hi my name is john whitmar i'm with rc health services out of the jacksonville florida office and i'm going to be narrating um some of the powerpoints from the 12th edition aaos textbook for uemt students so let's get started we're going to go into the introduction in this course excuse me you'll have to move patients and provide emergency care and transport in your role as an emt this is going to be something that you will probably do on every single call that you go on to move patients without injury you need to learn how to the proper techniques in lifting and moving and also the knowledge of body mechanics in this power grip that we're going to talk about later is very important probably the number one reason why young emts paramedics get out of the ems field is because of an injury it's probably due to improper lifting techniques so again learning these techniques may save your job and your career so they we're going to start off by talking about the wheeled ambulance stretcher or the ambulance cot that most people call it again this is going to be the gurney or the the device that you're going to wheel your patient from their house to the ambulance or from the ambulance into the hospital it weighs between 40 and 145 pounds that's quite a range why is that important well if you have to lift the ambulance stretcher as well as a patient on top think about the extra weight that's being added we don't take these upstairs or downstairs and again there's going to be a specific device that we're going to use for that moving the patient by rolling using a stretcher or other wheel device we'll talk about is preferred because it helps prevent injuries from carrying the patient and before going on any call even before you go on to your clinicals make sure that you are familiar with how to use the stretcher and the ambulance when you get to your clinical site ask your preceptor how does the ambulance cot work uh there's a foot in and there's a head end it's it's a metal basically uh it hinges at the center to allow for the head and back to be elevated so into us upright sitting position and there's even small guard rails to prevent them from rolling out the undercarriage frame allows for adjustment to any height so we can lower it down to pretty close to the ground level and then up to a height that makes it easy and safe for you to push or pull the the cot uh the excuse me that mattress must be fluid resistant we yeah we have to have something that is easily cleanable between patients uh and then there are straps that secure the patient onto your cot this is a backboard again it's used to carry and immobilize patients if you suspect that they have a spinal injury sometimes we use the backboard just to transfer patients uh to the cod or to the ambulance or or into the hospital as well again backboards are used for patients found lying down because we can put the board on the ground and then we can actually roll them onto the board very easily it's one of your skills that you're going to be taught and then again getting patients out of awkward places i always think of the the manufactured home with a small narrow hallway going to the back bedroom there's no way you can get your cot down that hallway and you might be able to get a backboard down though so the backboards are about six to seven feet long and there's holes that service handles and places to to secure your straps there's different kinds of securing straps across the nation so speaking specifically of one strap we're really kind of limiting that when you move a patient take care that the injury does not occur to number one you number two your partners your yeah your partner and number three your patient in that order okay so we always talk about bsi scene safe and we need to make sure that the scene is safe for us well same thing with moving and positioning your patient we want to make sure that we are safe our teammates safe and lastly the patient is safe again this is something that you're going to do repeatedly in a shift throughout your ambulance career if you use proper body mechanics and maintain physical fitness you're going to greatly reduce that chance of injury if we move our patients in a planned orderly and unhurried manner we're going to re reduce that risk of being injured as well mastery of skills necessary for the equipment you'll be using this is a great statement for everything that you'll be doing in emt or if you go on to paramedic or nursing or doctor whatever you have to have a mastery of the skills that you're going to be using so again this is something you're going to be using a lot so with body mechanics again when you stand upright the weight of anything you lift or carry with your hands is borne by the shoulders your spinal column your pelvis and your legs so everything that you lift goes right down your body your shoulder should be over your pelvis your hand should be close to your legs so we're not reaching out too far and then when you lift the force goes straight down your spinal column and then again very little strain occurs if you do it that proper way it's when we reach too far or we're in an awkward position it's when we're going to injure our back our tendons our muscles whatever again this shows the proper lifting technique here your body's aligned in a line uh and then again everything goes straight down your vertebrae and then again your vertebrae are going to help support the lift you may injure your back if you lift while leaning forward or if you lift with your back straight but not with your back straight but bent slightly forward at the hips so again if you're bent over and it's not slightly significantly forward at the hips so if you're bent significantly and you lift you're going to hurt your back lifting technique your leg should be spread about 15 inches apart place your feet so the center get your your center of gravity is balanced and with your back held upright bring your body down by bending your legs you have to bend your legs to avoid injuring your back lift the patient by raising your body and arms and then straightening your legs until standing keep the weight close and keep your arms about the same distance apart this is called that power grip that i had mentioned earlier in the presentation it's basically when you're lifting you're going to lift with your palms up your hands about 10 inches apart which is about the width of that board they talk about all your finger fingers at the same angle and then you fully support the handle on your curved palm so this is the power grip when directly lifting a patient tightly grip the patient in a place and manner that will ensure you will not lose grasp of your patient so there's another uh technique of moving your patient is called the body drag uh it's you use the same mechanics when you lift or move a patient you keep your back locked uh you can tighten your abdominal muscles that'll help you when you kneel and then you pull your arms no more than 50 are skimming you extend your arms no more than 15 20 inches in front of you and then you pull and then reposition and you pull and you reposition yourself as you move your patient here we are showing a body drag with an emt on each side of the patient if you notice they have their hands on her shoulders and her hips they're not using her clothing to move so if you're going to drag a patient across a bed you have a patient who's in their bed at home and you need to drag them over and put them on your ambulance cot so you kneel on the bed avoid reaching you drag them at 15 20 inches then you complete the drag while standing on the bed standing at the side of the bed so you kind of get into the bed with them and you pull them towards you until you can stand up without reaching too far use the sheet or a blanket under the patient rather than dragging them by their clothing especially in battery they may not have a very substantial clothing on you know like a night shirt or pajamas and you really don't want to be pulling them by that so when you get to the hospital you're going to transfer the patient from your stretcher to the bed at the hospital and we're going to do another body drag and your your stretchers should be at the same height or slightly higher than the hospital bed and you can kneel on the bed and you drag them over slowly in increments until you get your patient off your cod and onto the hospital bed if you're going to put them onto a backboard we use a technique called the log roll and we're going to log roll that patient up as a single unit and then we're going to place them onto the backboard when you do this log roll you want to kneel as close to the patient's side as possible keep your back straight and lean solely from the hips you roll the patient without stopping until they're resting on their side and braced against your thighs and when we do this we pull towards us to prevent that patient from rolling away from us whenever possible use a device that can be rolled that's that ambulance caught that's that wheeled stretcher that they talk about it when a wheeled device is not available which you know there's certain certain circumstances in which you can't use it um again think about uh using that backboard and using proper carrying techniques if you think about estimating the weight of a patient often adults weigh between 120 and 220 pounds i look at that and i think in a as a society as is a country a lot of our patients exceed that weight uh by a great amount so you have to think about what is safe for you so lifting 120 pound patient with two emts that's safe even up to 220 pounds they say that is a safe limit to weigh excuse me a safe limit of weight to carry but if possible you should always use four providers um that's more stability uh the the the chance of them or the chance of you losing your patient off that board and kind of tipping and twisting that all gets greatly reduced when you have four providers we talk about don't trying to lift any patient that weighs more than 250 pounds with less than four providers sometimes your equipment is going to dictate how much weight your can carry on that piece of equipment and then again special bariatric techniques and equipment are used when they weigh more than 350 pounds we've got specially designed equipment then for our larger patients so on a back border stretcher uh more than half the weight rests on the head end so uh if you're have a patient or excuse me if you have a provider partner that may have some difficulty lifting or carrying maybe put them on the foot end of the backboard if you can take the weight yourself on the head end there's something called the diamond carry and that's basically it's a one-handed carry where the emt is at the head one at the foot and then one at each side of the patient's torso and that is this maneuver this shows a one at the head one at the foot notice the one at the foot is walking forward they're not walking backward again if you walk backward the chances of you tripping are increased so we don't want to do that if you use four providers you can also do one at each corner of the stretcher or backboard and when rolling the ambulance stretcher make sure that it's in the fully elevated position so that you're not leaning over when you push or pull that cot this is the device that we're going to use when we go up or down stairs it's called a stair chair this is one of the newer designs of the stair chair it's lightweight it's foldable it has a seat and there's belts on it to basically keep the person onto the seat they have obviously have to be conscious uh for you to use this again if you notice the on the back of this uh stair chair it looks like almost like a tank track uh and that's kind of what we use when we go downstairs we lean it back and put those rubber treads if you will uh and that helps guide your stair your stair chair down uh stairs uh interestingly enough those rubber tank treads if you will uh actually um the descent of your stair chair to keep it from getting out of control it does it in a slow controlled fashion if you're moving a patient on stairs with a stretcher a backboard should be used yes especially if the patient is unresponsive uh they must be moved in a supine position for whatever reason and they must be immobilized you don't use your your wheel stretcher to go up and down stairs the backboard should be used carry the patient on the backboard down to the prepared wheel stretcher and except it talks about place the strongest emts at the head and foot ends with the taller at the foot you want to go down feet first downstairs so that the person feels like they're kind of in control place both the backboard and the patient on the stretcher and secure the patient the backboard at the same time onto your wheel stretcher using the the the straps that are attached to the cot itself so when loading a a wheel stretcher into ambulance make sure the frame is held firmly between two hands so it doesn't tip tipping is really uh important because if it starts to tip uh then you can become injured or we can actually tip our patient and lose the whole thing tips over onto the ground with our cot and our patient attached newer models are self-loading allowing you to push a stretcher into the ambulance which is really the best way other models need to be lowered and lifted to the height you don't see that very often anymore so what they're saying is you take your ambulance cot you lower it all the way down as low as it goes you get two people or three people on it you lift it up and push it into the ambulance most of the ambulance cots nowadays you once you get the head end into the ambulance you lift the uh the wheels and you just kind of push it in and it's being supported uh on the in the ambulance by the front wheels underneath the patient's head it's that's kind of a very confusing description i'm sorry that's the best way i can describe it uh and once you see it in practice you'll understand team leaders must be coordinated again there somebody should be in charge of the lifting and moving technique so that you move as a unit and it's controlled and it's organized team leader says all ready to stop gets everybody's attention then you say stop if you're gonna move we're gonna lift on three one two three lift that kind of thing you want to be plan ahead and you want to be careful with your planning because again we don't want to get injured we don't want our partners to be injured and lastly we don't want to injure our patient these are called emergency moves and which is different uh and we're going to get into different kinds of moves but emergency moves are when there's a potential for danger and and again with an emergency move uh we do take into consideration our patient but we also take into consideration we got to get them moved quickly or something's bad is going to happen uh this is like a closed drag a blanket drag they talk about an arm drag and an arm to arm drag the the reasons i think about emergency moves are the houses on fire you got to get them out the car is on fire you got to get them out they're laying on the roadway and we need to get them out of the roadway before they get hit again that kind of thing so here's the the close drag where we grab them by the close this time b is a blanket drag c is an arm drag and there's d that armed arm drag you're just basically moving them as quickly as possible using whatever technique you can to remove a unconscious patient from a vehicle uh we want to make sure their legs are clear of the pedals we want to rotate them so their back is towards the open car door put your arms through their armpits and just drag them out i'm thinking that the car's on fire uh they're unconscious and we need to get them out to treat them before the car blows up or whatever that's why you do it an emergency move we're gonna talk about urgent moves in a little bit but emergency means that if i leave them there they're going to be injured more this is showing you how you get that person out of that that car using an emergency move urgent now we need to move that patient because they're unconscious they're not breathing well they're they're in shock uh maybe it's extreme weather conditions i come from northern indiana and a lot of our car accidents would occur in the winter time when it's minus 20 degrees so again we need to move them urgently not emergent but urgent this is also called rapid extrication and again using this rapid extrication techniques means we're going to urgently remove our patient from the car so again rapid extrication should be used only if urgency exists the patient can be moved within a minute there's techniques to increase the risk of damage if the patient has a spinal injury and then we have to think about all the options before we use an urgent move so before we use this urgent move is there anything else we can do another reason where you might use an urgent move is let's say there's a car accident and the car is up against a tree so let's say the passenger door is up against the tree and the passenger is unconscious in the car and the driver is fine well we can use an urgent rapid extrication technique to remove the driver that'll allow us to get at the patient quick basically when we use non-urgent moves that's when the scene is safe and the patients are stable and now we're taking real cautious care on how to remove that patient again our team leadership plan to move making sure we identify our obstacles make sure we have the proper equipment and we have a procedure in place with non-urgent moves their direct ground lift that's when we're going to lift that patient when we don't suspect they have a spinal injury again they might need need to be carried over some distance and then emt stand side by side to lift the patient and carry the patient i think of areas where we can't get our wheel caught it might be a uh in the uh in the forest or in a cornfield in a swamp those are areas where we can't use our wheeled cot and we might need to lift them extremity lift again we don't suspect a spinal injury when we're lifting and moving these non-urgent people again helpful when the patient's in a small space maybe the patient uh passed out in the bathroom so now we have this small space that we have to get them out of one of the patient's head one of the patient's feet and we move transfer moves again we move the patient from the stretcher using a direct carry method we could use the draw sheet that's probably the most commonly used way to transfer a patient from a bed to the stretcher or from the stretcher to the hospital bed using a draw sheet method and then there's a device called the scoop stretcher and the scoop stretcher is basically a backboard if you will that comes apart in the middle and you put it on both sides of your patient and then it gets put back together and it kind of like scoops your patient up just like the word is but just like the device is called with geriatric patients again uh we're going to transport a lot of geriatrics in our lifetime in ems so you have to take into consideration some of the changes that occur with our geriatric patients like their bones maybe they're the rigidity of their their spine or their their joints uh spinal curvatures again those are all kinds of things that we might have to take into consideration and their fears uh have to go have to be taken into consideration as well so this shows you know the severity or the severe curvature of the spine you know lordosis and kyphosis those are the things that we talk about whether they're hunched over or they're and you think about looking at this person how am i going to put this person on a backboard so that they're lying flat you're not you you can't change the curvature of their spine but you have to make it comfortable for them bariatrics that refers to management of our obese patients about 76 million u.s adults are obese 30 to 40 percent of adults are obese and this is crazy to think about 17 percent of children are obese so again back injuries account for the largest number of days mr work in the ems field stretchers and equipment are being produced for higher capacities a lot of the backboards nowadays are designed to lift our bariatric patients without breaking again it does not address the danger to the users and again mechanical ambulance lifts are uncommon mechanical lifts if you're fortunate enough a lot of the newer ambulances are being equipped with automatic loading devices where you just wheel your car up to the back of your ambulance this device comes out grabs the ambulance cot lifts it the wheels lift up and it pulls it right into the ambulance if if you're fortunate that's what you're going to have there's bariatric stretchers so remember we talked about in the beginning those stretchers weighing between 45 and 145 pounds now the bigger the the bariatric stretcher it is the more weight there's going to be associated with that and then again there's lift handles where we don't lift the patient all the way up to the top of the uh stretcher we put it in a comfortable position and then we use these extended lift or excuse me pull and push handles uh pneumatic or electronic powered scots those lift and raise with a push of the button those are probably used more so than ever now again before we would have to lift our patient in the uh two people lift the cot and the in the patient at the same time now we just push a button and that cot lifts or raises and lowers you don't see these very often anymore this portable stretcher i think about these being used maybe in a factory where they have a first aid supplies mounted to the wall it's just a way to transport a patient without having them walk it does not provide for spinal immobilization like a backboard because it's just fabric that's kind of stretched across this i think i like this that in those old war movies that's kind of what i think about with these [Music] here's some other devices so this is called a flexible stretcher and it kind of wraps around your patient if you're going to lift and move them like in a a situation where we have to lift them out of uh i'm trying to think out of an environment like a they're digging a ditch and they get injured at the bottom of this ditch and we need to pull them out confined spaces is what we're really thinking about this is called the ked or the kendrick extrication device again this is to mobilize seated patients that are conscious alert and they're stable this is again one of the devices that you're going to become familiar with during your trauma skills days there's vacuum mattresses again we lay the patient on this large red i guess we call it a flexible soft uh lifting device and we remove the air out of the device and it basically molds around your patient so you use basically like a tire pump and you pump the air out of the device in the and it foams or forms around your patient this is a basket stretcher because it's kind of raised on the sides like a basket there's this comes the newer models obviously are going to be this plastic if it's an old one it's going to be metal and it kind of looks like chicken wire that supports the patient this might be used for water rescues or remote locations again you're going to be carrying this patient for quite a distance and it keeps them from rolling out and it secures them if they have a suspected spinal injury we put the backboard on our patient and then we put them in the backboard into the basket stretcher when you get to the ambulance you lift the backboard out of the basket stretcher and put them on your wheeled cot scoop stretcher we talk about that it splits into two or four pieces it goes or fits snugly around the patient and then it's reconnected uh the neonatal isolate uh again we can't transport neonatal patients so like we're talking less than a month old uh can't be transported on a wheeled stretcher that they're just too little so an isolet keeps your patient warm protects them from noise drafts infection and excessive handling now you take that isolette and it may be secured to the wheeled ambulance stretcher or you take your wheeled ambulance stretcher out of your ambulance and you put this wheeled isolate in place of your stretcher when you're done using your equipment again you need to decontaminate it you need to clean it for your safety number one the safety of your crew number two and when we reuse it the safety of your patient every time you get done transferring a patient you clean your cot you clean your wheeled ambulance cot you clean your backboard every time you use any piece of equipment you have to clean it patient positioning a patient reporting chest pain or respiratory distress should be put in a position of comfort we call that the fouler or semi filer position and with that the basically if you're having trouble breathing you're not going to feel comfortable laying flat on your back so you're going to feel more comfortable sitting upright when you try to breathe and you're having difficulty breathing the shock patient so the patient who's exhibiting signs and symptoms of shock we do want to lay them down patients in late stages of pregnancy they should be placed on their left side using amp as as our excuse the baby lays on your inferior vena cava which is the big pipe that has blood returning to your heart from your legs so if you lay on your left side the baby is not on that vena cava if you lay flat on your back the baby lies on that vena cava and kind of squishes it and it reduces the amount of blood coming back to the heart so again put them on their left side of the unresponsive patient with no spine injury put them in the recovery position which again is on their side and recovery positions there in case they were to who start to vomit or get sick now they're not going to be lying straight on their back when they vomit elevate for correctable or excuse me l evaluate for correctable causes of combativeness the head injury hypoxia hypoglycemia these are reasons why that person might be combative this might be a reason why we have to restrain our patient follow your protocols if you're restraining on a patient you it's going to take a lot of people we talk about five people one for each extremity and one person to control their head restraining the patient in a supine position again positional asphyxia may develop in the prone so we never lay our patient prone or face down because they could uh actually asphyxiate and die so we don't do that we always have them on their back or their side when you apply restraints you put a restraint on each extremity and again after you do that we assess our abc's our mental status and our circulation after we put these restraints on and then document just so you know handcuffs are not restraints that we use in ems that's for the police officers questions asked before moving the patient am i strong enough to lift or move this patient maybe something happened to you over your days off and you injured your shoulder when you were water skiing or something so again you have to think about am i going to be able to lift or move this patient if i have to is there adequate room to get the proper stance do i need additional help for lifting again an injured emt can't help anyone uh if you get injured uh doing these moves now our patient uh is compromised your compromise the whole operation is compromised if you were to get hurt so kind of as a review what is our first rule in lifting we should twist slow slowly we keep our back in a straight position we bend at the waist to pick something up or we use our arms to do most of the lifting give you a couple seconds and you're right it's b the first rule is always keep your back straight you never twist that's when you become injured never twist you should never bend at the waist you should use your leg muscles not your arm muscles to do the lifting when lifting a stretcher using the power lift you should bend at the hips knees back and arms bend at the waist keep your back straight place your hands palms up on the litter handles and place or place your hands palms down remember that power lift yes you palms are up when you lift reasoning when lifting keep your back straight your arms straight always bend at the knees keep your back straight never bend at the waist lift with the palms up it is impractical to apply a vest type extrication device on a critically injured patient to move him or her from a rec vehicle because it a takes too long to correctly apply b does not fully immobilize our spine c cannot be used on patients who are in their car or d does not provide adequate stabilization so that best type device is the ked or the kendrick extrication device that green thing uh think about this and being used from a using a for a patient in a wrecked motor vehicle first off is a it takes too long to apply this on a critically injured patient again using an urgent move or rapid extrication would be more appropriate when you use this and use it properly it does take a while to remove your patient from a car and it you must use it on paper on people who are stable in a car next review question proper guidelines for correct reaching include all the following except get used to you know looking for those clues in your test questions like all of the following except avoid twisting your back avoid hyper extension of your back keeping your back in a locked in position or reaching no more than 30 inches in front of your body so what is the proper guidelines for correct reaching it's d we don't go out more than 15 to 20 inches not 30 inches like the question said never twist never hyperextend keep your back straight and don't reach out more than 15 to 20 inches not 30 inches an injured hang glider is trapped at the top of a very large mountain and must be excavated or evacuate sorry to the ground the terrain is very rough and uneven which device should you use so a stair chair a stokes basket a scoop stretcher or a long backboard so we have to take them down this mountain it's very rough and uneven yep we're going to use that basket stretcher another name is called stokes basket it's metal or it's plastic and we're going to carry them over long distances because this is the device because there it's has protection on the sides from your patient rolling if we needed again to use a backboard we would backboard our patient put them in the stokes basket and then use the basket to transport our patient down that mountain when two emts are lifting a patient on a long backboard they should lift from the sides of the boards make every attempt to lift with their backs position the strongest at the foot or position the strongest at the head remember we talked about this d again more than half the weights at the head into the backboard so maybe the strongest emt should be in the head we don't uh lift on the sides of the boards we lift with somebody at the head and somebody at the foot that's so a is incorrect which of the following techniques is considered to be an emergency move extremely lift supine transfer firefighters drag or direct ground lift yep another name for that firefighters drag is where we just basically grab their shirt or grab them with a blanket we're just moving them as quickly as possible yes we take into consideration their c-spine but it's more important to remove them from that environment than to take time to move them properly supine is not emergency the extremely lift is a non-urgent lift and that direct ground lift is a non-urgent lift to extract a patient from a basement you must transport the patient up a flight of stairs in doing this you must ensure that the elevated head of the board goes first the backboard with the elevated foot end goes first the backboard is slightly tilted to the left or the patient's feet are higher than their head think about going up a flight of stairs with a backboard you go upstairs with the head first so again the patient feels in in um control that you're not having blood rush to their head again it's going to help distribute the weight yeah and we never uh tilt a backboard if an injured patient needs to be moved but it's not in immediate danger from a fire or building collapse you should order the equipment you need for the extrication check the patient's abc's airway breathing circulation remove the patient with a rapid extrication technique or determine the number of people you will need to move the patient so there they need to be moved but it's not but they are not in immediate danger yep b the only time your attention should be directed away from your primary assessment of the patient is when the patient's life or your life is in danger so again check their abcs that's going to determine if your patient really does need an emergent move or emergency move anything like that again after you check your abcs then we can determine what's the safest method to extricate our patient lastly the rapid extra tech extrication technique is a non-urgent move to move a patient from a vehicle a technique used to transfer a patient from a bed to a stretcher a technique used to lift a patient with no suspected spinal orange spinal injury onto a stretcher or it's a technique to use to quickly remove a patient from a vehicle and onto a backboard wrap an extrication yes it's d we're going to use that rapid extrication technique to remove the piece the patient from the sitting position in their motor vehicle onto a backboard and this is when we use these uh this rapid extrication technique we are going to consider protecting their spine it isn't like in the reason a is not correct is because it is an urgent move again our patient might be unconscious or showing signs of shock or having difficulty breathing we don't have time to put them in that kendrick extrication device we want to get them out we want to get them on the backboard as quickly as possible i hope this narrated a lesson helps again keep reading your textbook not everything that you need is going to be found on powerpoints and videos you have to read your textbook