EMT Notes Chapter 3: Moving Patients & Chapter 4: Medical, Legal and Ethical Issues


Moving Patients

  • Position your feet properly

  • Use your legs, not your back

  • Feet shoulder width apart

  • Never turn or twist

  • Do not compensate when lifting with one hand

  • Keep weight as close as possible to your body

How likely is it that we can do this every lift? Unlikely


Have the patient help you as much as possible or as much as makes sense for their condition

  • Are they able to stand and walk unassisted

  • Can you assist them to stand and then take a few steps


People are difficult to move: dead weight, challenging locations (basements, bathrooms etc.)

Train for Ems: do uneven weights for farmer carries, cross body dead lifts, etc

Train core for the job: deep core and stabilizers


Before every lift:

  • consider the following before lifting any patient:

  • the person: their weight and if you need extra help

  • your limitations

  • communication: make a plan

  • any challanges youll face: stairs, tight corners etc.


Reaching:

  • keep back in a locked in position

  • avoid twisting while reaching

  • avoid reaching more than 20 inches in front of body

  • avoid prolonged reaching when strenuous effort is required.


When pushing or pulling:

  • push rather than pull whenever possible

  • keep back locked in

  • keep line of pull through center of body

  • keep weight close to body

  • if the weight is below your waist push or pull from kneeling position

  • avoid pushing or pulling overhead

  • keep elbows bent close to your sides.


  1. emergency moves

  • car crash the scene is hazardous, on fire

  • care of life threatening conditions requires repositioning

  • you need to move the patient to reach other patients

  • move must be made immediately to protect the patient’s life

  • Three kinds of moves:

    do not take time to protect spine or other areas

  • life over limb

Mass casualty incidents, car crashes, fires, are all places for an emergency move.

Move first, then assess a spinal cord injury. Being immobilized is better than being dead.

How to protect the spine

  • no time to backboard

  • move the patient in the direction of the long axis of body (head to foot)


2. Urgent moves

Situations include car crashes, but they are trapped, no fires etc.

  • required treatment can be preformed only if patient is move

  • factors at the scene cause patient decline

  • extreme heat or cold

  • you take the time to take spinal precautions

  • frequently uses backboard for movement, not for spinal immobilization


  1. Non urgent moves

you have plenty of time, no immediate life threat: nausea or coughing

  • patient can be assessed, treated, and moved in a normal way (no external threats)

  • take all required precautions not to aggravate existing conditions or injuries.

  • take ur time


Patient carrying devices:

Stretchers

  • manual

  • power

  • Bariatric (obese, overweight patients)

Stair chairs

  • stairs where stretchers cannot be easily maneuvered

Spine boards

  • used to stabilize the spine, just a big plastic board, protects spinal cord from further harm in a traumatic situation

  • short spine boards are rarely used

  • long spine boards: remove patients from vehicles, and carry patients from where they are found to the stretcher

other:

  • scoop stretcher

  • litter

  • flexible stretcher


Moving patients onto carrying devices:

  • patient with suspected spinal injury

  • manual stabilization

  • rigid cervical collar

  • coordinated movement controlled by the person at head to minimize unnecessary movement of the spine

  • do a log roll (not for spinal patients)


Patient with no suspected spinal injury

  • extremity lift or draw sheet method

Patient positioning for shock: when BP, temperature, or electric impulses cannot be controlled (lack of perfusion, electric relates to spinal injury.)

  • place patients believed to be in shock in a supine position: get blood to your organs

  • do not lower head, do not raise legs.

  • if you suspect internal bleeding, leave the patient flat.


Critical Thinking: You arrive at a vehicle crash and find an elderly driver slumped over the wheel. Upon examination you determine the patient is isn respiratory arrest and is not trapped in the vehicle. which move would be appropriate for this patient?

This is could be an emergency or ugent move. It is slightly emergent because they are slumped over the wheel, making it harder to reposition them to intubate or help with the respiratory arrest.

Transferring the patient to a hospital stretcher


Chap 3. Review

things to consider while lifting the patient

  • know limitations

  • understand how heavy the patient is

  • understand if its emergent, non emergent, or urgent.


describe the difference between emergency, urgent, and non emergency

emergency: u need to get them out because there is an external life threat that could kill them there

urgent: they are in bad condition, but you don’t have the space

non emergent: no immediate life threat, assess the patient first.


patient carrying devices:

  • spinal boards

  • litter

  • Samson strap

  • scoop boards

  • stair chairs

  • gurneys

  • wheelchair

  • tarp / blanket / sheet



Chapter 4: Medical, Legal and Ethical Issues

Topics: scope of practice, patient consent/refusal, and other legal issues.

Scope of practice

  • regulations and ethical considerations that define the scope (extents and limits) of an EMT’s job.

  • Includes skills and medical interventions

  • defined by state legislation, regional rules and guidelines.

EMTs: we can give 7-8 types of medications, with fewer risks, and less invasive, while paramedics can give about 40 different kinds.

EMTs can give: Oxygen, Aspirin, Oral Glucose, Epinephrine, Albuterol, Nitroglycerin, Naloxone, and Activated Charcoal


Standard of Care:

  • care that would be expected from an EMT with similar training when caring for a paitent in a similar situation

  • what you can do: scope of practice

  • how you should do it: standard of care


Patient consent and refusal:

  • we need permission to take care of our patients.

  • permission from patients to: (1) assess (2) treat (3) transport

  • main types of consent: expressed consent, implied consent, informed consent


If a patient does not follow medical advice, they must sign against medical advice, so the caretakers are not liable if they die.


4 questions:

who are u?

where are you?

when is it?

what happened?


Forms of consent:

Involuntary transport (pink sheet)

  • patient is considered a threat to themselves or others

  • requires a decisions made by a professional or PD

  • if paitent is restrained, ensure well being.


Refusing care:

Patients refuse further care or transport if:

  • legally able to consent (18+)

  • awake and oriented, informed of risks

  • they sign a release form saying they understand, ems can still be held liable to document well.

  • forcing a patient to receive unwanted care and transport can be viewed as assault or battery in court


DNR & POLST

  • legal documents expressing the patients wishes if they are unable to speak for themselves

  • POLST: Physician order for life sustaining treatment

  • DNR: Do not resuscitate

POLST:

  • covers cpr, ventilators, feeding tubes, medical treatments

  • EMS must follow orders, and must see the order signed.


Living will or health care proxy:

Living will

  • provides general prefrences about life saving treatments

  • written by individual and does not require a doctor just a notary

  • EMTs cannot act on a living will

Healthcare proxy

  • identifying one person to make medical decisions on behalf of the patient so they can do it if they cant do it themselves.