Chapter 8: Lifting and Moving Patients

Medical Restraints

- behavioral emergencies; poses a danger to you, team members, the patient, or bystanders - legal consequences for applying/not applying restraints

Steps for Performing the Rapid Extrication Technique

1.

Using a Scoop Stretcher

1. With the scoop stretcher separated, measure the length of the scoop and adjust to the proper length. 2. Position the stretcher, one side at a time. Lift the patient's side slightly by pulling on the far hip and upper arm, while your partner slides the stretcher into place. 3. Lock the stretcher ends together by engaging their locking mechanisms one at a time and continue to lift the patient slightly as needed to avoid pinching. 4. Apply and tighten straps to secure the patient to the scoop stretcher before transferring the stretcher.

Body Mechanics

The relationship between the body's anatomical structures and the physical forces associated with lifting, moving and carrying; the ways in which the body moves to achieve a specific action.

Diamond Carry

A carrying technique in which one provider is located at the head end of the stretcher or backboard, one at the foot end, and one at each side of the patient; each of the two providers at the sides uses one hand to support the stretcher or backboard so that all are able to face forward as they walk.

Power Lift

A lifting technique in which the EMT's back is held upright, with legs bent, and the patient is lifted when the EMT straightens the legs to raise the upper body and arms.

Direct Ground Lift

A lifting technique that is used for patients who are found lying supine on the ground with no suspected spinal injury.

Extremity Lift

A lifting technique that is used for patients who are supine or in a sitting position with no suspected extremity or spinal injuries.

Stair Chair

A lightweight folding device that is used to carry a conscious, seated patient up or down stairs.

Backboard

A long, flat board made of rigid, rectangular material that is used to provide support to a patient who is suspected of having a hip, pelvic, spinal, or lower extremity injury; also called a spine board, trauma board, and longboard.

Emergency Move

A move in which the patient is dragged or pulled from a dangerous scene before assessment and care are provided.

Basket Stretcher

A rigid stretcher commonly used in technical and water rescues that surrounds and supports the patient yet allows water to drain through holes in the bottom. Also called a Stokes litter.

Wheeled Ambulance Stretcher

A specially designed stretcher that can be rolled along the ground. A collapsible undercarriage allows it to be loaded into the ambulance; also called an ambulance stretcher or gurney

Flexible Stretcher

A stretcher that is a rigid carrying device when secured around a patient but can be folded or rolled when not in use.

Scoop Stretcher

A stretcher that is designed to be split into two or four sections that can be fitted around a patient who is lying on the ground or other relatively flat surface; also called an orthopedic stretcher.

Portable Stretcher

A stretcher with a strong rectangular tubular metal frame and rigid fabric stretched across it.

Power Grip

A technique in which the stretcher or backboard is gripped by inserting each hand under the handle with the palm facing up and the thumb extended, fully supporting the underside of the handle on the curved palm with the fingers and thumb.

Rapid Extrication Technique

A technique to move a patient from a sitting position inside a vehicle to supine on a backboard in less than 1 minute when conditions do not allow for standard immobilization.

The proper technique for using the power grip is to:

A. lift with your palms up. B. rotate your palms down. C. hold the handle with your fingers. D. position your hands about 6² apart.

As you and your partner are carrying a stable patient down a flight of stairs in a stair chair, you feel a sudden, sharp pain in your lower back. You should:

A. reposition your hands and continue to move the patient. B. stop the move and request additional lifting assistance. C. guide your partner while moving the chair backwards. D. stop the move and have the patient walk down the stairs.

It is essential that you ____________ your equipment to prevent the spread of disease.

A. throw out B. decontaminate C. incinerate D. properly store

The MOST serious consequence of a poorly planned or rushed patient move is:

A. unnecessarily wasting time. B. injury to you or your patient. C. causing patient anxiety or fear. D. confusion among team members.

The _________ is both the mechanical weight-bearing base of the spinal column and the fused central posterior section of the pelvic girdle.

A. coccyx B. sacrum C. thorax D. ischium

To minimize the risk of injuring yourself when lifting or moving a patient, you should:

A. flex at the waist instead of the hips. B. avoid the use of log rolls or body drags. C. use a direct carry whenever possible. D. keep the weight as close to your body as possible.

Performing a Body Drag

1. An EMT should be on each side of the patient. 2. Kneel just beyond the patient's shoulder facing his or her groin. 3. Extend one arm across and in front of your chest, and grasp the armpit. 4. Extend your other arm in front and to the side of the patient's torso, and grasp the patient's belt. 5. Raise your elbows and flex your arms to pull the patient.

Steps for Carrying a Patient on Stairs on a Backboard

1. Apply a strap that passes tightly across the upper torso and through each armpit, but not over the arms, to hold the patient in place while leaving the arms free. The strap is secured to the handles at both sides of the backboard so that it cannot slide toward the foot end of the backboard. Strap the patient securely to the backboard. 2. When you carry the patient down stairs or an incline, make sure the backboard or stretcher is carried with the foot end first so that the head end is elevated higher than the foot end. The straps will prevent the patient from sliding down or off the backboard.

Steps for Performing the One-Handed Carry

1. Before lifting the backboard, be sure that at least two providers are on each side of the backboard facing across from each other and using both hands. 2. Lift the backboard to carrying height using correct lifting techniques, including a locked-in back. 3. Once you have lifted the backboard to carrying height, you and your partners turn in the directions you will be walking and switch to using one hand.

Performing the Power Grip

1. Grasp the handle of the stretcher or backboard with your palms up and your thumbs extending up. 2. Make sure your hands are about 10 inches apart and that your fingers are all at the same angle. 3. The underside of the handle should be fully supported by the palms of your hands.

Steps for Performing a Extremity Lift

1. Kneel behind the patient's head as your partner kneels at the patient's feet. You and your partner should be facing each other. 2. The patient's hands should be crossed over his or her chest. 3. Place one hand under each of the patient's armpits. Grasp the patient's wrists or forearms and pull the upper torso until the patient is in a sitting position. 4. Your partner moves to a position between the patient's legs, facing in the same direction as the patient, and slips his or her hands under the patient's knees. 5. As you give the command, stand fully upright and move the patient to the stretcher.

Placing a Patient onto a Backboard

1. Log roll the patient onto his or her side 2. Kneel as close to the patient's side as possible, leaving only enough room so that your knees will not prevent the patient from being rolled. 3. Lean forward, keeping your back straight and leaning solely from the hips. 4. Use your shoulder muscles to help with the roll.

Steps for a Direct Carry

1. Position the stretcher parallel to the bed, facing the same direction as the bed. Prepare the stretcher by unbuckling the straps and removing any other items from it. Secure the stretcher to prevent movement. 2. Position yourself at the had of the bed facing towards the patient. Your partner should be positioned between the bed and the stretcher facing both you and the patient. 3. Slide your arms under the patient's neck and shoulders. Your partner should slide his or her hands under the patient's knees and lock them together or use them to grasp the posterior part of the patient's thighs. 4. Lift the patient upwards slowly and smoothly. Your partner should move the patient's knees from the left side of the body to the right to facilitate placing the patient onto the stretcher. 5. Slowly carry the patient from the bed to the stretcher. 6. Gently lower the patient to the stretcher and secure with straps.

Steps for Using a Stair Chair

1. Secure the patient to the stair chair with straps. At a minimum, use a lap belt at the hips and a strap around the chest. You should also use some method to secure the arms and hands so the patient does not reach out to grasp something and throw the carrying team off-balance, and ensure that the feet are either strapped or placed in the footrest. 2. Take your places around the patient seated on the chair: one provider at the head end and one at the foot end. The provider at the head end will give directions to coordinate the lift and movement. If a third provider is on scene, he or she way precede you and your partner. Keeping his or her hand on the back on the second provider who is at the feet, the third provider can assist by opening doors and providing guidance and support. For lengthy carries, a third provider can also rotate into the carrying team to provide breaks for the other two. 3. When reaching landings and other flat intervals in the move, lower the chair to the ground and roll the chair to the next position. Upon reaching the ground level where the stretcher awaits, roll the chair into position next to the stretcher in preparation for transferring the patient.

Steps for Performing a Direct Ground Lift

1. Take your places on one side of the patient with the first provider at the patient's head, the second provider at the patient's waist, and the third provider at the patient's knees. All providers kneel on one knee, preferably the same knee. 2. The patient's arms should be placed on his or her chest if possible. 3. The first provider places one arm under the patient's neck and shoulders and cradles the patient's head. The first provider then places the other arm under the patient's low back. 4. The second provider places one hand under the patient's waist, and the other under the knees. 5. The third provider places one arm under the patient's knees and the other under the ankles. 6. On command, the team lifts the patient up to knee level as each provider rests an arm on his or her knee. 7. As a team and on command, each provider rolls the patient in toward his or her chest. Again on command, the team stands and carries the patient to the stretcher.

Performing the Power Lift

1. Tighten your back in its normal upright position, and use your abdominal muscles to lock it in a slight curve 2. Spread your legs apart about 15 inches, and bend your legs to lower your torso and arms 3. With arms extended down each side of the body, grasp the stretcher or backboard with your hands held palm up and just in front of the plane described by the anterior torso and imaginary lines extending vertically from it to the ground. 4. Adjust your orientation and position until the weight is balanced and centered between both arms. 5. Reposition your feet as necessary so that they are about 15 inches apart with one slightly father forward and rotated so that you and your center of gravity will be properly balanced between them. Be sure to straddle the object, keep your feet flat, and distribute your weight to the balls of the feet or just behind them. The knees should not bend more than 90 degrees, nor extend past the toes. 6. With the arms extended downward, lift by straightening your legs until you are fully standing. Make sure your back is held upright and that your upper body comes up before your hips.

Steps for Loading a Stretcher into an Ambulance

1. Tilt the head end of the main frame upward, and place it into the patient compartment with the wheels on the floor. The two additional wheels that extend just below the head are attached to the main frame and will enable this movement. Ensure that the safety bar under the head of the stretcher catches on the hook prior to lifting the stretcher. 2. With the patient's weight supported by these two head-end wheels and the EMT at the foot end of the stretcher, move to the side of the main frame and release the undercarriage lock to lift the undercarriage up to its fully retracted position. The wheels of the undercarriage and the two on the head end of the main frame will now be on the same level. 3. Simply roll the stretcher the rest of the way into the back of the ambulance, where it will rest on all six wheels. 4. Secure the stretcher in the ambulance with the strong clamps that fasten around the undercarriage when the stretcher is pushed into them. The clamps are located in a rack on the floor or side of the patient compartment.

Steps for Performing a Diamond Carry

1. To best balance the weight, the providers at each side should be located so that they are able to grasp the backboard or stretcher with one hand adjacent to the distal edge of the patient's pelvis and other mid-thorax. All four providers lift the device while facing toward the patient. 2. The provider at each side should grasp the backboard or stretcher with the head-end hand. 3. The providers at each side turn toward the patient's feet. The provider at the foot end turns to face forward. All four providers should face the same direction and walk forward when carrying the patient.

In contrast to typical wheeled ambulance stretchers, features of a bariatric stretcher include:

A. a collapsible undercarriage. B. weight capacity of up to 650 lb. C. increased stability from a wider wheelbase. D. two safety rails on both sides of the stretcher.

An EMT may injure his or her back, even if it is straight, if the:

A. back is bent forward at the hips. B. hands are held close to the legs. C. shoulder is aligned over the pelvis. D. force is exerted straight down the spine.

To facilitate a safe and coordinated move, the team leader should:

A. be positioned at the feet so the team can hear. B. use preparatory commands to initiate any moves. C. speak softly but clearly to avoid startling the patient. D. never become involved in the move, only direct the move.

To protect a restrained patient and prevent him from using leverage to break free, the EMT should secure __________.

A. both arms above the head B. both arms at the patient's sides C. only the patient's torso D. one arm above the head