1. Section 6: Scene Techniques

2. Chapter 27 Rescue Techniques: Lifts and Loads

3. Chapter 27: Rescue Techniques: Lifts and Loads 3 Discuss the guidelines and safety precautions that need to be followed when extricating and transferring a patient. Describe the safe lifting of immobilization devices, cots, and stretchers. Describe correct and safe carrying procedures on irregular terrain. Describe correct techniques for log rolls. Objectives (1 of 4)

4. Chapter 27: Rescue Techniques: Lifts and Loads 4 Objectives (2 of 4) State the guidelines for pushing and pulling. Discuss the general considerations of moving patients. Identify the following devices: immobilization devices, transfer devices, transportation devices. Explain the rationale for properly lifting and moving patients.

5. Chapter 27: Rescue Techniques: Lifts and Loads 5 With another rescuer, prepare each of the following devices, transfer a patient to the device, and properly position the patient on the device: Long backboard Short backboard KED Scoop stretcher SKED Stokes Objectives (3 of 4) Commercial or improvised stretcher Cots Toboggan Overland wheeled stretcher Stair chair

6. Chapter 27: Rescue Techniques: Lifts and Loads 6 Objectives (4 of 4) With another rescuer: Demonstrate techniques for the transfer of a patient from a long backboard to a toboggan. Move a patient (not on a backboard) from the ground to a toboggan. Transfer a patient from a toboggan to a cot or gurney. Transfer a patient to an automobile.

7. Chapter 27: Rescue Techniques: Lifts and Loads 7 Rescue Process Note patient’s location and any hazards. Always consider your protection! Avoid approaching the scene from directly above or below. Extrication is the process of safely moving a patient, from entrapment or danger, to provide further care.

8. Chapter 27: Rescue Techniques: Lifts and Loads 8 Basic Anatomic Positions (1 of 3) Position 1 –Patient supine –Anatomically neutral –Straight back Position 1a –Patient supine –Head, neck, back, or extremities not anatomically neutral

9. Chapter 27: Rescue Techniques: Lifts and Loads 9 Basic Anatomic Positions (2 of 3) Position 2 –Patient on side –Anatomically neutral Position 2a –Patient on side –Head, neck, back, or extremities not anatomically neutral

10. Chapter 27: Rescue Techniques: Lifts and Loads 10 Basic Anatomic Positions (3 of 3) Position 3 –Patient prone –Anatomically neutral –Head usually turned to the side Position 3a –Patient prone –Head, neck, back, or extremities not anatomically neutral

11. Chapter 27: Rescue Techniques: Lifts and Loads 11 Patient Positioning Three spinal reference points: head, shoulders, and hips Rescuer at each point Movements are in short increments (6” to 12”). All movement is directed by a single leader.

12. Chapter 27: Rescue Techniques: Lifts and Loads 12 Patient Positioning Align head and neck first to provide and protect airway (except in patients in position 3a). Limbs should be aligned one joint, one plane at a time. Align the patient using the fewest moves. Align a patient in increments, ie, from position 3 to position 2, then position 1. Patients may have to be moved before alignment.

13. Chapter 27: Rescue Techniques: Lifts and Loads 13 Specific Techniques Recovery position –Also known as NATO position One-rescuer side roll –Used to help prevent aspiration Log roll –Used to place patient onto a backboard

14. Chapter 27: Rescue Techniques: Lifts and Loads 14 Rescuer Body Mechanics Lifting should be done using the hips and legs. Keep your back straight. Do not twist or bend forward or to the side. Grasp with your palms up (power grip). Weight should be kept close to your body.

15. Chapter 27: Rescue Techniques: Lifts and Loads 15 Lifting Anatomy Shoulder girdle rests on vertebrae. The sacrum is the weight-bearing base and connection with pelvis. Lifting with hands is reflected onto shoulder girdle. Position of shoulder girdle will direct force. –Anterior to pelvis will exert force across spine. –Over pelvis will exert force in line with spine.

16. Chapter 27: Rescue Techniques: Lifts and Loads 16 Power Lift Tighten your back in an upright position. Spread your legs apart about shoulder width. Use power grip and hold close to your torso. Center your balance between both arms. Ensure firm and balanced footing. Straighten your legs and lift, keeping your back straight and upright.

17. Chapter 27: Rescue Techniques: Lifts and Loads 17 Power Grip Place hands about 10” apart with palms up and thumb on top. Curl your fingers and thumb tightly over top of handle. Handle should rest in your palm, not on fingers. Curl your biceps to maintain grip.

18. Chapter 27: Rescue Techniques: Lifts and Loads 18 Weight and Distribution Be aware of the effect of ski and snowboard boots on lifting. 68% to 78% of a patient’s weight is in the torso. Patient should be carried feet first. Ensure that patient is secured to device.

19. Chapter 27: Rescue Techniques: Lifts and Loads 19 Directions and Commands Moves must be coordinated. Direction must come from a single leader. Start with a preparatory command: –“Ready to stop.” Give command of execution: –“STOP.” Use a count for lifting: –“Lift on three. One, two, THREE.”

20. Chapter 27: Rescue Techniques: Lifts and Loads 20 Lifting and Carrying Guidelines Ideally, use four rescuers to lift or carry a patient on a backboard or stretcher. Communicate with other rescuers when lifting or carrying. Consider patient size, route, terrain, and rescuer strength and size when positioning rescuers.

21. Chapter 27: Rescue Techniques: Lifts and Loads 21 Safe Reaching and Pulling Use the same body mechanics as when lifting or carrying. Your back should be locked and upright. Do not twist. Kneel or bend the knees. Do not overextend your reach—15” to 20” is sufficient. Avoid repositioning yourself while moving a patient.

22. Chapter 27: Rescue Techniques: Lifts and Loads 22 Long-Axis Drag (1 of 2) Sliding a patient in-line with the spinal column Do not move a patient sideways! Maintain cervical stabilization throughout the drag. Avoid excessive cervical traction or compression.

23. Chapter 27: Rescue Techniques: Lifts and Loads 23 Long-Axis Drag (2 of 2) Patient can be dragged either head- first or feet-first. Usually three rescuers are needed: –One at patient’s head –One at each side of patient’s torso or ankles Some injuries may preclude using this technique.

24. Chapter 27: Rescue Techniques: Lifts and Loads 24 Emergency Moves (1 of 3) Used when hazards pose a risk of serious harm or death to rescuer or patient Primary risk is aggravating an existing spinal injury. Use a drag to pull the patient along the long axis of the body.

25. Chapter 27: Rescue Techniques: Lifts and Loads 25 Emergency Moves (2 of 3) Techniques include: –Clothes drag –Blanket drag –Arm drag –Arm-to-arm drag

26. Chapter 27: Rescue Techniques: Lifts and Loads 26 Emergency Moves (3 of 3) When spinal injuries are unlikely, techniques include: –Front cradle –Firefighter’s drag –One-person walking assist –Firefighter’s carry –Pack strap carry

27. Chapter 27: Rescue Techniques: Lifts and Loads 27 Nonurgent Moves Used when scene and patient are stable Three general methods include: –Bridge lift –Direct ground lift –Extremity lift Can be adapted to each situation

28. Chapter 27: Rescue Techniques: Lifts and Loads 28 Bridge Lift (1 of 2) Rescuers form a bridge by bracing head against other rescuer’s shoulder. Allows lifting with arms and shoulders instead of back. Patients with spinal injuries will require at least 4 rescuers for the lift.

29. Chapter 27: Rescue Techniques: Lifts and Loads 29 Bridge Lift (2 of 2)

30. Chapter 27: Rescue Techniques: Lifts and Loads 30 Direct Ground Lift (1 of 2) Usually not used on patients with suspected spinal injuries. Used to lift and carry a patient for some distance. Number of rescuers needed depends on size of patient and strength of rescuers.

31. Chapter 27: Rescue Techniques: Lifts and Loads 31 Direct Ground Lift (2 of 2)

32. Chapter 27: Rescue Techniques: Lifts and Loads 32 Extremity Lift

33. Chapter 27: Rescue Techniques: Lifts and Loads 33 Transfer Moves Direct carry—a variation of the direct ground lift Blanket lift—can use blanket, sheet, or jackets Backboard Scoop stretcher Two-rescuer assist to vehicle

34. Chapter 27: Rescue Techniques: Lifts and Loads 34 Transfer Devices (1 of 7) Backboards Short boards or extrication vests (KED)

35. Chapter 27: Rescue Techniques: Lifts and Loads 35 Transfer Devices (2 of 7) Backboards –Plastic or wooden boards with slots along sides for straps and hand holds –6’ to 7’ long –Must adhere to infection control guidelines Short boards or extrication vests –Used for extrication in confined spaces –Vest-type devices (KED) immobilize patients in a sitting position.

36. Chapter 27: Rescue Techniques: Lifts and Loads 36 Transfer Devices (3 of 7) Flexible stretcher (SKED) Scoop stretcherStokes

37. Chapter 27: Rescue Techniques: Lifts and Loads 37 Transfer Devices (4 of 7) Stretchers –Flexible type—used in confined space extrication, wilderness, and search and rescue operations (SKED) –Scoop stretcher or split litter –Stokes or rigid basket stretcher

38. Chapter 27: Rescue Techniques: Lifts and Loads 38 Transfer Devices (5 of 7) Scoop stretchers –Designed to be split into 2 or 4 pieces –Allow access to both sides of patient –Avoid trapping clothing, skin, hair, or straps in the closure area. –Consult local protocols regarding transfer of patients with spinal injuries.

39. Chapter 27: Rescue Techniques: Lifts and Loads 39 Transfer Devices (6 of 7) Stokes –Used to carry or move patients in rough terrain, during technical rope rescue, and during water rescue –Made of plastic or metal –Basket (wire mesh) needs additional padding for long-term use.

40. Chapter 27: Rescue Techniques: Lifts and Loads 40 Transfer Devices (7 of 7) Cots –Wheeled ambulance stretcher or pram –Clinic gurney –Usually a specific head end and foot end –Has specific carrying handles –Four rescuers needed for maximum security moving over rough terrain.

41. Chapter 27: Rescue Techniques: Lifts and Loads 41 Transportation Devices Toboggan (various brands and types) –Most common device at ski areas –Two or four fixed handles –Can be towed by snowmobiles with a rigid hitch –Consult NSP’s transportation text for more information about use and procedures

42. Chapter 27: Rescue Techniques: Lifts and Loads 42 Positioning Guidelines (1 of 2) Head downhill: Cardiac arrest Shock Hypothermia Lower extremity and pelvis injury Abdominal injuries without respiratory distress Head uphill: Injury to head, eye, face, neck, or upper extremity Shortness of breath Suspected AMI Steep terrain Unresponsiveness

43. Chapter 27: Rescue Techniques: Lifts and Loads 43 Positioning Guidelines (2 of 2) No rule is absolute; in some cases, let patient comfort dictate the position: –Chest injury –Dislocated upper extremity Use recovery position in patients with non-traumatic unresponsiveness and nausea and vomiting.

44. Chapter 27: Rescue Techniques: Lifts and Loads 44 Transportation Devices Overland wheeled stretchers: –Single wheel for use on trails –Multiple wheel for towing behind ATV Folding stretchers, often carried by ambulance crews Stair chair, designed to move a seated patient up or down stairs

45. Chapter 27: Rescue Techniques: Lifts and Loads 45 Improvised Devices Toboggans can be made with skis, shovels, ski poles, pads, and rope. Stretchers can be built from packs, paddles, poles, rope, and jackets. Devices may not be sufficiently rigid for spinal injuries. May be only option!

46. Chapter 27: Rescue Techniques: Lifts and Loads 46 Moving Patients Protect rescuers’ health and safety. Protect the patient. Training and practice is required for proficiency. Maintain equipment. Review procedures.