2-1

The Violent Scene

2-2

Violent Scene

• Scenes involving armed or potentially hostile persons are among the most dangerous

• EMS personnel may be mistaken for law enforcement officials

• Body armor

Warning Signs of Danger

2-3

Residences Unusual silence or darkened residence

Past history of problems or violence

Known drug or gang area

Loud noises or items breaking

Seeing or hearing acts of violence

Presence of alcohol or other drug use

Evidence of dangerous pets

Warning Signs of Danger

Street ScenesCrowds may quickly become large and unpredictable

Voices become louder Pushing, shoving Hostility toward others at scene Rapid increase in crowd size Inability of law enforcement to control crowds

2-4

Warning Signs of Danger

Highway Encounters

Disabled vehicle, “man slumped over wheel” calls, motor vehicle crashes

Suspicious movements in vehicle Grabbing or hiding items Arguing or fighting between passengers Lack of activity where activity is likely Signs of alcohol or drug use Open or unlatched trunks (may hide people)

2-5

2-6

Crime Scene

2-7

Crime Scene

• Law enforcement personnel are responsible for gathering evidence

• EMS personnel are responsible for patient care

2-8

Crime Scene

• Evidence– Fingerprints– Footprints– Blood and body fluid– Hair– Carpet and clothing fibers

2-9

Crime Scene

• Be observant

• Touch only what is required for patient care– If you touch something, remember what

you touched and tell police

• Wear gloves

2-10

Crime Scene

• Take the same path in and out of the scene

• Avoid stepping on bloodstains or splatter

• Disturb victim and victim’s clothing as little as possible

2-11

Crime Scene

• Avoid cuts to the victim’s clothing that may have been caused by a knife, bullet, or other penetrating weapon

• Save victim’s clothing and personal items in a paper bag

6-12

Lifting and Moving

• EMS professionals are injured every year because of improper lifting or moving techniques.

• In most cases, these injuries are preventable.

6-13

Lifting and Moving

• There is no one best way to move all patients.

• Analyze the situation• Think of all your options• Choose the method that is

safest for you, your coworkers, and the patient

6-14

Role of the EMT

• Patient care will usually be provided in the position in which the patient is found

6-15

Role of the EMT

• Your responsibilities:– Distinguishing an emergency from a

nonemergency situation– Positioning patients to prevent further

injury– Recognizing when to call for more help– Assisting other EMS professionals in

lifting and moving a patient

6-16

Principles of Moving Patients

6-17

The Big Decision…

• What is an emergency that requires immediately moving a patient from the area?

6-18

The Big Decision…

• Indications for an emergency move:

– Scene hazards

– The inability to reach other patients who need life-saving care

– The inability to provide immediate, lifesaving care because of the patient’s location or position

6-19

Indications for an Emergency Move

• Scene hazards– Fire or the danger of fire– Uncontrolled traffic– Explosives or the danger of an explosion– Electrical hazards– Rising flood water– Toxic gases– Radiation– Structural collapse or the threat of a structural

collapse– Potentially violent scenes

6-20

Indications for an Emergency Move

• The inability to reach other patients who need lifesaving care

• The inability to provide immediate, lifesaving care because of the patient’s location or position

6-21

Principles of Moving Patients

• An emergency move may aggravate a spinal injury

• Always drag the patient in the direction of the length of the body– Never push, pull, or drag a patient

sideways

• Think before you act!

6-22

Principles of Moving Patients

• Nonurgent move– Type of move performed most often– Use if no immediate threat to life exists– Done with the help of other EMS personnel– Requires communication before, during,

and after the lift

• Work as a team for success

6-23

Body Mechanics andLifting Techniques

6-24

Body Mechanics

• Body alignment– Good posture

• Balance

• Coordinated body movement

6-25

Balance

• You can improve your balance by:

– Separating your feet to a comfortable distance

– Bending your knees

– Flexing your hips to reach a squatting position

6-26

Preparation

• Important factors to consider: – Patient’s weight– Patient’s condition– Hazards or potential hazards– The terrain– Distance the patient must be moved– Your physical abilities and any limitations– Available equipment or additional

personnel

6-27

Power Grip

• Palms up

• Hands comfortable distance apart– About 10 inches

• Palms and fingers in complete contact with the object

6-28

Guidelines for Safe Lifting

6-29

Guidelines for Safe Lifting

• Keep your back aligned and use your leg strength

• Maintain your center of balance while lifting

• Consider the weight to be lifted

• Know your physical ability and limitations

• Plan– How will you move the patient?– Where will you move him?– Make sure path is clear

6-30

Guidelines for Safe Lifting

• Determine in advance who will direct the move – Usually the person at the patient’s head

• “On my count, lift on three: one, two, three”

• “On my count, turn on three: one, two, three”

6-31

Guidelines for Safe Lifting Key Point

• Agree in advance that if anyone involved in the move says “no” the move is immediately stopped

6-32

Guidelines for Safe Lifting

• Position your feet a comfortable width apart • Bend at the knees and hips, not at your waist

– Keep your back straight– Use your legs to lift, not your back

6-33

Guidelines for Safe Lifting

• Lift using a smooth, continuous motion• Do not jerk or twist when lifting• Keep the weight close to you • When possible, move forward rather than

backward• Walk slowly using short steps• Look where you are going• Communicate clearly and frequently with

others throughout the move

6-34

Power Lift

6-35

Carrying Patients and Equipment

6-36

Carrying Patients and Equipment

• Whenever possible, transport patients on devices that can be rolled.

• Know or find out the weight to be lifted.

• Know your physical abilities and limitations and that of your crew.

• Work in a coordinated manner.

• Communicate frequently with your partner and the patient.

6-37

Carrying Patients and Equipment

• Keep the weight as close to the body as possible.

• Keep your back in a locked-in position and avoid twisting.

• Flex at the hips, not at the waist

• Bend at the knees.

• Do not lean back from the waist.

6-38

Carrying Procedure on Stairs

6-39

Carrying Procedure on Stairs

• When possible, use a stair chair

• Make sure that the stairway is free of obstructions.

• Use a guide or “spotter”

• Secure the patient to the stair chair before lifting

• Carry the patient head first up the stairs and feet first down the stairs

6-40

Carrying Procedure on Stairs

• Keep your back in a locked-in position.

• Flex at the hips, not at the waist, and bend at the knees.

• Keep the weight and your arms as close to your body as possible.

• Always communicate with your partner during the move.

6-41

Guidelines for Safe Reaching

6-42

Guidelines for Safe Reaching

• Keep your back straight• Avoid stretching or leaning back from your

waist when reaching overhead– Lean from your hips

• Avoid twisting• Avoid reaching more than 15 to 20 inches in

front of you• Avoid situations where prolonged strenuous

effort (more than a minute) is needed

6-43

Logroll

• Keep your back straight while leaning over the patient.

• Lean from the hips.

• Use your shoulder muscles to help with the roll.

6-44

Guidelines for Safe Pushing and Pulling

6-45

Guidelines for Safe Pushing and Pulling

• Push, rather than pull, whenever possible.

• Keep your back straight.

• Keep the line of the pull through the center of your body by bending your knees.

• Keep the weight close to your body.

6-46

Guidelines for Safe Pushing and Pulling

• Keep your elbows bent and your arms close to your sides.

• Push at a level between your waist and shoulders.– If the weight is below your waist, kneel to

push or pull.– If possible, avoid pushing or pulling from

an overhead position.

6-47

Emergency Moves

6-48

Drags

• A good way to move patients already on the ground

• Try to stabilize the patient’s head and neck as much as possible before the move

• Use the clothes drag or blanket drag when injury to head or spine is suspected

6-49

Drags

• Always pull along the length of the spine

• Never pull the patient’s head away from her neck and shoulders

6-50

Clothes Drag

6-51

Blanket Drag

6-52

Shoulder Drag

6-53

Forearm Drag

Ankle Drag

• Not recommended – Patient’s head is not

supported

– Patient’s head may bounce if the patient is not pulled over a smooth surface

6-54

6-55

Firefighter’s Drag

6-56

Remember:

• Always drag the patient along the length (the long axis) of the spine.

• Never drag a patient sideways.

• Never pull the patient’s head away from her neck and shoulders.