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Chapter 11 Lifting and Moving Patients. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Back Injuries.

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Presentation on theme: "Chapter 11 Lifting and Moving Patients. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Back Injuries."— Presentation transcript:

1 Chapter 11 Lifting and Moving Patients

2 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Back Injuries  Body Mechanics  Planning a Move  Packaging the Patient

3 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Back Injuries  Anatomy review –Lumbar spine bears weight of body; 85% of back injuries occur there –Discs between vertebrae may deteriorate, move, or slip out of place –Injuries can result from improper lifting and carrying

4 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Back Injuries  Back care –Most common source of back injuries is twisting while lifting an object –Key to a strong back is exercise –To prevent injury, warm up the lower back before each tour of duty

5 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Back Injuries  Know your limitations –Two key questions Is there enough help to lift this patient? Is the right equipment being used? –Failure to answer the questions correctly can cause injury to the patient or EMT

6 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Back Injuries  Is there enough help? –One EMT must be able to lift and carry 125 lbs; two EMTs, 250 lbs –Request assistance for patients over 250 lbs –Factor in the stretcher and equipment

7 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Back Injuries  What is the “right stuff”? –Carefully consider the situation at hand –Mentally visualize the method used for the carry

8 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Back Injuries  Safety first –Back support braces Must be worn correctly Must fit correctly –Proper footwear Closed-toe shoes or boots Soles should be nonskid Midcalf boots provide support

9 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Stop and Review  Discuss proper back care.

10 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Body Mechanics  The proper or most efficient way to perform physical activities  The primary goal is to lift and carry without injury to spine

11 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Body Mechanics  Reaching –Never twist and arch the back backward –Never reach more than 18 inches away from the body –Keep elbows close to the body and never farther out than the knees –Bend at the knees, while keeping the back straight

12 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Body Mechanics  Lifting –The power lift Utilizes the stronger muscles of the leg instead of the weaker muscles of the lower back The closer the body’s center of gravity is to the object, the more powerful the lift The feet are the foundation of the power lift

13 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Body Mechanics  Lifting –The power grip Palms-up grasp utilizes powerful arm muscles The arms should be locked out On signal, two EMTs slowly lift together in a fluid motion Lift is complete when the EMT is upright and the weight suspended directly in front

14 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Body Mechanics  Carrying –A bag or case should be carried by a shoulder strap slung over the shoulder –Carry with a straight back and balance the loads  Pushing and pulling –Always try to push an object rather than pull it

15 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Planning a Move  Survey the scene and determine the priorities  Assess the resources at hand  Communicate the plan  The strongest EMT takes the heaviest end  Know your personal limits

16 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Planning a Move  Emergency moves –A patient may need to be moved immediately –Is the EMT prepared and capable of entering the scene and removing the patient? –Principle reasons for emergency moves Fire Explosion Life-threatening hazards Patient blocking access to more seriously injured patients

17 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Planning a Move  Emergency drags –The clothing drag The shirt collar or a handful of clothing is grabbed from behind the neck Using two hands, the EMT walks backward while dragging the patient along with him The patient’s head remains cradled between the rescuer’s forearms

18 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Planning a Move  Emergency drags –The arm drag The EMT grasps the wrists of the patient, crossing them over her chest, and drags her by the arms Effective if the patient can hold the head up Do not use if the patient is unconscious

19 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Planning a Move  Emergency drags –The blanket drag The EMT logrolls the patient onto a blanket and drags the patient backward to safety When others arrive, there are many handholds to help drag, lift, or carry the body

20 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Planning a Move  Emergency drags –The firefighter’s drag The EMT secures the patient’s wrists together and drapes the wrists over his neck and shoulders The patient is dragged while beneath the EMT The EMT sees where he is going; the patient is protected by the body of the EMT

21 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Planning a Move  Emergency carries –Rescuer assist EMT acts as a crutch for the walking patient Advantage—EMT can drag patient to safety if patient becomes weak

22 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Planning a Move  Emergency carries –Pack strap carry Can convert from the rescue assist The patient’s weight is on the EMT’s back and the patient’s feet are off the ground Use only when no other means are feasible –Cradle carry Only for small adults or children

23 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Planning a Move  Emergency carries –Firefighter’s carry Very effective but difficult to master The patient is moved from a supine to a near-standing position and over the EMT’s shoulder EMT has one hand free to open doors or carry bags

24 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Planning a Move  Emergency carries –Seat carry Use if patient is able to assist and two EMTs are available The two EMTs form a seat by grasping wrists Useful if the patient is unable to walk

25 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Planning a Move  Emergency carries –Chair carry Uses a standard kitchen chair to move the patient One EMT, facing forward, grasps the legs of the chair; the other EMT, the back of the chair Should not be used with unconscious patients

26 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Planning a Move  Nonurgent moves –Take time to prepare for the carry –The primary concern—the patient’s safety and comfort, and the safety of the prehospital team –A number of devices and methods can safely move a patient from the scene

27 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Planning a Move  Nonurgent moves –Command and coordination Team leader—EMT at the head of the patient Decides when to lift, turn, or stop Gives specific orders that are loud and clear Ensures all team members understand the objectives

28 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Planning a Move  Nonurgent moves –Extremity lift Transfers patient from bed or floor to stretcher First EMT slips his hands under the patient’s arms, and grasps the patient’s hands; second EMT slips his hands under the patient’s knees Does not protect the spine

29 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Planning a Move  Nonurgent moves –Direct lift Used when only one side of patient is accessible Moves a patient from the floor to bed or stretcher Three EMTs –First EMT—patient’s head, neck, and shoulders –Second EMT—patient’s back and buttocks –Third EMT—patient’s knees and ankles Does not protect the spine

30 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Planning a Move  Nonurgent moves –Scoop stretcher Designed to fit into tight or confined spaces Meant to be broken into two halves The halves slip under the patient from opposite sides and the stretcher is reconstructed Does not support the spine directly—a temporary transfer device

31 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Planning a Move  Nonurgent moves –Stairchairs Used if patient cannot tolerate lying flat on a stretcher Has seat belts for the patient, handles for the EMT Requires two EMTs to carry

32 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Planning a Move  Nonurgent moves –Stair carry EMT must concentrate on balancing, carrying, and stepping Guiding EMT calls out the steps until the bottom is reached Patient is carried down the stairs feet first Stairchair is held as close to the body as practical

33 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Planning a Move  Off-road stretchers –Designed to carry patient across uneven terrain and rough ground –Decrease the hazard to the EMT and the patient

34 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Planning a Move  Off-road stretchers –Basket stretcher Made of fiberglass-plastic composites Can be pulled across snow and ice like a sled Heavy to carry—some rescue experts still prefer lighter wire baskets

35 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Planning a Move  Off-road stretchers –Flexible stretcher Lightweight and can be rolled up SKED/Reeves stretchers Use in confined-space, cave, wilderness, and rope rescues Has multiple handholds and straps to secure patient

36 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 Planning a Move  Off-road carries –Decision of which to use is based on The nature and the distance of the carry Number of providers available The patient’s weight Rescuer fatigue

37 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 Planning a Move  Off-road carries –End-to-end carry Two EMTs grab each end of the litter and lift If the ground is level and the carry is only a few feet, the two EMTs can face one another If the carry is more than 20 feet, both EMTs should face forward

38 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 38 Planning a Move  Off-road carries –Diamond stretcher carry Use when carry is more than 12 feet and ground is uneven First two EMTs take ends of stretcher; next two take positions at sides All use a power grip and perform a power lift EMT at head faces and monitors the patient

39 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 39 Planning a Move  Off-road carries –The four corners carry Use when carrying a basket over a great distance Use when carrying heavy patients or equipment As many as six or even eight EMTs can be involved Each EMT grabs a corner of the basket or somewhere in the middle

40 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 40 Planning a Move  Off-road carries –The use of slings Loops of webbing (slings) are used to help even the load Sling is looped through the handhold and slung over the shoulder to the opposite hand After lifting, the EMT pulls down on the sling, using the shoulders as a fulcrum

41 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 41 Planning a Move  Off-road carries –Passing over obstacles EMTs must take care not to drop the patient while overcoming an obstacle Caterpillar pass passes patient to EMTs waiting on the other side of the obstacle The key—keep all EMTs standing still Can use to hand patient off to other EMTs

42 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 42 Stop and Review  State the guidelines for pushing and pulling.

43 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 43 Packaging the Patient  The ambulance cot is part of the plan of treatment  Linens provide comfort and warmth  Care must be taken to conserve the patient’s body heat

44 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 44 Packaging the Patient  Positioning –The decision on positioning the patient must be medically motivated Feet up—More blood goes to the brain Head up—Patient breathes more easily

45 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 45 Packaging the Patient  Strapping –First strap secures the upper torso—arms either inside or outside –Middle strap is adjusted over the bony pelvis –Last strap is across the knees –Equipment is secured with the last strap

46 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 46 Packaging the Patient  Transferring to the ambulance –Cot in high position is prone to tipping –Keep loaded cots in low position when moving the patient –If ground is rough or uneven, EMTs should be on both sides of the cot

47 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 47  Loading the ambulance –Depends on manufacturer recommendations –EMT must observe standard principles of lifting –Inspect the cot daily and provide regular maintenance Packaging the Patient

48 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 48 Packaging the Patient  Transferring to the hospital bed –Roll the cot feet first and in low position –Transfer to hospital gurney Be sure wheels of gurney are locked Use a transfer device (backboard) if necessary Lower side rails that might interfere with the transfer Two EMTs move the patient as a unit

49 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 49 Packaging the Patient  Transferring to the hospital bed –Carry transfer Direct carry of patient from the cot to the gurney Use when a space is too narrow to accept the crew Take time to plan this move

50 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 50 Packaging the Patient  Transferring to the hospital bed –Draw sheet transfer Linen is used to pull the patient from the cot to the hospital bed Four EMTs needed, two on each side With two stretchers next to each other, each EMT grabs a side of the cot’s linen and slides the patient onto the bed

51 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 51 Packaging the Patient  Transferring to the hospital bed –Use of a transfer board Helps reduce EMT back injuries Reduces friction between patient and stretcher Patient is pulled across using the draw sheet technique

52 © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 52 Stop and Review  State several situations that may require the use of an emergency move.


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