Lifting and Moving Patients Chapter 18 Lifting and Moving Patients

National EMS Education Standard Competencies (1 of 3) Preparatory Uses simple knowledge of the EMS system, safety/well-being of the EMR, and medical/legal issues at the scene of an emergency while awaiting a higher level of care.

National EMS Education Standard Competencies (2 of 3) Workforce Safety and Wellness Standard safety precautions Personal protective equipment Stress management Dealing with death and dying Prevention of response-related injuries Lifting and moving patients

National EMS Education Standard Competencies (3 of 3) EMS Operations Knowledge of operational roles and responsibilities to ensure safe patient, public, and personnel safety.

Introduction As an EMR, you must: Analyze the emergency situation. Quickly evaluate the patient’s condition. Carry out effective, lifesaving emergency medical procedures. These procedures may include lifting, moving, or positioning patients.

General Principles (1 of 4) Every time you move a patient, keep these general guidelines in mind. Do no further harm to the patient. Move the patient only when necessary. Move the patient as little as possible. Move the patient’s body as a unit. Use proper lifting and moving techniques. Have one rescuer give commands.

General Principles (2 of 4) Also consider these recommendations: Delay moving the patient, if possible, until additional EMS personnel arrive. Treat the patient before moving him or her unless the patient is unsafe. Do not step over the patient. Explain to the patient what you are doing. Move the patient as few times as possible.

General Principles (3 of 4) Keep these rules of good body mechanics in mind: Know your own physical limitations. Keep yourself balanced. Maintain a firm footing. Lift and lower the patient by bending your legs, not your back. Try to keep your arms close to your body for strength and balance.

General Principles (4 of 4)

Recovery Position Unconscious patients who have not suffered trauma should be placed in a sidelying or recovery position. Helps keep the airway open Allows secretions to drain from the mouth

Body Mechanics (1 of 3) Improper lifting or moving techniques can result in injury to you or to the patient. Good body mechanics Use the strength of the large muscles in your legs to lift patients instead of using your back muscles.

Body Mechanics (2 of 3) Good body mechanics (cont’d) Keep your back straight as you lift. Lift without twisting your body. Ensure that you have firm footing before you start to lift or move a patient. Assess the weight of the patient. Know your physical limitations.

Body Mechanics (3 of 3) Good body mechanics (cont’d) Call for additional personnel if needed. Communicate with the other members of the lifting team. Practice lifts and moves.

Emergency Movement of Patients Move a patient immediately in the following situations: Danger of fire, explosion, or structural collapse exists. Hazardous materials are present. The accident scene cannot be protected. It is otherwise impossible to gain access to other patients who need lifesaving care. The patient has experienced cardiac arrest.

Emergency Drags (1 of 8) Clothes drag Simplest way to move a patient Grasp the patient’s clothing in the neck and shoulder area. Rest the patient’s head on your arms. Drag the patient out of danger.

Emergency Drags (2 of 8) Cardiac patients and the clothes drag If the room in which you find the patient is not large enough, move the patient. Drag the patient from the tight space and quickly move furniture out of the way. Provide CPR.

Emergency Drags (3 of 8) Blanket drag Use this drag if the patient is not dressed or is dressed in clothing that could tear easily. Place the rug on the floor and roll the patient onto it. Pull the patient to safety by dragging the rug.

Emergency Drags (4 of 8) Arm-to-arm drag Place your hands under the patient’s armpits from the back and grasp the patient’s forearms. Used to move a heavy patient Offers some protection for the head and neck

Emergency Drags (5 of 8) Fire fighter drag Tie the patient’s wrists together. Get down on your hands and knees and straddle the patient. Pass the patient’s tied hands around your neck, straighten your arms, and drag the patient across the floor.

Emergency Drags (6 of 8) Emergency drag from a vehicle One rescuer Grasp the patient under the arms and cradle the patient’s head between your arms. Pull the patient down into a horizontal position as you ease him or her from the vehicle.

Emergency Drags (7 of 8)

Emergency Drags (8 of 8) Emergency drag from a vehicle (cont’d) Two or more rescuers One rescuer supports the patient’s head and neck while the second rescuer moves the patient by lifting under the arms. The patient is removed with the head and neck stabilized in a neutral position. Use a long backboard if time permits.

Carries for Nonambulatory Patients (1 of 10) Two-person extremity carry Rescuer One reaches under the patient’s arms and grasps the patient’s wrists. Rescuer Two reaches around the legs and grasps the patient behind the knees. The two rescuers stand up and carry the patient away.

Carries for Nonambulatory Patients (2 of 10) Two-person seat carry The rescuers kneel on opposite sides of the patient near the patient’s hips. The rescuers raise the patient to a sitting position and link arms behind the patient’s back. The rescuers place the other arm around the patient’s knees and link with each other. No equipment is required.

Carries for Nonambulatory Patients (3 of 10)

Carries for Nonambulatory Patients (4 of 10) Cradle-in-arms carry Used by one rescuer to carry a child Kneel beside the patient and place one arm around the back and the other under the thighs. Lift slightly and roll the child into the hollow formed by your arms and chest.

Carries for Nonambulatory Patients (5 of 10) Two-person chair carry Rescuer One stands behind the seated patient and grasps the back of the chair. Rescuer One tilts the chair backward so that Rescuer Two can grasp the front legs. Rescuer One gives the command to lift and walk away.

Carries for Nonambulatory Patients (6 of 10) Pack-strap carry Back into the patient as he or she is standing. Grasp the patient’s wrists and cross the arms over your chest. Pull the patient onto your back. Bend forward to lift the patient, stand up, and walk away.

Carries for Nonambulatory Patients (7 of 10) Direct ground lift Used to move a patient who is on the ground or the floor to an ambulance stretcher Should be used only for those patients who have not sustained a traumatic injury The steps for performing the direct ground lift are described in Skill Drill 18-1.

Carries for Nonambulatory Patients (8 of 10)

Carries for Nonambulatory Patients (9 of 10) Transferring a patient from bed to stretcher Place the stretcher next to the bed. Loosen the bottom sheet underneath the patient or log roll the patient onto a blanket. Reach across the stretcher and grasp the sheet and blanket firmly at the patient’s head, chest, hips, and knees. Slide the patient onto the stretcher.

Carries for Nonambulatory Patients (10 of 10)

Walking Assists for Ambulatory Patients (1 of 2) One-person walking assist Help the patient stand. Have the patient place one arm around your neck and hold the patient’s wrist. Put your free arm around the patient’s waist and help the patient to walk.

Walking Assists for Ambulatory Patients (2 of 2) Two-person walking assist Useful if the patient cannot bear weight The two rescuers completely support the patient.

Wheeled Ambulance Stretchers (1 of 3) One of the most commonly used EMS devices Can be raised and lowered to different heights Have belts to secure the patient

Wheeled Ambulance Stretchers (2 of 3) Stretchers can be rolled or carried by two or four people. If the surface is smooth, a wheeled stretcher can be rolled with one person guiding the head and one person pulling the foot end. If the loaded stretcher must be carried, it is best to use four people, one at each corner. If the stretcher must be carried through a narrow area, only two people will fit.

Wheeled Ambulance Stretchers (3 of 3)

Portable Stretchers Used when the wheeled stretcher cannot be moved into a small space Smaller and lighter than a wheeled stretcher Can be carried in the same ways that a wheeled stretcher is carried

Stair Chair Portable moving device that is used to carry a patient in a sitting position Useful for patients who are short of breath or who are more comfortable sitting Small, lightweight, and easy to carry Do not use with patients who have experienced any type of trauma.

Backboards (1 of 5) Used to immobilize patients who have neck or back injuries Used to assist in lifting patients and immobilizing lower extremity injuries Long backboards Used for moving patients who have experienced trauma Useful for lifting and moving patients who are in small places

Backboards (2 of 5) Long backboards (cont’d) Made of plastic or fiberglass Patients must be secured with straps. If the patient has sustained back or neck injuries, the head should be immobilized.

Backboards (3 of 5) Short backboard devices Used to immobilize the head and spine of patients found in a sitting position Usually made of plastic Some consist of a vest-like garment that wraps around the patient.

Backboards (4 of 5) Scoop stretchers Place one half on each side of the patient and then attach the two halves together. Helpful when moving patients out of small spaces Do not use for patients with head or spinal injuries.

Backboards (5 of 5) In an emergency situation, use: Wide, sturdy planks Doors Ironing boards Sturdy folding tables Full-length lawn chair recliners Surfboards Snowboards

Treatment of Patients With Suspected Head or Spine Injury Anytime a patient has sustained a traumatic injury, suspect injury to the head, neck, or spine. Improper treatment can lead to permanent damage or paralysis. Keep the patient’s head in a neutral position and immobilized.

Applying a Cervical Collar (1 of 2) Used to prevent excess movement of the head and neck Soft cervical collars do not provide sufficient support for trauma patients. Many types of rigid cervical collars are available.

Applying a Cervical Collar (2 of 2) A cervical collar should be applied before the patient is placed on a backboard. A B C D

Movement of Patients Using Backboards (1 of 2) Patients who should be transported on a backboard include: Any patient who has sustained spinal trauma in a motor vehicle crash or fall Any person who has sustained gunshot wounds to the trunk

Movement of Patients Using Backboards (2 of 2) If you suspect the patient has a spinal injury: Move the patient as a unit. Transport the patient face up (supine). Keep the patient’s head and neck in a neutral position. Be sure that all rescuers understand what is to be done before attempting any movement. One rescuer gives commands.

Assisting With Short Backboard Devices After the short backboard device is applied, the patient is carefully placed on a long backboard. Skill Drill 18-2 illustrates how one commonly used short backboard device is applied.

Log Rolling (1 of 2) Primary technique used to move a patient onto a long backboard Requires a team of four rescuers Movement technique of choice in all patients with suspected spinal injury The procedure for the four-person log roll is shown in Skill Drill 18-3.

Log Rolling (2 of 2) All patient movement commands have two parts: A question The order for movement Move the patient as a unit. Keep the patient’s head in a neutral position at all times.

Straddle Lift (1 of 2) Can be used to place a patient on a backboard if you do not have enough space to perform a log roll

Straddle Lift (2 of 2) Requires five rescuers One at the head and neck One to straddle the shoulders and chest One to straddle the hips and thighs One to straddle the legs One to insert the backboard under the patient The lift should be practiced often.

Straddle Slide (1 of 2) In the straddle slide, the patient, rather than the backboard, is moved.

Straddle Slide (2 of 2) May be useful when the patient is in an extremely narrow space The rescuers’ positions are the same. Lift the patient as a unit. Slide the patient forward about 10" at a time. Each rescuer should lean forward slightly and use a swinging motion to bring the patient onto the board.

Straps and Strapping Techniques (1 of 2) Every patient who is on a backboard should be strapped down to prevent sliding or slipping. The straps should be long enough to go around the board and a large patient. Straps 6′ to 9′ long with seatbelt-type buckles work well.

Straps and Strapping Techniques (2 of 2) Once the patient is centered on the board, secure the upper torso with straps. Secure the pelvis and upper legs, using padding as needed.

Head Immobilization (1 of 3) The blanket roll is an improvised device that works well and is readily available. Fold and roll the blanket as shown in Skill Drill 18-4. Stabilization is maintained by the blanket roll, as shown in Skill Drill 18-5.

Head Immobilization (2 of 3) Head stabilization must be maintained through the entire procedure. The blanket roll must be fitted securely against the patient’s shoulders. Secure the blanket roll to the head with two cravats tied around the blanket roll. Use two more cravats to bind the head and the blanket roll to the backboard.

Head Immobilization (3 of 3) Foam blocks are quick to apply and provide good stabilization of the head and neck. A B C D

Summary (1 of 4) General guidelines when moving patients Do no further harm to the patient. Move the patient only when necessary. Move the patient as little as possible. Move the patient’s body as a unit. Use proper lifting and moving techniques. Have one rescuer give commands when moving a patient.

Summary (2 of 4) Unconscious patients who have not sustained trauma should be placed in the recovery position. If a patient is on the floor or ground during an emergency situation, you may have to drag the person away from the scene instead of trying to lift and carry the person.

Summary (3 of 4) Do not lift or move a patient if you suspect a spinal injury, unless it is necessary to remove the patient from a life-threatening situation. EMS services typically use wheeled ambulance stretchers, portable stretchers, stair chairs, long backboards, short backboards, and scoop stretchers.

Summary (4 of 4) A cervical collar prevents excessive movement of the head and neck. Log rolling is the primary technique used to move a patient onto a backboard. Once a patient has been secured to the backboard, the head and neck must be immobilized.

Review As an EMR, you may injure your back, even if it is straight, if you: lift with your back bent forward at the hips. align your shoulders over your hips. hold your hands close to your legs. use your leg muscles. I capitalized the answers. 66

Review Answer: A. lift with your back bent forward at the hips.

Review Patients who should be transported on a backboard include any patient who: is intoxicated. requests it. has an upper extremity injury. has sustained gunshot wounds to the trunk. I capitalized the answers. 68

Review Answer: D. has sustained gunshot wounds to the trunk.

Review Head immobilization: is not required in all patients who are placed on a backboard. can be achieved using head blocks or towel rolls. does not need to be maintained during the backboarding process. can be properly accomplished only with special equipment. I capitalized the answers. 70

Review Answer: B. can be achieved using head blocks or towel rolls.

Credits Background slide images: © Jones & Bartlett Learning. Courtesy of MIEMSS.