1. Introduction to Emergency Medical Care 1
Advance Preparation
Invite an occupational/physical therapist to class.
Prepare anatomical models.
Invite programmed patients.
Prepare various lifting and moving devices.

2. Protecting Yourself: Body Mechanics
Teaching Time: 30 minutes
Teaching Tips: Assessing and preplanning a lift are very important components of safety. Spend time discussing these elements. Occupational and physical therapists teach lifting techniques to their patients every day. Invite one of these therapists to share their insight with your class. Practice these techniques. Even if your educational institution will not allow actual lifting, have students demonstrate position and body mechanics.

3. Moving and Positioning the Patient (1 of 3)
When you move a patient, take care that injury does not occur:
To you
To your team
To the patient
Many EMTs are injured lifting and moving patients.

4. 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 injury
Pregnant patients
Obese patients

5. 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.

6. Body Mechanics (3 of 12)
This is the correct way to lift.

7. Body Mechanics (4 of 12) You may injure your back:
If you lift with your back curved
If you lift with your back straight but bent significantly forward at the hips

8. Body Mechanics (5 of 12)
This is an incorrect method of lifting.

9. 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.

10. 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.

11. Body Mechanics (9 of 12) Power grip gets maximum force from hands.
Palms up
Hands about 10″ apart
All fingers at same angle
Fully support handle on curved palm

12. Body Mechanics (10 of 12)

13. Body Mechanics (11 of 12) To lift a patient by a sheet or blanket:
Center the patient.
Tightly roll up excess fabric on the sides.
Use the cylindrical handle to grasp fabric and lift patient.

14. Body Mechanics (12 of 12)

15. 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.

16. 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.

17. Weight and Distribution (3 of 9)

18. Weight and Distribution (4 of 9)
Always secure patient to backboard or stretcher.
So patient cannot slide significantly when stretcher is at an angle

19. Weight and Distribution (5 of 9)
Wheeled ambulance stretcher weighs 40–145 lb.
Generally too heavy for use on stairs

20. Weight and Distribution (6 of 9)
If you must use a backboard or wheeled stretcher on stairs

21. Weight and Distribution (7 of 9)
A stair chair can be used to bring a conscious patient down to stretcher

22. Weight and Distribution (8 of 9)

23. Weight and Distribution (9 of 9)
Backboard should be used instead for patient:
In cardiac arrest
Who must be moved in supine position
Who must be immobilized

24. Directions and Commands (1 of 3)
Team actions must be coordinated.
Team leader
Indicates where each team member should be
Rapidly describes sequence of steps to perform before lifting

25. 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.

26. Directions and Commands (3 of 3)
Estimate patient’s weight before lifting
Adults 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.

27. Principles of Safe Reaching and Pulling (1 of 4)
Body drag
When 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.

28. Principles of Safe Reaching and Pulling (2 of 4)
Log rolling
Log roll the patient onto his or her side to place a patient on a backboard.

29. 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.

30. Principles of Safe Reaching and Pulling (4 of 4)
Rolling the stretcher
Stretcher should be fully elevated.
Push the stretcher from the head end.
Never push with arms fully extended.

31. Protecting Yourself: Body Mechanics

32. Body Mechanics During Moving and Transferring Video
Video Clip
Body Mechanics During Moving and Transferring
List the five rules of body mechanics.
Why should you create an appropriate base of support when moving a patient?
What is a valsalva maneuver?
Discuss the challenges associated with transferring a patient.
Discuss the importance of a having a plan before moving a patient.
Transcript.
Correct posture and body mechanics are essential for a physical therapist. Lifting, lowering, pushing or pulling a patient or object increases stress and strain on the therapist's muscular skeletal system. Any activity in which a therapist must lift, lower, push, pull or carry a person or object should follow the five cardinal rules of correct body mechanics. One, keep the load close. The center of mass of the object being moved should be kept as close as possible to your body. Two, create an appropriate base of support. Your base of support when moving a patient should be as wide from side to side and as long from front to back as necessary to maintain balance throughout the maneuver. When it becomes necessary to change the base of support, you should avoid placing your body in awkward positions. When movement of your feet is required, then move so that you avoid crossing your legs or feet. Using these strategies will lessen the potential for tripping or falling. Three, use isometric contractions of the trunk extensor and abdominal muscles to keep the trunk in a steady position during the activity. Prior to moving the patient, move into position, set your position, and then look forward. Although isometric contractions of the trunk extensor and abdominal muscles are used, you should avoid performing a valsalva maneuver. A valsalva maneuver closes the windpipe during heavy exertion. This will result in increased internal pressure which can cause rapid and dramatic increase in blood pressure. Four, lift with your legs. Utilizing the large, strong muscles of the legs when lifting or lowering a patient or object will help prevent flexion or extension of the trunk. Lifting a person or object from the floor should start from the squatting position. The depth of the squat should be sufficient to reach the person or object being lifted. Five, don't twist your body. When you need to change direction, this should be achieved by moving the feet, not the trunk. Use the same rules of body mechanics, posture and alignment with the lifting or lowering a person or object. Transferring a patient requires movements which have the potential of causing loss of balance as the combined center of mass moves away from the center of the base of support. Moving your feet slightly further apart will increase the base of support. Before transferring a patient, check the arrangement of patient and chair, bed or treatment table. Keep the distance to be moved to a minimum and insure that the area is free of unnecessary equipment that might interfere with the transfer. To lift or lower a patient or object, place the feet in stride and slightly apart. This stance increases the base of support in both lateral and front-to-back directions. Centering the load within the base of support and keeping it close will aid stability and maintaining a balanced position. Using the isometric contractions discussed in rule number 3, maintain vertical alignment so as to reduce the potential for injury. Keeping the person or object being lifted as close to your body as possible maintains the combined center of mass within the base of support and makes balance and correct postural alignment easier to maintain. When moving large pieces of equipment, such as a plinth or gurney, or when guarding a patient during ambulation, you should be position behind the equipment or patient facing the direction of movement. This will provide the patient with an unobstructed view and path of movement. You can then determine a path that is free from obstruction. When guarding a patient during ambulation, you should be positioned with your feet in stride and with your body at a 45 degree angle slightly to the side and behind the patient. Note that the therapist is holding the patient by the gait belt and shoulder. If the patient should start to fall, this position will allow you to pull the patient center of mass toward you and the combined center of mass can be maintained within the base of support with a relatively small shift of your weight. This doesn't usually require large foot movements. The base of support must initially be large enough to support such shifts should a patient start to fall. In order to achieve easy movement, your feet should not be crossed during ambulation nor become entangled with the patient's feet or ambulatory equipment. Whenever you are lifting or moving a patient, plan ahead. Careful planning of your movements and preparation of the area to be used, plus the use of proper body mechanics and safety precautions will provide your patient with safe and effective care. If at any time you doubt your ability to lift or move a patient or object safely, always obtain appropriate assistance.
Click on the screenshot to view a video on the subject of body mechanics during moving and transferring patients.
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33. General Considerations
Move a patient in orderly, planned, unhurried manner.
Carefully plan ahead.
Select methods that will involve least amount of lifting and carrying.

34. 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.

35. Geriatrics (2 of 2) Kyphosis Spondylosis
Source: © Dr. P. Marazzi/Photo Researchers, Inc.
Kyphosis
Spondylosis

36. 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.

37. Bariatrics (2 of 2)
Stretchers and equipment are being produced with higher capacities.
Does not address danger to EMTs of carrying ever-heavier weights
Mechanical ambulance lifts are uncommon in United States.

38. Protecting Your Patient: Emergency, Urgent, and Non-Urgent Moves
Teaching Time: 30 minutes
Teaching Tips: This lesson is truly about decision making. Spend most of your time discussing the process of choosing the correct movement technique. Use a scenario-based approach that will allow students the opportunity both to make decisions and to practice technique. Consider using manikins to practice lifting. Often this is a safer alternative to actually lifting students.

39. Emergency Move Situations
Hazardous scene
Repositioning required to care for life-threatening conditions
Must reach other patients
Points to Emphasize: There are significant differences among emergency, urgent, and non-urgent moves. Consider how priority might alter your lifting strategy. Three situations may require the use of an emergency move: a hazardous scene, care of life-threatening conditions that require repositioning, and the necessity to reach other patients.
Talking Points: Hazards may make it necessary to move a patient quickly in order to protect yourself and the patient. Possible hazards include uncontrolled traffic, fire or threat of fire, possible explosions, electrical hazards, toxic gases, or radiation. You may have to move a patient to a hard, flat surface to provide CPR, or you may have to move a patient to reach life-threatening bleeding. When some patients have life-threatening problems, you may have to move another patient to access them. The greatest danger to the patient is aggravation of a spine injury. Since the move must be made immediately to protect the patient’s life, full spinal precautions will not be possible. To minimize or prevent aggravation of the injury, move the patient in the direction of the long axis of the body. Use emergency moves only when absolutely necessary.

40. Emergency Move: Clothes Drag
Point to Emphasize: When conducting an emergency move, move the patient in the direction of the long axis of the body to protect against aggravating a possible spinal injury.
Talking Points: There are several rapid moves called drags. In this type of move, the patient is dragged by the clothes, the feet, or the shoulders, or on a blanket. These moves are reserved for emergencies, because they do not provide protection for the neck and spine. Most commonly, a long-axis drag is made from the area of the shoulders. This causes the remainder of the body to fall into its natural anatomical position, with the spine and all limbs in normal alignment.

41. Emergency Move: Head First Drag

42. Emergency Move: Firefighter’s Drag

43. Emergency Move: Firefighter’s Carry

44. Emergency Move: One-Rescuer Assist

45. Emergency Move: Two-Rescuer Assist

46. Urgent Moves
Required treatment can be performed only if patient is moved
Patient’s condition deteriorating
Performed with precautions for spinal injury
Point to Emphasize: Urgent moves are required when the patient must be moved quickly for treatment of an immediate threat to life. Unlike emergency moves, urgent moves are performed with precautions for spinal injury.
Talking Points: Examples in which urgent moves may be required include the following: A patient must be moved in order to support inadequate breathing or to treat for shock or altered mental status. Factors at the scene, such as heat or cold, cause rapid patient decline.

47. Urgent Move: Onto Long Spine Board
Used if immediate threat to life and suspicion of spine injury
Patient supine, log-roll onto side
Place spine board next to body; log-roll onto board
Lift onto stretcher
Secure to stretcher; load into ambulance
Talking Points: When reaching across the patient to perform a log roll, remember the principles of body mechanics: keep back straight, lean from hips, and use shoulder muscles to help with roll.

48. Urgent Move: Rapid Extrication
Talking Points: Another example of an urgent move is the rapid extrication procedure from a vehicle. If the patient has critical injuries, taking the time to immobilize the patient with a short backboard or vest while still in the car may cause a deadly delay. Rapid extrication uses a quicker procedure: stabilize the spine manually as you move the patient from the car onto a long spine board.

49. Non-Urgent Move Patient stable No immediate life threat
Patient can be assessed, treated, and moved in normal way
Take all required precautions not to aggravate existing conditions
Point to Emphasize: When there is no immediate threat to life, the patient should be moved using a non-urgent move. Non-urgent moves should be carried out in such a way as to prevent injury or additional injury to the patient and to avoid discomfort and pain.
Discussion Topics: Describe the criteria that you would consider to deem a movement an emergency lift, an urgent lift, or a non-urgent lift. Discuss how the application of an emergency patient movement might differ from that of a non-urgent patient movement.
Knowledge Application: Work in small groups. Present lifting scenarios. Discuss the strategy chosen for the lift and the lifting decision-making process.

50. Patient-Carrying Devices
Teaching Tips: Have patient-carrying devices on hand. Demonstrate function. Take time to review specific devices and their safety features. Allow students to visualize and manipulate the straps, levels, and locking mechanisms for the individual devices. Remember that there is a tremendous variety of lifting devices in EMS. Teach students broad themes and impress upon them the need to educate themselves on the specific devices their service uses.
Points to Emphasize: Patient-carrying devices are mechanical devices and EMTs must be familiar with how to use them. Errors in use of these devices may result in injuries to the patient and to the provider. Various patient-carrying devices exist. An EMT must assess the situation and decide which device would be most appropriate to use in a particular lifting scenario.
Knowledge Application: Assign small groups to each patient-carrying device. Have each group demonstrate proper function and the movement of a patient onto the device.

51. Wheeled Ambulance Stretcher
Talking Points: Commonly referred to as the stretcher, cot, or litter, this is in the back of all ambulances. Its purpose is to safely transport a patient from one place to another, usually in a reclining position. The head of the stretcher can be elevated, which will be beneficial for some patients, including cardiac patients, who have no suspected neck or spinal injuries. A stretcher may have variable height settings. When moving the patient, the safest level is closest to the ground to avoid tipping. The stretcher is ideal for level surfaces, but not for rough terrain and uneven surfaces. Use proper body mechanics while placing the stretcher into or taking it out of the ambulance and when wheeling the stretcher from place to place. Transporting with an odd number of EMTs may cause the stretcher to become unbalanced. When lifting the stretcher, two EMTs should lift at opposite ends of the stretcher—head and foot.
Discussion Topic: Describe the operation of a wheeled stretcher. Discuss its key features.

52. Power Stretcher
Talking Points: A power stretcher will lift a patient from ground level to loading position or lower a patient from the raised position. These stretchers use a battery-powered hydraulic system that manufacturers state will lift patients on 20 consecutive runs and will lift patients up to 700 pounds. While these power stretchers undoubtedly help prevent back injuries, it is vital to follow the manufacturer’s guidelines for use, properly maintain the stretcher, and use safe techniques any time a patient is on the stretcher.
Knowledge Application: Invite an EMS crew and ambulance to class. Ask the crew to demonstrate the various lifting devices their ambulance carries.

53. Bariatric Stretcher
Talking Points: Many services use bariatric stretchers that can transport obese patients. Some are rated for 800 pounds or more. Many services have ambulances specially equipped for loading and transporting bariatric patients. These ambulances have oversized equipment for patient assessment and care as well as ramps or hydraulic lifts to raise the loaded stretcher into the ambulance. In addition, an increasing number of hospital emergency departments are being equipped with hydraulic lifts to transfer obese patients onto hospital cots.
Discussion Topic: Define the term bariatric stretcher. Discuss the uses of a bariatric stretcher.

54. Stair Chair
Talking Points: The stair chair, as the name implies, is excellent for use on stairs. The stair chair transports the patient in a sitting position, allowing EMTs to maneuver around corners and through narrow spaces. It also has a set of wheels that allows the device to be rolled like a wheelchair. Another type of stair chair now in wide use has wheels to roll the patient along the floor but also tracks that allow EMTs to gently slide the patient down a staircase. As with other models, two rescuers are necessary and a third as a spotter is preferred. Indications and contraindications for this stair chair are the same as for older models. The device is often ideal for patients with difficulty breathing who must sit up to breathe more easily. The stair chair must not be used for patients with neck or spine injury, unresponsive patients, those with severely altered mental status, or patients who require airway care. Do not use a chair found in the patient’s home as a substitute. It may not be able to support the patient’s weight and may break, potentially causing injury to both patient and EMTs.
Discussion Topic: Describe the operation of a stair chair. Discuss its key features.

55. Short Spine Board
Talking Points: Short spine boards are used primarily for removing patients from vehicles when a neck or spine injury is suspected. A short spine board can slide between the patient’s back and the seat back. Once secured to the short spine board and wearing a rigid cervical collar, the patient can be moved from a sitting position in the vehicle to a supine position on a long spine board.
Knowledge Application: Have students work in small groups. Assign each group a manikin and a lifting device. Ask each group to demonstrate the proper lifting technique for their specific device. Rotate groups through each device.

56. Vest-Type Extrication Device
Talking Points: Often, a vest-type extrication device is used in place of a short spine board.
Knowledge Application: Invite a service equipment manager or a manufacturer’s representative to class to discuss lifting device upkeep. Discuss specific preventative maintenance.

57. Scoop Stretcher
Talking Points: The scoop, or orthopedic, stretcher splits into two pieces vertically, allowing the patient to be “scooped” by pushing the halves together underneath. It does not offer any support directly under the spine, so it is not recommended for patients with suspected spinal injury. Follow local protocols on the use of this device.
Discussion Topic: Describe the types of patient movements for which you might use a scoop stretcher.

58. Basket Stretcher
Talking Points: A basket, or Stokes, stretcher can be used to move a patient from one level to another or over rough terrain. The basket should be lined with a blanket before positioning the patient. Some models include a spine board custom designed to fit inside for patients with spinal injuries. They may also be fitted with flotation devices for water rescue or lifting harnesses for vertical moves.

59. Flexible Stretcher
Talking Points: A flexible, or Reeves, stretcher is made of canvas or rubberized or other flexible material, often with wooden slats sewn into pockets and three carrying handles on each side. Because of its flexibility, it can be useful in restricted areas or narrow hallways.
Knowledge Application: Obtain manufacturer’s instruction booklets for lifting devices. Ask students to review the manufacturer’s recommendations against common practices.

60. Vacuum Mattress
Talking Points: Some services now use a vacuum mattress when transporting patients. The patient is placed on the device and air is withdrawn by means of a pump. The mattress then becomes rigid and conforming, padding voids naturally for greater comfort. Vacuum mattresses reduce some of the discomfort associated with rigid backboards.
Skill Demonstration: Practice using patient-carrying devices. If your educational institution allows, actually move programmed patients. If not, simulate movements with unloaded devices. (Instructor must actively supervise any movement of an actual patient.)
Critical Thinking: Think outside the box. Besides the patient-carrying devices demonstrated today, are there other devices that might be used to move patients?
Class Activity: Provide various examples of lifting devices. Have students rotate through stations where the devices are presented and demonstrated. Allow time for hands-on examination of each device.
Knowledge Application: Have students work in small groups. Assign each group a scenario and tell the group they do not have the proper lifting device. Ask each group to discuss how they might improvise a move using alternative devices.

61. Think About It
How do you choose the appropriate patient-carrying device?
Talking Points: Selection of the carrying device will often be based on patient location, position, weight, and medical condition.

62. Moving Patients With Suspected Spinal Injury
Immobilize head, neck, and spine before move
Point to Emphasize: When moving a patient to a lifting device, the EMT must use teamwork and good body mechanics to ensure a safe lift for all parties involved.
Talking Points: Immobilization is mandatory for any patient who has any possibility of a spine injury. There are several ways to move a patient onto a carrying device. Choose a move based on the position the patient is in when it is time to move to a carrying device and whether there is suspicion of a spine injury. Perform manual stabilization, place a rigid cervical collar, and maintain manual stabilization until the patient is immobilized to a spine board. If seated in a vehicle, first immobilize the patient with a short spine board or vest and then on a long spine board (unless movement is urgent and you substitute the rapid extrication procedure). If the patient is lying down or standing, move directly to a long spine board. The long spine board will then be placed on a wheeled ambulance stretcher for transport to the hospital.
Discussion Topic: Describe the procedure for moving a patient with a suspected spine injury to an immobilization device.

63. Moving Patients Without Suspected Spinal Injury
Extremity lift
Used to carry patient to stretcher or stair chair
Can be used to lift patient from ground or from sitting position
Talking Points: The extremity lift, direct ground lift, draw-sheet method, and direct carry are methods of moving a patient to a stretcher. All are appropriate only for a patient with no suspected spine injury. Extremity lift is used to carry a patient to a stretcher or stair chair. It can be used to lift a patient from the ground or from a sitting position.
Discussion Topic: Describe the process for employing an extremity lift. Describe what type of patient you might use this type of lift on.
continued

64. Moving Patients Without Suspected Spinal Injury
Direct ground lift
Lifting from ground to stretcher
continued

65. Moving Patients Without Suspected Spinal Injury
Draw sheet method (shown)
Direct carry method
Talking Points: The draw-sheet method is one of two methods that is performed during transfers between hospitals and nursing homes, or when a patient must be moved from a bed at home to a stretcher. Direct carry is performed to move a patient with no suspected spinal injury from a bed or from a bed-level position to a stretcher.
Discussion Topic: Describe the process for employing the draw sheet method. Describe what type of patient you might use this type of lift on.
Class Activity: Describe a scenario to the class. Ask the class to discuss what the best type of lift would be and why. Compare and contrast the different answers provided.

66. Recovery Position
Talking Points: Unresponsive patients with no suspected spinal injury should be placed in the recovery position. The patient should be on side to aid drainage from mouth and, if the patient vomits, to help prevent breathing vomitus into the lungs. This can be accomplished on a wheeled stretcher. Avoid transporting an unresponsive patient in a chair-type device since the airway cannot be properly maintained.

67. Position of Comfort
Talking Points: Many patients who have no suspected spine injuries may be transported in a position of comfort. This includes many patients with medical complaints such as chest pain, nausea, or difficulty breathing. In this situation, allow the patient to choose a position of comfort. Breathing is often aided by raising the back of the stretcher so that the patient is in a semi-sitting position (Fowler’s or semi-Fowler’s position). The position must be safe and not prohibit proper use of the transportation device. The position of comfort must be used cautiously in case the patient vomits. Always monitor the patient’s airway and level of responsiveness. Place the patient in the recovery position at the first sign of a decreased level of responsiveness.

68. Positioning for Shock
Place patients believed to be in shock in supine position
Do not lower head
Do not elevate legs
Talking Points: Patients believed to be in shock are placed in a supine position. This allows maximum blood flow throughout the body with minimal resistance from gravity. It is important that all parts of the body—especially vital organs such as the brain—remain perfused. Patients who have experienced trauma (injury) are placed on a spine board and immobilized to prevent further injury. These patients should remain in a supine, level position on the backboard. Do not lower the head (which may cause difficulty breathing) or raise the legs (which may aggravate injury and make transportation more difficult). In this case the risks of raising the legs outweigh the benefits. Recent research has shown there is minimal or no benefit to elevating the legs.

69. Transferring the Patient to a Hospital Stretcher
Talking Points: When you arrive at the hospital, you will move the patient from the ambulance stretcher to the hospital stretcher. You will probably use a modified draw-sheet method to transfer the patient.

70. Prehospital Lifting of Patients Video
Video Clip
Discuss the EMT’s role of lifting and moving patients in the prehospital environment.
Describe scenarios that would require an EMT to use an emergency move.
List three ways to help prevent injury when moving a patient to an ambulance.
What is body mechanics?
Discuss the purposes of different types of equipment that can be used to move a patient.
Describe the types of assists that an EMT might use on a call.
Transcript.
Properly moving a patient from where they were found and then to the ambulance needs to be accomplished on most EMS calls. In most cases this is done slowly and carefully. In some serious patients the lifts may need to be done very quickly to move the patient out of harms way. In all situations it is necessary for the first responder to understand which would be the best means of lifting the patient, how to use the device chosen to remove the patient to the ambulance and how to use good body mechanics to minimize the potential injury to themselves or their partners. In this video we will discuss the type of lifts and moves as well as tips to help you safely lift and move your patient. First it is essential that the first responder understand body mechanics. Body mechanics is the proper use of the body to prevent injury and to facilitate lifting and moving of the patient. Prior to lifting any object consider the following; the patient's weight, will additional assistance be required, what are the physical lifting abilities of you and your partner. Plan how you will accomplish the lift and communicate it. Another important aspect of body mechanics involves following a few simple rules when lifting. Position your feet on a firm surface and shoulder width apart, use your legs, not your back, to lift. Do not lean over and compensate when lifting with only one hand. Keep the weight as close to your body as possible, rather than carrying a stretcher or Reeves downstairs use a stair chair. First responders can be prone to injury when they are placed in a position where they are reaching, pushing or pulling. To prevent injury when reaching the first responder should keep your back in a locked in position, avoid twisting while reaching, avoid reaching more then 20 inches in front of you. Avoid a prolonged reach when a strenuous effort is necessary. When pushing or pulling the first responder should try to push rather than pull when practical. Keep you back in a locked in position. Keep the line of the pull through the center of you body by bending your knees; keep the weight close to your body. Avoid pushing or pulling overhead, keep your elbows bent and arms close to your sides. To prevent injury when lifting patients the first responder should try to use the power lift and the power grip. The power lift involves squatting rather than bending at the waist and keeping the weight as close to you as possible. The power grip involves using as much of the area surface of your hands and palms as possible, all fingers should be bent at the same angle. The palms should be up underneath the object you are lifting and the two hands should be at least ten inches apart. There are three classifications of moves, emergency moves, urgent moves, non-urgent moves. An emergency move is done as fast as possible with little regard for spinal integrity, an example would be a patient where the car is on fire and the patient needs to be immediately removed. An urgent move needs to happen very quickly but there is time to be cautious and not aggravate a potential spine injury, an example would be the rapid extrication technique used for the critical trauma patient found in a seated position in an automobile. A non-urgent move is used for the majority of moves, and it used for patients when there is no immediate threat to life or limb. Usually the patient is assessed and managed prior to the movement as is the case of assisting a cardiac patient with chest pains onto the stretcher.
Lets review the steps for a number of lifts used in the field, a one rescuer assist can be used to move the patient into a safer area. Place the patient's arm around your neck, grasp the patient's hand in your hand, place your other arm around your patient's waist then help the patient walk to safety communicating with him or her about obstacles or uneven terrain. The two rescuer assist is done in the following manner, each first responder stands at one side of the patient, each places a patient's arm around his or her shoulder and grips the patient's hand. And then both the first responders help the patient walk to safety. The direct ground lift is often used to move a patient to a stretcher. To accomplish this, the following steps are taken, set the stretcher in the lowest position and place it opposite the patient, both the first responders get in position along one side of the patient. First responder number 1 is at the head end and first responder number 2 is at the foot end. First responder number 1 will cradle the patient's head and neck by sliding one arm under the neck to grasp the shoulder, the other arm should be placed under the patient's lower back. First responder number 2 will now slide one arm under the patient's knees and the other under the patient's back, above the buttocks. If there is a third rescuer available have them place both arms under the patient's waist while first responders 1 and 2 slide their arms up to the mid back or down to the buttocks. On a signal the crew lifts the patient to their knees, stands and carries the patient to the stretcher, drop to one knee and roll forward to place the patient onto the mattress. There are a number of emergency moves that can be used by a single first responder to quickly move a non-spinal injured patient. To do the firefighter's drag, take the following steps. Place the patient in the supine position; tie the patient's hands together with something that will not cut into the skin. Straddle the patient using his or her head. Crouch and pass your head through the patient's trussed arms and then raise your body to raise the patient's head, neck and upper trunk. Crawl on your hands and knees dragging the patient and keeping the patient's head low to the ground. A blanket can be used for a blanket drag, gather half of the blanket up against the patient's side, roll the patient towards your knees, gently roll the patient onto the blanket. Roll up the blanket by the patient's head, neck and shoulders and drag this rolled material, keeping the patient's head as low to the ground as possible. The last emergency lift we will review is the firefighter's carry. Place your toes against the patient's toes and pull the patient towards you, bend at the waist and flex your knees, duck down and pull the patient across your shoulders keeping hold of one of their wrists. Use your free arm to reach between the legs and grasp their thigh. Let the weight of the patient fall onto your shoulder, next stand up transferring your grip on the patient's thigh to their wrist.
Click on the screenshot to view a video on the subject of prehospital lifting of patients.
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