chapter 35 lifting and moving patients. national ems education standard competencies ems operations...

Chapter 35Chapter 35Chapter 35Chapter 35

Lifting and Moving Patients

National EMS Education National EMS Education Standard CompetenciesStandard CompetenciesNational EMS Education National EMS Education Standard CompetenciesStandard Competencies

EMS Operations

Knowledge of operational roles and responsibilities to ensure patient, public, and personnel safety.

IntroductionIntroduction

• 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.



• Training and practice are required.

• Special lifting and moving techniques are necessary for:– Patients with head injury, shock, spinal injury

– Pregnant patients

– Obese patients



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Body Mechanics (1 of 12)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.

Body Mechanics (2 of 12)

Body Mechanics (2 of 12)


• 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.



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• 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)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 you.



• 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 ConsiderationsGeneral 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)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)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)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)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


• Choose between:– 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.


• Choose between (cont’d):– 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)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.

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Bariatrics (1 of 2)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)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.



• 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)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.

DecontaminationDecontamination

• 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)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)Medical Restraints (2 of 2)

• Apply restraint to each extremity.

• Assess circulation after restraints are applied.

• Document all information.

Personnel Considerations (1 of 2)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)Personnel Considerations (2 of 2)

• Remember, an injured rescuer cannot help anyone.

Summary Summary (1 of 13)(1 of 13)Summary Summary (1 of 13)(1 of 13)

• The first key rule of lifting is to always keep your back in an upright position and lift without twisting.

• The power lift is the safest and most powerful way to lift.


• Pushing is better than pulling.

• If you do not have a proper hold, you will not be able to bear your share of the weight, or you may lose your grasp and possibly cause a lower back injury to one or more EMTs.


• It is always best to move a patient on a device that can be rolled.

• You must constantly coordinate your movements with those of the other team members and make sure that you communicate with them.


• Ideally, members of the lifting team should also be of similar height and strength.

• If you must carry a loaded backboard or stretcher up or down stairs or other inclines, be sure that the patient is tightly secured to the device to prevent sliding.


• Carry the backboard or stretcher foot end first, so that the patient’s head is elevated higher than the feet.

• Directions and commands are an important part of safe lifting and carrying.


• You and your team must anticipate and understand every move and execute it in a coordinated manner.

• The team leader is responsible for coordinating the moves.

• You should try to use four rescuers whenever resources allow.


• You should know how much you can comfortably and safely lift and not attempt to lift more than this amount.

• Rapidly summon additional help to lift and carry a weight that is greater than you are able to lift.


• The same basic body mechanics apply for safe reaching and pulling as for lifting and carrying.

• Keep you back locked and straight, and avoid twisting.

• Do not hyperextend your back when reaching overhead.


• For a nonurgent move, move the patient in an orderly, planned, and unhurried manner, selecting methods that involve the least amount of lifting and carrying.

• At times, you may have to use an emergency move to maneuver a patient before providing assessment and care.


• You should perform an urgent move if a patient has an altered level of consciousness, inadequate ventilation, or shock, or in extreme weather conditions.


• The wheeled ambulance stretcher is the most commonly used device to move and transport patients.

• Other devices include portable stretchers, flexible stretchers, backboards, basket stretchers, scoop stretchers, and stair chairs.


• Whenever you are moving a patient, you must take special care so that neither you, your team, nor the patient is injured.


• You will learn the technical skills of patient packaging and handling through practice and training.

• Training and practice are required to use all the equipment that is available to you.

ReviewReview

1. What is the first rule of lifting?

A. Twist slowly when you lift

B. Keep your back in a straight position

C. Bend at the waist to pick something up

D. Use your arms to do most of the lifting

ReviewReview

Answer: B

Rationale: The first rule of lifting is to always keep your back in a straight, upright, position and use the powerful muscles of your thighs. Never twist while lifting.

ReviewReview

1. What is the first rule of lifting?A. Twist slowly when you lift

Rationale: You should never twist your back.

B. Keep your back in a straight positionRationale: Correct answer

C. Bend at the waist to pick something upRationale: You should never bend at the waist. Your back should be properly maintained in an upright position.

D. Use your arms to do most of the liftingRationale: Use your leg muscles since they are well developed and very strong.

ReviewReview

2. When lifting a stretcher using the power lift, you should:

A. bend at the hips, knees, back, and arms.

B. bend at the waist and keep your back straight.

C. place your hands palms up on the litter handle.

D. place your hands palms down on the litter's side bars.

ReviewReview

Answer: C

Rationale: When lifting any heavy object, your hands should be facing palms up; this provides better lifting power and is not as stressful on the wrists.

Review (1 of 2)Review (1 of 2)


A. bend at the hips, knees, back, and arms.Rationale: When lifting, keep your back and arms straight. Always bend at the knees.

B. bend at the waist and keep your back straight.Rationale: When lifting, always keep your back straight. Never bend at the waist.



C. place your hands palms up on the litter handle.Rationale: Correct answer

D. place your hands palms down on the litter's side bars.Rationale: Your hands have the greatest strength when your palms are facing up.

ReviewReview

3. It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:

A. takes too long to correctly apply.

B. does not fully immobilize the spine.

C. cannot be used on patients who are in their car.

D. does not provide adequate c-spine stabilization.

ReviewReview

Answer: A

Rationale: It takes several minutes to correctly apply a vest-style extrication device. This is too much time to waste when treating a critically-injured patient. A long spine board would be more appropriate. Vest-style immobilization devices, when applied correctly, provide adequate spinal motion restriction and are ideal to use in stable patients who need to be removed from their vehicle.


3. It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:

A. takes too long to correctly apply.Rationale: Correct answer

B. does not fully immobilize the spine.Rationale: When applied correctly, the vest provides adequate restriction of the spine.


3. It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it: C. cannot be used on patients who are in their car.

Rationale: When a patient is stable, the vest is a beneficial device for vehicle extrications.

D. does not provide adequate c-spine stabilization.Rationale: The vest provides adequate restriction of the spine.

ReviewReview

4. Proper guidelines for correct reaching include all of the following, EXCEPT:

A. avoiding twisting your back.

B. avoiding hyperextension of your back.

C. keeping the back in a locked-in position.

D. reaching no more than 30” in front of your body.

ReviewReview

Answer: D

Rationale: When reaching, you should keep your back in a locked-in position, and avoid twisting or hyperextending your back. Do not reach more than 15" to 20" in front of your body.



A. avoiding twisting your back.Rationale: Never twist your back while reaching or lifting.

B. avoiding hyperextension of your back.Rationale: Never bend or hyperextend your back.



C. keeping the back in a locked-in position.Rationale: Always keep your back straight in a locked position.

D. reaching no more than 30" in front of your body.Rationale: Correct answer

ReviewReview

5. An injured hang glider is trapped at the top of a large mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use?

A. Stair chair

B. Stokes basket

C. Scoop stretcher

D. Long spine board

ReviewReview

Answer: B

Rationale: A basket stretcher, also called a “stokes” basket, should be used to carry patients over rough or uneven terrain that is inaccessible by ambulance. Its closed-ended sides protect the patient from falling out of the device.



A. Stair chairRationale: This is used to transfer a patient up and down stairs.

B. Stokes basketRationale: Correct answer



C. Scoop stretcherRationale: This is designed to split into 2 or 4 pieces. It must have access to both sides of patient and the patient should be lying on a relatively flat surface.

D. Long spine boardRationale: There is no protection for the patient from falling off or out of the device.

ReviewReview

6. When two EMTs are lifting a patient on a long backboard, they should:

A. lift the patient from the sides of the board.

B. make every attempt to lift with their backs.

C. position the strongest EMT at the foot of the board.

D. position the strongest EMT at the head of the board.

ReviewReview

Answer: D

Rationale: Since more than half of the patient's weight is distributed to the head end of a backboard or stretcher, you should always ensure that the strongest EMT is at that position. This will reduce the risk of injury to less stronger personnel as well as the risk of dropping the patient.



A. lift the patient from the sides of the board.Rationale: This may cause the backboard to tip since the upper torso is heavier.

B. make every attempt to lift with their backs.Rationale: Never lift with your back. Always use your legs.



C. position the strongest EMT at the foot of the board.Rationale: The strongest EMT should be at the patient’s head, where the patient’s weight is greater.

D. position the strongest EMT at the head of the board.Rationale: Correct answer

ReviewReview

7. Which of the following techniques is considered to be an emergency move?

A. Extremity lift

B. Supine transfer

C. Firefighter's drag

D. Direct ground lift

ReviewReview

Answer: C

Rationale: The firefighter's drag is a one-person technique that is used when a patient must be removed from a life-threatening situation immediately.

ReviewReview

7. Which of the following techniques is considered to be an emergency move?A. Extremity lift

Rationale: This is a nonurgent move, helpful in narrow spaces.

B. Supine transferRationale: This is not considered to be an emergency move.

C. Firefighter's dragRationale: Correct answer

D. Direct ground liftRationale: This is a nonurgent move, used to carry a patient long distances to the cot.

ReviewReview

8. To extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:A. the elevated head of the backboard goes first.B. the backboard with the elevated foot end goes

first.C. the backboard is slightly tilted to the left to

distribute weight.D. the patient's feet are higher than his or her

head, whichever end is carried first.

ReviewReview

Answer: A

Rationale: When you carry a patient upstairs or up an incline, you must ensure that the elevated head of the backboard or stretcher goes first. This will help to equally distribute the weight.


8. To extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:

A. the elevated head of the backboard goes first.Rationale: Correct answer

B. the backboard with the elevated foot end goes first.Rationale: Always try to carry the head higher to distribute the weight.


8. To extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:

C. the backboard is slightly tilted to the left to distribute weight.Rationale: Backboards are designed to carry a patient flat and the weight is best distributed when the head is slightly elevated.

D. the patient's feet are higher than his or her head, whichever end is carried first.Rationale: Carries are easier with the patient’s head first and elevated for distribution of the patient’s weight.

ReviewReview

9. If an injured patient needs to be moved but is not in immediate danger from fire or building collapse, you should first:

A. order the equipment you need for extrication.

B. check the patient’s airway, breathing, and circulation.

C. remove the patient with the rapid extrication technique.

D. determine the number of people you will need to move the patient.

ReviewReview

Answer: B

Rationale: The only time your attention should be directed away from the primary assessment of the patient is when the patient’s life or your life is in immediate danger.



A. order the equipment you need for extrication.Rationale: This is not the first thing you should do.

B. check the patient’s airway, breathing, and circulation.Rationale: Correct answer



C. remove the patient with the rapid extrication technique.Rationale: The patient is not in immediate danger, so this is not needed.

D. determine the number of people you will need to move the patient.Rationale: After the ABC’s have been checked, then the EMT can determine the safest method of extrication.

ReviewReview

10. The rapid extrication technique is a:

A. nonurgent move to remove a patient from a vehicle.

B. technique used to transfer a patient from a bed to a stretcher.

C. technique used to lift a patient with no suspected spinal injury onto a stretcher.

D. technique used to quickly remove a patient from a vehicle and onto a backboard.

ReviewReview

Answer: D

Rationale: By using the rapid extrication technique, a seriously injured patient can be moved from a sitting position in a vehicle to a supine position on a backboard while protecting the spine at the same time.



A. nonurgent move to remove a patient from a vehicle.Rationale: This is considered to be an urgent move.

B. technique used to transfer a patient from a bed to a stretcher.Rationale: This is used to move a patient from a vehicle to a backboard.



C. technique used to lift a patient with no suspected spinal injury onto a stretcher.Rationale: This is not a lifting technique. The patient is placed on a backboard and not a stretcher.

D. technique used to quickly remove a patient from a vehicle and onto a backboard.Rationale: Correct answer

chapter 35 lifting and moving patients. national ems education standard competencies ems operations...

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