2-1

Violent Scene
• Scenes involving armed or potentially hostile persons are among the most dangerous
• EMS personnel may be mistaken for law enforcement officials
• Body armor
2-2

Warning Signs of Danger
Residences
 Unusual silence or darkened residence
 Past history of problems or violence
 Known drug or gang area
 Loud noises or items breaking
 Seeing or hearing acts of violence
 Presence of alcohol or other drug use
 Evidence of dangerous pets
2-3

Warning Signs of Danger
Street Scenes
Crowds may quickly become large and unpredictable
 Voices become louder
 Pushing, shoving
 Hostility toward others at scene
 Rapid increase in crowd size
 Inability of law enforcement to control crowds
2-4

Warning Signs of Danger
Highway Encounters
Disabled vehicle, “man slumped over wheel” calls, motor vehicle crashes
 Suspicious movements in vehicle
 Grabbing or hiding items
 Arguing or fighting between passengers
 Lack of activity where activity is likely
 Signs of alcohol or drug use
 Open or unlatched trunks (may hide people)
2-5

2-6

Crime Scene
• Law enforcement personnel are responsible for gathering evidence
• EMS personnel are responsible for patient care
2-7

Crime Scene
• Evidence
– Fingerprints
– Footprints
– Blood and body fluid
– Hair
– Carpet and clothing fibers
2-8

Crime Scene
• Be observant
• Touch only what is required for patient care
– If you touch something, remember what you touched and tell police
• Wear gloves
2-9

Crime Scene
• Take the same path in and out of the scene
• Avoid stepping on bloodstains or splatter
• Disturb victim and victim’s clothing as little as possible
2-10

Crime Scene
• Avoid cuts to the victim’s clothing that may have been caused by a knife, bullet, or other penetrating weapon
• Save victim’s clothing and personal items in a paper bag
2-11

Lifting and Moving
• EMS professionals are injured every year because of improper lifting or moving techniques.
• In most cases, these injuries are preventable.
6-12

Lifting and Moving
• There is no one best way to move all patients.
• Analyze the situation
• Think of all your options
• Choose the method that is safest for you, your coworkers, and the patient
6-13

Role of the EMT
• Patient care will usually be provided in the position in which the patient is found
6-14

Role of the EMT
• Your responsibilities:
– Distinguishing an emergency from a nonemergency situation
– Positioning patients to prevent further injury
– Recognizing when to call for more help
– Assisting other EMS professionals in lifting and moving a patient
6-15

Principles of Moving Patients
6-16

The Big Decision…
• What is an emergency that requires immediately moving a patient from the area?
6-17

The Big Decision…
• Indications for an emergency move:
– Scene hazards
– The inability to reach other patients who need life-saving care
– The inability to provide immediate, lifesaving care because of the patient’s location or position
6-18

Indications for an Emergency Move
• Scene hazards
– Fire or the danger of fire
– Uncontrolled traffic
– Explosives or the danger of an explosion
– Electrical hazards
– Rising flood water
– Toxic gases
– Radiation
– Structural collapse or the threat of a structural collapse
– Potentially violent scenes
6-19

Indications for an Emergency Move
• The inability to reach other patients who need lifesaving care
• The inability to provide immediate, lifesaving care because of the patient’s location or position
6-20

Principles of Moving Patients
• An emergency move may aggravate a spinal injury
• Always drag the patient in the direction of the length of the body
– Never push, pull, or drag a patient sideways
• Think before you act!
6-21

Principles of Moving Patients
• Nonurgent move
– Type of move performed most often
– Use if no immediate threat to life exists
– Done with the help of other EMS personnel
– Requires communication before, during, and after the lift
• Work as a team for success
6-22

Body Mechanics and
Lifting Techniques
6-23

Body Mechanics
• Body alignment
– Good posture
• Balance
• Coordinated body movement
6-24

Balance
• You can improve your balance by:
– Separating your feet to a comfortable distance
– Bending your knees
– Flexing your hips to reach a squatting position
6-25

Preparation
• Important factors to consider:
– Patient’s weight
– Patient’s condition
– Hazards or potential hazards
– The terrain
– Distance the patient must be moved
– Your physical abilities and any limitations
– Available equipment or additional personnel
6-26

Power Grip
• Palms up
• Hands comfortable distance apart
– About 10 inches
• Palms and fingers in complete contact with the object
6-27

Guidelines for Safe Lifting
6-28

Guidelines for Safe Lifting
• Keep your back aligned and use your leg strength
• Maintain your center of balance while lifting
• Consider the weight to be lifted
• Know your physical ability and limitations
• Plan
– How will you move the patient?
– Where will you move him?
– Make sure path is clear
6-29

Guidelines for Safe Lifting
• Determine in advance who will direct the move
– Usually the person at the patient’s head
• “On my count, lift on three: one, two, three”
• “On my count, turn on three: one, two, three”
6-30

Guidelines for Safe Lifting
Key Point
• Agree in advance that if anyone involved in the move says “no” the move is immediately stopped
6-31

Guidelines for Safe Lifting
• Position your feet a comfortable width apart
• Bend at the knees and hips, not at your waist
– Keep your back straight
– Use your legs to lift, not your back
6-32

Guidelines for Safe Lifting
• Lift using a smooth, continuous motion
• Do not jerk or twist when lifting
• Keep the weight close to you
• When possible, move forward rather than backward
• Walk slowly using short steps
• Look where you are going
• Communicate clearly and frequently with others throughout the move
6-33

Power Lift
6-34

Carrying Patients and Equipment
6-35

Carrying Patients and Equipment
• Whenever possible, transport patients on devices that can be rolled.
• Know or find out the weight to be lifted.
• Know your physical abilities and limitations and that of your crew.
• Work in a coordinated manner.
• Communicate frequently with your partner and the patient.
6-36

Carrying Patients and Equipment
• Keep the weight as close to the body as possible.
• Keep your back in a locked-in position and avoid twisting.
• Flex at the hips, not at the waist
• Bend at the knees.
• Do not lean back from the waist.
6-37

Carrying Procedure on Stairs
6-38

Carrying Procedure on Stairs
• When possible, use a stair chair
• Make sure that the stairway is free of obstructions.
• Use a guide or “spotter”
• Secure the patient to the stair chair before lifting
• Carry the patient head first up the stairs and feet first down the stairs
6-39

Carrying Procedure on Stairs
• Keep your back in a locked-in position.
• Flex at the hips, not at the waist, and bend at the knees.
• Keep the weight and your arms as close to your body as possible.
• Always communicate with your partner during the move.
6-40

Guidelines for Safe Reaching
6-41

Guidelines for Safe Reaching
• Keep your back straight
• Avoid stretching or leaning back from your waist when reaching overhead
– Lean from your hips
• Avoid twisting
• Avoid reaching more than 15 to 20 inches in front of you
• Avoid situations where prolonged strenuous effort (more than a minute) is needed
6-42

Logroll
• Keep your back straight while leaning over the patient.
• Lean from the hips.
• Use your shoulder muscles to help with the roll.
6-43

Guidelines for
Safe Pushing and Pulling
6-44

Guidelines for
Safe Pushing and Pulling
• Push, rather than pull, whenever possible.
• Keep your back straight.
• Keep the line of the pull through the center of your body by bending your knees.
• Keep the weight close to your body.
6-45

Guidelines for
Safe Pushing and Pulling
• Keep your elbows bent and your arms close to your sides.
• Push at a level between your waist and shoulders.
– If the weight is below your waist, kneel to push or pull.
– If possible, avoid pushing or pulling from an overhead position.
6-46

Emergency Moves
6-47

Drags
• A good way to move patients already on the ground
• Try to stabilize the patient’s head and neck as much as possible before the move
• Use the clothes drag or blanket drag when injury to head or spine is suspected
6-48

Drags
• Always pull along the length of the spine
• Never pull the patient’s head away from her neck and shoulders
6-49

Clothes Drag
6-50

Blanket Drag
6-51

Shoulder Drag
6-52

Forearm Drag
6-53

Ankle Drag
• Not recommended
– Patient’s head is not supported
– Patient’s head may bounce if the patient is not pulled over a smooth surface
6-54

Firefighter’s Drag
6-55

Remember:
• Always drag the patient along the length (the long axis) of the spine.
• Never drag a patient sideways.
• Never pull the patient’s head away from her neck and shoulders.
6-56