Training in Lifting and Moving Patients is included in this California-based EMT program as it is required in higher level scenario-based skills verification for California Registration.[1] Although it may seem like a simple and potentially redundant skill to teach as everyone lifts things in their daily life, this is in fact one of the most important skills for any healthcare worker to master as back injuries due to lifting are some of the most common injuries found in EMS workers. Back injuries are generally caused by incorrect lifting and moving of patients and can be long lasting and painful. Therefore, we will initially cover basic lifting mechanics and physics before speaking about some of the different patient movement devices you may be called to use.
Basic Lifting Mechanics[edit | edit source]
This section will discuss 8 basic actions you should perform before and during a lift.
- Think before you lift: Plan your lift as much as possible, making sure other lifters know who is lifting what, when lifting is happening, and where you are moving (e.g. to the edge of a bed, then the gurney or fully onto the gurney in one motion).
- Keep the load as close to the waist as possible: Moving the load farther from your waist will drastically increase the load on your lower back and shoulders and will lead to injury. If circumstances require that the load be farther from your waist (e.g. physical debris in the way that cannot be moved) use additional rescuers to reduce personal load.
- Adopt as stable a position as the situation allows: A stable base makes for a stable lift. Clear space if needed so that you have room to lift correctly and safely. Sometimes you may be called to remove a patient from a hill or encampment with unstable footing. Do everything in your power to make sure you have stable footing, tripping and falling is likely to cause injury to both yourself and the patient.
- Do not bend your back; lift with your legs: Bending your back causes the same issue as not keeping the load close to your waist: it massively increases the strain and effective weight that your lower back experiences. If you must squat all the way to the ground to pick up a patient, it is safer to use a slight bend to your back than fully squatting.
- Do not twist while lifting, if possible: Keep the load in front of you at all times. Twisting adds different forces to the body, ones that are generally poorly dealt with. If you must twist to facilitate patient movement, use additional rescuers.
- Maintain clear communication with other lifters: Communication is KEY to a successful multi-person lift. Common mistakes include moving the patient in the wrong direction, multiple directions, or at the wrong time. Remember, the difference between trying to move a patient with one person and four could be as simple as the leader stating "We will move the patient on three" and the other rescuers hearing "We will move the patient after three".
- Move smoothly: Smooth movement reduces the risk of injury; do not jerk the lift or move quickly as it may unbalance other rescuers.
- Know your limits: Call for additional resources if needed. Knowing your limits is the best way to assure that you are not performing a lift unsafely. Some patients may require additional resources by circumstance (e.g. difficult high/low angle extrication), others by physicality (e.g. the patient is 600 pounds). Calling for additional resources is always the best option to deal with these patients so that you do not become a patient yourself.
These actions are universal to any lift and should be in the forefront of your mind when moving any patient, with any device. We will now discuss different methods and devices used by EMS professionals to facilitate patient movement. Keep in mind that there is rarely one correct answer when in the field and that some patients may need to be moved in a way that differs from the following information due to their circumstances. The following is intended to be an overview of common systems, not a comprehensive guide.
Patient Movement[edit | edit source]
Assisted Movement[edit | edit source]
Assisting the patient to the gurney or the ambulance is perfectly alright, so long as the patient is ambulatory (can walk on their own, or with assistance). Patients that normally use a walker or cane may also be assisted to the gurney; this saves the patient the uncomfortable sensations involved in carrying and saves the providers the possible strain on their bodies.
Sit-Pick[edit | edit source]
The sit-pick is performed by having one rescuer move behind a patient and place their arms under the patient's armpits. The patient's arms are crossed in front of them and the provider uses each of their hands the grab the patient's opposite wrist. This "locks" the grip in place and allows for a better distribution of weight. A second provider will be in charge of moving the patient's legs. Sit-picks are versatile maneuvers that can be used for both conscious and unconscious patients, but carry increased strain for the rescuer located behind the patient, as most, if not all, of the patient's weight is directed downwards and away from the rescuer.
Patient Mover (Redi-Bed, Mega-Mover)[edit | edit source]
In the event that the patient is located in an area that is inaccessible by the gurney or the patient is large enough that a draw-sheet or sit-pick will not work, a commercial patient mover may be used. Patient movers go by many names such as Redi-Beds or Mega-Movers and are essentially reinforced tarps with many handles around the edges. Patient movers are made to be carried or dragged and are useful in moving both patients in difficult to access areas and bariatric patients. A patient may be placed on a mover by a variety of methods, but by far the most common is the log roll (c-spine immobilization is not needed). In this case, while the patient has been rolled to one side, half of the mover is bunched up long-ways and pushed as far under the patient as possible. The patient is then rolled to their other side which frees the part of the patient mover that was trapped under the patient. The patient is then returned to the supine position; the patient should be close to centered on the patient mover and can be carried (or dragged if necessary) to the gurney for packaging and transport.
Draw Sheet[edit | edit source]
The draw sheet maneuver is used to move patients from one surface to another parallel, adjacent surface using a sheet, towel, or blanket that the patient is on top of. The maneuver can be performed by a minimum of two rescuers, but more may be used to facilitate movement of the patient's feet and head. There are several methods to perform a draw sheet maneuver, only one will be detailed here. This example will use the minimum of two rescuers, more rescuers may be added where needed if they are available. To perform a draw-sheet maneuver, one rescuer will move to the opposite side of the side-by-side surfaces (often beds) as the other rescuer. The rescuer with the "end" surface is the "puller" and the rescuer on the "beginning" surface is the "pusher". Both rescuers will grab secure handholds on the blanket/sheet/towel under the patient with one hand in the vicinity of the patient's shoulders and the other at the patient's hips or knees. Any slack will be removed from the blanket/sheet/towel (some of these are stretchy; remove all stretch from the fabric before pulling) and the patient will be drawn from one surface to the other. This may be performed as a single or multiple movements based on the height and reach of the rescuers, patient weight, width of the surfaces, etc. If necessary, rescuers may need to stand or kneel on one of the surfaces.
Backboard and Scoop Stretcher[edit | edit source]
The backboard is a rigid piece of radiotranslucent (does not show up on an X-Ray) plastic with handholds placed around the perimeter of the board. Backboards serve a variety of functions for EMS personnel, chief among them being used for spinal motion restriction procedures. An in-depth look at patient placement on a backboard can be found here. Scoop stretchers are like backboards in that they are rigid, but the similarities end there. Scoop stretchers have a concave structure and are made to break into two parts. Once the two halves of the scoop stretcher have been separated, they may be slid under each side of the patient and re-secured to each other "scooping" the patient onto the board. Scoop stretchers, unlike backboards, are also adjustable to account for taller patients. Scoop stretchers are commonly used for patients with hip fractures and patients in cardiac arrest. Both scoop stretchers and backboards may be moved with a minimum of two rescuers, although it is recommended that at least 4 rescuers be used to improve stability and reduce mechanical stress.
Stair Chair[edit | edit source]
The stair chair is a device used to move patients up or down stairs in a seated position. There are many moving components, handles, and tracks to a stair chair that are shown in the video; these will not be fully discussed in this section. Patients should be fully secured into the chair before being moved, this prevents accidental falls out of the chair. Patients may be moved in a stair chair along the ground by just one rescuer in the same way a patient would be moved in a wheelchair; when ascending or descending stairs, a minimum of two rescuers is mandatory for stair chair use. Older stair chairs do not have the tracks found on newer chairs and will thus need to be carried both up and down stairs; newer chairs have a track system that allows for a controlled descent with significantly less mechanical stress placed on the operators. To use a stair chair in this manner, extend the upper rail, lower handles, track system (making sure all are locked in the extended position). Move the device to the top of the staircase with the front wheels in line with the top step. Explain the procedure to the patient, making sure to stress that they do not reach out and attempt to grab the railings or rescuers and to not kick out with their feet as this is dangerous. Tilt the device back and move it forward to the stairs until the tracks start to descend. The rescuer at the bottom is in charge of making sure the tracks clear each step in a way that the ride is as smooth as possible; the rescuer at the top is in charge of maintaining control over the device's speed (the tracks have a naturally slower speed that changes minimally with patient weight). Once at the bottom of the steps, tilt the chair forward until the front wheels again make contact with the ground and continue patient movement as planned.
Gurney[edit | edit source]
The gurney is the most commonly used patient movement device in EMS. Gurneys can differ significantly based on age, manufacturer, and technology available. Some examples of newer technology include hydraulic lifting, auto-loaders, loading systems without the "horns", quad-lock and omni-directional wheels, and gurney to chair configurations. Despite the large disparity in gurney systems, there are several universal rules to prehospital gurney operation and movement.
- Move the gurney in the way that it is most stable when possible. For most gurneys this is in the head-first or foot-first direction.
- A gurney in the tallest position is at a substantially higher risk of tipping than a gurney in a lower position. Transport patients in the lowest safe gurney position.
- Use at least two people when lifting or moving a loaded gurney to decrease tipping and injury chances.
- Keep the gurney on even, level surfaces when at all possible.
Refer to device and program specific requirements and training for any gurneys you may be called to use before attempting gurney operations.
Other Movement Devices[edit | edit source]
The above listed movement devices and maneuvers are by no means the only ones available for EMS use, but are among the most common in the California area around Foothill College. Other systems and maneuvers are both available and in use nationally and internationally and may be similar or differ greatly from the information provided in this page. Refer to regional specific protocols for using any device and make sure you are fully trained on each device's use and troubleshooting before using it to move patients. Examples of alternate patient movement systems include basket or Stoke's stretchers, Hovermat systems, Full body air casts, etc.
Documentation[edit | edit source]
- Appropriate documentation in the PCR allows for a better picture of the call. For example, "The patient was moved to the gurney and loaded into the ambulance" provides substantially less information on the patient condition than "The patient ambulated from her apartment to the stairway and was assisted down x2 flights of stairs to the gurney. The patient was placed in all safety belts and loaded into the ambulance".
Tips and Tricks[edit | edit source]
- Do not be afraid of moving items around on scene to facilitate easy movement. The first order of scene safety is provider safety, followed by patient safety. Improper lifting can place both the providers and the patients at risk for injury. Take the time to clear the movement path of any sharp edges and large furniture, as well as any trip or slip hazards (remember, at least one person will be travelling backwards normally).