Lifting and Moving Patients Chapter 6 Lifting and Moving Patients

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.

Safe Lifting When possible, use a stair chair. Know weight to be lifted Ensure enough help is available. Use at least two people. Use an even number of people to lift. Know weight limitations of equipment.

Power Lift Keep back locked. Keep feet a comfortable distance apart. Tighten your abdominal muscles. Keep feet flat on the ground . Keep the center of your body over the object. Allow the upper body to rise before the hips. Straighten your legs as you lift. Keep your back locked into position.

Carrying Whenever possible, use rolling devices. Know weight to be lifted. Know limitations. Work in a coordinated manner and communicate. Keep weight close to body. Keep back in a locked-in position. Flex at the hips, not the waist; bend at the knees. Do not hyperextend the back.

Carrying Correct carrying procedure One-handed carrying technique Use correct lifting techniques to lift the stretcher. Partners should have similar strength and height. One-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.

Carrying – Two Rescuers Preferable method in narrow spaces More strength required Easily unbalanced Rescuers facing each other from opposite ends of stretcher

Carrying – Four Rescuers One rescuer at each corner More stability and less strength required Safer over rough terrain

Log Roll onto Spine Board 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 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.

Log Roll onto Spine Board Move on command from the rescuer at the patient’s head. 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.

Log Roll onto Spine Board Patient is gently rolled onto the board. Torso and extremities are strapped securely to the board. Head is immobilized with pads and tape or a head immobilizer.

Reaching Guidelines for reaching Application of reaching techniques Keep back in locked-in position When reaching overhead, avoid hyperextended position Avoid twisting the back while reaching. Application of reaching techniques Avoid reaching more than 15 - 20 inches in front of the body. Avoid strenuous effort.

Pushing and Pulling Pushing is safer and more effective than pulling Keep back locked in position. Keep 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.

Pushing and Pulling 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. Avoid pushing or pulling from an overhead position, if possible. Keep your elbows bent with your arms close to your side.

Emergency Moves – Indications Fire or danger of fire Explosives or other hazardous materials Inability to protect the patient from hazards at the scene Inability to gain access to other patients in vehicle Lifesaving care precluded by location or position

Emergency Moves Greatest danger in moving is possibly aggravating a spinal injury. When possible, pull in the direction of the long axis of the body. Perfect spinal immobilization may not be possible.

Emergency Moves Blanket drag Clothes drag Foot drag

Urgent Moves – Immediate Threat to Life Altered mental state Inadequate breathing Shock Serious injuries in need of surgical intervention

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. 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.

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. 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.

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 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.

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. The long spine board is then properly positioned on the wheeled cot stretcher and secured.

Direct Ground Lift Two or three rescuers line up on one side of the patient. Rescuers kneel on one knee. The patient's arms are placed on his chest, if possible.

Direct Ground Lift On command, both rescuers smoothly lift the patient onto their elevated thighs.

Direct Ground Lift Rescuers then carefully load the patient onto the stretcher in unison.

Extremity Lift 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. In unison, the rescuers pull the patient to a sitting position.

Extremity Lift 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.

Extremity Lift Both rescuers rise smoothly to an upright position.

Extremity Lift The rescuer holding the legs can then turn 180 degrees to facilitate forward movement of the patient to the stretcher.

Direct Carry Position cot perpendicular to bed with head end of cot at foot of bed. Unbuckle straps and remove other items. Stand between bed and stretcher, facing patient. Slides arm under patient's neck and cups patient's shoulder.

Direct Carry Second rescuer slides hand under patient’s hips and lifts slightly. First rescuer slides other arm under patient's back. Second rescuer places arms underneath hips and calves.

Direct Carry Rescuers slide patient to edge of bed. Patient is lifted/curled toward the rescuers' chests.

Direct Carry Rescuers rotate and place patient gently onto cot.

Draw Sheet Method Loosen bottom sheet of bed. Position cot next to bed. Prepare cot: adjust height, lower rails, unbuckle straps.

Draw Sheet Method Reach across cot. Grasp sheet firmly at patient's head, chest, hips, and knees. Slide patient gently onto cot.

Equipment Stretchers/cots Portable stretchers Stair chair Backboards Scoop/orthopedic Flexible stretcher

Wheeled Stretcher Preferred device for transporting patients along smooth terrain Care needed in rougher terrain to avoid tipping Least effective device for moving a patient over rough terrain or down stairs Try Folding stretcher Scoop stretcher Basket stretcher Stair chair (stairs)

Loading an Ambulance 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.

Loading an Ambulance On command, both rescuers rise to the upright position and move the front wheels onto the floor of the passenger compartment.

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.

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.

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.

Unloading the Ambulance The stretcher is lowered to the ground while keeping the back straight and bending at the knees.

Unloading the Ambulance Both rescuers then lift the stretcher to an upright position while holding the top bar of the stretcher.

Folding Stretcher Lightweight device that can be folded and stored Permits easy transfer of a patient down stairs and over rough terrain Should be carried end to end Can be loaded in ambulance from end to end

Stair Chair Used to remove patients in sitting position Ideal device for narrow stairways Never used for: Suspected spinal injury Unconscious patients Patient should be transferred to wheeled cot stretcher in ambulance.

Stair Chair Move the patient into the chair using the extremity lift.

Stair Chair Secure the patient’s hands (optional) and tilt the device. Tilt the chair back to move to ground level.

Stair Chair Use a spotter to move down stairs.

Scoop or Orthopedic Stretcher Device facilitates easy lifting of patients. Stretcher splits lengthwise into two equal halves. Patients can be “scooped” off the ground. Patients can then be placed on a long spine board or a wheeled cot stretcher. Secure the patient with straps before moving.

Scoop or Orthopedic Stretcher Measure and adjust the length of the device next to the patient.

Scoop or Orthopedic Stretcher 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.

Scoop or Orthopedic Stretcher Place on the secondary device and secure in place.

Long Spine Board Several varieties Provide essentially the same function Rigid support for the spinal column to prevent further injury Primary device for patients who are supine or laterally recumbent Used for rapid extrication Secondary support device for patients removed with a short spine board

Short Spine Board Used 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 head Attached to the patient while maintaining cervical immobilization

Short Spine Board Vest-type device is an evolution of the short spine board. Semirigid form permits easy and speedy application. Device provides effective immobilization of the spine.

Basket Stretcher (Stokes) Ideal for removing patients on rough terrain or during high-angle rescues Constructed of hard plastic or wire mesh with a metal frame Must be well padded to prevent further injury to the patient

Flexible Stretcher Consists of rigid slats Useful for carrying a patient through narrow corridors or over difficult terrain

Transport Positions

Lateral Recumbent Unconscious and pregnant patients

Shock Position 8-12 inches

Patients with difficulty breathing Fowler’s Patients with difficulty breathing

Spinal Injury

Pregnant Patients 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 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.

Summary Back injuries are the plague of prehospital care. Injury 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.