Chapter 35 Lifting and Moving Patients. Introduction In the course of a call, EMTs move patients. To...

transcript

Chapter 35

Lifting and Moving Patients

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.

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.

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

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.

• This is the correct way to lift.

• 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

• This is an incorrect method of lifting.

• 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.

• 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.

• Power grip gets maximum force from hands.– Palms up– Hands about 10″ apart– All fingers at same angle– Fully support handle on curved palm

• 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.

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.

• 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.

• Always secure patient to backboard or stretcher.– So patient cannot slide significantly when

stretcher is at an angle

• Wheeled ambulance stretcher weighs 40–145 lb.– Generally too

heavy for use on stairs

• If you must use a backboard or wheeled stretcher on stairs, see Skill Drill 35-4.

• A stair chair can be used to bring a conscious patient down to stretcher (see Skill Drill 35-5).

• Backboard should be used instead for patient:– In cardiac arrest– Who must be

moved in supine position

– Who must be immobilized

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

• 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.

• 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.

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

• Log rolling• Log roll the patient onto his or her side to

place a patient on a backboard.

• Log rolling (cont’d)– Kneel as close to the patient’s side as possible.– Keep your back straight.– Roll the patient without stopping.

• Rolling the stretcher– Stretcher should be fully elevated.– Push the stretcher from the head end.– Never push with arms fully extended.

General Considerations

• Move a patient in orderly, planned, unhurried manner.

• Carefully plan ahead.• Select methods that will involve least amount

of lifting and carrying.

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.

• 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

• 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.

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.

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.

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

– 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.

– 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.

• 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)

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.

Geriatrics (2 of 2)So

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Kyphosis Spondylosis

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.

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.

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.

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.

Types of Stretchers (1 of 19)

• Wheeled ambulance stretcher– Also called

a stretcher or gurney

– Most commonly used device

• 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

• Bariatric stretcher– Specialized for overweight or obese patients– Wider wheel base for increased stability

Source: Courtesy of Stryker Medical

• Bariatric stretcher (cont’d)– Some have tow package with winch.– Rated to hold 850–900 lb• Regular stretcher rated for 650 lb max.

• 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

• Loading a wheeled stretcher into an ambulance– Ensure the

frame is held firmly between two hands so it does not tip.

• 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 35-11.

• Portable/folding stretcher– Strong, rectangular

tubular metal frame with fabric stretched across it

• 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

• 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

• Backboard– Long, flat, and made of rigid rectangular material

(mostly plastic)– Used to carry and immobilize patients with

suspected spinal injury or other trauma

• Backboard (cont’d)– Commonly used for patients found lying down– 6 to 7 long′ ′

– Holes serve as handles and a place to secure straps.

• Backboard (cont’d)– Short backboards

or half-boards are used to immobilize seated patients• Example: the KED

vest-type device

• Basket stretcher– Rigid stretcher also

called a Stokes litter– Used for remote

locations inaccessible by a vehicle, including water rescues and technical rope rescues

• 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.

• Scoop stretcher– Also called orthopaedic stretcher

• 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.

• Stair chair– Folding aluminum

frame chairs with fabric stretched across to form a seat and back

– Most have rubber wheels in the back

• 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.

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

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.

Medical Restraints (2 of 2)

• Apply restraint to each extremity.

• Assess circulation after restraints are applied.

• Document all information.

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?

Personnel Considerations (2 of 2)

• Remember, an injured rescuer cannot help anyone.

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Chapter 35 Lifting and Moving Patients. Introduction In the course of a call, EMTs move patients. To...

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