Chapter 8: Lifting and Moving Patients

Neonatal Isolette

Also called incubator, this device keeps the neonate warm, protects the child from noise, draft, infection, and excess handling. - The isolette may be secured to a wheeled ambulance stretcher or freestanding

Vacuum mattresses

Alternate to backboards for immobilizing geriatrc and pediatric patients - Air is removed from the device

In what carry does one provider walk backwards?

Two person carry

moving and positioning the patient

When you move a patient, take care that injury - To you - To your team - To the patient Patient lifting and moving are technical skills that require repeated training and practice - many EMTs are injured living and moving patients (twisting while lifting is the most common) - test question Note: back injuries account for the largest number of missed days of work

The scoop stretcher is also known as what?

orthopedic stretcher

The majority of a horizontal patient's weight is in...

the torso.

power grip

*hand 10 inches apart* test question 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.

Body drag

- The same body mechanics that apply to moving Extend your arms no more than 15 to 20 inches in front of you

Urgent move

- With altered level of consciousness - With inadequate ventilation - In shock - In extreme weather conditions - Rapid extrication technique

Principle of safe lifting

- know your limitations, Do not attempt to lift a patient weighing more than 220lb

patient often weigh an average of

120-220 Lb, two EMTs should be able to safely lift this weight. EMT should be able to lift 125 lb. Request help if needed. Only use bystanders in absolute emergencies.

When pulling a patient, you should extend your arms no more than ________ in front of your torso.

15 to 20 inches

direct ground lift

A lifting technique that is used for patients who are found lying supine on the ground with no suspected spinal injury. Step 1) Line up on the side of the patient, with one provider at the head, one at the waist, and one at the patient's knees. All providers should be kneeling. Place the patient's arms on his or her chest, if possible. Step 2) On command, lift the patient to knee level. Step 3) On command, roll the patient toward your chest, and then stand and carry the patient to the stretcher.

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. Step 1) The patient's hands are crossed over the chest. Grasp pt's wrist or forearms and pull pt to sitting position. Step 2) Your partner moves to a position between the patient's legs, facing in the same direction as the patient, and places his or her hand under the knees. Step 3) Rise to a crouching position. On command, lift and begin to move.

emergency move

A move in which the patient is dragged or pulled from a dangerous scene before assessment and care are provided. Examples: Fire, explosions, hazardous materials Note: This will be very rare. Nev

When lifting a backboard, how should you lift it?

A patient on a backboard or stretcher can be lifted and carried by four providers in a diamond carry, with one provider at the head end of the device, one at the foot end, and one at each side of the patient's torso.

What is considered an urgent move?

A rapid extrication technique is an urgent move.

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. Step 1) The first provider provides in-line manual support of the head and cervical spine. Step 2) The second provider gives commands, applies a cervical collar, and performs the primary assessment. Step 3) The second provider supports the torso. The third provider frees the patient's legs from the pedals and moves the legs together, without moving the pelvis or spine. Step 4) The second provider and the third provider rotate the patient as a unit in several short, coordinated moves. The first provider (relieved by the fourth provider as needed) supports the patient's head the neck during rotation (and later steps.) Step 5) The first (or fourth) provider places the blackboard on the seat against the patient's buttocks. (Use of the backboard may depend on local protocols.) Step 6) The third provider moves to an effective position for sliding the patient. The second and the third providers slide the patient along the backboard in coordinated 8-to-12inch (20-to-30cm) moves until the patient's hips rest on the blackboard. Step 7) The third provider exist the vehicle and moves to the blackboard opposite the second provider, and they continue to slide the patient until the patient is fully on the blackboard. Step 8) The first (or fourth) provider continues to stabilize the head and neck while the second provider and the third provider carry the patient away from the vehicle and onto the prepared stretcher.

Which of the following statements regarding an emergency patient move is correct?

An emergency move is performed before the primary assessment and treatment.

short backboard

KED vest-type device: Kendric's extrication device - Used to immobilize seated patients

Lifting techniques

Legs should be spread about 15 inches apart (shoulder width - test question - Place feet so the center of gravity is balanced with your back held upright, bring your upper body down by bending the legs - grasp the patient/stretcher - keep the weight as close you you as possible

bariatrics gurneys

Much wider gurney that has poles in front and back in order to lift him lower than normal. - rated to hold 850-900 lbs. Test question - some have a tow package with a winch Note: Regular stretcher rated for 650 lb maximum

geriatrics

Old folks are fragile. - Padding is key and put them on there side if there back is spondylosis

one handed carry

Step 1) Face each other and use both hands Step 2) Lift the blackboard to carrying height Step 3) Turn in one direction you will walk, and switch to using one hand

Direct carry

Step 1) Position the stretcher parallel to the bed. Secure the stretcher to prevent movement. Face the patient while standing between the bed and the stretcher. Position your arms under the patient's neck and shoulders. Your partner should position his hands under the patients knees. Step 2) Lift the patient from the bed in a smooth, coordinated fashion. Step 3) Slowly carry the patient to the stretcher. Step 4) Gently lower the patient onto the stretcher and secure with straps.

Moving a Patient on Stairs with a streacher

Step 1) Strap the patient securely. Make sure one strap is tight across the upper torso, under the arms, and secured to the handles to prevent the patient from sliding. Step 2) Carry a patient downstairs with the foot end first, always keeping the head elevated.

Loading a wheeled stretcher into an ambulance

Step 1) Tilt the head of the stretcher upward and place it into the patient compartment with the wheels on the floor and the safety bar latched on the hook. Step 2) The second EMT on the side of the stretcher releases the undercarriage lock and lifts the undercarriage. Step 3) Roll the stretcher into the back of the ambulance. Step 4) Secure the stretcher to the clamps mounted in the ambulance.

stair chair

Takes 3 people to perform the move - test question A lightweight, wheeled folding chair with molded seat, adjustable safety straps, and fold out handles at both the head and feet. Used to carry a conscious, seated patient up or down stairs. Step 1) Position and secure the patient on the chair with straps. Take your places at the head and foot of the chair. Step 2) Lower the chair to roll on landing and for transfer to the stretcher

You are transporting a 50-year-old patient who reports respiratory distress but has no other indications of other injury or illness. What is the best position in which to place this patient?

The best placement for this patient is a Fowler or semi-Fowler position.

diamond carry

The one handed carry use one EMT at the head and the foot, and one on each side of the patient's torso. 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. Step 1) Place yourself facing the patient Step 2) Both providers at each end turn hand palm-down and release their other hand Step 3) Both providers turn toward the foot end. Provider at the foot end turns to face forward.

When carrying a patient down a flight of stairs on a backboard, which person should be at the head end of the backboard?

The shorter of the strong team members

Principles of reaching and pulling

To drag a patient acros a bed - Kneel on the bed to avoid reaching beyond the recommended distance - drag the patient to within 15-20 inches - uses

To avoid the strain of unnecessary lifting and carrying, which of the following should you use when moving a patient from the ground onto a stretcher?

Using the draw sheet method can help you avoid the strain of unnecessary lifting and carrying.

When lifting the patient, it is imperative to use which proper body mechanics?

You should keep your spine aligned and upright.

You are called to a scene where a 40-year-old man was clearing trees in a remote area and was struck by a falling tree. When you arrive, he is conscious but the tree is laying across his lower legs. How should you remove the victim once the tree is removed?

You should use a direct lift for patients with no suspected spinal injury who are lying supine and need to be carried some distance to be placed on a stretcher.

You are dispatched to a house where an 80-year-old woman has fallen in an upstairs bathroom and hit her head on the sink. When you arrive she is unconscious. Which is the best equipment to use to move her to the ambulance?

a backboard is the best equipment to move her, Because the patient is unconscious and must be moved down a flight of stair.

Transfer move: draw-sheet method

a method of transferring a patient from bed to stretcher by grasping and pulling the loosened bottom sheet of the bed.

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

back is bent forward at the hips.

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

decontaminate

Upon arriving at the scene of a motor vehicle crash, you find a single patient still seated in his car. There are no scene hazards. As you approach the vehicle, you note that the patient is semiconscious and has a large laceration to his forehead. You should:

direct your partner to apply manual in-line support of the patient's head

You are attending to a 34-year-old male patient who requires transport to the hospital for assessment of his chronic back pain. The patient weighs over 750 pounds. Your bariatric stretcher has a wider surface area to allow for:

increased patient comfort and dignity.

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

increased stability from a wider wheelbase.

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

injury to you or your patient.

You are attending to a 26-year-old female who is 34 weeks pregnant with her first child. Your patient has been having lower abdominal pains and cramping for the past two hours. In placing your patient on the stretcher and preparing for transport, you should place her:

on her left side.

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

one arm above the head

When moving a conscious, weak patient down a flight of stairs, you should:

place the wheeled stretcher at the bottom of the stairs and carry the patient down the stairs with a stair chair

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

sacrum

You are attending to a 22-year-old female patient who has overdosed. The patient is unresponsive in an upstairs bedroom. The most appropriate way to bring the patient downstairs is:

secured to a fracture board with the strongest provider at the head end.

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:

stop the move and request additional lifting assistance.

log roll

the method used to turn a patient with a spinal injury, in which the patient is moved to the side in one and placed on the backboard - guy on head does the counting to protect cervical spine

packaging

the process of preparing a patient for transport

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

use preparatory commands to initiate any moves

Non urgent move

used when there are no hazards and no life-threatening conditions apparent and patient is stable. - Team leader should plan move.

bariatrics

A branch of medicine concerned with the management (prevention or control) of obesity and allied diseases. - Overall 30-40% of adults are obese - 40% among adults aged 40 to 59 - 30% among adults aged 20 to 39 - 35% among older adults aged 61 years or older - 17% among children and adolescents

You are responding to an accident where a 25-year-old female fell 15 feet while rock climbing. The terrain is steep and there is not much space to work. Which device should you use?

A flexible stretcher can be used if the patient must be belayed or rappelled by ropes or is in a confined space.

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. Step 1) Lock your back in a slight curve. Spread and bend your legs. Grasp the backboard, palms up and just in front of you. Balance and center the weight between your arms. Step 2) Position your feet, straddle the object, and distribute your weight evenly. Lift by straightening your legs, keeping your back locked in.

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. - 6 to 7 feet long - holes serve as handles and a place to secure straps - used to move patient out of akward places

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 the stretcher or an ambulance stretcher. (gurney very common) - Weighs 40-145lb - Head end and a foot end - Strong metal frame to which all other parts are attached - Hinges at center allow for elevation of head/back - The patient is secured in straps - Undercarriage frame allow adjustment of height - The patient is secured with straps

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. Step 1) Adjust the length of the stretcher Step 2) Lift the patient slightly and slide the stretcher into place, one side at a time. Step 3) Lock the stretcher ends together, and avoid pinching either the patient or your fingers. Step 4) Secure the patient to the scoop stretcher and transfer it to the wheeled stretcher.

portable stretcher

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

The MOST unique challenge to the EMT when immobilizing an elderly patient on a long backboard?

Abnormal spinal curvature

Medical Restraints

Evaluate for correctable causes of combativeness like head injury, hypoxia, hypoglycemia - Follow local protocols - Restraint requires five people

In lifting with the palm down, the weight is supported by the _________ rather than the palm.

Fingers

Which of the following is the MOST appropriate device to use when immobilizing a patient with a suspected spinal injury?

Long backboard

Body mechanics

Straight back and lift straight up the axis of the body

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.