Presentation on theme: "Lifting and Moving Patients"— Presentation transcript:
1 Lifting and Moving Patients Chapter 35Lifting and Moving Patients
2 National EMS Education Standard Competencies EMS OperationsKnowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.
3 Introduction In the course of a call, EMTs move patients. To move patients without injury, you need to learn proper techniques.Correct body mechanics, grips, and devices are important.
4 Moving and Positioning the Patient (1 of 3) When you move a patient, take care that injury does not occur:To youTo your teamTo the patientMany EMTs are injured lifting and moving patients.
5 Moving and Positioning the Patient (2 of 3) Training and practice are required.Special lifting and moving techniques are necessary for:Patients with head injury, shock, spinal injuryPregnant patientsObese patients
6 Moving and Positioning the Patient (3 of 3) If this video does not automatically play, please click here.
7 Body Mechanics (1 of 12) In lifting: Shoulder girdle should be aligned over pelvis.Hands should be held close to legs.Force then goes essentially straight down spinal column.Very little strain occurs.
9 Body Mechanics (3 of 12)This is the correct way to lift.
10 Body Mechanics (4 of 12) You may injure your back: If you lift with your back curvedIf you lift with your back straight but bent significantly forward at the hips
11 Body Mechanics (5 of 12)This is an incorrect method of lifting.
12 Body Mechanics (6 of 12) Power lift Legs should be spread about 15″ apart (shoulder width).Place feet so center of gravity is balanced.With your back held upright, bring your upper body down by bending the legs.Grasp the patient/stretcher.
13 Body Mechanics (7 of 12) Power lift (cont’d) Lift patient by raising your upper body and arms and straightening your legs until standing.Keep the weight close to your body.See Skill Drill 35-1.
14 If this video does not automatically play, please click here. Body Mechanics (8 of 12)If this video does not automatically play, please click here.
15 Body Mechanics (9 of 12) Power grip gets maximum force from hands. Palms upHands about 10″ apartAll fingers at same angleFully support handle on curved palm
19 Weight and Distribution (1 of 9) Whenever possible, use a device that can be rolled.When a wheeled device is not available, a backboard must be used.
20 Weight and Distribution (2 of 9) More of the patient’s weight rests on the head half of the device than on the foot half.Diamond carry and the one-handed carry use one EMT at head and foot, and one on each side of patient’s torso.See Skill Drill 35-2 and Skill Drill 35-3.
27 Weight and Distribution (9 of 9) Backboard should be used instead for patient:In cardiac arrestWho must be moved in supine positionWho must be immobilized
28 Directions and Commands (1 of 3) Team actions must be coordinated.Team leaderIndicates where each team member should beRapidly describes sequence of steps to perform before lifting
29 Directions and Commands (2 of 3) Preparatory commands are used.Example:Team leader says, “All ready to stop,” to get team’s attention.Then team leader says, “Stop!” in louder voice.Countdowns are also used.
30 Directions and Commands (3 of 3) Estimate patient’s weight before liftingAdults often weigh 120–220 lb.Two EMTs should be able to safely lift this weight.If patient weighs over 250 lb, use four rescuers.Place strongest EMT at head end.
31 Principles of Safe Reaching and Pulling (1 of 4) Body dragWhen you use a body drag, same principles apply as when lifting and carrying.Keep back locked and straight.Kneel.Extend arms no more than 15–20″ in front of you.
32 Principles of Safe Reaching and Pulling (2 of 4) Log rollingLog roll the patient onto his or her side to place a patient on a backboard.
33 Principles of Safe Reaching and Pulling (3 of 4) Log rolling (cont’d)Kneel as close to the patient’s side as possible.Keep your back straight.Roll the patient without stopping.
34 Principles of Safe Reaching and Pulling (4 of 4) Rolling the stretcherStretcher should be fully elevated.Push the stretcher from the head end.Never push with arms fully extended.
35 General Considerations Move a patient in orderly, planned, unhurried manner.Carefully plan ahead.Select methods that will involve least amount of lifting and carrying.
36 Emergency Moves (1 of 5)Use when there is potential for danger before assessment and management.Examples: fire, explosives, hazardous materialsUse when you cannot properly assess patient or provide immediate care because of patient’s location or position.
37 Emergency Moves (2 of 5)If you are alone, use a drag to pull patient along long axis of body.Use techniques to help prevent aggravation of patient spinal injury.Clothes dragBlanket dragArm dragArm-to-arm drag
39 Emergency Moves (4 of 5)To remove unconscious patient from vehicle alone:First move legs clear of pedals.Rotate patient so back is toward open car door.Place arms through armpits and support head against your body.Drag patient from seat to a safe location.
41 Urgent Moves (1 of 2) Necessary to move patient with: Altered level of consciousnessInadequate ventilationShockRapid extrication technique requires team of knowledgeable EMTs.See Skill Drill 35-6.
42 Urgent Moves (2 of 2)Rapid extrication technique is an urgent move and should only be used if urgency exists.Patient can be moved within 1 minute.Technique increases damage if patient has spinal injury.Look at all options before using technique.
43 Nonurgent Moves (1 of 5) Used when both scene and patient are stable Carefully plan how to move the patient.Team leader should plan the move.PersonnelObstacles identifiedEquipmentPath
44 Nonurgent Moves (2 of 5) Choose between: Direct ground lift (Skill Drill 35-7)For those with no suspected spinal injury who are supine.Patient will need to be carried distance.EMTs stand side by side to lift/carry.
45 Nonurgent Moves (3 of 5) Choose between (cont’d): Extremity lift (Skill Drill 35-8)For those with no suspected spinal injury who are supine or sittingHelpful when patient is in small spaceOne EMT at patient’s head and the other at patient’s feetCoordinate moves verbally.
46 Nonurgent Moves (4 of 5)To transfer a patient from bed to stretcher, use:Direct carry (see Skill Drill 35-9)Move supine patient from the bed to stretcher using a direct carry method.Draw sheet methodMove patient from bed to stretcher using a sheet or blanket.Scoop stretcher (see Skill Drill 35-10)
47 If this video does not automatically play, please click here. Nonurgent Moves (5 of 5)If this video does not automatically play, please click here.
48 Geriatrics (1 of 2)Most patients transported by EMS are geriatric patients.Skeletal changes cause brittle bones, and spinal curvatures present special challenges.Allay patient’s fears with sympathetic and compassionate approach.
50 Bariatrics (1 of 2) Refers to management of obese people 100 million adults in the US are overweight or obese.Approximately 20% to 25% of children are overweight or obese.Back injuries account for the largest number of missed days of work.
51 Bariatrics (2 of 2)Stretchers and equipment are being produced with higher capacities.Does not address danger to EMTs of carrying ever-heavier weightsMechanical ambulance lifts are uncommon in United States.
52 Patient-Moving Equipment (1 of 3) Stretcher is available in many models with various features.General featuresHead and foot endStrong metal frame (to push, pull, lift)Hinges at center allow for elevation of head/back.Guardrail prevents patient from rolling out.
53 Patient-Moving Equipment (2 of 3) General features (cont’d)Undercarriage frame allows adjustment to any height.Stretcher has locking mechanism when controls are not activated.Controls are located at the foot end and at one or both sides of most stretchers.
54 Patient-Moving Equipment (3 of 3) If this video does not automatically play, please click here.
55 Types of Stretchers (1 of 19) Wheeled ambulance stretcherAlso called a stretcher or gurneyMost commonly used device
56 Types of Stretchers (2 of 19) Wheeled ambulance stretcher (cont’d)Patient may be secured directly to stretcherOr, patient may be secured to backboard first if:Suspected spinal injury or multisystem traumaPatient is in need of CPR
57 Types of Stretchers (3 of 19) Bariatric stretcherSpecialized for overweight or obese patientsWider wheel base for increased stabilitySource: Courtesy of Stryker Medical
58 Types of Stretchers (4 of 19) Bariatric stretcher (cont’d)Some have tow package with winch.Rated to hold 850–900 lbRegular stretcher rated for 650 lb max.
59 Types of Stretchers (5 of 19) Pneumatic and electronic-powered wheeled stretcherBattery operated electronic controls to raise/lower undercarriageThis increases the weight of stretcher.Hazardous for uneven terrain or stairsSource: Courtesy of Stryker Medical
60 Types of Stretchers (6 of 19) Loading a wheeled stretcher into an ambulanceEnsure the frame is held firmly between two hands so it does not tip.
61 Types of Stretchers (7 of 19) Loading a wheeled stretcher into an ambulance (cont’d)Newer models are self-loading, allowing you to push the stretcher into ambulance.Other models need to be lowered and lifted to the height of the floor of ambulance.Clamps in ambulance hold stretcher in place.See Skill Drill
62 Types of Stretchers (8 of 19) Portable/folding stretcherStrong, rectangular tubular metal frame with fabric stretched across it
63 Types of Stretchers (9 of 19) Portable/folding stretcher (cont’d)Some models have two wheels.Some can be folded in half.Used in areas difficult to reachWeigh less then wheeled stretchers
64 Types of Stretchers (10 of 19) Flexible stretcherCan be rolled into a tubular packageExcellent for storage and carryingConform around a patient’s sidesUseful for confined spacesUncomfortable, but provides support and immobilization
65 Types of Stretchers (11 of 19) BackboardLong, flat, and made of rigid rectangular material (mostly plastic)Used to carry and immobilize patients with suspected spinal injury or other trauma
66 Types of Stretchers (12 of 19) Backboard (cont’d)Commonly used for patients found lying down6′ to 7′ longHoles serve as handles and a place to secure straps.
67 Types of Stretchers (13 of 19) Backboard (cont’d)Short backboards or half-boards are used to immobilize seated patientsExample: the KED vest-type device
68 Types of Stretchers (14 of 19) Basket stretcherRigid stretcher also called a Stokes litterUsed for remote locations inaccessible by a vehicle, including water rescues and technical rope rescues
69 Types of Stretchers (15 of 19) Basket stretcher (cont’d)If spinal injury, secure patient to backboard and place inside basket stretcher to carry patient out of location.When you return to ambulance, lift the backboard out of basket stretcher and place on wheeled stretcher.
70 Types of Stretchers (16 of 19) Scoop stretcherAlso called orthopaedic stretcher
71 Types of Stretchers (17 of 19) Scoop stretcher (cont’d)Splits into two or four piecesPieces fit around patient who is lying on flat surface and reconnectBoth sides of patient must be accessible.Patient must be stabilized and secured on scoop stretcher.
72 Types of Stretchers (18 of 19) Stair chairFolding aluminum frame chairs with fabric stretched across to form a seat and backMost have rubber wheels in the back
73 Types of Stretchers (19 of 19) Neonatal isoletteAlso called an incubatorNeonates cannot be transported on a wheeled stretcher.Isolette keeps neonate warm, protects from noise, draft, infection, excess handling.Isolette may be secured to wheeled ambulance stretcher or freestanding.
74 Decontamination Decontaminate equipment after use. For your safety For the safety of the crewFor the safety of the patientTo prevent the spread of disease
75 Medical Restraints (1 of 2) Evaluate for correctible causes of combativeness.Head injury, hypoxia, hypoglycemiaFollow local protocols.Restraint requires five personnel.Restrain patient supine.Positional asphyxia may develop in prone position.
76 Medical Restraints (2 of 2) Apply restraint to each extremity.Assess circulation after restraints are applied.Document all information.
77 Personnel Considerations (1 of 2) Questions to ask before moving patient:Am I physically strong enough to lift/move this patient?Is there adequate room to get the proper stance to lift the patient?Do I need additional personnel for lifting assistance?
78 Personnel Considerations (2 of 2) Remember, an injured rescuer cannot help anyone.
79 Summary (1 of 13)The first key rule of lifting is to always keep your back in an upright position and lift without twisting.The power lift is the safest and most powerful way to lift.
80 Summary (2 of 13) Pushing is better than pulling. If you do not have a proper hold, you will not be able to bear your share of the weight, or you may lose your grasp and possibly cause a lower back injury to one or more EMTs.
81 Summary (3 of 13)It is always best to move a patient on a device that can be rolled.You must constantly coordinate your movements with those of the other team members and make sure that you communicate with them.
82 Summary (4 of 13)Ideally, members of the lifting team should also be of similar height and strength.If you must carry a loaded backboard or stretcher up or down stairs or other inclines, be sure that the patient is tightly secured to the device to prevent sliding.
83 Summary (5 of 13)Carry the backboard or stretcher foot end first, so that the patient’s head is elevated higher than the feet.Directions and commands are an important part of safe lifting and carrying.
84 Summary (6 of 13)You and your team must anticipate and understand every move and execute it in a coordinated manner.The team leader is responsible for coordinating the moves.You should try to use four rescuers whenever resources allow.
85 Summary (7 of 13)You should know how much you can comfortably and safely lift and not attempt to lift more than this amount.Rapidly summon additional help to lift and carry a weight that is greater than you are able to lift.
86 Summary (8 of 13)The same basic body mechanics apply for safe reaching and pulling as for lifting and carrying.Keep you back locked and straight, and avoid twisting.Do not hyperextend your back when reaching overhead.
87 Summary (9 of 13)For a nonurgent move, move the patient in an orderly, planned, and unhurried manner, selecting methods that involve the least amount of lifting and carrying.At times, you may have to use an emergency move to maneuver a patient before providing assessment and care.
88 Summary (10 of 13)You should perform an urgent move if a patient has an altered level of consciousness, inadequate ventilation, or shock, or in extreme weather conditions.
89 Summary (11 of 13)The wheeled ambulance stretcher is the most commonly used device to move and transport patients.Other devices include portable stretchers, flexible stretchers, backboards, basket stretchers, scoop stretchers, and stair chairs.
90 Summary (12 of 13)Whenever you are moving a patient, you must take special care so that neither you, your team, nor the patient is injured.
91 Summary (13 of 13)You will learn the technical skills of patient packaging and handling through practice and training.Training and practice are required to use all the equipment that is available to you.
92 Review What is the first rule of lifting? Twist slowly when you lift Keep your back in a straight positionBend at the waist to pick something upUse your arms to do most of the lifting
93 ReviewAnswer: BRationale: The first rule of lifting is to always keep your back in a straight, upright, position and use the powerful muscles of your thighs. Never twist while lifting.
94 Review What is the first rule of lifting? Twist slowly when you lift Rationale: You should never twist your back.Keep your back in a straight position Rationale: Correct answerBend at the waist to pick something up Rationale: You should never bend at the waist. Your back should be properly maintained in an upright position.Use your arms to do most of the lifting Rationale: Use your leg muscles since they are well developed and very strong.
95 Review When lifting a stretcher using the power lift, you should: bend at the hips, knees, back, and arms.bend at the waist and keep your back straight.place your hands palms up on the litter handle.place your hands palms down on the litter's side bars.
96 ReviewAnswer: CRationale: When lifting any heavy object, your hands should be facing palms up; this provides better lifting power and is not as stressful on the wrists.
97 Review (1 of 2)When lifting a stretcher using the power lift, you should:bend at the hips, knees, back, and arms. Rationale: When lifting, keep your back and arms straight. Always bend at the knees.bend at the waist and keep your back straight. Rationale: When lifting, always keep your back straight. Never bend at the waist.
98 Review (2 of 2)When lifting a stretcher using the power lift, you should:place your hands palms up on the litter handle. Rationale: Correct answerplace your hands palms down on the litter's side bars. Rationale: Your hands have the greatest strength when your palms are facing up.
99 ReviewIt is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:takes too long to correctly apply.does not fully immobilize the spine.cannot be used on patients who are in their car.does not provide adequate c-spine stabilization.
100 ReviewAnswer: ARationale: It takes several minutes to correctly apply a vest-style extrication device. This is too much time to waste when treating a critically-injured patient. A long spine board would be more appropriate. Vest-style immobilization devices, when applied correctly, provide adequate spinal motion restriction and are ideal to use in stable patients who need to be removed from their vehicle.
101 Review (1 of 2)It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:takes too long to correctly apply. Rationale: Correct answerdoes not fully immobilize the spine. Rationale: When applied correctly, the vest provides adequate restriction of the spine.
102 Review (2 of 2)It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:cannot be used on patients who are in their car. Rationale: When a patient is stable, the vest is a beneficial device for vehicle extrications.does not provide adequate c-spine stabilization. Rationale: The vest provides adequate restriction of the spine.
103 ReviewProper guidelines for correct reaching include all of the following, EXCEPT:avoiding twisting your back.avoiding hyperextension of your back.keeping the back in a locked-in position.reaching no more than 30” in front of your body.
104 ReviewAnswer: DRationale: When reaching, you should keep your back in a locked-in position, and avoid twisting or hyperextending your back. Do not reach more than 15" to 20" in front of your body.
105 Review (1 of 2)Proper guidelines for correct reaching include all of the following, EXCEPT:avoiding twisting your back. Rationale: Never twist your back while reaching or lifting.avoiding hyperextension of your back. Rationale: Never bend or hyperextend your back.
106 Review (2 of 2)Proper guidelines for correct reaching include all of the following, EXCEPT:keeping the back in a locked-in position. Rationale: Always keep your back straight in a locked position.reaching no more than 30" in front of your body. Rationale: Correct answer
107 ReviewAn injured hang glider is trapped at the top of a large mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use?Stair chairStokes basketScoop stretcherLong spine board
108 ReviewAnswer: BRationale: A basket stretcher, also called a “stokes” basket, should be used to carry patients over rough or uneven terrain that is inaccessible by ambulance. Its closed-ended sides protect the patient from falling out of the device.
109 Review (1 of 2)An injured hang glider is trapped at the top of a large mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use?Stair chair Rationale: This is used to transfer a patient up and down stairs.Stokes basket Rationale: Correct answer
110 Review (2 of 2)An injured hang glider is trapped at the top of a large mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use?Scoop stretcher Rationale: This is designed to split into 2 or 4 pieces. It must have access to both sides of patient and the patient should be lying on a relatively flat surface.Long spine board Rationale: There is no protection for the patient from falling off or out of the device.
111 ReviewWhen two EMTs are lifting a patient on a long backboard, they should:lift the patient from the sides of the board.make every attempt to lift with their backs.position the strongest EMT at the foot of the board.position the strongest EMT at the head of the board.
112 ReviewAnswer: DRationale: Since more than half of the patient's weight is distributed to the head end of a backboard or stretcher, you should always ensure that the strongest EMT is at that position. This will reduce the risk of injury to less stronger personnel as well as the risk of dropping the patient.
113 Review (1 of 2)When two EMTs are lifting a patient on a long backboard, they should:lift the patient from the sides of the board. Rationale: This may cause the backboard to tip since the upper torso is heavier.make every attempt to lift with their backs. Rationale: Never lift with your back. Always use your legs.
114 Review (2 of 2)When two EMTs are lifting a patient on a long backboard, they should:position the strongest EMT at the foot of the board. Rationale: The strongest EMT should be at the patient’s head, where the patient’s weight is greater.position the strongest EMT at the head of the board. Rationale: Correct answer
115 ReviewWhich of the following techniques is considered to be an emergency move?Extremity liftSupine transferFirefighter's dragDirect ground lift
116 ReviewAnswer: CRationale: The firefighter's drag is a one-person technique that is used when a patient must be removed from a life-threatening situation immediately.
117 ReviewWhich of the following techniques is considered to be an emergency move?Extremity lift Rationale: This is a nonurgent move, helpful in narrow spaces.Supine transfer Rationale: This is not considered to be an emergency move.Firefighter's drag Rationale: Correct answerDirect ground lift Rationale: This is a nonurgent move, used to carry a patient long distances to the cot.
118 ReviewTo extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:the elevated head of the backboard goes first.the backboard with the elevated foot end goes first.the backboard is slightly tilted to the left to distribute weight.the patient's feet are higher than his or her head, whichever end is carried first.
119 ReviewAnswer: ARationale: When you carry a patient upstairs or up an incline, you must ensure that the elevated head of the backboard or stretcher goes first. This will help to equally distribute the weight.
120 Review (1 of 2)To extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:the elevated head of the backboard goes first. Rationale: Correct answerthe backboard with the elevated foot end goes first. Rationale: Always try to carry the head higher to distribute the weight.
121 Review (2 of 2)To extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:the backboard is slightly tilted to the left to distribute weight. Rationale: Backboards are designed to carry a patient flat and the weight is best distributed when the head is slightly elevated.the patient's feet are higher than his or her head, whichever end is carried first. Rationale: Carries are easier with the patient’s head first and elevated for distribution of the patient’s weight.
122 ReviewIf an injured patient needs to be moved but is not in immediate danger from fire or building collapse, you should first:order the equipment you need for extrication.check the patient’s airway, breathing, and circulation.remove the patient with the rapid extrication technique.determine the number of people you will need to move the patient.
123 ReviewAnswer: BRationale: The only time your attention should be directed away from the primary assessment of the patient is when the patient’s life or your life is in immediate danger.
124 Review (1 of 2)If an injured patient needs to be moved but is not in immediate danger from fire or building collapse, you should first:order the equipment you need for extrication. Rationale: This is not the first thing you should do.check the patient’s airway, breathing, and circulation. Rationale: Correct answer
125 Review (2 of 2)If an injured patient needs to be moved but is not in immediate danger from fire or building collapse, you should first:remove the patient with the rapid extrication technique. Rationale: The patient is not in immediate danger, so this is not needed.determine the number of people you will need to move the patient. Rationale: After the ABC’s have been checked, then the EMT can determine the safest method of extrication.
126 Review The rapid extrication technique is a: nonurgent move to remove a patient from a vehicle.technique used to transfer a patient from a bed to a stretcher.technique used to lift a patient with no suspected spinal injury onto a stretcher.technique used to quickly remove a patient from a vehicle and onto a backboard.
127 ReviewAnswer: DRationale: By using the rapid extrication technique, a seriously injured patient can be moved from a sitting position in a vehicle to a supine position on a backboard while protecting the spine at the same time.
128 Review (1 of 2) The rapid extrication technique is a: nonurgent move to remove a patient from a vehicle. Rationale: This is considered to be an urgent move.technique used to transfer a patient from a bed to a stretcher. Rationale: This is used to move a patient from a vehicle to a backboard.
129 Review (2 of 2) The rapid extrication technique is a: technique used to lift a patient with no suspected spinal injury onto a stretcher. Rationale: This is not a lifting technique. The patient is placed on a backboard and not a stretcher.technique used to quickly remove a patient from a vehicle and onto a backboard. Rationale: Correct answer