10)Lifting And Moving Patients


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10)Lifting And Moving Patients

  1. 1. Lifting and Moving Patients
  2. 2. Body Mechanics Safety Precautions <ul><li>Using specific methods to lift large weights without injury </li></ul><ul><ul><li>Safety Precautions </li></ul></ul><ul><ul><ul><li>Use legs, not back to lift </li></ul></ul></ul><ul><ul><ul><ul><li>Largest bone/muscle group </li></ul></ul></ul></ul><ul><ul><ul><li>Keep weight close to body </li></ul></ul></ul><ul><ul><ul><ul><li>Shifts center of gravity to patient </li></ul></ul></ul></ul><ul><ul><ul><ul><li>More leverage </li></ul></ul></ul></ul>
  3. 3. Body Mechanics Condiserations <ul><li>Guidelines for lifting/carrying </li></ul><ul><ul><li>Consider pt weight </li></ul></ul><ul><ul><li>Know your limitations </li></ul></ul><ul><ul><li>Lift without twisting </li></ul></ul><ul><ul><li>Position feet one in front of the other </li></ul></ul><ul><ul><li>Communicate with partner </li></ul></ul><ul><ul><li>Keep back locked and don’t twist </li></ul></ul><ul><ul><li>Flex at hips (not at waist) </li></ul></ul><ul><ul><li>Bend at knees </li></ul></ul><ul><ul><li>Keep elbows bent with arms close to sides </li></ul></ul><ul><ul><li>Don’t hyperextend your back </li></ul></ul><ul><ul><li>Avoid reaching more than 15”-20” in front of your body </li></ul></ul><ul><ul><li>Push rather than pull </li></ul></ul><ul><ul><li>Keep line of pull through midline </li></ul></ul>
  4. 4. Power Lift <ul><li>Know/find out pt weight </li></ul><ul><li>Consider pt exceeding limitations </li></ul><ul><li>“ Power lift” </li></ul><ul><ul><li>Keep back locked in normal curvature </li></ul></ul><ul><ul><li>Place your feet a comfortable distance apart </li></ul></ul><ul><ul><li>Tighten your abs and lock back into a slight inward curve </li></ul></ul><ul><ul><li>Bring center of your body over object </li></ul></ul><ul><ul><ul><li>Vertical lift </li></ul></ul></ul><ul><ul><li>Distribute your weight to the balls of your feet OR just behind them </li></ul></ul><ul><ul><li>Lock your back and allow upper body to rise before the hips as you lift </li></ul></ul>
  5. 5. Power Grip <ul><li>“ Power Grip” </li></ul><ul><ul><li>Maximizes force from hands </li></ul></ul><ul><ul><li>Palm and fingers are in contact with object </li></ul></ul><ul><ul><li>All fingers are bent at the same angle </li></ul></ul><ul><ul><li>Hands at least 10” apart </li></ul></ul>
  6. 6. Carrying One-handed carrying technique <ul><li>One-handed carrying technique </li></ul><ul><ul><li>Multiple providers positioned around pt </li></ul></ul><ul><ul><li>Keep back in locked position </li></ul></ul><ul><ul><li>Don’t lean to either side </li></ul></ul><ul><ul><li>Lift as normal </li></ul></ul>
  7. 7. Stairs… <ul><li>Whenever possible use stair chair </li></ul><ul><ul><li>Keep back locked </li></ul></ul><ul><ul><li>Flex at hips (not waist) </li></ul></ul><ul><ul><li>Bend at knees (not with back) </li></ul></ul><ul><ul><li>Keep your weight close to the device </li></ul></ul><ul><ul><li>Have stronger rescuer at the bottom </li></ul></ul>
  8. 8. Log Rolling <ul><li>Log rolls </li></ul><ul><li>Movement of a supine/prone pt </li></ul><ul><ul><li>EMT 1: Maintain C-spine </li></ul></ul><ul><ul><li>EMT 2 & 3: Position kneeling at pt side </li></ul></ul><ul><ul><li>EMT 2: Raise pt nearest arm over pt head </li></ul></ul><ul><ul><li>EMT 2: Place 1 hand on pt shoulder the other on pt hip </li></ul></ul><ul><ul><li>EMT 3: Place 1 hand on pt waist and the other at knees </li></ul></ul><ul><ul><li>EMT 2 & 3: On count of 3 from EMT 1, roll pt onto side </li></ul></ul><ul><ul><li>Place pt on backboard, transport </li></ul></ul>
  9. 9. Emergency Moves <ul><li>Fastest move </li></ul><ul><li>No spinal immobilization </li></ul><ul><li>Immediate danger to pt if not moved </li></ul><ul><ul><li>Fire or danger of fire </li></ul></ul><ul><ul><li>Explosives or other hazardous materials </li></ul></ul><ul><ul><li>Inability to protect pt from other hazards </li></ul></ul><ul><ul><li>Inability to access other pts in a vehicle who need life saving care </li></ul></ul><ul><ul><li>Life saving care cannot be given due to pt position </li></ul></ul><ul><li>Examples: </li></ul><ul><ul><li>Clothes drag </li></ul></ul><ul><ul><li>Blanket drag </li></ul></ul><ul><ul><li>Torso drag </li></ul></ul>
  10. 10. Urgent Moves <ul><li>Fast </li></ul><ul><li>Spinal immobilization </li></ul><ul><li>Scene is safe, immediate threat to pt life </li></ul><ul><ul><li>Altered Mental Status (AMS) </li></ul></ul><ul><ul><li>Inadequate breathing </li></ul></ul><ul><ul><li>Shock/Hypoperfusion </li></ul></ul><ul><li>Example </li></ul><ul><ul><li>Rapid extrication </li></ul></ul><ul><ul><ul><li>Moving pt from MVA with constant spinal immobilization </li></ul></ul></ul>
  11. 11. Rapid Extrication <ul><li>Rapid extrication from vehicle </li></ul><ul><ul><li>1 EMT provides manual C-Spine support </li></ul></ul><ul><ul><li>2 nd EMT applies C-Collar </li></ul></ul><ul><ul><li>3 rd EMT places back board near door and moves to the passengers seat </li></ul></ul><ul><ul><li>2 nd EMT supports thorax as 3 rd EMT frees pt feet from pedals </li></ul></ul><ul><ul><li>At direction of 2 nd EMT he and 3 rd EMT rotate pt so that pt back is not in doorway </li></ul></ul><ul><ul><li>Tx C-Spine control </li></ul></ul><ul><ul><li>1 st EMT exits vehicle and supports head from outside </li></ul></ul><ul><ul><li>Back board is places against pt buttock </li></ul></ul><ul><ul><li>1 st EMT and 2 nd EMT lower pt to back board </li></ul></ul><ul><ul><li>2 nd and 3 rd EMT slide the pt onto the board </li></ul></ul><ul><ul><li>Rapid Extrication Demo </li></ul></ul>
  12. 13. Non-Urgent Moves <ul><li>Scene Safe </li></ul><ul><li>Stable pt </li></ul><ul><li>Suspect spinal injury </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Direct Ground Lift </li></ul></ul><ul><ul><li>Extremity Lift </li></ul></ul><ul><ul><li>Direct Carry </li></ul></ul><ul><ul><li>Draw Shift </li></ul></ul>
  13. 14. Direct Ground Lift <ul><li>Direct Ground Lift (No spine injury) </li></ul><ul><li>Two or more rescuers lifting a patient from the side -Cradle </li></ul><ul><ul><li>2-3 rescuers line up on one side of pt </li></ul></ul><ul><ul><li>Rescuers kneel on one knee </li></ul></ul><ul><ul><li>Pt arms placed on pt chest </li></ul></ul><ul><ul><li>Rescuer @ head places one arm under pt neck and cradles head. He places other hand under pt lower back </li></ul></ul><ul><ul><li>Second rescuer places one under the pt knees and the other under the pt buttock </li></ul></ul><ul><ul><li>On signal the rescuers lift pt to their knees and roll pt towards their chest </li></ul></ul><ul><ul><li>On signal the rescuers stand and tx pt to stretcher </li></ul></ul><ul><ul><li>Steps are reversed to lower pt </li></ul></ul>
  14. 15. Extremity Lift <ul><li>Extremity Lift (No extremity injuries) </li></ul><ul><li>Two rescuers lifting the patient by the extremities </li></ul><ul><li>One rescuer in the armpit-forearm drag position and the other holding the patient behind the knees. </li></ul><ul><ul><li>1 EMT kneels at the pt head, another kneels at pt side by the knees </li></ul></ul><ul><ul><li>EMT at the head places 1 hand under each of the pt shoulders </li></ul></ul><ul><ul><li>EMT at the knees grasps the wrists </li></ul></ul><ul><ul><li>EMT at head slips his hands under the pt arms and grasps pt wrists </li></ul></ul><ul><ul><li>EMT at feet slips his hands under the pt knees </li></ul></ul><ul><ul><li>Both EMT’s move to a crouching position </li></ul></ul><ul><ul><li>EMTs stand simultaneously and move pt to stretcher </li></ul></ul>
  15. 17. Direct Carry <ul><li>Similar to direct ground lift except the pt is carried </li></ul><ul><li>Tx of supine pt from bed to stretcher </li></ul><ul><ul><li>Place cot perpendicular to bed with head of cot at foot of bed </li></ul></ul><ul><ul><li>Both EMTs stand between stretcher and bed facing pt </li></ul></ul><ul><ul><li>1 st EMT slips arm under pt neck and cups pt shoulders </li></ul></ul><ul><ul><li>2 nd EMT slips hand under hips and lifts slightly </li></ul></ul><ul><ul><li>1 st EMT slips other arm under pt back </li></ul></ul><ul><ul><li>2 nd EMT places arms under pt hips/calves </li></ul></ul><ul><ul><li>EMTS slide pt to edge of bed </li></ul></ul><ul><ul><li>Pt is lifted/curled towards EMTs chest </li></ul></ul><ul><ul><li>EMTs rotate and place pt on stretcher </li></ul></ul>
  16. 18. Draw Sheet <ul><ul><li>Loosen sheets from bed </li></ul></ul><ul><ul><li>Place stretcher next to bed </li></ul></ul><ul><ul><li>Reach across and firmly grasp sheet </li></ul></ul><ul><ul><ul><li>Head </li></ul></ul></ul><ul><ul><ul><li>Chest </li></ul></ul></ul><ul><ul><ul><li>Hips </li></ul></ul></ul><ul><ul><ul><li>Knees </li></ul></ul></ul><ul><ul><li>Slide pt gently onto stretcher </li></ul></ul>
  17. 19. Stretchers <ul><li>Most commonly used </li></ul><ul><li>Easy to tip over </li></ul><ul><ul><li>High center of gravity </li></ul></ul>
  18. 20. Stretchers <ul><li>Rolling </li></ul><ul><ul><li>Restricted to smooth terrain </li></ul></ul><ul><ul><li>Pulled by foot end </li></ul></ul><ul><ul><li>One person guides the head </li></ul></ul><ul><li>Carrying </li></ul><ul><ul><li>Two EMTs </li></ul></ul><ul><ul><ul><li>EMTs face each other from opposite ends of stretcher </li></ul></ul></ul><ul><ul><ul><li>Ideal for small spaces </li></ul></ul></ul><ul><ul><ul><li>Requires more strength </li></ul></ul></ul><ul><ul><li>Four EMTs </li></ul></ul><ul><ul><ul><li>One EMT on each corner </li></ul></ul></ul><ul><ul><ul><li>Requires less strength </li></ul></ul></ul><ul><ul><ul><li>Safer of rough terrain </li></ul></ul></ul><ul><li>Loading into ambulance </li></ul><ul><ul><li>Use sufficient lifting power </li></ul></ul><ul><ul><li>Follow manufacturers directions </li></ul></ul><ul><ul><li>Ensure all pt and stretchers are secure </li></ul></ul><ul><ul><li>before moving </li></ul></ul>
  19. 21. Portable Stretchers <ul><li>Lightweight, foldable </li></ul><ul><li>Permits tx of pt </li></ul><ul><ul><li>Down stairs </li></ul></ul><ul><ul><li>Over rough terrain </li></ul></ul><ul><li>Carried end to end </li></ul>
  20. 22. Scoop/Orthopedic Stretcher <ul><li>Function </li></ul><ul><ul><li>Splits apart to scoop up the patient on the ground from either side </li></ul></ul><ul><ul><li>Facilitates easy lifting of supine pt </li></ul></ul><ul><li>Form </li></ul><ul><ul><li>Aluminum frame </li></ul></ul><ul><ul><li>Splits lengthwise in half </li></ul></ul><ul><ul><li>Allows pt to be “scooped” off ground </li></ul></ul><ul><li>For spinal injury pt, </li></ul><ul><ul><li>Cervical immobilization is maintained </li></ul></ul>
  21. 23. Scoop/Orthopedic Stretcher <ul><li>How to use it… </li></ul><ul><ul><li>Measure and adjust the length of the device to be just longer than the pt </li></ul></ul><ul><ul><li>Slide the stretcher under both sides of the pt </li></ul></ul><ul><ul><li>Lock the head first </li></ul></ul><ul><ul><li>Lock the feet </li></ul></ul><ul><ul><li>Strap the pt in place </li></ul></ul><ul><ul><li>Place pt on a secondary device and secure </li></ul></ul><ul><ul><ul><li>Ex. LBB </li></ul></ul></ul>
  22. 24. Stair Chair <ul><li>Designed to move pt who are able to assume sitting position </li></ul><ul><li>Not used for </li></ul><ul><ul><li>Pt with spinal injuries </li></ul></ul><ul><ul><li>Unconscious </li></ul></ul><ul><li>Extremity lift is preferred to load pts </li></ul><ul><li>Best to have a spotter behind EMT at feet while descending stairs </li></ul>
  23. 25. Backboards <ul><li>Long Spine Boards </li></ul><ul><li>Function: </li></ul><ul><ul><li>Rigid support for spinal column to prevent further injury </li></ul></ul><ul><li>Types: </li></ul><ul><ul><li>Wooden </li></ul></ul><ul><ul><li>Plastic </li></ul></ul><ul><li>Uses: </li></ul><ul><ul><li>Primary device for supine/recumbent pt </li></ul></ul><ul><ul><li>Rapid extrications </li></ul></ul><ul><ul><li>Secondary support in assoc with short spine board </li></ul></ul>
  24. 26. Short Spine Boards <ul><li>Function </li></ul><ul><ul><li>Extends from base of the buttock to just above pt head </li></ul></ul><ul><ul><li>Attached by straps or cravats Support of spinal column to prevent further injury </li></ul></ul><ul><li>Types </li></ul><ul><ul><li>Wooden </li></ul></ul><ul><ul><li>Vest type </li></ul></ul><ul><ul><ul><li>Kendrick Extrication Device (KED) </li></ul></ul></ul><ul><li>Uses </li></ul><ul><ul><li>Extricate pt in MVA who are in sitting position </li></ul></ul>
  25. 27. Stokes Basket <ul><li>Function </li></ul><ul><ul><li>Movement of pt over rough terrain </li></ul></ul><ul><li>Form </li></ul><ul><ul><li>Large basket </li></ul></ul><ul><ul><li>Flat bottom </li></ul></ul><ul><ul><li>LBB can fit </li></ul></ul><ul><ul><li>Pt can be immobilized as normal </li></ul></ul>
  26. 28. Patient Positioning <ul><li>Unresponsive pt (non traumatic) </li></ul><ul><ul><li>Rolled into recovery position (Left side) </li></ul></ul><ul><li>Pt with dyspnea or chest pain </li></ul><ul><ul><li>Position of comfort </li></ul></ul><ul><ul><li>As long as hypotension doesn’t occur </li></ul></ul><ul><li>Suspected spine injury </li></ul><ul><ul><li>Immobilized to long backboard </li></ul></ul><ul><li>Pregnant Pt </li></ul><ul><ul><li>Left lateral recumbent </li></ul></ul><ul><ul><li>Supine= Fetus on vena cava </li></ul></ul><ul><li>Shock </li></ul><ul><ul><li>Elevated legs 8”-12” </li></ul></ul><ul><li>Nausea/Vomiting </li></ul><ul><ul><li>Position of comfort </li></ul></ul><ul><ul><li>EMT in position to control airway </li></ul></ul>