LIFTING AND MOVING PATIENTS

1. LESSON 23 LIFTING AND MOVING PATIENTS

2. Introduction • Moving injured patient likely to cause further injury • In most cases wait for professional help • May have to move patient to protect from danger at scene • May need to assist other EMS personnel

3. Back injury is hazard for EMRs To minimize risks, use good body mechanics Body mechanics are principles of using your body safely Body Mechanics

4. Body Mechanics andLifting Techniques • Know your physical ability and limitations • Plan the lift • Ensure you have a good grip • Test the load • Position your feet properly before starting lift • Lift with your legs, not with your back (power lift) • Keep patient’s weight close to your body

5. Body Mechanics and Lifting Techniques (continued) • Lift straight up, maintain good posture • Avoid twisting your back during lift • Use good technique when reaching • When possible, push rather than pull • Communicate clearly with your partner and other EMS providers

6. Patient Positioning • Reposition patient only when necessary • Reposition breathing, unresponsive, non-trauma patient in recovery position • Don’t move or reposition trauma patient unless necessary to treat life-threatening condition • Allow responsive patient to assume comfortable position

7. Log Roll • Use log roll to move patient from prone to supine • 3-5 rescuers are needed to safely roll patient • For trauma patient with spinal injury, stabilize head in line with body during move

8. Skill: Log Roll • Rescuer at patient’s head holds head in line with body as 2 or 3 additional rescuers take position with hands at patient’s lower and upper leg, hip and torso, and shoulder • On the count of responder at the head, rescuers in unison roll patient toward them, with head held in line and spine straight • Rescuers complete log roll, positioning patient on back with head and neck still in line with body

9. Emergency Moves Use only if: • Patient faces immediate danger • You cannot give lifesaving care because of location or position

10. Risk of Spinal Injury • Moving patient quickly risks aggravating a spinal injury • Keep head and neck in line with spine • It is impossible to completely protect spine while removing patient from a vehicle quickly

11. Extrication from Vehicles • EMRs may be trained in rapid extrication using cervical collar and inline stabilization of head/neck • Follow local protocol • Wait for EMTs trained in special extrication techniques

12. 1-Rescuer Emergency Drags • Pull or drag patient in direction of long axis of body • Don’t drag patient sideways • Avoid twisting neck and trunk • Never pull head away from neck and shoulders • Risk of spinal injury can be minimized by using blanket, rug, board, etc. • Choice of move depends on materials at hand, patient’s condition and situation

13. 1-Rescuer Emergency Drags(continued) • Clothing drag • Blanket drag • Shoulder drag • Firefighter’s drag • Upper extremity drag • Upper extremity drag for rapid extrication

14. Emergency Carries • Used when patient must be moved immediately • 1 or more rescuers may carry patient • Method used depends on patient’s size and condition and the situation

15. Use good body mechanics and lifting techniques Don’t try to lift or carry person before checking for injuries With All Emergency Carries

16. Moving Patients – If Alone • Unresponsive patient who cannot safely be dragged – Packstrap carry

17. Moving Patients – If Alone (continued) • Lighter patient or child • Cradle carry (responsive or unresponsive patients) • Piggyback carry (responsive patient)

18. Piggyback Carry • Support patient’s weight with your arms under patient’s thighs • If able, have patient clasp hands and lean forward; if not able, grasp patient’s hands with yours to keep patient from falling back

19. Support patient’s weight on your shoulders while holding patient’s thigh and arm Firefighter’s Carry

20. Moving Patients – If Alone (continued) • Responsive patient who can walk with help – 1-rescuer walking assist

21. Moving Patients – With Help Responsive patient: • 2-rescuer walking assist • 2-rescuer cradle carry • 2-rescuer extremity carry

22. Both rescuers clasp arms behind patient’s back and under the legs 2-Rescuer Cradle Carry

23. To carry patient down steps: Forward rescuer grasps patient’s legs under the knees Rear rescuer reaches under patient’s armpits from behind to grasp patient’s forearms 2-Rescuer Extremity Carry

24. Both rescuers position patient’s arms over their shoulders Each rescuer grasps patient’s wrist, with the other arm around patient’s waist 2-Rescuer Walking Assist

25. Urgent Moves • Used when patient must be moved urgently and quickly, but situation allows a little more time to ensure patient safety • An urgent move may be needed for: • Patients with altered mental status • Patients with inadequate breathing • Patients in shock • Other situations involving potential danger to patient

26. Non-Emergency Moves • Used to move patient when no threat to life • Performed by multiple rescuers • Not used if patient has suspected spinal injury, internal bleeding or uncontrolled external bleeding • Generally used to prepare patient for transport • Stabilize patient before moving • Minimize any chance of aggravating illness or injury • These moves are usually performed by responding EMS personnel

27. Complete primary and secondary assessments Correct any life-threatening problems Immobilize all suspected fractures and dislocations Ensure there are nosigns and symptoms of neck or spinal injury Before Using a Non-Emergency Move

28. Direct Ground Lift • Non-emergency move for patients without suspected neck or spinal injuries • Used to lift and carry supine patient from ground to stretcher

29. Skill: Direct Ground Lift • Rescuers kneel on one side of the patient • Rescuers position their hands on the patient • Rescuers lift patient to their knees and roll the patient in toward their chests • Rescuers stand and move patient to stretcher, and reverse steps to lower patient

30. Extremity Lift • 2-rescuer technique used for patients without suspected injury to neck, spine or extremities • May be used with responsive or unresponsive patient • May be used to carry patient a short distance or move patient from chair to stretcher • May be used to carry patient through a tight space

31. Skill: Extremity Lift • The first rescuer kneels at the patient’s head and the second rescuer kneels by the patient’s feet. The rescuer at the head places 1 arm under each of the patient’s shoulders while the rescuer at the feet positions the patient’s arms. • The rescuer at the head then slips his or her hands under the patient’s armpits and grasps the patient’s wrists and crosses them on the patient’s chest. The rescuer at the feet turns around and reaches his or her hands back and under the patient’s knees.

32. Skill: Extremity Lift (continued) • Both rescuers move to a crouching position and assess their grip on the patient. • On a signal from the rescuer at the head, the rescuers stand up simultaneously and move forward with the patient.

33. Extremity Lift – Alternative Position • Previous technique is preferred if rescuers must move some distance or over inclined surface • Alternatively, rescuer at patient’s feet may face patient and other rescuer • Can be used to move patient to side or short distance

34. Transfer from Bed to Stretcher • Assist EMS personnel transferring patient from bed to stretcher • Use either direct carry or draw sheet technique • Not used with patient with suspected spinal injury

35. Skill: Direct Carry • Position the stretcher at a right angle to the bed, ideally, with the head end of the stretcher at the foot of the bed. The stretcher should be at the same height as the bed. Unbuckle the straps and remove other items from the stretcher. Both rescuers stand between the bed and the stretcher, facing the patient.

36. Skill: Direct Carry (continued) • The rescuer at the head slides 1 arm under the patient’s neck and cups the patient’s farther shoulder. The second rescuer slides 1 arm under the patient’s hips and lifts slightly. The rescuer at the head slides his or her other arm under the patient’s back, and the second rescuer places his or her other arm underneath the patient’s thighs near the knees. Together, both rescuers slide the patient to the edge of the bed.

37. Skill: Direct Carry (continued) • On a signal of the rescuer at the head, the rescuers lift and curl the patient toward their chests. • The rescuers step back, rotate toward the stretcher and place the patient gently on the stretcher.

38. Draw Sheet Transfer

39. Skill: Draw Sheet Transfer • Loosen bottom bed sheet and roll its edge on the side where you will place stretcher • Position stretcher alongside bed; prepare stretcher: • Adjust height, lower rails and unbuckle straps • Both responders reach across stretcher and grasp rolled sheet edge firmly at level of patient’s head, chest, hips and knees • Slide patient gently onto stretcher

40. Draw Sheet Transfer –Alternative Method • Rescuers first roll patient onto one side, and 1 rescuer holds the patient in that position; second rescuer positions a sheet with rolled edge beneath patient • The patient is rolled back into original position, now on the sheet • The rescuers together pull on sheet to slide patient onto stretcher

41. EMRs often assist EMTs with packaging and moving patients Wide range of commercial devices is used Learn devices you are likely to encounter in your area EMS Equipment for Moving Patients

42. Long backboard Kendrick Extrication Device (KED) Standard stretcher Portable stretcher Orthopedic stretcher Basket stretcher Stair chair Typical Equipment for Packaging and Moving Patients