EMT CH 8

performing a patient move should be done in an

• orderly

• planned

• unhurried manner

body mechanics

relationship betw body’s anatomic structures + physical forces associated w/ lifting, moving, and carrying

• wasy in which the body moves to achieve a specific action

when standing upright

weight of anything being lifted + carried in the hands is reflected onto the shoulder girdle, spinal column inferior to it, pelvis, and legs

properly maintained back in an upright position leads to

little strain against the muscles + ligaments keeping spinal column in alignment

rules of lifting

1. keep your back in a straight upright position + lift w/o twisting

2. face the patient + point your feed in the same direction, after lifting the patient, change the direction of your feet as opposed to twisting / turning fr the waist

3. avoid lifting w/ your arms outstretched ; hold your arms so that your hands are almost adjacent to the plane described by your anterior torso

4. keep the weight you’re lifting as close to body as possible

5. avoid placing lateral force across the spine + sideways leverage against the low back

6. keep your arms approximately the same distance apart as when hanging @ each side of the body, w/ the weight distributed equally + properly centered between them

power lift

lifting technique where back is upright, legs bend, patient is lifted when EMT straightens legs to raise upper body + arms

1st half of deadlift

1. tighten back in its normal upright position, use abdominal core muscles to lock in

2. spread legs apart abt 15 in + bend legs to lower torso + arms

3. reach down each side of body w/ arms + gras stretcher or backboard w/ hands palm up in front of the plane described by ant. torso

4. adjust orientation + position until weight is balanced + centered between both arms

2nd half of deadlift

1. reposition feet to abt 15 in apart w. one foot farther forward + rotated → COG properly balanced

2. keep feet flat + distribute weight to balls of the feet or just behind them

3. don’t bend knees more than 90 deg or extend past toes

4. lift by straightening legs until fully standing w/ upright back + upper body

power grip

technique in which stretcher / backboard is gripped by inserting each hand under the handle w/ the palm facing up + thumb extended ; fully supporting the underside of the handle on the curved palm of the fingers + thumb

power grip + stretcher

• grasp stretcher / backboard w/ hands @ least 10 in apart

• insert each hand under handle w/ palms up + extended thumbs

• advance hand until thumb prevents further insertion + cylindrical handle lies firmly in crease of curved palm

• curl fingers + thumb tightly over top of the handle → fingers @ same angle

things not to do w/ a patient - power grip

• grasp platform w/ palm down → weight supported by fingers rather than palm

safe reaching + pulling

similar to lifting + power grip

• extend arms no more than 15-20 in in front of your torso

• avoid strenuous situations that last longer than 1 minute

• move back 15-20 in when you can’t move back anymore

safe body drags

• kneel on the bed to avoid reaching beyond recommended distance

• use sheet or blanket to drag the patient

transferring patient fr a stretcher to a bed w/ another person

• position stretcher against bedside @ same height or slightly higher

• kneel on bed + drag the patient in until properly centered

• prevent sideways pulling

log roll

1. kneel as close to the patient’s side as possible → leave only enough room so knees don’t prevent patient fr being rolled

2. lean forward + keep back straight + learn solely fr hips

3. roll patient w/o stopping until the patient is resting on their side braced against your thigh

4. pull towards your legs to prevent patient fr rolling over completely

when performing a body drag on a patient who’s lying on the ground, what’s the safest technique

reach forward so that elbows are just beyond the front of your torso

maximum lifting strength + full handle contact w/ curved palm is

power grip

carrying a patient on a patient moving device steps

1. estimate weight of both patient + equipment + gauge limitations of team’s abilities

2. coordinate movements w/ other team members while communicating

3. don’t twist body as you’re carrying patient

4. keep weight you’re carrying close to the body as possible while keeping back in locked-in position

5. don’t bed @ waist → prevents hyperextension

patient weight

• if patient weight too heavy for your own good, maybe use 4 people

• if there’s a strain, stop lift, lower patient, obtain additional help

• find weight limitations of equipment you’re using + how to handle patients who exceed those weight limitations

before lifting is initiated, team leader should

• indicate where each team member is located

• describe the sequence of steps that will be performed

orders that initiate lifting / a change in movement should be given in 2 parts

• preparatory command

• execution command

leader clarifies whether three is a part of preparatory or execution command during countdown

preparatory command

all ready to stop

execution command

stop

patients w/ potential spinal injury

secured to restrict movement of spine

patients w/ no suspected spinal injury reporting chest pain or respiratory distress should be placed in a position of comfort unless they are

hypertensive

patients who are in shock should be placed in a

supine position

patients in late stages of pregnancy should be positioned on their

L side if they are supine

unresponsive patients w/ no suspected spinal, hip, pelvic injury should be positioned in

recovery position

patients who’re nauseated / vomiting should be placed in

a position of comfort while maintaining airway

personal consideration Q’s for patient lifting

• am i strong enough to lift + move patient

• is there adequate room to get proper stance to lift patient

• do i need additional clinicians for lifting assistance

situations where you emergency move a patient

• risk of serious arm or death due to fire, explosives, hazardous materials

• inability to protect the patient fr other hazards

• inability to gain access to others in a vehicle who need lifesaving care

• can’t properly assess the patient / provide critical emergency care bc patient’s location / position

• patient is in immediate danger + must be moved before assessment or spinal motion restriction

how to emergency move a patient - general

• pull along the long axis of the body

emergency clothes drag

pull on patient’s clothing in the neck + shoulder area

• if shirt has buttons, undo top 2 to prevent patient fr choking

emergency blanket drag

place patient onto blanket, coat, or other item that can be pulled

arm to arm emergency drag

place arms under patient’s shoulders + through armpits

• while grasping opposite wrist, drag patient back ward

moving an unresponsive patient fr a vehicle

1. move patient’s legs so they’re clear of pedals + against seat

2. rotate patient → back positioned toward the open vehicle door

3. place arms through armpits + support patient’s head against your body

4. drag patient fr seat

5. check to see if legs + feet clear vehicle to proceed safely

6. use long axis body drag to move the patient to a safe distance

one-person patient moving techniques - when to use

• immediate life threatening danger + you’re alone

• pressing nature of danger, partner is moving a second patient simultaneously

single person front cradle

like the movies - carrying patient like baby

firefighter’s drag

looks like you’re abt to makeout w/ patient

one person walking assist

looks like helping a limping friend

firefighter’s carry

looks like they’re carrying a rag doll over their shoulder

pack strap carry

carry patient like a backpack

rapid extraction techniques should be used when

• vehicle or scene is unsafe

• explosives or other hazardous materials are on the scene

• there’s a fire danger / fire

• patient’ can’t be properly assessed before being removed fr the vehicle

• spinal motion restriction is attempted during an urgent situation w/ limited space

rapid extraction technique steps 1-4

1. clinician 1 provides in-line manual support of the head + cervical spine

2. clinician 2 gives commands, applies cervical collar, performs primary assessment

3. clinician 2 supports torso, clinician 3 frees patient’s legs fr pedals + moves the legs together w/o moving the pelvis or spine

4. clinician 2 + 3 rotate patient as a unit in short coordinated moves , clinician 1 supports patient’s head + neck during rotation (can be replaced by clinician 4)

rapid extraction technique steps 5-8

5. clinician 1 places backboard on seat against patient’s butt

6. clinician 3 moves to position for backboard sliding , clinicians 2 + 3 slide patient along backboard in coordinated 8-12 in moves until patient’s hips rest on backboard

7. clinician 3 exits vehicle + moves backboard opposite fr clinician 2 , continue sliding patient until fully on backboard

8. clinician 1 continues to stabilize head + neck while clinician 2 + 3 carry patient away fr vehicle + onto prepared stretcher

special bariatric techniques + equipment are required for patients that weight over 350 lbs

YES , require special bariatric techniques

nonurgent extremity lift definition

lifting technique used for patients who are supine / sitting position w/ no suspected extremity / spinal injuries

extremity lift steps

1. patient’s hands crossed over their chest ; grasp patient’s wrists / forearms + pull patient to a sitting position

2. parter moves to a position between patient’s legs facing same direction as the patient + places their hands under the knees

3. rise to a crouching position, on command, lift + begin to move

• looks like a two person wheel barrow carry

wheeled ambulance stretcher

specially designed stretched that can be rolled along the ground

• collapsible undercarriage allows it to be loaded into the ambulance

• weights abt 110-165 lbs

• specific head + foot end w/ retractable side rail

• controls located on foot end

pneumatic + electronic stretchers

decrease potential for back injuries for EMS people

• battery operated + have electronic controls to facilitate rising + lowering of the undercarriage

• can be loaded / unloaded by 1 person

• weight more than conventional wheeled stretchers

bariatrics

branch of medicine concerned w/ management of obesity + allied diseases

bariatric stretcher differences

• wider patient surface area

• wider wheelbase

• optional tow package feature

  • allows ambulance mounted winch → assist in loading patient into the ambulance

• optional telescoping side lift handles → provide increased leverage when lifting w/ multiple clinicians

• increased weightlifting capacity

has to be requested

transfer fr bed to stretcher - sit up technique

1. assist person to edge of bed + place legs over the side

2. help patient sit up

3. move stretcher so foot end touches

transfer fr bed to stretcher - draw sheet method

1. loosen bottom sheet underneath patient / log roll patient onto blanket / transfer device making sure they’re centered

2. place stretcher next to bed making sure it’s @ same height / slightly lower than the bed + rails lowered + straps unbuckled

   1. hold stretcher secure to keep it fr moving

   2. reach across stretcher, grasp sheet / blanket firmly @ patient’s head, chest, hips, knees

3. slide patient onto stretcher

patient transfer fr ground → stretcher methods

• log roll / long axis drag → backboard → lift + carry onto stretcher

• scoop stretcher

• log roll patient

long rolling a patient on the ground → stretcher steps

1. loosen bottom sheet underneath patient / log roll patient onto blanket / transfer device

   1. make sure they’re centered

2. log roll patient

3. position blanket underneath patient

4. lower patient onto blanket + log roll patient in opposite direction to unroll blanket

5. lift blanket + transfer the patient to the stretcher

pushing a wheeled stretcher - general

one clinician pushes head of the stretcher while another clinician guides the foot. ofthe stretcher

pushing a wheeled stretcher - guiding foot end

• hold arms close to body + avoid reaching significantly behind you

• bend slightly forward + the hips + try to keep the line of pull through the center of your body

pushing a wheeled stretcher - guiding head end

• push elbows bent → hands in front of the torso between waist + shoulder

pushing a wheeled stretcher - securing patient to stretcher

1. hold main frame → prevent movement

2. secure safety belts over patient’s shoulders + around the patient’s chest in 4 pt harness fashion

3. secure the stretcher’s safety belts over the patient’s hips, thighs, ankles

4. fasten clamps around undercarriage + hold stretcher in place

pushing a wheeled stretcher - moving over irregular surface

must lift + carry stretcher over terrain

pushing a wheeled stretcher - moving over steps

retract or raise undercarriage

loading a wheeled stretcher into an ambulance

1. lift stretcher into load position

   1. place it into patient compartment w/ wheels on the floor + safety bar latched on hook

2. 2nd clinician on side of stretcher releases undercarriage lock + lifts undercarriage

   1. some have button that does this

3. roll stretcher into back of ambulance

4. secure stretcher to clamps in ambulance

backboard

flat board made of rigid rectangular material that is used to provide support to a patient who’s suspected of having a hip, pelvic, spinal, or lower extremity injury

• spine board / trauma board / longboard

• 6-7 ft long

scoop stretcher

stretcher designed to be split into 2-4 sections that can be fitted around a patient who’s lying on the ground or other relatively flat surface

who are scoop stretchers used on

• patients @ risk for spine injury, unstable pelvis, injuries that prevent rolling

scoop stretcher steps

1. adjust length of stretcher

2. lift patient slightly + slide stretcher into place, 1 side @ a time

3. lock stretcher ends together + avoid pinching anyone’s fingers

4. secure patient to scoop stretcher + transfer to stretcher

vacuum mattress

patient placed on mattress + air is removed fr device → molds around patient

• fit snugly to curvatures of body + limit pressure point tenderness

• padding may be used for tender areas but is not required for most patients

• vacuum mattress is equivalent to padding to secure patient’s neck + spine

lifting + carrying a patient on a backboard - diamond carry definition

• 1 clinician @ the head

• 1 clinician @ the foot

• 1 clinician on each side of patient

lifting + carrying a patient on a backboard - diamond carry steps

1. all 4 clinicians lift device while facing patient

2. clinicians turn the hand closest to patient’s head so palm’s facing themselves + release the other hand

3. clinicians turn towards the foot end

lifting + carrying a patient on a backboard - one handed carry definition

4+ clinicians use one hand to support the backboard so that they are able to face forward as they’re walking

lifting + carrying a patient on a backboard - one handed carry steps

1. 2 clinicians face eachother on each side of backboard (4 total), clinicians grip backboard w/ both hands

2. team lifts backboard to carrying height

3. clinicians turn in direction they’ll walk + witch to using one hand

moving a patient on stairs using a backboard - things to consider

• 2 strongest clinicians should be @ each end of the device

• if 2 of the strongest clinicians are taller than the other, position the shorter clinician @ the upper end + the taller clinician @ the lower end

• once you reach the stretcher, place both device + patient on the stretcher

moving a patient on stairs using a backboard - steps

1. strap patient securely

   1. make sure one strap is tight across upper torso, under arms, secured to handles to prevent patient fr sliding

2. carry patient down stairs w/ foot end first, always keeping head elevated

   1. unless patient is completely alert + cooperative, hands need to be secured for safety + to prevent patient fr grabbing onto railing of stairs or patient’s hands fr falling off the side of the board

stair chair

lightweight folding device that is used to carry an alert, seated patient up or down stairs

stair chair characteristics

• lightweight, folds, molded seat, safety straps, handles @ both ends

• most have rear wheels + front casters for maneuvering

• help move patients to ground floor where stretcher is

  • can be used as a transfer device if patient is sitting in a chair + can’t assist in moving or if patient needs to be moved down narrow hallway that doesn’t fit stretcher

using stair chair steps

1. position + secure the patient on their chair w/ straps

   1. take places @ head + foot of the chair

2. lower chair to roll on landings + for transfer to the stretcher

neonatal isolette

incubator

• provides warm, clean environment w/ moistened air + protects against noise, drafts, infection, handling

types of transport isolettes

• one placed on a wheeled stretcher + secured w/ seatbelts

• one frees standing + secured in the ambulance in place of a standard stretcher

binder lift definition

safe way to lift patients as a team to help prevent injuries

• used for patients w/ nontraumatic injuries who don’t require spinal motion restriction

• allows for application in confined spaces / assist patients into a standing position when they’ve slid down onto floor + need assistance up

how binder lift works

• binder wrapped around patient’s torso

• has 24-32 handles for clinicians to use during patient lift before moving patient to stair chair / stretcher

slipp patient mover - definition

device that can be used to transfer patients of any weight fr one surface to another

slipp patient mover - steps

1. roll patient onto their side

2. position slipp w/ drawsheet on top , under patient

3. roll patient back onto slipp

4. pull draw sheet w/ patient across slipp + onto whatever bed you need them on

portable stretcher

stretcher w/ a strong rectangular, tubular metal frame + rigid fabric stretched across it

• have wheels that fold down 4 in under the foot end + similar length legs that fold down fr the head @ each side

• can be folded in half for storage

• weighs less than a wheeled stretcher + lacks bulky undercarriage

• team has to support full weight of patient, equipment, stretcher bc of lack of wheels

flexible stretchers

stretcher that is a rigid carrying device when secured around a patient but can be folded or rolled when not in use

• = soft stretcher

basket stretcher

rigid stretcher used in technical + water rescues + uneven terrain in remote location

• surrounds + supports the patient but allows water to drain through holes in the bottom

• = stokes basket or litter

• made of plastic w/ aluminum frame / full steel frame connected by woven wire mesh

• patients w/ spinal injury are secured to backboard before placing them into basket stretcher

short backboards

used to stabilize the torso, head, + neck of an alert seated patient w/ a suspected spinal injury + no life threatening injuries who can’t self extricate

• 3-4 ft long

• useful for extracting patients fr confined spaces but not used often

decontamination

should be done after each use

a conscious patient going down a narrow staircase should be taken on what

a stair chair w/ a head + foot rest

MOI

mechanism of injury

42 YO man w/ tree fall on him - best way to remove the patient once tree is lifted

power lift

when lifting a backboard you should use the

power lift

when freeing the patient, it is imperative to use which of the following proper body mechanics

keep your back straight

should you consider spinal motion restriction for this patient? - tree fall guy

no theres’s no significant MOI

how should he be moved to the backboard

scoop stretcher

when you use a body drag to move a patient, your back should be locked and straight and

in an upright vertical position

because you are unable to bring the stretcher to the patient, the best way to carry him to the stretcher is using the

diamond carry

requirement everytime you are lifting / moving a patient

treat patient w/ respect + preserve their dignity

in most instances, you should move a patient on a wheeled ambulance stretcher by

pushing the head of the stretcher while your partner guides the foot

it’s essential that you __ your equipment to prevent the spread of disease

decontaminate