Lifting and Moving Patients

Chapter Overview

• Chapter Title: Lifting and Moving Patients
• Book: Emergency Care and Transportation of the Sick and Injured, 12th Edition
• Key Learning Objectives:
  • Body mechanics of patient movement
  • Principles of safe reaching and pulling
  • Urgent and non-urgent moves
  • Team-based patient movement
  • Patient packaging and moving equipment
  • Injury prevention during patient movement
  • Use of medical restraints

Importance of Proper Technique

• Moving patients safely is crucial to prevent injury to patients, EMTs, and the team
• Essential tasks: Lifting, carrying to stretcher, moving to ambulance, loading into patient compartment
• Proper body mechanics and power grip are essential

Equipment Overview

Wheeled Ambulance Stretcher (Gurney)

• Structure: Rectangular tubular metal frame, retractable guard rails, adjustable undercarriage, fluid-resistant mattress
• Usage: Most commonly used device for moving and transporting patients; not for stairs or long distances if carrying is required

Backboards

• Purpose: Immobilization of supine patients with suspected hip, pelvic, spinal, or extremity injuries
• Features: Long, flat, rigid, with holes for handles and straps
• Usage: Ideal for moving patients out of confined spaces

Body Mechanics and Lifting Techniques

Anatomy Review

• Spinal Alignment: Vertebrae stacked on sacrum, sacrum as weight-bearing base
• Body Mechanics: Relationship between body's structures and physical forces

Lifting Position

• Correct Alignment: Shoulders over pelvis, hands close to legs
• Spreading Feet: About 15 inches or shoulder width apart
• Power Grip: Palms up, thumbs extended, fingers curled over handle
• Power Lift Technique: Using legs to lift; avoid lifting with outstretched arms

Safe Reaching and Pulling Principles

Body Drag

• Technique: Keep back locked, extend arms no more than 15-20 inches, alternate pulling and repositioning
• In Bed: Use sheet or blanket; avoid dragging by clothing

Log Roll

• Technique: Roll patient onto side for backboard placement by kneeling close and leaning from hips

Lifting and Carrying Devices

Stair Chair

• Usage: Carrying conscious patients up/down stairs
• Features: Lightweight, folding chair with safety straps and handles

Stretcher on Stairs

• For Unresponsive Patients: Use backboard with strong EMTs at head/thighs

Loading Stretcher into Ambulance

• Procedure: Ensure firm grip, follow skill drills, use clamps for securing
• Self-Loading Models: Extra wheels for easy loading

Team Coordination and Safety

Commands and Planning

• Team Leader Role: Indicate positions and steps
• Preparatory Commands: Use countdowns and clear instructions

Emergency and Urgent Moves

• Emergency Moves: Required when immediate danger is present; techniques include clothes drag, blanket drag, arm drag, armpit drag
• Urgent Moves: Necessary for altered consciousness or inadequate ventilation; use rapid extrication for vehicle scenarios

Non-Urgent Moves

• When to Use: Scene and patient stability
• Methods:
  • Direct Ground Lift: For no suspected spinal injuries
  • Extremity Lift: For patients in tight spaces

Transfer Moves

• Methods:
  • Direct Carry: From bed to stretcher
  • Draw Sheet Method: Using sheet or blanket
  • Scoop Stretcher: Fitting around patient

Special Considerations

Geriatrics

• Skeletal Changes: Brittle bones, rigidity, spinal curvatures
• Positioning: Use vacuum mattresses, avoid flat boards

Bariatrics

• Equipment: Specialized stretchers with higher weight capacity
• Mechanical Lifts: Used mainly in Europe

Additional Devices and Safety

Other Stretchers

• Portable, Flexible: For difficult access areas
• Short Boards: For spinal immobilization in tight spaces
• Vacuum Mattresses: Mold to patient’s body for comfort

Basket Stretchers

• Usage: Uneven terrain; secure patient with backboard

Neonatal Isolette

• Purpose: Warm, moist, clean environment for neonatal patients
• Securing: Placed on wheeled stretcher or back of ambulance

Decontamination and Patient Positioning

• Decontamination: Follow local SOPs for disinfecting equipment
• Positioning: Based on chief complaint; examples include:
  • Chest Pain/Respiratory Distress: Fowler/Semi-Fowler
  • Shock: Supine position
  • Pregnancy: Left side if discomfort or hypotension
  • Unresponsive: Recovery position
  • Nauseated/Vomiting: Position of comfort

Medical Restraints

Usage and Safety

• When to Restrain: Evaluate for combativeness causes (e.g., head injury, hypoxia)
• Personnel: Minimum of five people
• Positioning: Supine, with one arm restrained above and one below head
• Monitoring: Regularly assess ABCs, mental status, circulation

Personal Considerations

Self-Assessment Before Lifting

• Questions to Ask: Physical strength, available space, need for assistance
• Avoid Injury: Proper technique to prevent EMT injury

Review Questions

1. First Rule of Lifting: Keep back straight and use legs
2. Power Lift: Hands palms up for less wrist stress
3. Emergency Move Technique: Firefighter's drag for life-threatening situations
4. Stair Patient Movement: Strongest EMT at head, head goes first
5. Initial Patient Assessment in Non-Immediate Danger: Check airway, breathing, circulation
6. Rapid Extrication: Move quickly to supine position on backboard

Conclusion

• Summary of key points and techniques
• Importance of proper technique for safety and efficiency