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

2. Objectives 5.1 Define body mechanics.
5.2 Describe and demonstrate a power grip.
5.3 Describe and demonstrate a power lift.
5.4 Describe the basic guidelines for safely moving a patient.
5.5 Explain the difference between an urgent move and a nonurgent move.
5.6 List and describe various devices used to move and transport patients.
Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care.
All participants have a license to stop unsafe lifting when observed!
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3. Objectives
5.7 Describe and demonstrate the following drags, lifts, and carries:
Shoulder drag
Extremity lift
Bridge/BEAN lift
Human crutch
Fore and aft carry
Chair carry
BEAM lift
Draw sheet carry
Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care.
All participants have a license to stop unsafe lifting when observed!
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4. Objectives
5.8 List and demonstrate the proper use of equipment to move, lift, and carry a patient.
5.9 Compare and contrast common transportation devices.
5.10 List the components of a safe landing zone (LZ).
Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care.
All participants have a license to stop unsafe lifting when observed!
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5. Objectives
5.11 Describe and demonstrate how to safely move when near a helicopter.
5.12 Describe the use of CPR during transport.
Must emphasize repeatedly, throughout this presentation, the importance of ALWAYS using safe lifting techniques during practice as well as in patient care.
All participants have a license to stop unsafe lifting when observed!

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

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

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

9. Body Mechanics Power Lift for strength & safety!
Remain erect, spine straight, shoulders over hips (axial loading), feet shoulder-width apart.
Use abdominal/back muscles – maintain vertebral alignment, bend knees to squat.
Discussion Points:
Relevance of this information, i.e. injury rates, chronic nature of back injury, career-ending injuries.
Use spine analogy of child’s building blocks, while stacked squarely upon one another, are very strong. If stacked askew, then wobbly, unsteady and not strong.
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10. Body Mechanics Power Lift for strength & safety!
Power Grip for object to be lifted.
Keep head up and straighten legs to lift.
Exercise regularly & lose weight
Discussion Points:
Relevance of this information, i.e. injury rates, chronic nature of back injury, career-ending injuries.
Use spine analogy of child’s building blocks, while stacked squarely upon one another, are very strong. If stacked askew, then wobbly, unsteady and not strong.
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11. Body Mechanics What is wrong with this picture? continued
Copyright Edward McNamara

12. Body Mechanics Plan the lift. Know your physical limitations.
Get help! Make it a team effort.
Keep feet shoulder’s width apart.
Keep your back straight.
Do not reach over your head.
Get a good grip on object lifted.
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13. Body Mechanics Bend your knees! Lift with your legs.
Keep shoulders centered over spine.
Keep object close to your body.
Keep your head up while lifting.
Turn with your feet, not your hips.
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14. Body Mechanics What is right with this picture?
Discussion Points:
Put all of this into practice, with students coaching each other and being watchful for improper techniques.
Practice leading bystanders to help a team in safely lifting.
For props, bring bulky, light weight items to practice proper technique, e.g. very large empty boxes, rolls of bubble wrap, garbage bags of packing peanuts.
Copyright Edward McNamara

15. Devices and Equipment Transfer flat – for very large patient
Reinforced material with handles
Log-roll patient onto material
Slide, lift or carry with a team
Portable stretcher – for transport
Lightweight, aluminum frame
Folding or one-piece
Load patient with appropriate move.
Discussion Points:
Demonstrate each available device or piece of equipment.
Allow hands-on practice by students.
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16. Devices and Equipment
Long Spine Board (LSB) – for spine, hip, pelvis & femur immobilization; transportation or extrication.
Discussion Points:
LSBs come in variety of shapes, sizes & materials.
Lift or log-roll patient onto board as dictated by injury.
Pad voids between board and body.
Secure patient to board.
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17. Devices and Equipment
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Copyright Scott Smith

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

20. Devices and Equipment
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Copyright Edward McNamara

21. Devices and Equipment
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Copyright Edward McNamara

22. Devices and Equipment
Basket stretcher (Stokes) – primarily backcountry or high-angle rescue use
Discussion Points:
Basket stretcher
Ultra lightweight Kevlar or titanium
One piece or splits-in-two for carrying
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23. Devices and Equipment
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24. Devices and Equipment
Short Spine Board & Vest-Type Lifting/Immobilizing Devices – seated patient requiring extrication.
Commonly used in vehicle extrication
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25. Devices and Equipment
Sitting Lift Device – to transport non-ambulatory patient short distance with one leg extended.
Discussion Points:
Patient sits on board with injured leg extended and supported.
Carry patient from aid room to car.
Leg must be stabilized by rescuers.
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26. Devices and Equipment
Copyright Edward McNamara

27. Moving the Patient Do NO Harm! NEVER drop a patient or allow a fall!
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28. Moving the Patient
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Copyright Jon Politis

29. Moving the Patient Does the patient have a suspected spinal injury?
Yes  protect the spine
No  invite the patient to assist in move
Does the patient need to be moved immediately?
Yes  Urgent Move
No  Non-urgent move
Discussion Points:
Precautions for having the patient assist in move, i.e. protect/stabilize injured part, protect from fall due to syncope (fainting) or instability.
Scenarios that may warrant an Urgent Move.
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30. Moving the Patient
Urgent Moves – hazard is present or patient position prevents urgent care.
Life-threatening hazard to patient/rescuer
Or need move in order to administer CPR
Usually moved before assessment
Usually moved less than 100 feet
Usually a drag
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31. Moving the Patient Greatest Risks of Urgent Moves
Delaying life-saving interventions
Aggravating existing injury, particularly spine injury
Rescuer injury
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32. Moving the Patient Minimize risk of further spine injury:
Minimize patient movement
Maintain anatomical alignment of patient’s spine – long axis
Discussion Points:
Practice Reminders - protect rescuer back when practicing drags – keep knees bent, spine straight, head facing forward.
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33. Moving the Patient Long-axis drags (often unconscious) Shoulder drag
Underarm-wrist drag
Blanket drag
Feet drag (head not protected)
Discussion Points:
Practice Reminders - protect rescuer back when practicing drags – keep knees bent, spine straight, head facing forward.
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34. Moving the Patient
Non-urgent Moves – patient may be moved in a controlled fashion.
Human crutch
Two-person assist
Chair carry
Fore and aft carry
Back carries
Improvised carries
Discussion Points:
Non-urgent moves are the most commonly utilized, for example moving the patient from the ground to the toboggan, from the toboggan to the gurney and from the gurney to the car.
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35. Case Update
You confirm that no others involved You have called the fire department, requested help, equipment, and O2. The fire continues to grow; you must move unconscious man, using a long-axis drag. The coworker assists with underarm wrist drag to 50 feet away from building.
Next steps: What do you do next?
Complete the primary and secondary assessment, vital signs.
Protect airway.
On-going assessment.
EMS arrives on scene.

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

38. Lifting the Patient Multiple Person Direct Ground Lift continued
Discussion Points:
Direct Ground Lift – when to use?
No spine injury.
All rescuers on same side of patient.
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39. Lifting the Patient
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40. Lifting the Patient
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41. Lifting the Patient
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42. Lifting the Patient Bridge/BEAN lift continued
BEAN = Body Elevation And Non-movement
No suspicion of spine injury.
Load a spine board.
Explain: BEAM = Body Elevation And Movement
Simply a BEAN lift with travel of the patient
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43. Lifting the Patient
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Copyright Edward McNamara

44. Lifting the Patient
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Copyright Edward McNamara

45. Lifting the Patient
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Copyright Edward McNamara

46. Lifting the Patient
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Copyright Edward McNamara

47. Lifting the Patient BEAM lift Is a BEAN lift with Movement. continued
BEAN = Body Elevation And Non-movement
No suspicion of spine injury.
Load a spine board.
Explain: BEAM = Body Elevation And Movement
Simply a BEAN lift with travel of the patient
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48. Lifting the Patient Draw-Sheet lift To lift just a few inches
Transfer to surface of similar height
Discussion Points:
Draw-Sheet lift – when to use?
To lift just a few inches
Transfer to surface of similar height
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49. Transporting the Patient
Semi-Fowler position
Sitting with upper body at 45°
Conscious and no serious injury
High-Fowler position
Sitting with upper body at 90°
Severe breathing problem
Supine position
Flat on back, face up
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50. Transporting the Patient
Rothberg position
Upper body at 45° and legs raised with flexion at knees and hip.
Chest pain or heart attack.
Trendelenburg position
Head 15-30° lower than heart and feet 15-30° higher than heart.
Patient in shock
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51. Transporting the Patient
Types of ground transport
Toboggan/sled and sled pack
Stretcher or litter
Transport vehicles
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52. Transporting the Patient
Packaging the Patient Basics
Properly positioned on transport device.
Comfortable as possible
Secured within transport device.
Medical equipment sent, as needed.
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53. Transporting the Patient
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54. Transporting the Patient
Toboggan Transport: Injury uphill
Dictated by injury/illness.
Generally most comfortable
Prevents pressure on injury
Discuss challenges of toboggan transport – steep terrain, gravity, shifting downhill within toboggan.
Discuss rationale and priorities in decision making and exceptions.
Discuss aspects of comfort & safety during toboggan transport: Prevent heat loss, secure with straps, assure secure inclusion of necessary medical equipment.
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55. Transporting the Patient
Exceptions to Rule
Difficulty breathing – Head Uphill
Shock – Head Downhill
Serious head injury – Head Uphill
Discuss challenges of toboggan transport – steep terrain, gravity, shifting downhill within toboggan.
Discuss rationale and priorities in decision making and exceptions.
Discuss aspects of comfort & safety during toboggan transport: Prevent heat loss, secure with straps, assure secure inclusion of necessary medical equipment.
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56. Transporting the Patient
Basket Stretcher/Litters
Wheeled Ambulance Stretcher
Evacuation Chair
Improvised Litters
Transport Vehicles
All-terrain vehicles
Snow machines
Golf carts
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57. Transporting the Patient
Air Transportation – rotary wings
Weather limitation – rescue usually VFR
Altitude & temperature limitations
 Altitude  Air Density  Power Required
 Temp  Air Density  Power Required
Space & load limitations
Pilot responsible for limiting load
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58. Transporting the Patient
Helicopter safety
Landing zone (LZ) selection
100 ft. × 100 ft.
Flat, or no more than 8° slope
Free of overhead obstructions
Free of loose objects or debris
Well lit (shine no lights at pilot)
Control access by pedestrians or animals
Discussion Points:
Rationale for LZ selection guidelines
Danger of crash during landing or take-off.
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59. Transporting the Patient
Helicopter safety
Ground-to-Air Communications
Landing coordinator formally trained
Pre-arrival communications
Helicopter ETA & direction of travel
LZ coordinates, weather & wind direction
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60. Transporting the Patient
Helicopter safety
Ground operations
Approach helicopter only when crew says.
Never approach helicopter from rear.
Maintain eye contact with pilot at all times.
Stay low.
Hold nothing above your head
Remove loose hat or clothing
Secure any loose items

61. CPR During Transport Sled CPR Method – 3 rescuers min.
Call for ALS, AED and O2 rescue pack.
Initiate CPR
Stop CPR to log roll to LSB & continue
Secure patient to LSB, continuing CPR
Set up toboggan & secure front rescuer
Stop CPR to load LSB/patient in sled
Front rescuer resumes 1-rescuer CPR
Secure LSB in sled & evac.
Techniques and protocols of CPR are discussed in the Cardiovascular Emergencies chapter.
Urgent rendezvous with AED improves patient survival.
Specific on-hill procedures are area-specific and developed with your medical advisor and area management.
Invite discussion of difficulties of CPR during transport down from the ski slope.
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62. CPR During Transport Leap Frog CPR Method – 5 rescuers
Used in steep terrain or moguls
Call for ALS, AED and O2 rescue pack.
Initiate CPR
Stop CPR to log roll to LSB & continue CPR
Secure patient to LSB, continuing CPR
Stop CPR to load LSB/patient in sled
Discuss selection of method, advantages, and limitations.
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63. CPR During Transport Leap Frog CPR Method – 5 rescuers
Resume 2-rescuer CPR – 5 cycles
Run toboggan seconds downhill
Repeat 2-rescuer CPR & sled run
Discuss selection of method, advantages, and limitations.

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

65. Chapter Summary
Back injuries may be prevented through exercise, weight
maintenance, and good body mechanics.
Plan each move carefully; get help when lifting.
Keep your back straight and lift with your legs.
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66. Chapter Summary Do not drop the patient.
Urgent moves require preserving the long axis of the spine.
Used properly, equipment can facilitate a move or a lift.
A landing zone should be at least 100 feet by 100 feet.
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67. Chapter Summary
Do not approach a helicopter unless instructed to do so by the pilot or a crew member; keep your head low.
Never approach a helicopter from the rear.