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Copyright © 2004, Mosby Inc. All rights reserved..

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1 Copyright © 2004, Mosby Inc. All rights reserved.

2 Lifting and Moving Patients Chapter 6 Slide 1 Copyright © 2004, Mosby Inc. All rights reserved.

3 Case History You respond to a report of an injury to find an adult male at the bottom of his basement stairs. The patient states that he missed a step and fell down approximately six stairs and cannot get to his feet. Your assessment discloses pain in the left leg. Slide 2 Copyright © 2004, Mosby Inc. All rights reserved.

4 Safe Lifting When possible, use a stair chair.When possible, use a stair chair. Know weight to be liftedKnow weight to be lifted Ensure enough help is available.Ensure enough help is available. Use at least two people.Use at least two people. Use an even number of people to lift.Use an even number of people to lift. Know weight limitations of equipment.Know weight limitations of equipment. Slide 3 Copyright © 2004, Mosby Inc. All rights reserved.

5 Power Lift Keep back locked.Keep back locked. Keep feet a comfortable distance apart.Keep feet a comfortable distance apart. Tighten your abdominal muscles.Tighten your abdominal muscles. Keep feet flat on the ground.Keep feet flat on the ground. Keep the center of your body over the object.Keep the center of your body over the object. Allow the upper body to rise before the hips.Allow the upper body to rise before the hips. Straighten your legs as you lift.Straighten your legs as you lift. Keep your back locked into position.Keep your back locked into position. Slide 4 Copyright © 2004, Mosby Inc. All rights reserved.

6 Carrying Whenever possible, use rolling devices.Whenever possible, use rolling devices. Know weight to be lifted.Know weight to be lifted. Know limitations.Know limitations. Work in a coordinated manner and communicate.Work in a coordinated manner and communicate. Keep weight close to body.Keep weight close to body. Keep back in a locked-in position.Keep back in a locked-in position. Flex at the hips, not the waist; bend at the knees.Flex at the hips, not the waist; bend at the knees. Do not hyperextend the back.Do not hyperextend the back. Slide 5 Copyright © 2004, Mosby Inc. All rights reserved.

7 Carrying Correct carrying procedureCorrect carrying procedure  Use correct lifting techniques to lift the stretcher.  Partners should have similar strength and height. One-handed carrying techniqueOne-handed carrying technique  Pick up and carry with the back in the locked-in position.  Avoid leaning to either side to compensate for any imbalance. Slide 6 Copyright © 2004, Mosby Inc. All rights reserved.

8 Carrying – Two Rescuers Preferable method in narrow spacesPreferable method in narrow spaces More strength requiredMore strength required Easily unbalancedEasily unbalanced Rescuers facing each other from opposite ends of stretcherRescuers facing each other from opposite ends of stretcher Slide 7 Copyright © 2004, Mosby Inc. All rights reserved.

9 Carrying – Four Rescuers One rescuer at each cornerOne rescuer at each corner More stability and less strength requiredMore stability and less strength required Safer over rough terrainSafer over rough terrain Slide 8 Copyright © 2004, Mosby Inc. All rights reserved.

10 Log Roll onto Spine Board Apply a cervical collar, and place the patient’s arms by his side.Apply a cervical collar, and place the patient’s arms by his side. Rescuer at the lower extremities holds the patient’s lower legs and the thigh region.Rescuer at the lower extremities holds the patient’s lower legs and the thigh region. Rescuer at the hip holds the patient’s lower legs and patient’s buttocks or waist.Rescuer at the hip holds the patient’s lower legs and patient’s buttocks or waist. Rescuer at the chest holds the patient’s arms and lower buttocks.Rescuer at the chest holds the patient’s arms and lower buttocks. Slide 9 Copyright © 2004, Mosby Inc. All rights reserved.

11 Log Roll onto Spine Board Move on command from the rescuer at the patient’s head.Move on command from the rescuer at the patient’s head. The patient should be rotated toward the rescuers, keeping the body in alignment.The patient should be rotated toward the rescuers, keeping the body in alignment. Rescuers reach across with one hand and pull the board beneath the patient.Rescuers reach across with one hand and pull the board beneath the patient. Slide 10 Copyright © 2004, Mosby Inc. All rights reserved.

12 Log Roll onto Spine Board Patient is gently rolled onto the board.Patient is gently rolled onto the board. Torso and extremities are strapped securely to the board.Torso and extremities are strapped securely to the board. Head is immobilized with pads and tape or a head immobilizer.Head is immobilized with pads and tape or a head immobilizer. Slide 11 Copyright © 2004, Mosby Inc. All rights reserved.

13 Reaching Guidelines for reachingGuidelines for reaching  Keep back in locked-in position  When reaching overhead, avoid hyperextended position  Avoid twisting the back while reaching. Application of reaching techniquesApplication of reaching techniques  Avoid reaching more than inches in front of the body.  Avoid strenuous effort. Slide 12 Copyright © 2004, Mosby Inc. All rights reserved.

14 Pushing and Pulling Pushing is safer and more effective than pullingPushing is safer and more effective than pulling Keep back locked in position.Keep back locked in position. Keep the line of pull through the center of your bodyKeep the line of pull through the center of your body  With cot stretcher, mattress should be on straight line with waist. Keep weight close to the body.Keep weight close to the body. Slide 13 Copyright © 2004, Mosby Inc. All rights reserved.

15 Pushing and Pulling Push from the area between the waist and the shoulder.Push from the area between the waist and the shoulder. If weight is below the level of your waist, use the kneeling position, if possible.If weight is below the level of your waist, use the kneeling position, if possible. Avoid pushing or pulling from an overhead position, if possible.Avoid pushing or pulling from an overhead position, if possible. Keep your elbows bent with your arms close to your side.Keep your elbows bent with your arms close to your side. Slide 14 Copyright © 2004, Mosby Inc. All rights reserved.

16 Emergency Moves – Indications Fire or danger of fireFire or danger of fire Explosives or other hazardous materialsExplosives or other hazardous materials Inability to protect the patient fromInability to protect the patient from hazards at the scene Inability to gain access to other patients in vehicleInability to gain access to other patients in vehicle Lifesaving care precluded byLifesaving care precluded by location or position Slide 15 Copyright © 2004, Mosby Inc. All rights reserved.

17 Emergency Moves Greatest danger in moving is possibly aggravating a spinal injury.Greatest danger in moving is possibly aggravating a spinal injury. When possible, pull in the direction of the long axis of the body.When possible, pull in the direction of the long axis of the body. Perfect spinal immobilization may not be possible.Perfect spinal immobilization may not be possible. Slide 16 Copyright © 2004, Mosby Inc. All rights reserved.

18 Emergency Moves Blanket dragBlanket drag Clothes dragClothes drag Foot dragFoot drag Slide 17 Copyright © 2004, Mosby Inc. All rights reserved.

19 Urgent Moves – Immediate Threat to Life Altered mental stateAltered mental state Inadequate breathingInadequate breathing ShockShock Serious injuries in need of surgical interventionSerious injuries in need of surgical intervention Slide 18 Copyright © 2004, Mosby Inc. All rights reserved.

20 Rapid Extrication First rescuer takes position behind the patient and maintains immobilization of the cervical spine while second EMT performs the initial assessment and applies CSID.First rescuer takes position behind the patient and maintains immobilization of the cervical spine while second EMT performs the initial assessment and applies CSID. Rescuer who performed the initial assessment takes over inline immobilization from the outside of the vehicle. Rescuer who was in the back of the vehicle slides a long spine board under the patient’s buttocks.Rescuer who performed the initial assessment takes over inline immobilization from the outside of the vehicle. Rescuer who was in the back of the vehicle slides a long spine board under the patient’s buttocks. Slide 19 Copyright © 2004, Mosby Inc. All rights reserved.

21 Rapid Extrication Rescuer takes position in the seat next to the patient on the opposite side of the rescuer who is now holding immobilization and places his or her hands under the patient’s thighs just proximal to the knees.Rescuer takes position in the seat next to the patient on the opposite side of the rescuer who is now holding immobilization and places his or her hands under the patient’s thighs just proximal to the knees. A third rescuer takes position on the same side of the vehicle as the rescuer holding immobilization and grasps the patient under the armpit with one hand and in the midposterior thorax with the other hand.A third rescuer takes position on the same side of the vehicle as the rescuer holding immobilization and grasps the patient under the armpit with one hand and in the midposterior thorax with the other hand. Slide 20 Copyright © 2004, Mosby Inc. All rights reserved.

22 Rapid Extrication Patient is rotated with the patient’s back toward the long spine board, so that the legs come in contact with the front of the seat.Patient is rotated with the patient’s back toward the long spine board, so that the legs come in contact with the front of the seat. Patient is then lowered to the board, with the rescuer at the leg lifting, the rescuer at the chest supporting and lowering, and the rescuer maintaining cervical spine immobilization maintaining alignment and lowering to one knee.Patient is then lowered to the board, with the rescuer at the leg lifting, the rescuer at the chest supporting and lowering, and the rescuer maintaining cervical spine immobilization maintaining alignment and lowering to one knee. Slide 21 Copyright © 2004, Mosby Inc. All rights reserved.

23 Rapid Extrication Once the patient is supine, the rescuer holding the chest positions both hands under the patient’s armpits and on command slides the patient in 6- to 12- inch increments until the patient is properly positioned on the long spine board.Once the patient is supine, the rescuer holding the chest positions both hands under the patient’s armpits and on command slides the patient in 6- to 12- inch increments until the patient is properly positioned on the long spine board. The long spine board is then properly positioned on the wheeled cot stretcher and secured.The long spine board is then properly positioned on the wheeled cot stretcher and secured. Slide 22 Copyright © 2004, Mosby Inc. All rights reserved.

24 Direct Ground Lift Two or three rescuers line up on one side of the patient.Two or three rescuers line up on one side of the patient. Rescuers kneel on one knee.Rescuers kneel on one knee. The patient's arms are placed on his chest, if possible.The patient's arms are placed on his chest, if possible. Slide 23 Copyright © 2004, Mosby Inc. All rights reserved.

25 Direct Ground Lift On command, both rescuers smoothly lift the patient onto their elevated thighs.On command, both rescuers smoothly lift the patient onto their elevated thighs. Slide 24 Copyright © 2004, Mosby Inc. All rights reserved.

26 Direct Ground Lift Rescuers then carefully load the patient onto the stretcher in unison.Rescuers then carefully load the patient onto the stretcher in unison. Slide 25 Copyright © 2004, Mosby Inc. All rights reserved.

27 Extremity Lift One rescuer is positioned at the patient’s head and one at the patient’s knees.One rescuer is positioned at the patient’s head and one at the patient’s knees. Rescuer at the patient’s head lifts the shoulders while the second rescuer straddles the patient’s knees and grasps the patient’s wrists.Rescuer at the patient’s head lifts the shoulders while the second rescuer straddles the patient’s knees and grasps the patient’s wrists. In unison, the rescuers pull the patient to a sitting position.In unison, the rescuers pull the patient to a sitting position. Slide 26 Copyright © 2004, Mosby Inc. All rights reserved.

28 Extremity Lift The first rescuer then grasps the patient under the armpits and supports the patient’s wrists.The first rescuer then grasps the patient under the armpits and supports the patient’s wrists. Second rescuer supports the patient with one hand behind each knee.Second rescuer supports the patient with one hand behind each knee. Slide 27 Copyright © 2004, Mosby Inc. All rights reserved.

29 Extremity Lift Both rescuers rise smoothly to an upright position.Both rescuers rise smoothly to an upright position. Slide 28 Copyright © 2004, Mosby Inc. All rights reserved.

30 Extremity Lift The rescuer holding the legs can then turn 180 degrees to facilitate forward movement of the patient to the stretcher.The rescuer holding the legs can then turn 180 degrees to facilitate forward movement of the patient to the stretcher. Slide 29 Copyright © 2004, Mosby Inc. All rights reserved.

31 Direct Carry Position cot perpendicular to bed with head end of cot at foot of bed.Position cot perpendicular to bed with head end of cot at foot of bed. Unbuckle straps and remove other items.Unbuckle straps and remove other items. Stand between bed and stretcher, facing patient.Stand between bed and stretcher, facing patient. Slides arm under patient's neck and cups patient's shoulder.Slides arm under patient's neck and cups patient's shoulder. Slide 30 Copyright © 2004, Mosby Inc. All rights reserved.

32 Direct Carry Second rescuer slides hand under patient’s hips and lifts slightly.Second rescuer slides hand under patient’s hips and lifts slightly. First rescuer slides other arm under patient's back.First rescuer slides other arm under patient's back. Second rescuer places arms underneath hips and calves.Second rescuer places arms underneath hips and calves. Slide 31 Copyright © 2004, Mosby Inc. All rights reserved.

33 Direct Carry Rescuers slide patient to edge of bed.Rescuers slide patient to edge of bed. Patient is lifted/curled toward the rescuers' chests.Patient is lifted/curled toward the rescuers' chests. Slide 32 Copyright © 2004, Mosby Inc. All rights reserved.

34 Direct Carry Rescuers rotate and place patient gently onto cot.Rescuers rotate and place patient gently onto cot. Slide 33 Copyright © 2004, Mosby Inc. All rights reserved.

35 Draw Sheet Method Loosen bottom sheet of bed.Loosen bottom sheet of bed. Position cot next to bed.Position cot next to bed. Prepare cot: adjust height, lower rails, unbuckle straps.Prepare cot: adjust height, lower rails, unbuckle straps. Slide 34 Copyright © 2004, Mosby Inc. All rights reserved.

36 Draw Sheet Method Reach across cot.Reach across cot. Grasp sheet firmly at patient's head, chest, hips, and knees.Grasp sheet firmly at patient's head, chest, hips, and knees. Slide patient gently onto cot.Slide patient gently onto cot. Slide 35 Copyright © 2004, Mosby Inc. All rights reserved.

37 Equipment Stretchers/cotsStretchers/cots Portable stretchersPortable stretchers Stair chairStair chair BackboardsBackboards Scoop/orthopedicScoop/orthopedic Flexible stretcherFlexible stretcher Slide 36 Copyright © 2004, Mosby Inc. All rights reserved.

38 Wheeled Stretcher Preferred device for transporting patients along smooth terrainPreferred device for transporting patients along smooth terrain Care needed in rougher terrain to avoid tippingCare needed in rougher terrain to avoid tipping Least effective device for moving a patient over rough terrain or down stairsLeast effective device for moving a patient over rough terrain or down stairs  Try »Folding stretcher »Scoop stretcher »Basket stretcher »Stair chair (stairs) Slide 37 Copyright © 2004, Mosby Inc. All rights reserved.

39 Loading an Ambulance Rescuers stand on opposite sides of the stretcher, bend their knees, and grasp the lower bar of the stretcher.Rescuers stand on opposite sides of the stretcher, bend their knees, and grasp the lower bar of the stretcher. Hands are positioned at each end of the lower bar, with one hand palm-down and the other hand palm-up.Hands are positioned at each end of the lower bar, with one hand palm-down and the other hand palm-up. Slide 38 Copyright © 2004, Mosby Inc. All rights reserved.

40 Loading an Ambulance On command, both rescuers rise to the upright position and move the front wheels onto the floor of the passenger compartment.On command, both rescuers rise to the upright position and move the front wheels onto the floor of the passenger compartment. Slide 39 Copyright © 2004, Mosby Inc. All rights reserved.

41 Loading an Ambulance The stretcher is rolled forward until all wheels are on the passenger floor and the stretcher is guided into the sidebar to lock it in place.The stretcher is rolled forward until all wheels are on the passenger floor and the stretcher is guided into the sidebar to lock it in place. Slide 40 Copyright © 2004, Mosby Inc. All rights reserved.

42 Unloading the Ambulance Unlatch the lock on the side of the stretcher and roll the stretcher so that the wheels are at the end of the patient compartment.Unlatch the lock on the side of the stretcher and roll the stretcher so that the wheels are at the end of the patient compartment. Slide 41 Copyright © 2004, Mosby Inc. All rights reserved.

43 Unloading the Ambulance Each rescuer should hold the bottom bar of the stretcher with one hand palm- down and the other hand palm-up. The stretcher is then lifted from the back of the vehicle.Each rescuer should hold the bottom bar of the stretcher with one hand palm- down and the other hand palm-up. The stretcher is then lifted from the back of the vehicle. Slide 42 Copyright © 2004, Mosby Inc. All rights reserved.

44 Unloading the Ambulance The stretcher is lowered to the ground while keeping the back straight and bending at the knees.The stretcher is lowered to the ground while keeping the back straight and bending at the knees. Slide 43 Copyright © 2004, Mosby Inc. All rights reserved.

45 Unloading the Ambulance Both rescuers then lift the stretcher to an upright position while holding the top bar of the stretcher.Both rescuers then lift the stretcher to an upright position while holding the top bar of the stretcher. Slide 44 Copyright © 2004, Mosby Inc. All rights reserved.

46 Folding Stretcher Lightweight device that can be folded and storedLightweight device that can be folded and stored Permits easy transfer of a patient down stairs and over rough terrainPermits easy transfer of a patient down stairs and over rough terrain Should be carried end to endShould be carried end to end Can be loaded in ambulance from end to endCan be loaded in ambulance from end to end Slide 45 Copyright © 2004, Mosby Inc. All rights reserved.

47 Stair Chair Used to remove patients in sitting positionUsed to remove patients in sitting position Ideal device for narrow stairwaysIdeal device for narrow stairways Never used for:Never used for:  Suspected spinal injury  Unconscious patients Patient should be transferred to wheeled cot stretcher in ambulance.Patient should be transferred to wheeled cot stretcher in ambulance. Slide 46 Copyright © 2004, Mosby Inc. All rights reserved.

48 Stair Chair Move the patient into the chair using the extremity lift.Move the patient into the chair using the extremity lift. Slide 47 Copyright © 2004, Mosby Inc. All rights reserved.

49 Stair Chair Secure the patient’s hands (optional) and tilt the device.Secure the patient’s hands (optional) and tilt the device. Tilt the chair back to move to ground level.Tilt the chair back to move to ground level. Slide 48 Copyright © 2004, Mosby Inc. All rights reserved.

50 Stair Chair Use a spotter to move down stairs.Use a spotter to move down stairs. Slide 49 Copyright © 2004, Mosby Inc. All rights reserved.

51 Scoop or Orthopedic Stretcher Device facilitates easy lifting of patients.Device facilitates easy lifting of patients. Stretcher splits lengthwise into two equal halves.Stretcher splits lengthwise into two equal halves. Patients can be “scooped” off the ground.Patients can be “scooped” off the ground. Patients can then be placed on a long spine board or a wheeled cot stretcher.Patients can then be placed on a long spine board or a wheeled cot stretcher. Secure the patient with straps before moving.Secure the patient with straps before moving. Slide 50 Copyright © 2004, Mosby Inc. All rights reserved.

52 Scoop or Orthopedic Stretcher Measure and adjust the length of the device next to the patient.Measure and adjust the length of the device next to the patient. Slide 51 Copyright © 2004, Mosby Inc. All rights reserved.

53 Scoop or Orthopedic Stretcher Carefully slide the stretcher under both sides of the patient.Carefully slide the stretcher under both sides of the patient. Lock the head and the feet sections of the scoop stretcher, then strap the patient in place.Lock the head and the feet sections of the scoop stretcher, then strap the patient in place. Slide 52 Copyright © 2004, Mosby Inc. All rights reserved.

54 Scoop or Orthopedic Stretcher Place on the secondary device and secure in place.Place on the secondary device and secure in place. Slide 53 Copyright © 2004, Mosby Inc. All rights reserved.

55 Long Spine Board Several varietiesSeveral varieties Provide essentially the same functionProvide essentially the same function  Rigid support for the spinal column to prevent further injury Primary device for patients who are supine or laterally recumbentPrimary device for patients who are supine or laterally recumbent Used for rapid extricationUsed for rapid extrication Secondary support device for patients removed with a short spine boardSecondary support device for patients removed with a short spine board Slide 54 Copyright © 2004, Mosby Inc. All rights reserved.

56 Short Spine Board Used to immobilize and extricate victims of motor vehicle crashes who are found in the sitting positionUsed to immobilize and extricate victims of motor vehicle crashes who are found in the sitting position Extends from the base of the buttocks to just above the headExtends from the base of the buttocks to just above the head Attached to the patient while maintaining cervical immobilizationAttached to the patient while maintaining cervical immobilization Slide 55 Copyright © 2004, Mosby Inc. All rights reserved.

57 Short Spine Board Vest-type device is an evolution of the short spine board.Vest-type device is an evolution of the short spine board. Semirigid form permits easy and speedy application.Semirigid form permits easy and speedy application. Device provides effective immobilization of the spine.Device provides effective immobilization of the spine. Slide 56 Copyright © 2004, Mosby Inc. All rights reserved.

58 Basket Stretcher (Stokes) Ideal for removing patients on rough terrain or during high-angle rescuesIdeal for removing patients on rough terrain or during high-angle rescues Constructed of hard plastic or wire mesh with a metal frameConstructed of hard plastic or wire mesh with a metal frame Must be well padded to prevent further injury to the patientMust be well padded to prevent further injury to the patient Slide 57 Copyright © 2004, Mosby Inc. All rights reserved.

59 Flexible Stretcher Consists of rigid slatsConsists of rigid slats Useful for carrying a patient through narrow corridors or over difficult terrainUseful for carrying a patient through narrow corridors or over difficult terrain Slide 58 Copyright © 2004, Mosby Inc. All rights reserved.

60 Transport Positions Slide 59 Copyright © 2004, Mosby Inc. All rights reserved.

61 Lateral Recumbent Unconscious and pregnant patients Slide 60 Copyright © 2004, Mosby Inc. All rights reserved.

62 Shock Position 8-12 inches Slide 61 Copyright © 2004, Mosby Inc. All rights reserved.

63 Fowler’s Patients with difficulty breathing Slide 62 Copyright © 2004, Mosby Inc. All rights reserved.

64 Spinal Injury Slide 63 Copyright © 2004, Mosby Inc. All rights reserved.

65 Pregnant Patients In late stages of pregnancy (6-9 months) –In late stages of pregnancy (6-9 months) – do not place patient flat on her back.  Causes fetus to compress vena cava Position of choice – lateral recumbentPosition of choice – lateral recumbent  If patient is uncomfortable, consider semireclining position. If suspected spinal injury, place patient on long spine board, then tilt board to the left to relieve pressure.If suspected spinal injury, place patient on long spine board, then tilt board to the left to relieve pressure. Slide 64 Copyright © 2004, Mosby Inc. All rights reserved.

66 Summary Back injuries are the plague of prehospital care.Back injuries are the plague of prehospital care. Injury prevention techniquesInjury prevention techniques  Stay close to the lifting device.  Maintain a straight posture.  Lift with strong leg muscles rather than back muscles Coordinate lifts with team members to ensure a smooth and unhurried lift, with all team members lifting in unison.Coordinate lifts with team members to ensure a smooth and unhurried lift, with all team members lifting in unison. Slide 65 Copyright © 2004, Mosby Inc. All rights reserved.


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