SADASDASD

1. Chapter 35
Lifting and Moving
Patients

2. National EMS Education
Standard Competencies
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public, and
personnel safety.

3. 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.

4. 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.

5. 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

6. Moving and Positioning the
Patient (3 of 3)

7. 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.

8. Body Mechanics
(2 of 12)

9. Body Mechanics (3 of 12)
• This is the correct
way to lift.

10. Body Mechanics (4 of 12)
• 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

11. Body Mechanics (5 of 12)
• This is an incorrect method of lifting.

12. Body Mechanics (6 of 12)
• 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.

13. Body Mechanics (7 of 12)
• 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.

14. Body Mechanics (8 of 12)

15. Body Mechanics (9 of 12)
• Power grip gets maximum force from
hands.
– Palms up
– Hands about 10″ apart
– All fingers at same angle
– Fully support handle on curved palm

16. Body Mechanics (10 of 12)

17. Body Mechanics (11 of 12)
• 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.

18. Body Mechanics (12 of 12)

19. 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.

20. Weight and Distribution (2 of 9)
• 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.

21. Weight and Distribution (3 of 9)

22. Weight and Distribution (4 of 9)
• Always secure patient to backboard or
stretcher.
– So patient cannot slide significantly when
stretcher is at an angle

23. Weight and Distribution (5 of 9)
• Wheeled
ambulance
stretcher weighs
40–145 lb.
– Generally too
heavy for use on
stairs

24. Weight and Distribution (6 of 9)
• If you must use a backboard or wheeled
stretcher on stairs, see Skill Drill 35-4.

25. Weight and Distribution (7 of 9)
• A stair chair can be used to bring a
conscious patient down to stretcher
(see Skill Drill 35-5).

26. Weight and Distribution (8 of 9)

27. Weight and Distribution (9 of 9)
• Backboard
should be used
instead for
patient:
– In cardiac arrest
– Who must be
moved in supine
position
– Who must be
immobilized

28. 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

29. Directions and Commands
(2 of 3)
• 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.

30. Directions and Commands
(3 of 3)
• 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.

31. 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.

32. Principles of Safe Reaching
and Pulling (2 of 4)
• Log rolling
• Log roll the patient onto his or her side to
place a patient on a backboard.

33. Principles of Safe Reaching
and Pulling (3 of 4)
• Log rolling (cont’d)
– Kneel as close to the patient’s side as possible.
– Keep your back straight.
– Roll the patient without stopping.

34. Principles of Safe Reaching
and Pulling (4 of 4)
• Rolling the stretcher
– Stretcher should be fully elevated.
– Push the stretcher from the head end.
– Never push with arms fully extended.

35. General Considerations
• Move a patient in orderly, planned,
unhurried manner.
• Carefully plan ahead.
• Select methods that will involve least
amount of lifting and carrying.

36. 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.

37. Emergency Moves (2 of 5)
• 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

38. Emergency Moves (3 of 5)

39. Emergency Moves (4 of 5)
• 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.

40. Emergency Moves (5 of 5)

41. 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.

42. 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.

43. 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

44. Nonurgent Moves (2 of 5)
• 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.

45. Nonurgent Moves (3 of 5)
• 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.

46. Nonurgent Moves (4 of 5)
• 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)

47. Nonurgent Moves (5 of 5)

48. 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.

49. Geriatrics (2 of 2)
Source:
©
Dr.
P.
Marazzi/Photo
Researchers,
Inc.
Kyphosis Spondylosis

50. 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.

51. 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.

52. 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.

53. 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.

54. Patient-Moving Equipment
(3 of 3)

55. Types of Stretchers (1 of 19)
• Wheeled
ambulance
stretcher
– Also called
a stretcher
or gurney
– Most
commonly
used
device

56. Types of Stretchers (2 of 19)
• 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

57. Types of Stretchers (3 of 19)
• Bariatric stretcher
– Specialized for overweight or obese patients
– Wider wheel base for increased stability
Source: Courtesy of Stryker Medical

58. Types of Stretchers (4 of 19)
• Bariatric stretcher (cont’d)
– Some have tow package with winch.
– Rated to hold 850–900 lb
• Regular stretcher rated for 650 lb max.

59. Types of Stretchers (5 of 19)
• 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

60. Types of Stretchers (6 of 19)
• Loading a
wheeled
stretcher into
an ambulance
– Ensure the
frame is held
firmly
between two
hands so it
does not tip.

61. Types of Stretchers (7 of 19)
• 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.

62. Types of Stretchers (8 of 19)
• Portable/folding
stretcher
– Strong, rectangular
tubular metal frame
with fabric
stretched across it

63. Types of Stretchers (9 of 19)
• 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

64. Types of Stretchers (10 of 19)
• 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

65. Types of Stretchers (11 of 19)
• Backboard
– Long, flat, and made of rigid rectangular
material (mostly plastic)
– Used to carry and immobilize patients with
suspected spinal injury or other trauma

66. Types of Stretchers (12 of 19)
• Backboard (cont’d)
– Commonly used for patients found lying down
– 6′ to 7′ long
– Holes serve as handles and a place to secure
straps.

67. Types of Stretchers (13 of 19)
• Backboard (cont’d)
– Short backboards
or half-boards are
used to immobilize
seated patients
• Example: the
KED vest-type
device

68. Types of Stretchers (14 of 19)
• Basket stretcher
– Rigid stretcher also
called a Stokes
litter
– Used for remote
locations
inaccessible by a
vehicle, including
water rescues and
technical rope
rescues

69. Types of Stretchers (15 of 19)
• 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.

70. Types of Stretchers (16 of 19)
• Scoop stretcher
– Also called orthopaedic stretcher

71. Types of Stretchers (17 of 19)
• 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.

72. Types of Stretchers (18 of 19)
• Stair chair
– Folding aluminum
frame chairs with
fabric stretched
across to form a
seat and back
– Most have rubber
wheels in the back

73. Types of Stretchers (19 of 19)
• 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.

74. 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

75. 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.

76. Medical Restraints (2 of 2)
• Apply restraint
to each
extremity.
• Assess
circulation
after restraints
are applied.
• Document all
information.

77. 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?

78. Personnel Considerations (2 of 2)
• Remember, an injured rescuer cannot help
anyone.

79. Summary (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.

80. Summary (2 of 13)
• 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.

81. Summary (3 of 13)
• 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.

82. Summary (4 of 13)
• 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.

83. Summary (5 of 13)
• 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.

84. Summary (6 of 13)
• 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.

85. Summary (7 of 13)
• 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.

86. Summary (8 of 13)
• 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.

87. Summary (9 of 13)
• 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.

88. Summary (10 of 13)
• You should perform an urgent move if a
patient has an altered level of
consciousness, inadequate ventilation, or
shock, or in extreme weather conditions.

89. Summary (11 of 13)
• 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.

90. Summary (12 of 13)
• Whenever you are moving a patient, you
must take special care so that neither you,
your team, nor the patient is injured.

91. Summary (13 of 13)
• 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.