a unit in several short, coordinated moves. The first provider, relieved by the fourth provider as needed, supports the patient's head and neck during rotation, and later steps. Step 5. The first, or fourth, provider places the backboard on the seat against the patient's buttocks. Use of a backboard may depend on local protocols.
Step 6. The third provider moves to an effective position for sliding the patient. The second and the third providers slide the patient along the backboard in coordinated 8 to 12 inch, 20 to 30 centimeter moves until the patient's hips rest on the backboard. Step 7. The third provider exits the vehicle and moves to the backboard opposite the second provider.
They continue to slide the patient until the patient is fully on the backboard. Step 8. The first or fourth. Provider continues to stabilize the head and neck while the second provider and the third provider carry the patient away from the vehicle and onto the prepared stretcher. Non-urgent moves. When both the scene and the patient are stable, carefully plan how to move the patient.
If your patient move is rushed or poorly planned, it may result in discomfort or injury to the patient, you, and or your team. Before you attempt any move, The team leader must be sure that there are enough providers, any obstacles have been identified or removed, the proper equipment is available, and the procedure and path to be followed have been clearly identified and discussed. Remember, communication is the key to success.
In non-urgent situations, you and your team may choose one of several methods for lifting and carrying a patient and should coordinate your movements through direct verbal commands. Three general methods are presented here. which may serve as a basis for your plan.
You may adapt these procedures to meet your needs on a case-by-case basis. Direct ground lift. The direct ground lift is used for patients with no suspected spinal injury who are found lying supine on the ground.
Use this lift when you have to lift and carry the patient some distance to be placed on the stretcher. If you find the patient semi-prone or lying on his or her side, first log roll the patient onto his or heard back. Ideally, the direct ground lift should be performed by three providers, however, it can be done with only two. Perform the direct ground lift as follows.
1. Take your places on one side of the patient with the first provider at the patient's head, the second provider at the patient's waist, and the third provider at the patient's knees. All providers kneel on one knee, preferably the same knee. 2. The patient's arms should be placed on his or her chest if possible.
Step 1. 3. The first provider places one arm under the patient's neck and shoulders and cradles the patient's head. The first provider then places the other arm under the patient's low back. 4. The second provider places one hand under the patient's waist and the other under the knees. 5. The third provider places one arm under the patient's knees.
and the other under the ankles. 6. On command, the team lifts the patient up to knee level as each provider rests an arm on his or her knee. Step 2. 7. As a team, and on command, each provider rolls the patient in toward his or her chest. Again on command, the team stands and carries the patient to the stretcher.
Step 3. Note. The steps are reversed to lower the patient onto the stretcher. Skill Drill 8-8. Performing the Direct Ground Lift. Step 1. Line up on one side of the patient, with one provider at the head, one at the waist, and one at the patient's knees.
Place a soft stretcher underneath the patient. All providers should be kneeling. Place the patient's arms on his or her chest, if possible. Step 2. On command, lift the patient to knee level.
Step 3. On command, roll the patient toward your chest, and then stand and carry the patient to the stretcher. Extremity lift. The extremity lift may also be used for patients with no suspected extremity or spinal injuries who are supine or in a sitting position.
The extremity lift may be especially helpful when the patient is in a very narrow space or there is not enough room for the patient, and several emergency medical technicians to stand side by side. Perform the extremity lift as follows. Skill drill 8-9. 1. Kneel behind the patient's head as your partner kneels at the patient's feet.
You and your partner should be facing each other. 2. The patient's hands should be crossed over his or her chest. 3. Place one hand under each of the patient's armpits. Grasp the patient's wrists or forearms, and pull the upper torso until the patient is in a sitting position. Step 1. 4. Your partner moves to a position between the patient's legs, facing in the same direction as the patient, and slips his or her hands under the patient's knees.
Step 2. 5. As you give the command, Stand fully upright and move the patient to the stretcher. Step 3. You will be less likely to injure yourself if you bend at the hips and knees and use your legs for lifting. However, this lift and carry method increases pressure on the patient's chest, so the patient may be uncomfortable in this position.
Skill Drill 8-9. Performing the Extremity Lift. Step 1. The patient's hands are crossed over the chest.
grasp Lift the patient's wrists or forearms, and pull the patient to a sitting position. Step 2. Your partner moves to a position between the patient's legs, facing in the same direction as the patient, and places his or her hands under the knees. Step 3. Rise to a crouching position.
On command, lift and begin to move. Transfer Moves. There are several ways to transfer the patient from a bed onto the stretcher.
carry. Transfer a supine patient from a bed to the stretcher using the direct carry method. 1. Position the stretcher parallel to the bed, facing the same direction as the bed.
Prepare the stretcher by unbuckling the straps, and removing any other items from it. Secure the stretcher to prevent movement. 2. Position yourself at the head of the bed facing toward the patient. Your partner should be positioned between the bed.
and the stretcher facing both you and the patient. 3. Slide your arms under the patient's neck and shoulders. Your partner should slide his or her hands under the patient's knees and lock them together or use them to grasp the posterior part of the patient's thighs. Step 1. 4. Lift the patient upward slowly and smoothly. Your partner should move the patient's knees from the left side of his body to the right to facilitate placing the patient onto the stretcher.
Step 2. 5. Slowly carry the patient from the bed to the stretcher. Step 3. 6. Gently lower the patient onto the stretcher and secure with straps. Step 4. Skill drill 8-10 performing the direct carry. Step 1. Position the stretcher parallel to the bed. Secure the stretcher to prevent movement.
Face the patient while standing between the bed and the stretcher. Position your arms under the patient's neck and shoulders. Your partner should position his or her hands under the patient's knees. Step 2. Lift the patient from the bed in a smooth, coordinated fashion.
Step 3. Slowly carry the patient to the stretcher. Step 4. Gently lower the patient onto the stretcher, and secure with straps. This carry can also be performed with three providers. If a third provider is available, He or she can be positioned to support the patient's feet and legs from the bottom of the bed. Draw Sheet Method To move the patient from a bed onto a stretcher, use the draw sheet method.
Place the stretcher next to the bed, making sure it is at the same height or slightly lower than the bed, and that the rails are lowered and straps are unbuckled. Be sure to hold or secure the stretcher to keep it from moving. Loosen the bottom sheet underneath the patient.
or log roll the patient onto a blanket. Reach across the stretcher and grasp the sheet or blanket firmly at the patient's head, chest, hips, and knees. Gently slide the patient onto the stretcher.
When lifting a patient by a sheet or blanket, center the patient on the sheet and tightly roll up the excess fabric on each side. This produces a cylindrical handle that provides a strong, Secure way to grasp the fabric. Although sliding boards or other devices are not routinely carried on an ambulance, you may have access to these items in the hospital or at nursing homes that will assist you in sliding the patient from bed to stretcher or stretcher to bed with minimal effort. Using a Scoop Stretcher Another option when moving a patient is to use a scoop stretcher. With a scoop stretcher, the two halves of the device are inserted under each side of the patient, and the two sides are fastened together.
Then the patient is lifted and carried to the nearby prepared stretcher. Note that you can also log roll a patient onto a scoop stretcher that is already locked together. Use a scoop stretcher. Follow the steps in skill drill 8-11.
1. With the scoop stretcher separated, measure the length of the scoop, and adjust to the proper length. Step 1. 2. Position the stretcher, one side at a time. Lift the patient's side slightly by pulling on the far hip, and upper arm, while your partner slides the stretcher into place.
Step 2. 3. Lock the stretcher ends together by engaging their locking mechanisms one at a time, and continue to lift the patient slightly as needed to avoid pinching. Step 3. 4. Apply anti-dent straps to secure the patient to the scoop stretcher before transferring to the stretcher. Step 4. Skill Drill 8-11. Using a scoop stretcher.
Step 1. Adjust the length of the stretcher. Step 2. Lift the patient slightly and slide the stretcher into place, one side at a time. Step 3. Lock the stretcher ends together, and avoid pinching both the patient, and your fingers. Step 4. Secure the patient to the scoop stretcher, and transfer to the stretcher. Other carries.
Other carries are performed in the following manner. Place a back board next to the patient, and... After using a log roll or slide to move the patient onto the backboard, secure the patient, and lift and carry the backboard to the nearby prepared stretcher.
Assist an able patient to the edge of the bed, and place the patient's legs over the side, helping the patient to sit up. Move the stretcher so that its foot end touches the bed near the patient. Help the patient to stand and rotate so that he or she can sit down on the center of the stretcher. Lift the patient's legs. and rotate them onto the stretcher while your partner lowers the patient's torso onto the stretcher.
To avoid the strain of unnecessary lifting and carrying, use the draw sheet method or assist enable patient to the stretcher whenever possible. To move a patient from the ground or the floor onto the stretcher, use one of the following methods. Lift and carry the patient to the nearby prepared stretcher using a direct body carry. Use a log roll or long axis drag to place the patient onto a backboard, and then lift and carry the backboard to the stretcher. Place both the backboard, and the patient onto the stretcher.
Use a scoop stretcher. Log roll the patient onto a blanket, centering the patient on the blanket, and rolling up the excess material on each side. Lift the patient by the blanket, and carry him or her to the nearby stretcher.
If a patient is sitting in a chair, and cannot assist you, transfer the patient from the chair to a stair chair as described earlier in this chapter. Geriatrics Most patients transported by emergency medical service are older adults, geriatric patients. These patients will need to be moved, lifted, and carried frequently. The aging process is associated with multiple changes in the body, including the musculoskeletal system, and the integumentary system, that is, the skin as people age they may become less flexible and bones become more brittle using the extremities to move or carry a geriatric patient may cause the person a significant amount of pain or discomfort in some older patients pulling an arm or leg may cause a dislocation or fracture the skin of a geriatric patient is thinner and more susceptible to tears and bruising be careful not to cause a skin tear when gripping an arm or leg Chronic medical conditions such as rheumatoid arthritis may limit the patient's movement and are associated with pain.
Some older patients cannot lie flat or straighten their arms. Extra padding and support may be necessary to transport some patients comfortably. Emergency medical technicians must keep these considerations in mind as they prepare to move, lift, and carry geriatric patients. Do not cause additional injury or pain to your patient.
See Chapter 36, Geriatric Emergencies, for a more detailed discussion of the concepts specific to moving and carrying geriatric patients. Bariatrics. Just fewer than half, 42.4%, of the adults in the United States, more than 100 million people, are considered obese.
The incidence of obesity is higher among adults aged 40 to 59 years, almost 45%. than among adults aged 20 to 39 years 40 percent or adults aged 61 years or older almost 43 percent the incidence among children is also alarming approximately 18 percent of all children and adolescents in the united states are classified as obese The obesity rate has tripled compared to just one generation ago and continues to increase. In 2008, the estimated annual cost of medical care for patients with obesity in the United States was $147 billion, or approximately $1,429 higher for an obese person than for a person of normal weight.
Obesity has reached epidemic proportions in the United States. and many programs are now aimed at teaching people from a young age the importance exercise and a healthy diet bariatrics is the branch of medicine concerned with the management prevention or control of obesity and allied diseases it comes from the Greek words borrows weight and I atria medical treatment there is a direct correlation between the degree of obesity and the frequency and severity of health problems therefore The larger the patient, the more likely he or she will need emergency treatment and transportation. This issue is taking an increasing toll on the health of emergency medical technicians because back injuries account for the highest number of missed days of work, and both temporary and permanent disability. Additional patient moving equipment. Bariatric stretchers.
Because of the weight and large girth of bariatric patients, they may not fit comfortably or safely on the standard wheeled stretcher. As a result, a specialized type of wheeled stretcher has been developed, called a bariatric stretcher. This type of stretcher is similar in design to the common wheeled stretcher, however, it has several differences.
Bariatric stretchers typically have a wider patient surface area to allow for increased comfort, and in addition ensure the patient's dignity is maintained during transport. Bariatric stretchers also have a wider wheelbase, allowing for increased stability when rolling the patient over uneven terrain. Bariatric stretchers are sometimes equipped with optional features such as a tow package, which allows an ambulance-mounted winch to assist in loading the patient into the ambulance, decreasing the potential for emergency medical technician back injuries.
Another optional feature is telescoping side lift handles. which provide increased leverage when lifting with multiple providers. However, the most important feature of the bariatric stretcher is the increased weight lifting capacity.
Typical wheeled ambulance stretchers, depending on manufacturer ratings, allow for a maximum weight of 650 pounds, 295 kilogram. Bariatric stretchers are usually able to support maximum weight as high as 1600, 725 kilogram Pounce when rolled in the lowest position. Pneumatic and electronic powered wheeled stretchers.
In an effort to decrease the potential for back injuries to emergency medical service providers, manufacturers have developed pneumatic and electronic stretchers. Similar in appearance to conventional wheeled stretchers, electronic stretchers are battery operated and have electronic controls to facilitate raising and lowering of the undercarriage at the touch of a button. Some of these wheeled stretchers also have the ability to be loaded and unloaded from the ambulance by motor, and thus only require the provider to control the equipment.
These devices limit the risk of injury to providers, and to the patient by removing the physical strain of the task. Binder Lift A binder lift gives emergency medical service providers another safe way to lift patients as a team to help prevent injuries. The binder is wrapped around patient's torso. The binder lift design has up to 25 handles for providers to use during the patient lift before moving the patient to a stair chair or stretcher. Portable or folding stretchers.
A portable stretcher is a stretcher with a strong, rectangular, tubular metal frame, and rigid fabric stretched across it. Portable stretchers do not have a second multi-positioning frame or adjustable undercarriage. Some models have two wheels that fold down about 4 inches, 10 centimeters. underneath the foot end of the frame and legs of a similar length that fold down from the head end at each side.
The wheels make it easier to move the loaded stretcher. The legs should not be used as handles. Some portable stretchers can be folded in half across the center of each side so that the stretcher is only half its usual length during storage.
A portable stretcher weighs much less than a wheeled stretcher and does not have a bulky undercarriage. However, Because most models do not have wheels, you and your team must support all of the patient's weight, and any equipment along with the weight of the stretcher. Flexible stretchers. Several types of flexible stretchers are available and can be rolled up across either the stretcher's width or length, so that the stretcher becomes a smaller, tubular package for storage, and carrying. When you must carry the equipment a considerable distance from the nearest place that the ambulance can be located, this is an important consideration.
A flexible stretcher forms a rigid stretcher that conforms around the patient's sides, and does not extend beyond them. When these stretchers are extended, they are particularly useful when you must remove a patient from or through a confined space. Certain flexible stretchers can also be used if the patient must be belayed or repelled by ropes.
Short backboards. You can use a short backboard to immobilize the torso, head, and neck of a seated patient with a suspected spinal injury until you can immobilize the patient on a backboard. Short backboards are 3 to 4 feet long, approximately 1 meter. However, the wooden short backboard has generally been replaced with a vest-type device, such as the Kendrick Extrication Device, that is specifically designed to immobilize the patient until he or she is moved from a sitting position to a supine position on a backboard.
Vacuum mattresses. Another alternative to the backboard is the vacuum mattress. With this device, the patient is placed on the mattress, and the air is removed from the device, allowing it to mold around the patient. It fits snugly to the curvatures and contours of the body and limits pressure point tenderness.
Padding may be used for tender areas but is not required for most patients. The vacuum mattress is seen as equivalent to padding to secure the patient's neck and spine and is more comfortable for the patient than the long spine board. See Chapter 29, Head and Spine Injuries, for more information about the vacuum mattress.
Basket stretchers. Use a rigid basket stretcher, also called a Stokes litter, to carry a patient across uneven terrain from a remote location that is inaccessible by ambulance or other vehicle. If you suspect that the patient has a spinal injury, first secure him or her on a backboard, and then place the backboard into their basket stretcher. Once you have reached the ambulance, and wheeled ambulance stretcher, you can remove the patient secured to their backboard from the basket stretcher and place the patient on the stretcher. Basket stretchers are made of plastic with an aluminum frame or have a full steel frame that is connected by a woven wire mesh.
The wire basket is uncomfortable for the patient unless the wire is padded. Either type can be used to carry a patient across fields, rough terrain, or trails or on a toboggan, boat, or all-terrain vehicle. Basket stretchers are also used for technical rope rescues, and some water rescues.
Not all basket stretchers are rated or appropriate for each of these specialized rescue uses. Neonatal isolates When you need to transport a neonatal patient from one hospital to another, the common wheeled ambulance stretcher will not suffice. To safely transport a neonatal patient, the patient must be placed inside of an isolette, sometimes referred to as an incubator. The isolette keeps the neonatal patient warm with moist and air in a clean environment, and helps to protect the infant from noise, drafts, infection, and excess handling.
These specialized transport devices come in one of two forms, an isolate that is placed directly on top of the wheeled stretcher, and secured with seatbelts or a freestanding isolate that is secured into the back of the ambulance, taking the place of the standard stretcher. Decontamination. It is essential that you decontaminate your equipment after each use to prevent the spread of disease. For your own safety, the safety of the emergency medical technicians using the equipment after you.
and the safety of your patients. Just as you expect a hospital bed to be disinfected after the previous patient, so too with your stretcher and other transport equipment. Know and follow your local standard operating procedures for disinfecting equipment after each call.
Patient positioning. It is imperative while treating a patient that he or she be properly positioned based on the chief complaint. Certain patient conditions such as head injury, Shock. spinal injury pregnancy and obesity call for special lifting and moving techniques although a patient with a potential spinal injury should be secured to restrict movement of the spine a patient with no Suspected injury reporting chest pain or respiratory distress should be placed in a position of comfort Typically a fowler or semi fowler position unless he or she is hypotensive Patients who are in shock should be packaged and placed in a supine position Patients in late stages of pregnancy should be positioned and transported on their left side if they are uncomfortable or hypotensive when supine. Place an unresponsive patient with no suspected spinal, hip, or pelvic injury into the recovery position by rolling the patient onto his or her side without twisting the body.
Transport a patient who is nauseated or vomiting in a position of comfort, but ensure that you are positioned appropriately to manage and maintain a patent airway. Patients with obesity should be positioned the same as other patients with a similar condition, however. Particular attention must be paid to ensure their dignity is maintained. Personnel considerations.
As an emergency medical technician, you will be required to assist in the movement of patients. In an effort to minimize injuries, prior to moving any patient, a complete plan needs to be developed and discussed among your team. Some questions to ask are the following. Am I physically strong enough to lift and move this patient?
Is there adequate room to get the proper stance to lift the patient? Do I need additional providers for lifting assistance? The answers to these questions need to be evaluated prior to moving your patient. Remember that injured emergency medical technicians cannot help anyone.