CHAPTER 5

Lifting and Moving Patients

Safety Precautions for Lifting

Use your legs to lift, not your back. Back injuries are a leading cause of long-term disability for EMTs.

Keep weight as close to the body as possible

Lifting Considerations

Consider the weight of object/ patient and the need for additional help.

Know your physical ability and limitations.

Lift without twisting or turning.

Have feet positioned properly.

Communicate clearly and frequently with partner.

Have a plan.

Do not compensate when lifting with one hand.

Use a stair chair when on stairs.

Use legs, not back, to lift.Use legs, not back, to lift.

Keep weight close to your body.Keep weight close to your body.

Safe Lifting of Cots and Stretchers

• Know or find out the weight to be lifted.• Use at least two people (should be an even

number – maintains balance)• Ensure enough help is available• Know or find out the weight limitations of

equipment• Know what to do with patients who exceed

weight limitations of equipment.• Lift while keeping back in locked-in position.• When lowering cot or stretcher, reverse steps• Avoid bending at the waist.

Power-LiftPower-LiftPositionPosition

Using the power-lift or squat-lift position, keep back locked into normal curvature. The power-lift position is useful for individuals with weak knees or thighs. The feet are a comfortable distance apart. The back is tight and the abdominal muscles lock the back in a slight inward curve. Straddle the object. Keep feet flat. Distribute weight to balls of feet or just behind them. Stand by making sure the back is locked in and the upper body comes up before the hips.

Power-GripPower-Grip

Use power grip to get maximum force from hands. The palm and fingers come into complete contact with the object and all fingers are

bent at the same angles. The power grip should always be used in lifting. This allows force to be developed. Hands should be at least 10

inches apart.

Carrying

• Whenever possible, transport patients on devices that can be rolled

• Know or find out the weight to be lifted• Know limitations of the crew’s abilities• Work in a coordinated manner and communicate with

partners – even numbers• Keep the weight as close to the body as possible• Keep back in a locked-in position and refrain from

twisting• Flex at the hips, not the waist; bend at the knees (lift

with the knees)• Do not hyperextend the back (do not lean back from

the waist)

Carrying cont’d…

• Correct carrying procedure– Use correct lifting techniques to lift the stretcher– Partners should have similar strength and height

• One-handed carrying technique– Pick up and carry with the back in the locked-in position– Avoid leaning to either side to compensate for the

imbalance

• Correct carrying procedure on stairs– When possible, use a stair chair instead of a stretcher– Keep back in locked-in position– Flex at the hips, not the waist; bend at the knees– Keep weight and arms as close to the body as possible– Have someone guiding the person who is going backwards

Guidelines for reaching

Keep your back locked in.

Avoid twisting the back while reaching.

When reaching overhead, avoid hyperextension of the back

Application of reaching techniques

Avoid reaching more than 15-20 inches in front of your body.

Avoid situations where prolonged (more than a minute) strenuous effort is need in order to avoid injury

Correct reaching for log rolls

Keep back straight while leaning over patient

Lean from the hips

Use shoulder muscles to help with roll

Safe Reaching Techniques

Safe Pushing and PullingPush, rather than pull.

Keep your back locked in (whenever possible).

Keep line of pull through center of body by bending knees

Keep weight close to your body.

Push from the area between the waist and shoulder

If weight is below waist level, use kneeling position

Avoid pushing or pulling from an overhead position if possible

Keep elbows bent with arms close to the sides

Types ofTypes ofMovesMoves

Emergency MovesIn general, a patient should be moved immediately (emergency move) only when:

Scene is hazardous – immediate danger to the patient.

Fire or danger of fire

Explosives or other hazardous materials

Inability to protect the patient from other hazards at the scene

Inability to gain access to other patients in a vehicle who need life-saving care

Life-saving care cannot be given because of the patient’s location or position (e.g. a cardiac arrest patient sitting in a chair or lying on a bed).

Emergency Moves cont’d…• The greatest danger in moving a patient quickly is the

possibility of aggravating a spine injury• In an emergency, every effort should be made to pull the

patient in the direction of the long axis of the body to provide as much protection to the spine as possible

• It is impossible to remove a patient from a vehicle quickly and at the same time provide as much protection to the spine as can be accomplished with an interim immobilization device.

• If the patient is on the floor or ground, he can be moved by:– Pulling on the patient’s clothing in the neck and shoulder area– Putting the patient on a blanket and dragging the blanket– Putting the EMT-B’s hands under the patient’s armpits (from the

back), grasping the patient’s forearms and dragging the patient– Straddle slide to a long board

Emergency Move:Emergency Move: Clothes Drag Clothes Drag

Emergency Move: Emergency Move: Incline Drag (Head-First)Incline Drag (Head-First)

Emergency Emergency Move: Move: Firefighter’sFirefighter’sDragDrag

Emergency Emergency Move:Move:Firefighter’s Firefighter’s CarryCarry

Emergency Emergency Move: Move: One-Rescuer One-Rescuer AssistAssist

Emergency Emergency Move:Move:Two-Rescuer Two-Rescuer AssistAssist

Urgent Moves

Scene factors cause a decline in patient condition.

Treatment of patient’s condition requires a move.

Urgent Move with Spinal PrecautionsUrgent Move with Spinal Precautions

Non-Urgent Moves

Use when there is no threat to life.

Use when patient’s condition allows for assessment and care.

Typically utilize a carrying device.

Non-Urgent Non-Urgent Move:Move:Extremity Extremity CarryCarry

Patient-Carrying Patient-Carrying DevicesDevices

Wheeled Ambulance StretcherWheeled Ambulance Stretcher

•Most commonly used device

•Rolling

•Restricted to smooth terrain – designs are getting much better though

•Foot end should be pulled

•One person must guide the stretcher at the head

Portable StretcherPortable Stretcher

Stair ChairStair Chair

• Should use whenever possible, if stairs are in the path to be taken

• Transports patient in the sitting position until stretcher is reached

• DO NOT USE if back/neck/spine injury is suspected.

Long Spine BoardLong Spine Board

Traditionally, these were wooden, but with advances in technology they are now x-ray translucent and water safe

Patient Immobilized on Long Spine BoardPatient Immobilized on Long Spine Board

Short Spine BoardShort Spine Board

Again, these were traditionally a wooden device.

Not commonly used in the field any longer, due to the invention of the K.E.D.

Vest-Type Extrication Device (K.E.D.)Vest-Type Extrication Device (K.E.D.)

Patient Immobilized in Vest-TypeExtrication Device

Scoop (Orthopedic) StretcherScoop (Orthopedic) Stretcher

•This device comes apart at the head and foot. It is commonly used for patients who have fallen in tight spaces (e.g. bathrooms, between a bed and a wall).

•It does not ensure spine stabilization.

Basket (Stokes) StretcherBasket (Stokes) Stretcher

Flexible (Reeves) StretcherFlexible (Reeves) Stretcher

Moving Patients toMoving Patients toCarrying DevicesCarrying Devices

Carrying Device Choice

What is the patient’s position?

Is there a suspected spinal cord injury?

Patient Positioning

Part of patient care plan

Must not cause harm to patient

Must be safe

Recovery PositionRecovery PositionAn unresponsive patient without suspected spine injury should be moved into the recovery position by rolling the patient onto his/her side (preferably left) without twisting the body.

Position of Comfort (Fowler’s)Position of Comfort (Fowler’s)

A patient with chest pain or discomfort or difficulty breathing should sit in a position of comfort as long as hypotension is not present.

Shock PositionShock Position Patient without Spinal Injury

A patient in shock (hypoperfusion) should have his legs elevated 8 – 12 inches. This position is known as the Trendelenberg position.

Transferring the Transferring the Patient to a Patient to a

Hospital StretcherHospital Stretcher

Position stretcher.Position stretcher.

Pull sheet under patient taut.Pull sheet under patient taut.

Slide patient to hospital stretcher.Slide patient to hospital stretcher.

Be sure patient is centered. Raise side rail.Be sure patient is centered. Raise side rail.