Chapter 8 — Lifting & Moving Patients: Comprehensive Bullet-Point Study Notes

Introduction & Scope of Patient Movement

• Every EMS call generally involves multiple patient transfers:

  • From initial position → backboard or stretcher → ambulance → emergency department (ED) bed.

• Goals of proper movement:

  • Protect patient from further harm.

  • Prevent EMT/team musculoskeletal injury.

  • Maintain efficiency of patient care.

• Core competencies to master:

  • Lifts, carries, body drags (emergency, urgent, non-urgent).

  • Spinal-injured patient packaging vs. non-spinal.

  • Use of equipment: wheeled stretcher, stair chair, scoop/folding/basket/flexible stretchers, backboards, bariatric aids, restraint devices.

  • Verbal commands & team positioning.

Wheeled Ambulance Stretcher (Gurney)

• Primary transport device in modern ambulances.

• Construction & weight:

  • Tubular metal main frame; weighs 40–145\,\text{lb} (18–66\,\text{kg}).

  • Three-section inner frame with platform plates.

  • Hinged head section for semi-Fowler or full-upright positioning; foot section may hinge to elevate knees (not on all models).

• Guardrails:

  • Retractable; must be locked up after loading.

• Undercarriage:

  • Folding; adjustable height 12–36\,\text{in} (30–91\,\text{cm}).

  • Safety interlock: stretcher must be slightly lifted to fold, preventing sudden drops if handle is pulled accidentally.

• Mattress requirements: fluid-resistant, non-absorbent.

• Strap use mandatory for all transports to prevent crash ejection.

• Words of Wisdom: Only transport patient on alternate device (folding stretcher/backboard on bench) when two pts share one ambulance.

Backboards

• AKA long backboards, spine boards, trauma boards.

• Dimensions: 6–7\,\text{ft} (≈2\,\text{m}).

• Uses:

  • Supine immobilization for suspected hip, pelvic, spinal, lower-extremity injury, multisystem trauma.

  • Extrication from confined/awkward spaces.

• Features:

  • Parallel long hand holes 0.5–1\,\text{in} from edge for lifting & strapping.

  • Materials: legacy marine-plywood (requires infection-control varnish); modern plastic – lighter, non-absorbent.

Body Mechanics Fundamentals

• Definition: relationship between anatomical structures & physical forces during movement.

• Weight transfer path (upright): object → shoulder girdle → spine → pelvis → legs.

• Key lifting rules:

  • Keep back straight & vertical; avoid twisting.

  • Face patient; point feet same direction; pivot with feet, not torso.

  • Stance: feet shoulder-width (~15\,\text{in}/38\,\text{cm} apart), one slightly forward.

  • Bend at knees/hips ≤ 90^{\circ}; let leg muscles (powerful, conditioned) do the work.

  • Keep load close to body; arms nearly adjacent to torso plane.

  • Distribute weight symmetrically; avoid lateral forces.

• Power Lift (Skill Drill 8-1):

  1. Lock back with slight curve, tighten abdominals.

  2. Spread & flex legs.

  3. Palms-up grip, hands just in front of torso plane.

  4. Center load; reposition feet if needed.

  5. Lift by straightening legs, then curling arms if higher elevation needed.

• Power Grip:

  • Hands \ge 10\,\text{in} (25\,\text{cm}) apart, palms up, thumb extended, handle deep into palm.

  • Avoid palm-down grasp (relies on fingertips; high failure risk).

Reaching, Pulling, & Dragging Principles

• Keep back locked; no lateral curvature.

• Kneel to minimize forward lean; reach only 15–20\,\text{in} (38–50\,\text{cm}) beyond torso.

• Pulling sequence: flex arms → reposition body → repeat (prevents jostling & spinal torque).

• Bed drags: kneel on bed; use sheet/blanket rolled into 6-inch "handles" to glide patient.

• Two-provider side drag technique: each kneels beyond shoulder, grasps armpit + belt, elbows high to minimize trunk rotation.

• Log-roll considerations: kneel close; lean from hips; continuous motion until pt braced against thighs.

Lifting & Carrying Configurations

• Diamond Carry (Skill Drill 8-2): 4 providers – head, foot, two sides.

  • Side providers rotate palms down with head-end hand, release opposite, then turn toward foot; all walk same direction.

• One-Handed Carry (Skill Drill 8-3): after initial two-hand lift to waist, providers pivot, switch to outside hand so all face forward.

• Weight awareness:

  • Typical adult 120–220\,\text{lb} (≈54–100\,\text{kg}).

  • ≥250\,\text{lb} (≥114\,\text{kg}) requires ≥4 providers.

  • Special bariatric resources often >350\,\text{lb} (≈159\,\text{kg}).

• Guideline table highlights:

  • Estimate combined pt + equipment weight.

  • Communicate; avoid twisting; keep load close; flex knees/hips.

Stair Transport

Stair Chair (Skill Drill 8-4)

• Indications: conscious pt able to sit.

• Features: fold-out head/foot handles, safety straps, rear wheels or tracks.

• Procedure:

  1. Secure lap, chest, arm/hand, and foot.

  2. Provider positions: head (commander) & foot; optional 3rd for guidance/opening doors.

  3. Roll on landings; carry on steps; transfer to stretcher at bottom.

Backboard on Stairs (Skill Drill 8-5)

• Indications: unresponsive, supine, spinal, or cannot sit.

• Strap high-torso “armpit through” strap to prevent sliding.

• Descent/ascent head-high orientation: foot end first going down, head higher than feet.

• Strongest providers at head & foot; height differential: shorter at head if stair descent.

Loading into Ambulance (Skill Drill 8-6)

1. Tilt head end into patient compartment; safety bar catches hook.

2. Side EMT lifts & retracts undercarriage via lock.

3. Roll fully inside onto all six wheels.

4. Engage floor/side clamps; verify lock before vehicle movement.

• Guidelines (Table 8-2): adequate crew, manufacturer’s instructions, always secure before motion.

Command & Communication

• Team leader assigns positions, gives overview, uses two-part commands: preparatory + execution (louder).

• Countdowns: clarify whether “3” or “lift” is execution word.

• Dynamic adjustment: leader may alter sequence as situation evolves.

Safety Rules Summary

• Minimize total body lifts; use wheels when possible.

• Coordinate every lift; ask for help promptly.

• Never lift with a curved/twisted back.

Emergency Moves

• Justified for:

  • Imminent environmental danger (fire, explosion, HAZMAT, traffic, water, structural collapse).

  • Inability to access other critical pts.

  • Inability to provide lifesaving care in current position.

• Principles:

  • Prioritize speed over spinal precautions but drag along long axis to limit spinal movement.

• Solo drags:

  • Clothing drag (neck/shoulders; unbutton top two buttons).

  • Blanket/coat drag.

  • Arm drag (pt’s arms overhead, rescuer grasps wrists).

  • Arm-to-arm/under-axilla drag.

• Vehicle solo extraction:

  1. Move legs off pedals, against seat.

  2. Rotate pt’s back toward door.

  3. Arms through axillae, grasp wrists; support head on torso; drag out.

  4. If legs snag, lower to ground, clear limbs, long-axis drag away.

• Additional one-rescuer techniques: fireman’s carry, pack-strap carry, cradle carry (see Fig 8-17 references).

Non-Emergency Transfers

• Draw-Sheet Method (Fig 8-18): roll sheet under pt, slide to stretcher.

• Blanket Transfer (Fig 8-20): roll edges for handles; lift as sling.

• Scoop Stretcher (Skill Drill 8-11): adjust length → separate halves → slide under each side → lock → secure → move.

• Direct Body Carry (chair/bed to stretcher) if pt cannot stand.

• Stair-chair transfer from household chairs for conscious pt (Fig 8-21).

Scenario Connections (“YOU Are the Provider” Cases)

• Part 1 MVA with overturned sedan in water:

  • Immediate challenges: unstable vehicle, partial submersion, limited access, two entrapped unrestrained pts, potential hypoxia for Pt 1.

  • Body mechanics relevance: confined space requires awkward reaches; risk of EMT injury during extrication.

  • Additional resources: rescue unit for stabilization/extrication, paramedics for ALS airway & oxygen, fire for water hazard.

• Part 2 Critical decision-making:

  • Pt 1 unstable (unresponsive, cyanotic, snoring) → rapid access imperative before full rescue arrival.

  • Safety & body mechanics: confined ditch, water; plan for minimal-angle pulls, coordinated commands; maintain C-spine.

  • Removal plan: rapid extrication onto backboard through rear door, simultaneous manual inline stabilization, prioritize airway/oxygen.

• Part 3 Implementation:

  • Half-board wedge technique; firefighter assists; remote holding of other end due to space; use long-axis drag onto board; lift-and-carry mindful of water-filled ditch traction hazards.

Special Populations & Equipment

• Geriatrics: high anxiety, fear of not returning home; fragile bones/skin – avoid skin pulls, use draw sheets, slow deliberate moves.

• Technology aids:

  • Soft stretchers, tarps, sliding transfer boards.

  • Hydraulic sling lifts (reduce manual lifting).

  • Bariatric stretchers, ramps, winches for >350\,\text{lb} patients.

Infection Control & Equipment Maintenance

• Clean/disinfect wooden backboards per protocol; plastic boards preferred.

• Maintain stretcher mechanisms per manufacturer; fluid-resistant mattresses mandatory.

• Post-call debrief: identify technique gaps, equipment needing service, skills to retrain.

Ethical & Practical Implications

• Dual obligation: patient dignity/safety and rescuer occupational safety.

• Documentation: chart specific movement methods (e.g., “Pt transferred via draw-sheet lift”); aids QA and legal review.

• Continuous training: dynamic weight shifts; rehearse commands & positions with unfamiliar partners.

Key Numbers & Formulas Recap

• Stretcher weight: 40–145\,\text{lb}.

• Stretcher height range: 12–36\,\text{in}.

• Patient torso weight percentage: 68\%-78\%.

• Safe reach limit: 15–20\,\text{in} forward.

• Standard stance width: 15\,\text{in} (38\,\text{cm}).

• Heavy pt threshold: >250\,\text{lb} requires ≥4 rescuers; bariatric resources ≥350\,\text{lb}.

Quick Study Checklist

• Practice: power lift & grip; diamond/one-hand carries; stair chair sequence; loading stretcher.

• Memorize: emergency move indications; weight limits; communication protocol.

• Review: infection-control cleaning, geriatric handling considerations.

• Reflect: after each transport, debrief to reinforce or adjust technique.