2Introduction Moving injured patient likely to cause further injury In most cases wait for professional helpMay have to move patient to protect from danger at sceneMay need to assist other EMS personnel
3Body Mechanics Back injury is hazard for EMRs To minimize risks, use good body mechanicsBody mechanics are principles of using your body safely
4Body Mechanics and Lifting Techniques Know your physical ability and limitationsPlan the liftEnsure you have a good gripTest the loadPosition your feet properly before starting liftLift with your legs, not with your back (power lift)Keep patient’s weight close to your body
5Body Mechanics and Lifting Techniques (continued) Lift straight up, maintain good postureAvoid twisting your back during liftUse good technique when reachingWhen possible, push rather than pullCommunicate clearly with your partner and other EMS providers
6Patient Positioning Reposition patient only when necessary Reposition breathing, unresponsive, non-trauma patient in recovery positionDon’t move or reposition trauma patient unless necessary to treat life-threatening conditionAllow responsive patient to assume comfortable position
7Log Roll Use log roll to move patient from prone to supine 3-5 rescuers are needed to safely roll patientFor trauma patient with spinal injury, stabilize head in line with body during move
8Skill: Log RollRescuer at patient’s head holds head in line with body as 2 or 3 additional rescuers take position with hands at patient’s lower and upper leg, hip and torso, and shoulderOn the count of responder at the head, rescuers in unison roll patient toward them, with head held in line and spine straightRescuers complete log roll, positioning patient on back with head and neck still in line with body
9Emergency Moves Use only if: Patient faces immediate danger You cannot give lifesaving care because of location or position
10Risk of Spinal InjuryMoving patient quickly risks aggravating a spinal injuryKeep head and neck in line with spineIt is impossible to completely protect spine while removing patient from a vehicle quickly
11Extrication from Vehicles EMRs may be trained in rapid extrication using cervical collar and inline stabilization of head/neckFollow local protocolWait for EMTs trained in special extrication techniques
121-Rescuer Emergency Drags Pull or drag patient in direction of long axis of bodyDon’t drag patient sidewaysAvoid twisting neck and trunkNever pull head away from neck and shouldersRisk of spinal injury can be minimized by using blanket, rug, board, etc.Choice of move depends on materials at hand, patient’s condition and situation
14Emergency Carries Used when patient must be moved immediately 1 or more rescuers may carry patientMethod used depends on patient’s size and condition and the situation
15With All Emergency Carries Use good body mechanics and lifting techniquesDon’t try to lift or carry person before checking for injuries
16Moving Patients – If Alone Unresponsive patient who cannot safely be dragged – Packstrap carry
17Moving Patients – If Alone (continued) Lighter patient or childCradle carry (responsive or unresponsive patients)Piggyback carry (responsive patient)
18Piggyback CarrySupport patient’s weight with your arms under patient’s thighsIf able, have patient clasp hands and lean forward; if not able, grasp patient’s hands with yours to keep patient from falling back
19Firefighter’s CarrySupport patient’s weight on your shoulders while holding patient’s thigh and arm
20Moving Patients – If Alone (continued) Responsive patient who can walk with help – 1-rescuer walking assist
21Moving Patients – With Help Responsive patient:2-rescuer walking assist2-rescuer cradle carry2-rescuer extremity carry
222-Rescuer Cradle CarryBoth rescuers clasp arms behind patient’s back and under the legs
232-Rescuer Extremity Carry To carry patient down steps:Forward rescuer grasps patient’s legs under the kneesRear rescuer reaches under patient’s armpits from behind to grasp patient’s forearms
242-Rescuer Walking Assist Both rescuers position patient’s arms over their shouldersEach rescuer grasps patient’s wrist, with the other arm around patient’s waist
25Urgent MovesUsed when patient must be moved urgently and quickly, but situation allows a little more time to ensure patient safetyAn urgent move may be needed for:Patients with altered mental statusPatients with inadequate breathingPatients in shockOther situations involving potential danger to patient
26Non-Emergency Moves Used to move patient when no threat to life Performed by multiple rescuersNot used if patient has suspected spinal injury, internal bleeding or uncontrolled external bleedingGenerally used to prepare patient for transportStabilize patient before movingMinimize any chance of aggravating illness or injuryThese moves are usually performed by responding EMS personnel
27Before Using a Non-Emergency Move Complete primary and secondary assessmentsCorrect any life-threatening problemsImmobilize all suspected fractures and dislocationsEnsure there are no signs and symptoms of neck or spinal injury
28Direct Ground LiftNon-emergency move for patients without suspected neck or spinal injuriesUsed to lift and carry supine patient from ground to stretcher
29Skill: Direct Ground Lift Rescuers kneel on one side of the patientRescuers position their hands on the patientRescuers lift patient to their knees and roll the patient in toward their chestsRescuers stand and move patient to stretcher, and reverse steps to lower patient
30Extremity Lift2-rescuer technique used for patients without suspected injury to neck, spine or extremitiesMay be used with responsive or unresponsive patientMay be used to carry patient a short distance or move patient from chair to stretcherMay be used to carry patient through a tight space
31Skill: Extremity LiftThe first rescuer kneels at the patient’s head and the second rescuer kneels by the patient’s feet. The rescuer at the head places 1 arm under each of the patient’s shoulders while the rescuer at the feet positions the patient’s arms.The rescuer at the head then slips his or her hands under the patient’s armpits and grasps the patient’s wrists and crosses them on the patient’s chest. The rescuer at the feet turns around and reaches his or her hands back and under the patient’s knees.
32Skill: Extremity Lift (continued) Both rescuers move to a crouching position and assess their grip on the patient.On a signal from the rescuer at the head, the rescuers stand up simultaneously and move forward with the patient.
33Extremity Lift – Alternative Position Previous technique is preferred if rescuers must move some distance or over inclined surfaceAlternatively, rescuer at patient’s feet may face patient and other rescuerCan be used to move patient to side or short distance
34Transfer from Bed to Stretcher Assist EMS personnel transferring patient from bed to stretcherUse either direct carry or draw sheet techniqueNot used with patient with suspected spinal injury
35Skill: Direct CarryPosition the stretcher at a right angle to the bed, ideally, with the head end of the stretcher at the foot of the bed. The stretcher should be at the same height as the bed. Unbuckle the straps and remove other items from the stretcher. Both rescuers stand between the bed and the stretcher, facing the patient.
36Skill: Direct Carry (continued) The rescuer at the head slides 1 arm under the patient’s neck and cups the patient’s farther shoulder. The second rescuer slides 1 arm under the patient’s hips and lifts slightly. The rescuer at the head slides his or her other arm under the patient’s back, and the second rescuer places his or her other arm underneath the patient’s thighs near the knees. Together, both rescuers slide the patient to the edge of the bed.
37Skill: Direct Carry (continued) On a signal of the rescuer at the head, the rescuers lift and curl the patient toward their chests.The rescuers step back, rotate toward the stretcher and place the patient gently on the stretcher.
39Skill: Draw Sheet Transfer Loosen bottom bed sheet and roll its edge on the side where you will place stretcherPosition stretcher alongside bed; prepare stretcher:Adjust height, lower rails and unbuckle strapsBoth responders reach across stretcher and grasp rolled sheet edge firmly at level of patient’s head, chest, hips and kneesSlide patient gently onto stretcher
40Draw Sheet Transfer – Alternative Method Rescuers first roll patient onto one side, and 1 rescuer holds the patient in that position; second rescuer positions a sheet with rolled edge beneath patientThe patient is rolled back into original position, now on the sheetThe rescuers together pull on sheet to slide patient onto stretcher
41EMS Equipment for Moving Patients EMRs often assist EMTs with packaging and moving patientsWide range of commercial devices is usedLearn devices you are likely to encounter in your area
42Typical Equipment for Packaging and Moving Patients Long backboardKendrick Extrication Device (KED)Standard stretcherPortable stretcherOrthopedic stretcherBasket stretcherStair chair