Moving, Lifting and Transporting Patients Chapter 5 Moving, Lifting and Transporting Patients

Objectives 5.1 Define body mechanics. 5.2 Describe and demonstrate a power grip. 5.3 Describe and demonstrate a power lift. 5.4 Describe the basic guidelines for safely moving a patient. 5.5 Explain the difference between an urgent move and a nonurgent move. 5.6 List and describe various devices used to move and transport patients. Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care. All participants have a license to stop unsafe lifting when observed! continued

Objectives 5.7 Describe and demonstrate the following drags, lifts, and carries: Shoulder drag Extremity lift Bridge/BEAN lift Human crutch Fore and aft carry Chair carry BEAM lift Draw sheet carry Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care. All participants have a license to stop unsafe lifting when observed! continued

Objectives 5.8 List and demonstrate the proper use of equipment to move, lift, and carry a patient. 5.9 Compare and contrast common transportation devices. 5.10 List the components of a safe landing zone (LZ). Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care. All participants have a license to stop unsafe lifting when observed! continued

Objectives 5.11 Describe and demonstrate how to safely move when near a helicopter. 5.12 Describe the use of CPR during transport. Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care. All participants have a license to stop unsafe lifting when observed!

Topics Body Mechanics Devices and Equipment Moving a Patient Lifting the Patient Transporting Patients CPR During Transport Discussion Points: Emphasize that, in addition to assessment, moving a patient is a skill that is utilized with almost all patients. It is also a skill that, when done well, can significantly improve the well-being of the patient.

Case Presentation A commercial building is on fire in full flames/smoke coming from the back of the building. A worker stumbles out front door and says a coworker hit his head and is unresponsive. You can see him just outside front door. Smoke is slowly billowing out the door. Discussion Points: Scene Size Up: Fire/smoke hazard? Accelerants/explosives? Prevailing wind direction? Number of patients? Safe to approach and rescue unconscious worker? Transportation considerations? General Impression: Chief complaints and MOI/NOI? Initial patient appearance? Call for Fire Department, necessary equipment, additional help

Body Mechanics continued Copyright Edward McNamara Body mechanics is the manner in which we move our body in daily activities. “Proper Body Mechanics” is what is defined in Key Terms. There may also be poor body mechanics. Discussion Points: Define “Body Mechanics” Relevance of this information, i.e. injury rates, chronic nature of back injury, career-ending injuries. Spine analogy to child’s building blocks, while stacked squarely upon one another, are very strong. If stacked askew, then wobbly, unsteady and not strong. continued Copyright Edward McNamara

Body Mechanics Power Lift for strength & safety! Remain erect, spine straight, shoulders over hips (axial loading), feet shoulder-width apart. Use abdominal/back muscles – maintain vertebral alignment, bend knees to squat. Discussion Points: Relevance of this information, i.e. injury rates, chronic nature of back injury, career-ending injuries. Use spine analogy of child’s building blocks, while stacked squarely upon one another, are very strong. If stacked askew, then wobbly, unsteady and not strong. continued

Body Mechanics Power Lift for strength & safety! Power Grip for object to be lifted. Keep head up and straighten legs to lift. Exercise regularly & lose weight Discussion Points: Relevance of this information, i.e. injury rates, chronic nature of back injury, career-ending injuries. Use spine analogy of child’s building blocks, while stacked squarely upon one another, are very strong. If stacked askew, then wobbly, unsteady and not strong. continued

Body Mechanics What is wrong with this picture? continued Copyright Edward McNamara

Body Mechanics Plan the lift. Know your physical limitations. Get help! Make it a team effort. Keep feet shoulder’s width apart. Keep your back straight. Do not reach over your head. Get a good grip on object lifted. continued

Body Mechanics Bend your knees! Lift with your legs. Keep shoulders centered over spine. Keep object close to your body. Keep your head up while lifting. Turn with your feet, not your hips. continued

Body Mechanics What is right with this picture? Discussion Points: Put all of this into practice, with students coaching each other and being watchful for improper techniques. Practice leading bystanders to help a team in safely lifting. For props, bring bulky, light weight items to practice proper technique, e.g. very large empty boxes, rolls of bubble wrap, garbage bags of packing peanuts. Copyright Edward McNamara

Devices and Equipment Transfer flat – for very large patient Reinforced material with handles Log-roll patient onto material Slide, lift or carry with a team Portable stretcher – for transport Lightweight, aluminum frame Folding or one-piece Load patient with appropriate move. Discussion Points: Demonstrate each available device or piece of equipment. Allow hands-on practice by students. continued

Devices and Equipment Long Spine Board (LSB) – for spine, hip, pelvis & femur immobilization; transportation or extrication. Discussion Points: LSBs come in variety of shapes, sizes & materials. Lift or log-roll patient onto board as dictated by injury. Pad voids between board and body. Secure patient to board. continued

Devices and Equipment continued Copyright Scott Smith

Devices and Equipment Orthopedic stretcher (scoop) – to move a person in the position found. The chapter instructs to first separate the halves of the stretcher, then adjust for height. You may also adjust for height before separating halves. The issue with “comparing the number of exposed holes” goes away. Disconnect two sides of stretcher Place one half on each side of patient Adjust length, 1-3” longer than patient Count tubing holes to assure equal sides Slide stretcher halves under patient until ends click together Secure patient before lifting Caution against pinching the patient’s buttocks between the halves when closing together. Transfer patient to long spine board for immobilization. Very heavy patients may require a strap from side to side, under the stretcher to prevent separation of the halves when lifting. continued

Devices and Equipment continued Copyright Edward McNamara

Devices and Equipment continued Copyright Edward McNamara

Devices and Equipment continued Copyright Edward McNamara

Devices and Equipment Basket stretcher (Stokes) – primarily backcountry or high-angle rescue use Discussion Points: Basket stretcher Ultra lightweight Kevlar or titanium One piece or splits-in-two for carrying continued

Devices and Equipment continued

Devices and Equipment Short Spine Board & Vest-Type Lifting/Immobilizing Devices – seated patient requiring extrication. Commonly used in vehicle extrication continued

Devices and Equipment Sitting Lift Device – to transport non-ambulatory patient short distance with one leg extended. Discussion Points: Patient sits on board with injured leg extended and supported. Carry patient from aid room to car. Leg must be stabilized by rescuers. continued

Devices and Equipment Copyright Edward McNamara

Moving the Patient Do NO Harm! NEVER drop a patient or allow a fall! continued

Moving the Patient continued Copyright Jon Politis

Moving the Patient Does the patient have a suspected spinal injury? Yes  protect the spine No  invite the patient to assist in move Does the patient need to be moved immediately? Yes  Urgent Move No  Non-urgent move Discussion Points: Precautions for having the patient assist in move, i.e. protect/stabilize injured part, protect from fall due to syncope (fainting) or instability. Scenarios that may warrant an Urgent Move. continued

Moving the Patient Urgent Moves – hazard is present or patient position prevents urgent care. Life-threatening hazard to patient/rescuer Or need move in order to administer CPR Usually moved before assessment Usually moved less than 100 feet Usually a drag continued

Moving the Patient Greatest Risks of Urgent Moves Delaying life-saving interventions Aggravating existing injury, particularly spine injury Rescuer injury continued

Moving the Patient Minimize risk of further spine injury: Minimize patient movement Maintain anatomical alignment of patient’s spine – long axis Discussion Points: Practice Reminders - protect rescuer back when practicing drags – keep knees bent, spine straight, head facing forward. continued

Moving the Patient Long-axis drags (often unconscious) Shoulder drag Underarm-wrist drag Blanket drag Feet drag (head not protected) Discussion Points: Practice Reminders - protect rescuer back when practicing drags – keep knees bent, spine straight, head facing forward. continued

Moving the Patient Non-urgent Moves – patient may be moved in a controlled fashion. Human crutch Two-person assist Chair carry Fore and aft carry Back carries Improvised carries Discussion Points: Non-urgent moves are the most commonly utilized, for example moving the patient from the ground to the toboggan, from the toboggan to the gurney and from the gurney to the car. continued

Case Update You confirm that no others involved You have called the fire department, requested help, equipment, and O2. The fire continues to grow; you must move unconscious man, using a long-axis drag. The coworker assists with underarm wrist drag to 50 feet away from building. Next steps: What do you do next? Complete the primary and secondary assessment, vital signs. Protect airway. On-going assessment. EMS arrives on scene.

Lifting the Patient Extremity lift continued Discussion Points: Extremity Lift – when to use? No spine injury, chest injury, breathing disorder, or very heavy patient. Same rescuer positions as Fore and Aft Carry. continued

Lifting the Patient continued Copyright Mike Halloran

Lifting the Patient Multiple Person Direct Ground Lift continued Discussion Points: Direct Ground Lift – when to use? No spine injury. All rescuers on same side of patient. continued

Lifting the Patient continued

Lifting the Patient continued

Lifting the Patient continued

Lifting the Patient Bridge/BEAN lift continued BEAN = Body Elevation And Non-movement No suspicion of spine injury. Load a spine board. Explain: BEAM = Body Elevation And Movement Simply a BEAN lift with travel of the patient continued

Lifting the Patient continued Copyright Edward McNamara

Lifting the Patient continued Copyright Edward McNamara

Lifting the Patient continued Copyright Edward McNamara

Lifting the Patient continued Copyright Edward McNamara

Lifting the Patient BEAM lift Is a BEAN lift with Movement. continued BEAN = Body Elevation And Non-movement No suspicion of spine injury. Load a spine board. Explain: BEAM = Body Elevation And Movement Simply a BEAN lift with travel of the patient continued

Lifting the Patient Draw-Sheet lift To lift just a few inches Transfer to surface of similar height Discussion Points: Draw-Sheet lift – when to use? To lift just a few inches Transfer to surface of similar height continued

Transporting the Patient Semi-Fowler position Sitting with upper body at 45° Conscious and no serious injury High-Fowler position Sitting with upper body at 90° Severe breathing problem Supine position Flat on back, face up continued

Transporting the Patient Rothberg position Upper body at 45° and legs raised with flexion at knees and hip. Chest pain or heart attack. Trendelenburg position Head 15-30° lower than heart and feet 15-30° higher than heart. Patient in shock continued

Transporting the Patient Types of ground transport Toboggan/sled and sled pack Stretcher or litter Transport vehicles continued

Transporting the Patient Packaging the Patient Basics Properly positioned on transport device. Comfortable as possible Secured within transport device. Medical equipment sent, as needed. continued

Transporting the Patient continued

Transporting the Patient Toboggan Transport: Injury uphill Dictated by injury/illness. Generally most comfortable Prevents pressure on injury Discuss challenges of toboggan transport – steep terrain, gravity, shifting downhill within toboggan. Discuss rationale and priorities in decision making and exceptions. Discuss aspects of comfort & safety during toboggan transport: Prevent heat loss, secure with straps, assure secure inclusion of necessary medical equipment. continued

Transporting the Patient Exceptions to Rule Difficulty breathing – Head Uphill Shock – Head Downhill Serious head injury – Head Uphill Discuss challenges of toboggan transport – steep terrain, gravity, shifting downhill within toboggan. Discuss rationale and priorities in decision making and exceptions. Discuss aspects of comfort & safety during toboggan transport: Prevent heat loss, secure with straps, assure secure inclusion of necessary medical equipment. continued

Transporting the Patient Basket Stretcher/Litters Wheeled Ambulance Stretcher Evacuation Chair Improvised Litters Transport Vehicles All-terrain vehicles Snow machines Golf carts continued

Transporting the Patient Air Transportation – rotary wings Weather limitation – rescue usually VFR Altitude & temperature limitations  Altitude  Air Density  Power Required  Temp  Air Density  Power Required Space & load limitations Pilot responsible for limiting load continued

Transporting the Patient Helicopter safety Landing zone (LZ) selection 100 ft. × 100 ft. Flat, or no more than 8° slope Free of overhead obstructions Free of loose objects or debris Well lit (shine no lights at pilot) Control access by pedestrians or animals Discussion Points: Rationale for LZ selection guidelines Danger of crash during landing or take-off. continued

Transporting the Patient Helicopter safety Ground-to-Air Communications Landing coordinator formally trained Pre-arrival communications Helicopter ETA & direction of travel LZ coordinates, weather & wind direction continued

Transporting the Patient Helicopter safety Ground operations Approach helicopter only when crew says. Never approach helicopter from rear. Maintain eye contact with pilot at all times. Stay low. Hold nothing above your head Remove loose hat or clothing Secure any loose items

CPR During Transport Sled CPR Method – 3 rescuers min. Call for ALS, AED and O2 rescue pack. Initiate CPR Stop CPR to log roll to LSB & continue Secure patient to LSB, continuing CPR Set up toboggan & secure front rescuer Stop CPR to load LSB/patient in sled Front rescuer resumes 1-rescuer CPR Secure LSB in sled & evac. Techniques and protocols of CPR are discussed in the Cardiovascular Emergencies chapter. Urgent rendezvous with AED improves patient survival. Specific on-hill procedures are area-specific and developed with your medical advisor and area management. Invite discussion of difficulties of CPR during transport down from the ski slope. continued

CPR During Transport Leap Frog CPR Method – 5 rescuers Used in steep terrain or moguls Call for ALS, AED and O2 rescue pack. Initiate CPR Stop CPR to log roll to LSB & continue CPR Secure patient to LSB, continuing CPR Stop CPR to load LSB/patient in sled Discuss selection of method, advantages, and limitations. continued

CPR During Transport Leap Frog CPR Method – 5 rescuers Resume 2-rescuer CPR – 5 cycles Run toboggan 20-30 seconds downhill Repeat 2-rescuer CPR & sled run Discuss selection of method, advantages, and limitations.

Case Disposition The patient becomes responsive and ground transport selected. The patient lifted to ambulance stretcher using 4-person direct ground lift. The patient is determined to have a mild concussion and is discharged next day. Discussion Points: Other options available for these decision points in this scenario, depending on assumptions? Primary/Secondary assessment before drag? Alternative drags or carries? Ground vs Air transportation? Use LSB for immobilization?

Chapter Summary Back injuries may be prevented through exercise, weight maintenance, and good body mechanics. Plan each move carefully; get help when lifting. Keep your back straight and lift with your legs. continued

Chapter Summary Do not drop the patient. Urgent moves require preserving the long axis of the spine. Used properly, equipment can facilitate a move or a lift. A landing zone should be at least 100 feet by 100 feet. continued

Chapter Summary Do not approach a helicopter unless instructed to do so by the pilot or a crew member; keep your head low. Never approach a helicopter from the rear.