Section 6: Scene
Techniques
Chapter 27
Rescue Techniques:
Lifts and Loads
Chapter 27: Rescue Techniques: Lifts and Loads
Objectives (1 of 4)
• Discuss the guidelines and safety
precautions that need to be followed when
extricating and transferring a patient.
• Describe the safe lifting of immobilization
devices, cots, and stretchers.
• Describe correct and safe carrying
procedures on irregular terrain.
• Describe correct techniques for log rolls.
3
Chapter 27: Rescue Techniques: Lifts and Loads
Objectives (2 of 4)
• State the guidelines for pushing and pulling.
• Discuss the general considerations of
moving patients.
• Identify the following devices: immobilization
devices, transfer devices, transportation
devices.
• Explain the rationale for properly lifting and
moving patients.
4
Chapter 27: Rescue Techniques: Lifts and Loads
Objectives (3 of 4)
• With another rescuer, prepare each of the
following devices, transfer a patient to the
device, and properly position the patient on the
device:
•
•
•
•
•
•
Long backboard
Short backboard
KED
Scoop stretcher
SKED
Stokes
• Commercial or
improvised stretcher
• Cots
• Toboggan
• Overland wheeled
stretcher
• Stair chair
5
Chapter 27: Rescue Techniques: Lifts and Loads
Objectives (4 of 4)
• With another rescuer:
• Demonstrate techniques for the transfer of
a patient from a long backboard to a
toboggan.
• Move a patient (not on a backboard) from
the ground to a toboggan.
• Transfer a patient from a toboggan to a cot
or gurney.
• Transfer a patient to an automobile.
6
Chapter 27: Rescue Techniques: Lifts and Loads
Rescue Process
• Note patient’s location and any
hazards.
• Always consider your protection!
• Avoid approaching the scene from
directly above or below.
• Extrication is the process of safely
moving a patient, from entrapment or
danger, to provide further care.
7
Chapter 27: Rescue Techniques: Lifts and Loads
Basic Anatomic Positions (1 of 3)
• Position 1
– Patient supine
– Anatomically neutral
– Straight back
• Position 1a
– Patient supine
– Head, neck, back, or
extremities not
anatomically neutral
8
Chapter 27: Rescue Techniques: Lifts and Loads
Basic Anatomic Positions (2 of 3)
• Position 2
– Patient on side
– Anatomically neutral
• Position 2a
– Patient on side
– Head, neck, back, or
extremities not
anatomically neutral
9
Chapter 27: Rescue Techniques: Lifts and Loads
Basic Anatomic Positions (3 of 3)
• Position 3
– Patient prone
– Anatomically neutral
– Head usually turned
to the side
• Position 3a
– Patient prone
– Head, neck, back, or
extremities not
anatomically neutral
10
Chapter 27: Rescue Techniques: Lifts and Loads
Patient Positioning
• Three spinal reference points: head,
shoulders, and hips
• Rescuer at each point
• Movements are in short increments
(6” to 12”).
• All movement is directed by a single
leader.
11
Chapter 27: Rescue Techniques: Lifts and Loads
Patient Positioning
• Align head and neck first to provide and
protect airway (except in patients in position
3a).
• Limbs should be aligned one joint, one
plane at a time.
• Align the patient using the fewest moves.
• Align a patient in increments, ie, from
position 3 to position 2, then position 1.
• Patients may have to be moved before
alignment.
12
Chapter 27: Rescue Techniques: Lifts and Loads
Specific Techniques
• Recovery position
– Also known as NATO position
• One-rescuer side roll
– Used to help prevent aspiration
• Log roll
– Used to place patient onto a
backboard
13
Chapter 27: Rescue Techniques: Lifts and Loads
Rescuer Body Mechanics
• Lifting should be done using the hips
and legs.
• Keep your back straight.
• Do not twist or bend forward or to the
side.
• Grasp with your palms up (power grip).
• Weight should be kept close to your
body.
14
Chapter 27: Rescue Techniques: Lifts and Loads
Lifting Anatomy
• Shoulder girdle rests on vertebrae.
• The sacrum is the weight-bearing base
and connection with pelvis.
• Lifting with hands is reflected onto
shoulder girdle.
• Position of shoulder girdle will direct force.
– Anterior to pelvis will exert force across spine.
– Over pelvis will exert force in line with spine.
15
Chapter 27: Rescue Techniques: Lifts and Loads
Power Lift
• Tighten your back in an upright position.
• Spread your legs apart about shoulder
width.
• Use power grip and hold close to your
torso.
• Center your balance between both arms.
• Ensure firm and balanced footing.
• Straighten your legs and lift, keeping your
back straight and upright.
16
Chapter 27: Rescue Techniques: Lifts and Loads
Power Grip
• Place hands about 10” apart with
palms up and thumb on top.
• Curl your fingers and thumb tightly
over top of handle.
• Handle should rest in your palm,
not on fingers.
• Curl your biceps to maintain grip.
17
Chapter 27: Rescue Techniques: Lifts and Loads
Weight and Distribution
• Be aware of the effect of ski and
snowboard boots on lifting.
• 68% to 78% of a patient’s weight is
in the torso.
• Patient should be carried feet first.
• Ensure that patient is secured to
device.
18
Chapter 27: Rescue Techniques: Lifts and Loads
Directions and Commands
• Moves must be coordinated.
• Direction must come from a single leader.
• Start with a preparatory command:
– “Ready to stop.”
• Give command of execution:
– “STOP.”
• Use a count for lifting:
– “Lift on three. One, two, THREE.”
19
Chapter 27: Rescue Techniques: Lifts and Loads
Lifting and Carrying Guidelines
• Ideally, use four rescuers to lift or
carry a patient on a backboard or
stretcher.
• Communicate with other rescuers
when lifting or carrying.
• Consider patient size, route, terrain,
and rescuer strength and size when
positioning rescuers.
20
Chapter 27: Rescue Techniques: Lifts and Loads
Safe Reaching and Pulling
• Use the same body mechanics as when
lifting or carrying.
• Your back should be locked and upright.
• Do not twist.
• Kneel or bend the knees.
• Do not overextend your reach—15” to 20”
is sufficient.
• Avoid repositioning yourself while moving a
patient.
21
Chapter 27: Rescue Techniques: Lifts and Loads
Long-Axis Drag (1 of 2)
• Sliding a patient in-line with the
spinal column
• Do not move a patient sideways!
• Maintain cervical stabilization
throughout the drag.
• Avoid excessive cervical traction or
compression.
22
Chapter 27: Rescue Techniques: Lifts and Loads
Long-Axis Drag (2 of 2)
• Patient can be dragged either headfirst or feet-first.
• Usually three rescuers are needed:
– One at patient’s head
– One at each side of patient’s torso or
ankles
• Some injuries may preclude using
this technique.
23
Chapter 27: Rescue Techniques: Lifts and Loads
Emergency Moves (1 of 3)
• Used when hazards pose a risk of
serious harm or death to rescuer or
patient
• Primary risk is aggravating an
existing spinal injury.
• Use a drag to pull the patient along
the long axis of the body.
24
Chapter 27: Rescue Techniques: Lifts and Loads
Emergency Moves (2 of 3)
• Techniques include:
– Clothes drag
– Blanket drag
– Arm drag
– Arm-to-arm drag
25
Chapter 27: Rescue Techniques: Lifts and Loads
Emergency Moves (3 of 3)
• When spinal injuries are unlikely,
techniques include:
– Front cradle
– Firefighter’s drag
– One-person walking assist
– Firefighter’s carry
– Pack strap carry
26
Chapter 27: Rescue Techniques: Lifts and Loads
Nonurgent Moves
• Used when scene and patient are
stable
• Three general methods include:
– Bridge lift
– Direct ground lift
– Extremity lift
• Can be adapted to each situation
27
Chapter 27: Rescue Techniques: Lifts and Loads
Bridge Lift (1 of 2)
• Rescuers form a bridge by bracing
head against other rescuer’s shoulder.
• Allows lifting with arms and shoulders
instead of back.
• Patients with spinal injuries will require
at least 4 rescuers for the lift.
28
Chapter 27: Rescue Techniques: Lifts and Loads
Bridge Lift (2 of 2)
29
Chapter 27: Rescue Techniques: Lifts and Loads
Direct Ground Lift (1 of 2)
• Usually not used on patients with
suspected spinal injuries.
• Used to lift and carry a patient for
some distance.
• Number of rescuers needed depends
on size of patient and strength of
rescuers.
30
Chapter 27: Rescue Techniques: Lifts and Loads
Direct Ground Lift (2 of 2)
31
Chapter 27: Rescue Techniques: Lifts and Loads
Extremity Lift
32
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Moves
• Direct carry—a variation of the direct
ground lift
• Blanket lift—can use blanket, sheet,
or jackets
• Backboard
• Scoop stretcher
• Two-rescuer assist to vehicle
33
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (1 of 7)
• Backboards
• Short boards or
extrication vests
(KED)
34
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (2 of 7)
• Backboards
– Plastic or wooden boards with slots along sides
for straps and hand holds
– 6’ to 7’ long
– Must adhere to infection control guidelines
• Short boards or extrication vests
– Used for extrication in confined spaces
– Vest-type devices (KED) immobilize patients in
a sitting position.
35
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (3 of 7)
Scoop stretcher
Stokes
Flexible stretcher
(SKED)
36
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (4 of 7)
• Stretchers
– Flexible type—used in confined
space extrication, wilderness, and
search and rescue operations
(SKED)
– Scoop stretcher or split litter
– Stokes or rigid basket stretcher
37
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (5 of 7)
• Scoop stretchers
– Designed to be split into 2 or 4 pieces
– Allow access to both sides of patient
– Avoid trapping clothing, skin, hair, or
straps in the closure area.
– Consult local protocols regarding
transfer of patients with spinal injuries.
38
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (6 of 7)
• Stokes
– Used to carry or move patients in
rough terrain, during technical rope
rescue, and during water rescue
– Made of plastic or metal
– Basket (wire mesh) needs additional
padding for long-term use.
39
Chapter 27: Rescue Techniques: Lifts and Loads
Transfer Devices (7 of 7)
• Cots
– Wheeled ambulance stretcher or pram
– Clinic gurney
– Usually a specific head end and foot
end
– Has specific carrying handles
– Four rescuers needed for maximum
security moving over rough terrain.
40
Chapter 27: Rescue Techniques: Lifts and Loads
Transportation Devices
• Toboggan (various brands and types)
– Most common device at ski areas
– Two or four fixed handles
– Can be towed by snowmobiles with a
rigid hitch
– Consult NSP’s transportation text for
more information about use and
procedures
41
Chapter 27: Rescue Techniques: Lifts and Loads
Positioning Guidelines (1 of 2)
Head downhill:
• Cardiac arrest
• Shock
• Hypothermia
• Lower extremity and
pelvis injury
• Abdominal injuries
without respiratory
distress
Head uphill:
• Injury to head, eye,
face, neck, or upper
extremity
• Shortness of breath
• Suspected AMI
• Steep terrain
• Unresponsiveness
42
Chapter 27: Rescue Techniques: Lifts and Loads
Positioning Guidelines (2 of 2)
• No rule is absolute; in some cases,
let patient comfort dictate the
position:
– Chest injury
– Dislocated upper extremity
• Use recovery position in patients
with non-traumatic
unresponsiveness and nausea and
vomiting.
43
Chapter 27: Rescue Techniques: Lifts and Loads
Transportation Devices
• Overland wheeled stretchers:
– Single wheel for use on trails
– Multiple wheel for towing behind ATV
• Folding stretchers, often carried by
ambulance crews
• Stair chair, designed to move a
seated patient up or down stairs
44
Chapter 27: Rescue Techniques: Lifts and Loads
Improvised Devices
• Toboggans can be made with skis,
shovels, ski poles, pads, and rope.
• Stretchers can be built from packs,
paddles, poles, rope, and jackets.
• Devices may not be sufficiently rigid
for spinal injuries.
• May be only option!
45
Chapter 27: Rescue Techniques: Lifts and Loads
Moving Patients
• Protect rescuers’ health and safety.
• Protect the patient.
• Training and practice is required for
proficiency.
• Maintain equipment.
• Review procedures.
46