1. Lifting and Moving Patients
Chapter 35

2. Introduction In the course of a call, EMTs move patients.
To move patients without injury, you need to learn proper techniques.
Correct body mechanics, grips, and devices are important.

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 (2 of 12)

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

8. 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

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

10. 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.

11. 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.
See Skill Drill 35-1.

12. 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

13. Body Mechanics (10 of 12)

14. 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.

15. Body Mechanics (12 of 12)

16. 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.

17. 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.
See Skill Drill 35-2 and Skill Drill 35-3.

18. Weight and Distribution (3 of 9)

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

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

21. Weight and Distribution (6 of 9)
If you must use a backboard or wheeled stretcher on stairs, see Skill Drill 35-4.

22. Weight and Distribution (7 of 9)
A stair chair can be used to bring a conscious patient down to stretcher (see Skill Drill 35-5).

23. Weight and Distribution (8 of 9)

24. 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

25. 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

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. 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.

32. General Considerations
Move a patient in orderly, planned, unhurried manner.
Carefully plan ahead.
Select methods that will involve least amount of lifting and carrying.

33. Emergency Moves (1 of 5)
Use when there is potential for danger before assessment and management.
Examples: fire, explosives, hazardous materials
Use when you cannot properly assess patient or provide immediate care because of patient’s location or position.

34. Emergency Moves (2 of 5)
If you are alone, use a drag to pull patient along long axis of body.
Use techniques to help prevent aggravation of patient spinal injury.
Clothes drag
Blanket drag
Arm drag
Arm-to-arm drag

35. Emergency Moves (3 of 5)

36. Emergency Moves (4 of 5)
To remove unconscious patient from vehicle alone:
First move legs clear of pedals.
Rotate patient so back is toward open car door.
Place arms through armpits and support head against your body.
Drag patient from seat to a safe location.

37. Emergency Moves (5 of 5)

38. Urgent Moves (1 of 2) Necessary to move patient with:
Altered level of consciousness
Inadequate ventilation
Shock
Rapid extrication technique requires team of knowledgeable EMTs.
See Skill Drill 35-6.

39. Urgent Moves (2 of 2)
Rapid extrication technique is an urgent move and should only be used if urgency exists.
Patient can be moved within 1 minute.
Technique increases damage if patient has spinal injury.
Look at all options before using technique.

40. Nonurgent Moves (1 of 5) Used when both scene and patient are stable
Carefully plan how to move the patient.
Team leader should plan the move.
Personnel
Obstacles identified
Equipment
Path

41. Nonurgent Moves (2 of 5) Direct ground lift (Skill Drill 35-7)
For those with no suspected spinal injury who are supine.
Patient will need to be carried distance.
EMTs stand side by side to lift/carry.

42. Nonurgent Moves (3 of 5) Extremity lift (Skill Drill 35-8)
For those with no suspected spinal injury who are supine or sitting
Helpful when patient is in small space
One EMT at patient’s head and the other at patient’s feet
Coordinate moves verbally.

43. Nonurgent Moves (4 of 5)
To transfer a patient from bed to stretcher, use:
Direct carry (see Skill Drill 35-9)
Move supine patient from the bed to stretcher using a direct carry method.
Draw sheet method
Move patient from bed to stretcher using a sheet or blanket.
Scoop stretcher (see Skill Drill 35-10)

44. 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.

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

46. 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.

47. 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.

48. Patient-Moving Equipment (1 of 3)
Stretcher is available in many models with various features.
General features
Head and foot end
Strong metal frame (to push, pull, lift)
Hinges at center allow for elevation of head/back.
Guardrail prevents patient from rolling out.

49. Patient-Moving Equipment (2 of 3)
General features (cont’d)
Undercarriage frame allows adjustment to any height.
Stretcher has locking mechanism when controls are not activated.
Controls are located at the foot end and at one or both sides of most stretchers.

50. Types of Stretchers (1 of 19)
Wheeled ambulance stretcher
Also called a stretcher or gurney
Most commonly used device

51. Types of Stretchers (2 of 19)
Wheeled ambulance stretcher (cont’d)
Patient may be secured directly to stretcher
Or, patient may be secured to backboard first if:
Suspected spinal injury or multisystem trauma
Patient is in need of CPR

52. Types of Stretchers (3 of 19)
Bariatric stretcher
Specialized for overweight or obese patients
Wider wheel base for increased stability
Source: Courtesy of Stryker Medical

53. Types of Stretchers (4 of 19)
Bariatric stretcher (cont’d)
Some have tow package with winch.
Rated to hold 850–900 lb
Regular stretcher rated for 650 lb max.

54. Types of Stretchers (5 of 19)
Pneumatic and electronic-powered wheeled stretcher
Battery operated electronic controls to raise/lower undercarriage
This increases the weight of stretcher.
Hazardous for uneven terrain or stairs
Source: Courtesy of Stryker Medical

55. Types of Stretchers (6 of 19)
Loading a wheeled stretcher into an ambulance
Ensure the frame is held firmly between two hands so it does not tip.

56. Types of Stretchers (7 of 19)
Loading a wheeled stretcher into an ambulance (cont’d)
Newer models are self-loading, allowing you to push the stretcher into ambulance.
Other models need to be lowered and lifted to the height of the floor of ambulance.
Clamps in ambulance hold stretcher in place.
See Skill Drill

57. Types of Stretchers (8 of 19)
Portable/folding stretcher
Strong, rectangular tubular metal frame with fabric stretched across it

58. Types of Stretchers (9 of 19)
Portable/folding stretcher (cont’d)
Some models have two wheels.
Some can be folded in half.
Used in areas difficult to reach
Weigh less then wheeled stretchers

59. Types of Stretchers (10 of 19)
Flexible stretcher
Can be rolled into a tubular package
Excellent for storage and carrying
Conform around a patient’s sides
Useful for confined spaces
Uncomfortable, but provides support and immobilization

60. Types of Stretchers (11 of 19)
Backboard
Long, flat, and made of rigid rectangular material (mostly plastic)
Used to carry and immobilize patients with suspected spinal injury or other trauma

61. Types of Stretchers (12 of 19)
Backboard (cont’d)
Commonly used for patients found lying down
6′ to 7′ long
Holes serve as handles and a place to secure straps.

62. Types of Stretchers (13 of 19)
Backboard (cont’d)
Short backboards or half-boards are used to immobilize seated patients
Example: the KED vest-type device

63. Types of Stretchers (14 of 19)
Basket stretcher
Rigid stretcher also called a Stokes litter
Used for remote locations inaccessible by a vehicle, including water rescues and technical rope rescues

64. Types of Stretchers (15 of 19)
Basket stretcher (cont’d)
If spinal injury, secure patient to backboard and place inside basket stretcher to carry patient out of location.
When you return to ambulance, lift the backboard out of basket stretcher and place on wheeled stretcher.

65. Types of Stretchers (16 of 19)
Scoop stretcher
Also called orthopaedic stretcher

66. Types of Stretchers (17 of 19)
Scoop stretcher (cont’d)
Splits into two or four pieces
Pieces fit around patient who is lying on flat surface and reconnect
Both sides of patient must be accessible.
Patient must be stabilized and secured on scoop stretcher.

67. Types of Stretchers (18 of 19)
Stair chair
Folding aluminum frame chairs with fabric stretched across to form a seat and back
Most have rubber wheels in the back

68. Types of Stretchers (19 of 19)
Neonatal isolette
Also called an incubator
Neonates cannot be transported on a wheeled stretcher.
Isolette keeps neonate warm, protects from noise, draft, infection, excess handling.
Isolette may be secured to wheeled ambulance stretcher or freestanding.

69. Decontamination Decontaminate equipment after use. For your safety
For the safety of the crew
For the safety of the patient
To prevent the spread of disease

70. Medical Restraints (1 of 2)
Evaluate for correctible causes of combativeness.
Head injury, hypoxia, hypoglycemia
Follow local protocols.
Restraint requires five personnel.
Restrain patient supine.
Positional asphyxia may develop in prone position.

71. Medical Restraints (2 of 2)
Apply restraint to each extremity.
Assess circulation after restraints are applied.
Document all information.

72. Personnel Considerations (1 of 2)
Questions to ask before moving patient:
Am I physically strong enough to lift/move this patient?
Is there adequate room to get the proper stance to lift the patient?
Do I need additional personnel for lifting assistance?

73. Personnel Considerations (2 of 2)
Remember, an injured rescuer cannot help anyone.

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