1. LESSON 23
LIFTING AND
MOVING PATIENTS

2. Introduction Moving injured patient likely to cause further injury
In most cases wait for professional help
May have to move patient to protect from danger at scene
May need to assist other EMS personnel

3. Body Mechanics Back injury is hazard for EMRs
To minimize risks, use good body mechanics
Body mechanics are principles of using your body safely

4. Body Mechanics and Lifting Techniques
Know your physical ability and limitations
Plan the lift
Ensure you have a good grip
Test the load
Position your feet properly before starting lift
Lift with your legs, not with your back (power lift)
Keep patient’s weight close to your body

5. Body Mechanics and Lifting Techniques (continued)
Lift straight up, maintain good posture
Avoid twisting your back during lift
Use good technique when reaching
When possible, push rather than pull
Communicate clearly with your partner and other EMS providers

6. Patient Positioning Reposition patient only when necessary
Reposition breathing, unresponsive, non-trauma patient in recovery position
Don’t move or reposition trauma patient unless necessary to treat life-threatening condition
Allow responsive patient to assume comfortable position

7. Log Roll Use log roll to move patient from prone to supine
3-5 rescuers are needed to safely roll patient
For trauma patient with spinal injury, stabilize head in line with body during move

8. Skill: Log Roll
Rescuer at patient’s head holds head in line with body as 2 or 3 additional rescuers take position with hands at patient’s lower and upper leg, hip and torso, and shoulder
On the count of responder at the head, rescuers in unison roll patient toward them, with head held in line and spine straight
Rescuers complete log roll, positioning patient on back with head and neck still in line with body

9. Emergency Moves Use only if: Patient faces immediate danger
You cannot give lifesaving care because of location or position

10. Risk of Spinal Injury
Moving patient quickly risks aggravating a spinal injury
Keep head and neck in line with spine
It is impossible to completely protect spine while removing patient from a vehicle quickly

11. Extrication from Vehicles
EMRs may be trained in rapid extrication using cervical collar and inline stabilization of head/neck
Follow local protocol
Wait for EMTs trained in special extrication techniques

12. 1-Rescuer Emergency Drags
Pull or drag patient in direction of long axis of body
Don’t drag patient sideways
Avoid twisting neck and trunk
Never pull head away from neck and shoulders
Risk of spinal injury can be minimized by using blanket, rug, board, etc.
Choice of move depends on materials at hand, patient’s condition and situation

13. 1-Rescuer Emergency Drags (continued)
Clothing drag
Blanket drag
Shoulder drag
Firefighter’s drag
Upper extremity drag
Upper extremity drag for rapid extrication

14. Emergency Carries Used when patient must be moved immediately
1 or more rescuers may carry patient
Method used depends on patient’s size and condition and the situation

15. With All Emergency Carries
Use good body mechanics and lifting techniques
Don’t try to lift or carry person before checking for injuries

16. Moving Patients – If Alone
Unresponsive patient who cannot safely be dragged – Packstrap carry

17. Moving Patients – If Alone (continued)
Lighter patient or child
Cradle carry (responsive or unresponsive patients)
Piggyback carry (responsive patient)

18. Piggyback Carry
Support patient’s weight with your arms under patient’s thighs
If able, have patient clasp hands and lean forward; if not able, grasp patient’s hands with yours to keep patient from falling back

19. Firefighter’s Carry
Support patient’s weight on your shoulders while holding patient’s thigh and arm

20. Moving Patients – If Alone (continued)
Responsive patient who can walk with help – 1-rescuer walking assist

21. Moving Patients – With Help
Responsive patient:
2-rescuer walking assist
2-rescuer cradle carry
2-rescuer extremity carry

22. 2-Rescuer Cradle Carry
Both rescuers clasp arms behind patient’s back and under the legs

23. 2-Rescuer Extremity Carry
To carry patient down steps:
Forward rescuer grasps patient’s legs under the knees
Rear rescuer reaches under patient’s armpits from behind to grasp patient’s forearms

24. 2-Rescuer Walking Assist
Both rescuers position patient’s arms over their shoulders
Each rescuer grasps patient’s wrist, with the other arm around patient’s waist

25. Urgent Moves
Used when patient must be moved urgently and quickly, but situation allows a little more time to ensure patient safety
An urgent move may be needed for:
Patients with altered mental status
Patients with inadequate breathing
Patients in shock
Other situations involving potential danger to patient

26. Non-Emergency Moves Used to move patient when no threat to life
Performed by multiple rescuers
Not used if patient has suspected spinal injury, internal bleeding or uncontrolled external bleeding
Generally used to prepare patient for transport
Stabilize patient before moving
Minimize any chance of aggravating illness or injury
These moves are usually performed by responding EMS personnel

27. Before Using a Non-Emergency Move
Complete primary and secondary assessments
Correct any life-threatening problems
Immobilize all suspected fractures and dislocations
Ensure there are no signs and symptoms of neck or spinal injury

28. Direct Ground Lift
Non-emergency move for patients without suspected neck or spinal injuries
Used to lift and carry supine patient from ground to stretcher

29. Skill: Direct Ground Lift
Rescuers kneel on one side of the patient
Rescuers position their hands on the patient
Rescuers lift patient to their knees and roll the patient in toward their chests
Rescuers stand and move patient to stretcher, and reverse steps to lower patient

30. Extremity Lift
2-rescuer technique used for patients without suspected injury to neck, spine or extremities
May be used with responsive or unresponsive patient
May be used to carry patient a short distance or move patient from chair to stretcher
May be used to carry patient through a tight space

31. Skill: Extremity Lift
The first rescuer kneels at the patient’s head and the second rescuer kneels by the patient’s feet. The rescuer at the head places 1 arm under each of the patient’s shoulders while the rescuer at the feet positions the patient’s arms.
The rescuer at the head then slips his or her hands under the patient’s armpits and grasps the patient’s wrists and crosses them on the patient’s chest. The rescuer at the feet turns around and reaches his or her hands back and under the patient’s knees.

32. Skill: Extremity Lift (continued)
Both rescuers move to a crouching position and assess their grip on the patient.
On a signal from the rescuer at the head, the rescuers stand up simultaneously and move forward with the patient.

33. Extremity Lift – Alternative Position
Previous technique is preferred if rescuers must move some distance or over inclined surface
Alternatively, rescuer at patient’s feet may face patient and other rescuer
Can be used to move patient to side or short distance

34. Transfer from Bed to Stretcher
Assist EMS personnel transferring patient from bed to stretcher
Use either direct carry or draw sheet technique
Not used with patient with suspected spinal injury

35. Skill: Direct Carry
Position the stretcher at a right angle to the bed, ideally, with the head end of the stretcher at the foot of the bed. The stretcher should be at the same height as the bed. Unbuckle the straps and remove other items from the stretcher. Both rescuers stand between the bed and the stretcher, facing the patient.

36. Skill: Direct Carry (continued)
The rescuer at the head slides 1 arm under the patient’s neck and cups the patient’s farther shoulder. The second rescuer slides 1 arm under the patient’s hips and lifts slightly. The rescuer at the head slides his or her other arm under the patient’s back, and the second rescuer places his or her other arm underneath the patient’s thighs near the knees. Together, both rescuers slide the patient to the edge of the bed.

37. Skill: Direct Carry (continued)
On a signal of the rescuer at the head, the rescuers lift and curl the patient toward their chests.
The rescuers step back, rotate toward the stretcher and place the patient gently on the stretcher.

38. Draw Sheet Transfer

39. Skill: Draw Sheet Transfer
Loosen bottom bed sheet and roll its edge on the side where you will place stretcher
Position stretcher alongside bed; prepare stretcher:
Adjust height, lower rails and unbuckle straps
Both responders reach across stretcher and grasp rolled sheet edge firmly at level of patient’s head, chest, hips and knees
Slide patient gently onto stretcher

40. Draw Sheet Transfer – Alternative Method
Rescuers first roll patient onto one side, and 1 rescuer holds the patient in that position; second rescuer positions a sheet with rolled edge beneath patient
The patient is rolled back into original position, now on the sheet
The rescuers together pull on sheet to slide patient onto stretcher

41. EMS Equipment for Moving Patients
EMRs often assist EMTs with packaging and moving patients
Wide range of commercial devices is used
Learn devices you are likely to encounter in your area

42. Typical Equipment for Packaging and Moving Patients
Long backboard
Kendrick Extrication Device (KED)
Standard stretcher
Portable stretcher
Orthopedic stretcher
Basket stretcher
Stair chair