1. Lifting and Moving Patients
Chapter 11
Lifting and Moving Patients

2. Overview Back Injuries Body Mechanics Planning a Move
Packaging the Patient

3. Back Injuries Anatomy review
Lumbar spine bears weight of body; 85% of back injuries occur there
Discs between vertebrae may deteriorate, move, or slip out of place
Injuries can result from improper lifting and carrying
A back injury can strike an EMT and take him out of work, perhaps permanently. Understanding how to prevent back injuries is vital to a long career in EMS.
Back injuries are injuries of the spine or the adjacent muscles, or both. The spinal column is a series of bone segments, called vertebrae, stacked on top of one another. Between each pair of vertebrae is a soft disc that acts as a shock absorber.
The lumbar vertebrae section of the back is the site of 85% of all back injuries.
The lower back, and the lumbar section in particular, can be injured by strains or sprains of the muscles, by deterioration or movement of the intervertebral discs, or by fractures to the vertebrae themselves.
These injuries are often the result of careless lifting and carrying.

4. Back Injuries Back care
Most common source of back injuries is twisting while lifting an object
Key to a strong back is exercise
To prevent injury, warm up the lower back before each tour of duty
The most common source of back injury is twisting while lifting an object. An EMT is subject to regularly lifting and carrying patients and equipment. In order to be able to withstand the demands of the intense bending and twisting that occur on the job, an EMT should maintain a strong and healthy back.
The key to a strong back is regular exercise. Exercise will strengthen the back muscles and prepare them for the hard work ahead.
The EMT should warm up the lower back at the start of every tour of duty. Regular back exercises, utilizing proper lifting techniques, and using assistive devices when needed are part of a program of back care.

5. Back Injuries Know your limitations Two key questions
Is there enough help to lift this patient?
Is the right equipment being used?
Failure to answer the questions correctly can cause injury to the patient or EMT
Before lifting a patient, the EMT should ask two questions:
1. Is there enough help to lift this patient?
Is the right equipment being used?
Since having a healthy back is one of the primary requirements for an EMT, the questions posed above should be answered honestly. It would be foolish to try to lift a patient if resources were not available to complete this safely.

6. Back Injuries Is there enough help?
One EMT must be able to lift and carry 125 lbs; two EMTs, 250 lbs
Request assistance for patients over 250 lbs
Factor in the stretcher and equipment
The functional job description for an EMT states that the EMT must be able to lift and carry 125 pounds. Thus, two EMTs should be able to lift and carry most patients without difficulty.
Additional assistance should be requested for any patient who weighs more than 250 pounds.
The EMT should factor in the weight of the stretcher and equipment, which could add another 50 pounds.
Patients weighing more than 300 lbs present a special challenge to EMTs. Many jurisdictions have fire department backup available. These resources should be used whenever possible to help lift heavy patients.

7. Back Injuries What is the “right stuff”?
Carefully consider the situation at hand
Mentally visualize the method used for the carry
There are many methods of carrying a patient, as well as special equipment to assist the EMT.
In planning the carry, the EMT should carefully consider the situation at hand.
The well-trained EMT should mentally visualize the carry in order to determine what equipment would improve the performance.

8. Back Injuries Safety first Back support braces Proper footwear
Must be worn correctly
Must fit correctly
Proper footwear
Closed-toe shoes or boots
Soles should be nonskid
Midcalf boots provide support
A back support brace should be worn whenever a heavy patient is carried. Back supports can be harmful, however, if not used correctly. If worn for too long, a brace can actually weaken the back muscles.
The EMT must also wear proper footwear. Boots serve as the foundation for lifting and carrying as well as protection for toes and feet. Shoes or boots should have closed toes and have nonskid soles. A midcalf boot will provide additional support to the ankles.

9. Stop and Review Discuss proper back care.
The key to a strong back is regular exercise. Exercise strengthens the back muscles and prepares them for the hard work ahead. Regular back exercise (as part of Tai Chi or weight training, for example) along with practice in proper lifting techniques, the use of certain assistive devices, and warming up the lower back before every tour of duty are part of proper back care.

10. Body Mechanics
The proper or most efficient way to perform physical activities
The primary goal is to lift and carry without injury to spine
Body mechanics consists of the proper or most efficient way to perform physical activities that are safe, energy conserving, and help prevent the physical strains that may cause injury.
The primary goal of body mechanics is to learn how to lift and carry without injury to spine.

11. Body Mechanics Reaching Never twist and arch the back backward
Never reach more than 18 inches away from the body
Keep elbows close to the body and never farther out than the knees
Bend at the knees, while keeping the back straight
There are several fundamental rules for reaching.
Never twist and arch the back backward. Instead, the EMT should always face the object he is reaching for.
Never reach more than 18 inches away from the body to grasp an object.
The elbows should remain close to the body and never further out than the knees.
When lifting an object more than 10 pounds, bend at the knees while keeping the back straight.

12. Body Mechanics Lifting The power lift
Utilizes the stronger muscles of the leg instead of the weaker muscles of the lower back
The closer the body’s center of gravity is to the object, the more powerful the lift
The feet are the foundation of the power lift
When lifting, having a straight back with good vertical spinal alignment will place the weight of the load on the pelvis and strong leg muscles, while taking the weight off the lower back. The power lift, or squat lift, uses the stronger muscles of the leg instead of the weaker muscles of the lower back. It is useful when lifting baskets or stretchers or even when moving heavy furniture out of the way.
The closer the body’s center of gravity to the object, the more powerful the lift.
The EMT’s feet are the foundation of the power lift. Good footwear and a comfortable, flat stance are important.

13. Body Mechanics Lifting The power grip
Palms-up grasp utilizes powerful arm muscles
The arms should be locked out
On signal, two EMTs slowly lift together in a fluid motion
Lift is complete when the EMT is upright and the weight suspended directly in front
When performing a power lift, the EMT squats to reach the object, such as a backboard.
The palms-up grasp, sometimes called the power grip, utilizes the most powerful muscles of the arm. The amount that can be lifted is limited only by the strength of the grip.
The arms are locked out, with the elbows straight and the arms rigid. This ensures that the EMT uses the legs and back to lift.
On signal, usually from the EMT at the head, the two EMTs lift together in a smooth, fluid motion.
The lift is complete when the EMT is upright and the weight suspended directly in front.

14. Body Mechanics Carrying Pushing and pulling
A bag or case should be carried by a shoulder strap slung over the shoulder
Carry with a straight back and balance the loads
Pushing and pulling
Always try to push an object rather than pull it
Improved technology has translated to an increased amount of equipment that an EMT carries every day.
A bag or case should be carried by a shoulder strap slung over the shoulder.
When carrying kits, the EMT should keep his back straight and balance the loads.
Whenever possible, an EMT should push an object rather than pull it. Trying to pull patients out of cars and other confined spaces has resulted in back injuries for many EMTs.

15. Planning a Move Survey the scene and determine the priorities
Assess the resources at hand
Communicate the plan
The strongest EMT takes the heaviest end
Know your personal limits
The EMT should always have a plan for how to move a patient. That way the patient can be moved quickly without further injury, and the EMT’s safety is not compromised.
Suggested Responses to “Fire Rescue”
1. Heavy smoke and presence of fire make it imperative that this patient be rescued immediately.
2. This elderly patient may have sustained injuries that prevented him from escaping. Movement may further injure the patient.
3. The situation described is potentially life-threatening, and life comes before limb.
4. If the patient is ambulatory, the FF-EMT could help the patient using an emergency assist or an emergency drag.
5. The FF-EMT would use an emergency carry if the patient was unconscious. If another FF-EMT was available, a seat carry or chair carry may be useful.
Suggested Responses to “A Fall at Home”
1. Patient movement will be dictated by physical conditions. If there is room in the hallway, a log-axis drag may be in order. If there is not enough room, either a three-person lift or an orthopedic stretcher may be appropriate.
2. If a larger area is available to work in, the EMT can choose a variety of moving devices, including a Reeves stretcher or a long backboard.
3. If the patient is short of breath, it is unlikely that he would tolerate lying flat (orthopnea). The patient would therefore have to moved onto a stairchair or carried down the stairs in a cradle carry to the ambulance gurney.
Suggested Responses to “A Hunting Accident”
1. The hunter would likely be carried out on a Stokes basket or similar device using a four-person carry.
2. If the trail is narrow, the basket would be carried using the diamond configuration. If the trail is too narrow for this approach, an end-to-end carry with frequent breaks would be necessary.
3. When coming across an obstruction in the pathway, the team would have to perform a caterpillar pass over the obstacle before continuing.

16. Planning a Move Emergency moves
A patient may need to be moved immediately
Is the EMT prepared and capable of entering the scene and removing the patient?
Principle reasons for emergency moves
Fire
Explosion
Life-threatening hazards
Patient blocking access to more seriously injured patients
In some situations the patient needs to be moved immediately. The risk of serious injury, or even death, outweighs the risk of harm that might occur from hastily moving the patient.
In such emergencies, the EMT must consider whether he is capable of entering the scene and removing the patient. If he can, he should attempt to do so.
The principle reasons for emergency moves are fires, explosions, life-threatening hazards, and the patient blocking other, more seriously injured patients.

17. Planning a Move Emergency drags The clothing drag
The shirt collar or a handful of clothing is grabbed from behind the neck
Using two hands, the EMT walks backward while dragging the patient along with him
The patient’s head remains cradled between the rescuer’s forearms
When the situation is critical and time is of the essence, the EMT cannot afford to wait for additional support. He must act quickly and efficiently. In an emergency drag, an EMT, using a minimum of supplies, grabs a patient and hauls her to safety.
The clothing drag is the easiest of the emergency drags. Using two hands, the EMT grabs the shirt collar or handful of clothing from behind the neck. The EMT walks backwards, dragging the patient along with him, with the patient’s head cradled in the EMT’s forearms.

18. Planning a Move Emergency drags The arm drag
The EMT grasps the wrists of the patient, crossing them over her chest, and drags her by the arms
Effective if the patient can hold the head up
Do not use if the patient is unconscious
If a good handhold on the clothing cannot be obtained, the arm drag may be tried.
In this maneuver, the EMT is behind the patient. He grasps the wrists of the patient, crossing them over her chest, slips each of his arms under the patient’s shoulders, and drags her by the arms.
The arm drag can be very effective provided the patient can hold her head up.
It should not be used if the patient is unconscious. The unconscious patient’s head may fall forward, blocking the airway, or fall back, injuring the head and neck.

19. Planning a Move Emergency drags The blanket drag
The EMT logrolls the patient onto a blanket and drags the patient backward to safety
When others arrive, there are many handholds to help drag, lift, or carry the body
If the patient is large or the EMT is having trouble dragging the patient, a blanket can be an invaluable tool.
The EMT logrolls the patient onto the blanket, pulling the blanket from underneath her. Once the patient is supine on the blanket, the EMT rolls up the edges of the blanket to form a horseshoe-shaped collar. This supports the patient’s head and keeps it from hitting the floor.
An advantage of the blanket drag is that when others arrive, there are readymade handholds to help with dragging, lifting, or carrying the patient.

20. Planning a Move Emergency drags The firefighter’s drag
The EMT secures the patient’s wrists together and drapes the wrists over his neck and shoulders
The patient is dragged while beneath the EMT
The EMT sees where he is going; the patient is protected by the body of the EMT
All of the preceding drags require that the EMT drag the patient backward. These drags are effective when the patient has to be moved only a few yards, but they are physically exhausting for a single EMT to perform.
The firefighter’s drag uses a triangular cotton bandage, called a cravat, to make moving easier. The EMT uses the cravat to tie the patient’s hands together and drape them over the EMT’s neck, while the EMT is on hands and knees. The EMT then drags the patient and is able to look forward to see where he is going.

21. Planning a Move Emergency carries Rescuer assist
EMT acts as a crutch for the walking patient
Advantage—EMT can drag patient to safety if patient becomes weak
Although more difficult to perform than a drag, a carry will move the patient farther from the danger more quickly.
In the rescuer assist, the EMT (the rescuer) acts like a crutch (the assist) for a patient who is able to walk.
An advantage of the rescuer assist is that if the patient suddenly becomes weak, the EMT can drag the patient to safety.

22. Planning a Move Emergency carries Pack strap carry Cradle carry
Can convert from the rescue assist
The patient’s weight is on the EMT’s back and the patient’s feet are off the ground
Use only when no other means are feasible
Cradle carry
Only for small adults or children
If a walking patient becomes weak or even loses consciousness during a rescuer assist, the EMT can quickly change from a walking assist to a pack strap carry. The EMT simply lets go of the arm under the patient’s shoulder, steps in front of the patient, and, having a firm grasp of the patient’s wrists, pulls both of the patient’s arms forward while bending over.
When done correctly, the patient’s weight should be on the EMT’s back and the patient’s feet should be off the ground.
Note that this technique is very hard on the EMT’s back and should be done only when no other means are feasible.
In the cradle carry, the EMT picks up the patient in his arms and quickly moves to safety. This move should only be attempted with children or small adults. Like the pack strap carry, the cradle carry places great stress upon the EMT’s back.

23. Planning a Move Emergency carries Firefighter’s carry
Very effective but difficult to master
The patient is moved from a supine to a near-standing position and over the EMT’s shoulder
EMT has one hand free to open doors or carry bags
If the patient is unconscious and needs to be moved quickly, the firefighter’s carry is extremely effective. It also takes a great deal of practice to perform correctly.
In this technique, the patient is moved from a supine to near-standing position and over the EMT’s shoulders. If available, a second EMT can help hoist the patient over the shoulders of the first EMT.
An advantage of this technique is that it leaves one of the EMT’s hands free to open doors or carry equipment.

24. Planning a Move Emergency carries Seat carry
Use if patient is able to assist and two EMTs are available
The two EMTs form a seat by grasping wrists
Useful if the patient is unable to walk
To use the seat carry, two EMTs must be available and the patient must remain capable of assisting with the carry. The EMTs form a seat by grasping wrists. With arms locked at the elbows, they drop to opposite knees and the patient sits in the seat that has been created.

25. Planning a Move Emergency carries Chair carry
Uses a standard kitchen chair to move the patient
One EMT, facing forward, grasps the legs of the chair; the other EMT, the back of the chair
Should not be used with unconscious patients
When there are two EMTs, and time permits it, transferring a patient to a carrying device can be helpful.
If no special carrying device such as a backboard or stairchair is available, a kitchen chair can be used for a chair carry. With the patient supine, the patient’s legs are lifted and the chair is slid under the patient’s buttocks.
One EMT faces forward and grabs the legs of the chair. The other EMT grabs the back of the chair. Together they lift the chair.
Although useful for the debilitated patient, the chair carry should not be used with unconscious patients.

26. Planning a Move Nonurgent moves Take time to prepare for the carry
The primary concern—the patient’s safety and comfort, and the safety of the prehospital team
A number of devices and methods can safely move a patient from the scene
Most of the time, patients are not urgent.
When an EMT takes the time to carefully prepare for the carry, it is a low-priority move.
The primary concern is the patient’s safety and comfort, and the safety of the prehospital team.
A number of devices and methods exist to move a patient safely from the scene.

27. Planning a Move Nonurgent moves Command and coordination
Team leader—EMT at the head of the patient
Decides when to lift, turn, or stop
Gives specific orders that are loud and clear
Ensures all team members understand the objectives
Without coordination of all team members, a fall may occur that could injure the patient or a member of the EMT team. A few simple rules, agreed to ahead of time, can prevent tragedy from striking and ensure that the patient’s transport will be uneventful.
The EMT at the head or left side of the patient is the team leader.
That person decides when to lift, turn, or stop.
The team leader issues specific orders in a voice that is loud and clear.
The team leader ensures that all team members understand the objectives.

28. Planning a Move Nonurgent moves Extremity lift
Transfers patient from bed or floor to stretcher
First EMT slips his hands under the patient’s arms, and grasps the patient’s hands; second EMT slips his hands under the patient’s knees
Does not protect the spine
The extremity lift is perhaps one of the most commonly used lifts.
It is used to transfer a patient from a bed or floor to a stretcher.
The first EMT kneels behind the patient and slips his hands under the patient’s arms to grasp the hands. The second EMT slips his hands under the patient’s knees.
Because it does not protect the spine, the extremity lift cannot be used on trauma patients.

29. Planning a Move Nonurgent moves Direct lift
Used when only one side of patient is accessible
Moves a patient from the floor to bed or stretcher
Three EMTs
First EMT—patient’s head, neck, and shoulders
Second EMT—patient’s back and buttocks
Third EMT—patient’s knees and ankles
Does not protect the spine
EMTs can use a direct lift if only one side of the patient can be reached.
This lift is useful when the patient needs to be moved from the floor to a bed or stretcher.
It takes disciplined teamwork and two or three EMTs to perform a direct ground lift correctly. The first EMT supports the patient’s head and neck and shoulders. The second supports the lumbar section of the back and the buttocks. The third EMT supports the knees and ankles. If the patient needs to be moved a distance greater than a foot or so, the EMTs roll the patient toward their chests on command. They then stand and walk, in unison, to the bed or stretcher.
This lift does not protect the spine.

30. Planning a Move Nonurgent moves Scoop stretcher
Designed to fit into tight or confined spaces
Meant to be broken into two halves
The halves slip under the patient from opposite sides and the stretcher is reconstructed
Does not support the spine directly—a temporary transfer device
The orthopedic stretcher, also called the scoop stretcher, was designed to fit in small or cramped spaces.
It breaks into two halves, using releases at both ends.
The patient is scooped up by the two halves of the stretcher and it is reconstructed. The EMT must be cautious, since the patient’s clothing and skin can be pinched in the gap between the halves.
The stretcher has a void in the middle and does not support the spine directly. Therefore, it is used as a temporary device to transfer a patient to a backboard for spinal immobilization.

31. Planning a Move Nonurgent moves Stairchairs
Used if patient cannot tolerate lying flat on a stretcher
Has seat belts for the patient, handles for the EMT
Requires two EMTs to carry
The stairchair is frequently used in the city or anywhere there are narrow hallways and flights of stairs.
It is also used for patients who will not tolerate lying flat on a stretcher, usually because of difficulty breathing.
It is basically a chair with seat belts for the patient and handles for the EMTs.
It requires two EMTs to move a patient in a stairchair.

32. Planning a Move Nonurgent moves Stair carry
EMT must concentrate on balancing, carrying, and stepping
Guiding EMT calls out the steps until the bottom is reached
Patient is carried down the stairs feet first
Stairchair is held as close to the body as practical
Stair carries, using a stairchair or other carrying device, can be very dangerous.
The EMT must concentrate on both balancing and carrying the load, as well as stepping without the benefit of seeing where he is stepping.
The EMT who guides the crew should call out steps until the EMT carrying the patient reaches the bottom. The guide EMT can also place a hand on the small of the back of the EMT at the feet, providing reassurance as well as immediate support should it be needed.
The patient is carried down feet first, primarily to keep her from feeling as if she is falling.
When carrying patients down stairs, the EMT must keep the stairchair or device as close to the body as possible.

33. Planning a Move Off-road stretchers
Designed to carry patient across uneven terrain and rough ground
Decrease the hazard to the EMT and the patient
Walking across uneven terrain and rough ground while carrying a patient is a formula for disaster. A misjudged step or the turn of an ankle and both crew and patient take a fall. Using special off-road stretchers can decrease the hazard that these uneven surfaces pose to EMTs and patients.

34. Planning a Move Off-road stretchers Basket stretcher
Made of fiberglass-plastic composites
Can be pulled across snow and ice like a sled
Heavy to carry—some rescue experts still prefer lighter wire baskets
The original basket stretcher was made of chicken wire stretched over a rigid steel metal frame. It was used to carry patients between ships during World War II.
Modern basket stretchers, such as the Stokes basket, are made of fiberglass-plastic composites and are built to withstand rugged use.
They can be pulled across snow and ice much as sleds are.
They are very heavy to carry, however, and some rescue experts still prefer the older wire baskets.

35. Planning a Move Off-road stretchers Flexible stretcher
Lightweight and can be rolled up
SKED/Reeves stretchers
Use in confined-space, cave, wilderness, and rope rescues
Has multiple handholds and straps to secure patient
The flexible stretcher is a modern cousin of the basket stretcher. One example of flexible stretchers is the SKED. It is lightweight and can be rolled up. Another device is the Reeves stretcher. It consists of long, thin slats sewn into a canvas litter. All stretchers have multiple handholds and straps to secure the patient.

36. Planning a Move Off-road carries Decision of which to use is based on
The nature and the distance of the carry
Number of providers available
The patient’s weight
Rescuer fatigue
There are a number of methods of carrying a stretcher off-road. Which carry to use depends on factors such as the nature and distance of the carry, whether a short haul or long wilderness carry; the number of providers available; the patient’s weight; and the degree of rescuer fatigue.

37. Planning a Move Off-road carries End-to-end carry
Two EMTs grab each end of the litter and lift
If the ground is level and the carry is only a few feet, the two EMTs can face one another
If the carry is more than 20 feet, both EMTs should face forward
In the end-to-end stretcher carry, two EMTs grab the ends of the litter and lift. If a large distance needs to be covered, the two EMTs should be facing forward because the danger of tripping is greater when walking backward. If the distance is small and the ground is level, the two EMTs can face one another.

38. Planning a Move Off-road carries Diamond stretcher carry
Use when carry is more than 12 feet and ground is uneven
First two EMTs take ends of stretcher; next two take positions at sides
All use a power grip and perform a power lift
EMT at head faces and monitors the patient
If the trip is more than a dozen or so feet and the ground is uneven, then it is not safe for two people to carry a patient. In such cases, a diamond stretcher carry is used.
The first two EMTs take positions at the ends of the stretcher, and the other two EMTs take positions at the two sides.
At a signal from the EMT at the head, the EMTs lift together, using a power lift and power grip. The EMT at the patient’s feet turns and faces forward before travel begins.
The EMT at the patient’s head is responsible for monitoring the patient’s condition, that is, mental status, airways, and so on.

39. Planning a Move Off-road carries The four corners carry
Use when carrying a basket over a great distance
Use when carrying heavy patients or equipment
As many as six or even eight EMTs can be involved
Each EMT grabs a corner of the basket or somewhere in the middle
The four corners carry is very similar to the diamond carry. As many as six or eight EMTs can be involved, each grabbing a corner of the basket or somewhere in the middle. The carry is useful when carrying a basket over a great distance or when carrying a heavy patient or a patient and equipment. This arrangement works to create a balanced load. After lifting, all team members are facing the same direction, with only one hand in contact with the basket.

40. Planning a Move Off-road carries The use of slings
Loops of webbing (slings) are used to help even the load
Sling is looped through the handhold and slung over the shoulder to the opposite hand
After lifting, the EMT pulls down on the sling, using the shoulders as a fulcrum
It is tiring to carry a patient on a litter or in a basket with one hand. The body has a tendency to twist to one side, and the back muscles have to compensate in order to keep the back straight.
The use of loops of webbing called slings can help even the load.
The sling is looped in a half-hitch through the handhold and slung over the shoulder to the opposite hand.
After lifting the load, the EMT pulls down on the sling, an action that uses the shoulders as a fulcrum and helps balance the load.

41. Planning a Move Off-road carries Passing over obstacles
EMTs must take care not to drop the patient while overcoming an obstacle
Caterpillar pass passes patient to EMTs waiting on the other side of the obstacle
The key—keep all EMTs standing still
Can use to hand patient off to other EMTs
In the course of moving a patient, obstacles can get in the way. One common obstacle is a roadside guardrail.
EMTs must be careful not to drop the patient while overcoming the obstacle.
The best way to overcome an obstacle is to use the caterpillar pass, which passes the patient over the obstacle to EMTs waiting on the other side. At the obstacle, the EMTs turn and face each other. Two or more EMTs line up on the other side of the obstacle. The basket is now handed over to the EMTs on the other side.
The key to success in a caterpillar pass is to have all EMTs standing still during the maneuver.
The caterpillar pass can also be used to hand off the patient to other EMTs. Two fresh EMTs replace the two EMTs at the head. They slide down to the middle, and the EMTs in the middle slide to the end. The EMTs at the end are relieved of duty.

42. Stop and Review State the guidelines for pushing and pulling.
Always try to push an object rather than pull it. Keep the back straight. Push while standing and walking only if the object is at waist height. If the object is below the waist, either kneel or use a rope to extend the arm’s reach. Keep the elbows bent and close to your sides.

43. Packaging the Patient
The ambulance cot is part of the plan of treatment
Linens provide comfort and warmth
Care must be taken to conserve the patient’s body heat
The ambulance cot, also called the trundle, gurney, or stretcher, is part of the plan of treatment.
Ambulance cots usually have linens that provide comfort and warmth for the patient. The linens, called bedrolls, are wrapped around the patient as she is prepared for transportation to help conserve the patient’s body heat.
Because a large percentage of body heat is lost from the head and neck, the EMT should wrap the patient’s head with the bedroll’s collar.

44. Packaging the Patient Positioning
The decision on positioning the patient must be medically motivated
Feet up—More blood goes to the brain
Head up—Patient breathes more easily
The patient’s condition should dictate her position during transport.
If the patient’s feet are elevated, more blood goes to the brain.
If the head is elevated, the patient will breathe more easily.

45. Packaging the Patient Strapping
First strap secures the upper torso—arms either inside or outside
Middle strap is adjusted over the bony pelvis
Last strap is across the knees
Equipment is secured with the last strap
To prevent the patient from being thrown from the ambulance cot during sudden stops, the EMT must secure her to the cot. Usually seat belt-style straps are used, like those used on a backboard.
The first strap secures the torso, with the arms left outside of the strap if possible. This position is more comfortable for most patients and allows the EMT to take blood pressures and pulses more easily.
The middle strap is adjusted over the bony pelvis, not higher over the abdomen.
The last strap is secured across the legs, usually at about the knees.
Equipment, such as an oxygen tank, is also usually secured with this strap.

46. Packaging the Patient Transferring to the ambulance
Cot in high position is prone to tipping
Keep loaded cots in low position when moving the patient
If ground is rough or uneven, EMTs should be on both sides of the cot
Ambulance cots are usually rolled to their destination.
Although large wheels and a large base provide some stabilization, the cot is prone to tipping when it is in the high position, especially when going around corners or when it is on rough or uneven ground.
Many rescue squads and ambulance companies state that loaded cots should be in the low position every time the patient is moved.
If the ground is rough or uneven, an EMT should be on each side of the cot to protect the patient from a fall.

47. Packaging the Patient Loading the ambulance
Depends on manufacturer recommendations
EMT must observe standard principles of lifting
Inspect the cot daily and provide regular maintenance
How an EMT loads an ambulance cot depends on the ambulance manufacturer’s recommendations.
The principles of lifting discussed previously remain the same, that is, the EMT must have his feet firmly planted, lift with the legs and not the back, and lift as a team member.
The cot is the most frequently used equipment aboard any ambulance and is subject to grueling conditions. Thus, it needs to be inspected daily and given regular preventive maintenance.

48. Packaging the Patient Transferring to the hospital bed
Roll the cot feet first and in low position
Transfer to hospital gurney
Be sure wheels of gurney are locked
Use a transfer device (backboard) if necessary
Lower side rails that might interfere with the transfer
Two EMTs move the patient as a unit
1. Arriving at the hospital, the crew unloads the ambulance cot and rolls the patient into the hospital. The cot should be rolled feet first to prevent the patient from feeling nauseated and should be in the low position to prevent tipping.
2. Once the patient has a room, the EMTs will prepare to transfer the patient from the cot to the hospital gurney. When transferring, the EMTs should be sure the gurney is flat and the wheels are in the locked position.
3. If necessary, a transfer device such as a backboard can be used.
4. Get the two stretchers as close to each other as possible, making sure to lower any side rails that would interfere with the transfer. Release the cot straps but not the backboard straps.
5. With one EMT at each end of the backboard, move the patient over as a unit. If the patient is heavy, an additional EMT can switch the two stretchers as the first two EMTs lift the patient.

49. Packaging the Patient Transferring to the hospital bed Carry transfer
Direct carry of patient from the cot to the gurney
Use when a space is too narrow to accept the crew
Take time to plan this move
Occasionally the space at a doctor’s office or a clinic is too narrow to accept the crew, the ambulance cot, and the gurney. In these cases, the ambulance cot is placed against an adjacent wall and the crew performs a carry transfer, or direct carry, from the ambulance cot to the gurney.
The first EMT supports the patient’s head, neck, and shoulders. The second supports the lumbar section of the back and the buttocks. They simultaneously hoist the patient to the chest and, shuffling sideways, move the patient to the awaiting stretcher. All straps on the stretcher must be attached before moving the patient.

50. Packaging the Patient Transferring to the hospital bed
Draw sheet transfer
Linen is used to pull the patient from the cot to the hospital bed
Four EMTs needed, two on each side
With two stretchers next to each other, each EMT grabs a side of the cot’s linen and slides the patient onto the bed
With the draw sheet transfer, the cot’s linen is used to pull the patient across from the cot to the hospital bed.
Four EMTs are needed, two on each side.
With the two stretchers next to each other, each EMT grabs a side of the cot’s linen transfers. Each take a moment to pull opposite another, ensuring that the sheet has integrity and that all slack has been taken out. Simultaneously the EMTs slide the patient from the cot to the bed in one fluid motion. EMTs are cautioned that it is very easy to overextend the back in this move, with resultant injury.

51. Packaging the Patient Transferring to the hospital bed
Use of a transfer board
Helps reduce EMT back injuries
Reduces friction between patient and stretcher
Patient is pulled across using the draw sheet technique
In response to an alarming rise in back injuries, many hospitals have purchased transfer boards. Some newer model hospital gurneys now have a transfer board built into the frame.
Transfer boards, which are also called slide boards, act as a surface on which to slide the patient from the cot to the gurney. The smooth surface of the board reduces the friction between the patient and the stretcher, and thus reduces the work.
With the hospital gurney slightly lower than the ambulance cot, the patient is pulled across using the draw sheet technique.

52. Stop and Review
State several situations that may require the use of an emergency move.
Suggested Responses:
There is a fire or immediate danger of fire (such as a house fire or motor vehicle accident in which there is leaking fuel).
There is an explosion or an immediate danger of explosion (e.g., a fire at a petrochemical site).
The patient must be removed from a life-threatening hazard (such as a potential structural collapse, a gathering hostile crowd, or gunfire in the vicinity).
The patient is blocking access to another, more seriously injured patient or patients.