Chapter 3:
Lifting and Moving Patients
National EMS Education
Standard Competencies (1 of 3)
Preparatory
Uses simple knowledge of the emergency
medical services (EMS) system, safety/wellbeing of the emergency medical responder
(EMR), and medical/legal issues at the scene
of an emergency while awaiting a higher level
of care.
National EMS Education
Standard Competencies (2 of 3)
Workforce Safety and Wellness
• Standard safety precautions
• Personal protective equipment
• Stress management
– Dealing with death and dying
• Prevention of response-related injuries
• Lifting and moving patients
National EMS Education
Standard Competencies (3 of 3)
EMS Operations
Knowledge of operational roles and
responsibilities to ensure safe patient, public,
and personnel safety.
Introduction
• As an EMR, you must
– Analyze the emergency situation.
– Quickly evaluate the patient’s condition.
– Carry out effective, lifesaving emergency
medical procedures.
• These procedures may include lifting,
moving, or positioning patients.
General Principles (1 of 3)
• Every time you move a patient, keep
general guidelines in mind:
– Do no further harm to the patient.
– Move the patient only when necessary.
– Move the patient as few times as possible.
– Move the patient’s body as a unit.
– Use proper lifting and moving techniques.
– Have one rescuer give commands.
General Principles (2 of 3)
• Also consider these recommendations:
– Delay moving the patient, if possible, until
additional EMS personnel arrive.
– Treat the patient before moving him or her
unless the patient is unsafe.
– Do not step over the patient.
– Explain to the patient what you are doing.
General Principles (3 of 3)
• Keep the rules of good body mechanics in
mind:
– Know your own physical limitations.
– Keep yourself balanced.
– Maintain a firm footing.
– Lift and lower the patient by bending your legs,
not your back.
– Try to keep your arms close to your body for
strength and balance.
– Move the patient as few times as possible.
Recovery Position
• Unconscious patients who have not
suffered trauma should be placed in a
sidelying or recovery position.
– Helps keep the airway open
– Allows secretions to drain from the mouth
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Body Mechanics (1 of 3)
• Improper lifting or
moving techniques can
result in injury to you or
to the patient.
• Good body mechanics
– Use the strength of the
large muscles in your
legs to lift patients
instead of using your
back muscles.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Body Mechanics (2 of 3)
• Good body mechanics (cont’d)
– Keep your back straight as you lift.
– Lift without twisting your body.
– Ensure that you have firm footing before you
start to lift or move a patient.
– Assess the weight of the patient.
– Know your physical limitations.
Body Mechanics (3 of 3)
• Good body mechanics (cont’d)
– Call for additional personnel if needed.
– Communicate with the other members of the
lifting team.
– Practice lifts and moves.
Emergency Movement of
Patients
• Move a patient immediately in the following
situations:
– Danger of fire, explosion, or structural collapse
exists.
– Hazardous materials are present.
– The emergency scene cannot be protected.
– It is otherwise impossible to gain access to
other patients who need lifesaving care.
– The patient has experienced cardiac arrest.
Emergency Drags (1 of 8)
• Clothes drag
– Simplest way to
move a patient
– Grasp the patient’s
clothing in the neck
and shoulder area.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Rest the patient’s
head on your arms.
– Drag the patient out
of danger.
Emergency Drags (2 of 8)
• Cardiac patients and
the clothes drag
– If the room in which
you find the patient is
not large enough,
move the patient.
– Drag the patient from
the tight space and
quickly move furniture
out of the way.
– Provide
cardiopulmonary
resuscitation (CPR).
© American Academy of Orthopaedic Surgeons.
Emergency Drags (3 of 8)
• Blanket drag
– Use this drag if the
patient is not dressed
or is dressed in
clothing that could
tear easily.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Place the rug on the
floor and roll the
patient onto it.
– Pull the patient to
safety by dragging the
rug.
Emergency Drags (4 of 8)
• Arm-to-arm drag
– Place your hands
under the patient’s
armpits from the
back and grasp the
patient’s forearms.
– Used to move a
heavy patient
– Offers some
protection for the
head and neck
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Emergency Drags (5 of 8)
• Firefighter drag
– Tie the patient’s wrists
together.
– Get down on your hands
and knees and straddle
the patient.
– Pass the patient’s tied
hands around your neck,
straighten your arms, and
drag the patient across
the floor.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Emergency Drags (6 of 8)
• Emergency drag from a vehicle
– One rescuer
• Grasp the patient under the arms and cradle
the patient’s head between your arms.
• Pull the patient down into a horizontal
position as you ease him or her from the
vehicle.
Emergency Drags (7 of 8)
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Emergency Drags (8 of 8)
• Emergency drag from a vehicle (cont’d)
– Two or more rescuers
• One rescuer supports the patient’s head and
neck while the second rescuer moves the
patient by lifting under the arms.
• The patient is removed with the head and
neck stabilized in a neutral position.
• Use a long backboard if time permits.
Carries for Nonambulatory
Patients (1 of 9)
• Two-person extremity
carry
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Rescuer One reaches
under the patient’s arms
and grasps the patient’s
wrists.
– Rescuer Two reaches
around the legs and
grasps the patient behind
the knees.
– The two rescuers stand
up and carry the patient
away.
Carries for Nonambulatory
Patients (2 of 9)
• Two-person seat carry
– The rescuers kneel on opposite sides of the
patient near the patient’s hips.
– The rescuers raise the patient to a sitting
position and link arms behind the patient’s back.
– The rescuers place the other arm around the
patient’s knees and link with each other.
– No equipment is required.
Carries for Nonambulatory
Patients (3 of 9)
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Carries for Nonambulatory
Patients (4 of 9)
• Cradle-in-arms carry
– Used by one rescuer
to carry a child
– Kneel beside the
patient and place one
arm around the back
and the other under
the thighs.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Lift slightly and roll
the child into the
hollow formed by your
arms and chest.
Carries for Nonambulatory
Patients (5 of 9)
• Two-person chair carry
– Rescuer One stands behind
the seated patient and
grasps the back of the chair.
– Rescuer One tilts the chair
backward so that rescuer
Two can grasp the front
legs.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Rescuer One gives the
command to lift and walk
away.
Carries for Nonambulatory
Patients (6 of 9)
• Pack-strap carry
– Back into the patient as
he or she is standing.
– Grasp the patient’s
wrists and cross the
arms over your chest.
– Pull the patient onto
your back.
– Bend forward to lift the
patient, stand up, and
walk away.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Carries for Nonambulatory
Patients (7 of 9)
• Direct ground lift
– Used to move a patient who is on the ground or
the floor to an ambulance stretcher
– Should be used only for those patients who
have not sustained a traumatic injury
– The steps for performing the direct ground lift
are described in Skill Drill 3-1.
Carries for Nonambulatory
Patients (8 of 9)
• Transferring a patient from bed to stretcher
– Place the stretcher next to the bed.
– Loosen the bottom sheet underneath the patient
or log roll the patient onto a blanket.
– Reach across the stretcher and grasp the sheet
and blanket firmly at the patient’s head, chest,
hips, and knees.
– Slide the patient onto the stretcher.
Carries for Nonambulatory
Patients (9 of 9)
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Walking Assists for
Ambulatory Patients (1 of 2)
• One-person walking
assist
– Help the patient
stand.
– Have the patient
place one arm around
your neck and hold
the patient’s wrist.
– Put your free arm
around the patient’s
waist and help the
patient to walk.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Walking Assists for
Ambulatory Patients (2 of 2)
• Two-person
walking assist
– Useful if the patient
cannot bear weight
– The two rescuers
completely support
the patient.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Wheeled Ambulance
Stretchers (1 of 2)
• One of the most
commonly used
EMS devices
• Can be raised and
lowered to different
heights
• Have belts to
secure the patient
© Jones & Bartlett Learning.
Wheeled Ambulance
Stretchers (2 of 2)
• Stretchers can be rolled or carried by two or
four people.
– If the surface is smooth, a wheeled stretcher
can be rolled with one person guiding the head
and one person pulling the foot end.
– If the loaded stretcher must be carried, it is best
to use four people, one at each corner.
– If the stretcher must be carried through a
narrow area, only two people will fit.
Portable Stretchers
• Used when the
wheeled stretcher
cannot be moved into
a small space
• Smaller and lighter
than a wheeled
stretcher
• Can be carried in the
same ways that a
wheeled stretcher is
carried
© American Academy of Orthopaedic Surgeons.
Stair Chairs
• Portable moving device
that is used to carry a
patient in a sitting
position
– Useful for patients who
are short of breath or who
are more comfortable
sitting
– Small, lightweight, and
easy to carry
– Do not use with patients
who have experienced
any type of trauma.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Immobilization Devices (1 of 5)
• Used to immobilize patients who have neck
or back injuries
• Used to assist in lifting patients and
immobilizing lower extremity injuries
• Long backboards
– Used for moving patients who have experienced
trauma
– Useful for lifting and moving patients who are
in small places
Immobilization Devices (2 of 5)
• Long backboards (cont’d)
– Made of plastic or fiberglass
– Patients must be secured with straps.
– If the patient has sustained back or neck
injuries, the head should be immobilized.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Immobilization Devices (3 of 5)
• Short backboard
devices
– Used to immobilize
the head and spine of
patients found in a
sitting position
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Usually made of
plastic
– Some consist of a
vest-like garment that
wraps around the
patient.
Immobilization Devices (4 of 5)
• Scoop stretchers
– Helpful when moving patients out of small spaces
– Do not use for patients with head or spinal
injuries.
– Follow the steps in Skill Drill 3-2 for using a
scoop stretcher.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Immobilization Devices (5 of 5)
• In an emergency situation, use
– Wide, sturdy planks
– Doors
– Ironing boards
– Sturdy folding tables
– Full-length lawn chair recliners
– Surfboards
– Snowboards
Treatment of Patients With
Suspected Head or Spine Injury
• Any time a patient has sustained a
traumatic injury, suspect injury to the head,
neck, or spine.
– Improper treatment can lead to permanent
damage or paralysis.
– Keep the patient’s head and neck in a neutral
position and immobilized.
Applying a Cervical Collar (1 of 2)
• Used to prevent
excess movement
of the head and
neck
© Jones & Bartlett Learning. Courtesy of MIEMSS.
– Soft cervical collars
do not provide
sufficient support for
trauma patients.
– Many types of rigid
cervical collars are
available.
Applying a Cervical Collar (2 of 2)
• A cervical collar should be applied before
the patient is placed on a backboard.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Movement of Patients Using
Backboards (1 of 2)
• Patients who should be transported on a
backboard include
– Any patient who has sustained spinal trauma in
a motor vehicle crash or fall
– Any person who has sustained gunshot wounds
to the trunk
Movement of Patients Using
Backboards (2 of 2)
• If you suspect the patient has a spinal injury
– Move the patient as a unit.
– Transport the patient face up (supine).
– Keep the patient’s head and neck in a neutral
position.
– Be sure that all rescuers understand what is to
be done before attempting any movement.
– Be sure one rescuer gives commands.
Assisting With Short
Backboard Devices
• After the short backboard device is applied,
the patient is carefully placed on a long
backboard.
• Skill Drill 3-3 illustrates how one commonly
used short backboard device is applied.
Log Rolling (1 of 2)
• Primary technique used to move a patient
onto a long backboard
• Requires a team of four rescuers
• Movement technique of choice in all
patients with suspected spinal injury
• The procedure for the four-person log roll is
shown in Skill Drill 3-4.
Log Rolling (2 of 2)
• All patient movement commands have two
parts:
– A question
– The order for movement
• Move the patient as a unit.
• Keep the patient’s head in a neutral position
at all times.
Straddle Lift (1 of 2)
• Can be used to place a patient on a
backboard if you do not have enough space
to perform a log roll
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Straddle Lift (2 of 2)
• Requires five rescuers
– One at the head and neck
– One to straddle the shoulders and chest
– One to straddle the hips and thighs
– One to straddle the legs
– One to insert the backboard under the patient
• The lift should be practiced often.
Straddle Slide (1 of 2)
• In the straddle slide, the patient, rather than
the backboard, is moved.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Straddle Slide (2 of 2)
• May be useful when the patient is in an
extremely narrow space
• The rescuers’ positions are the same.
– Lift the patient as a unit.
– Slide the patient forward about 10 inches at a
time.
– Each rescuer should lean forward slightly and
use a swinging motion to bring the patient onto
the board.
Straps and Strapping
Techniques (1 of 2)
• Every patient who is on a backboard should be
strapped down to prevent sliding or slipping.
– The straps should be long enough to go around the
board and a large patient.
– Straps 6 feet to 9 feet long with seatbelt-type buckles
work well.
© American Academy of Orthopaedic Surgeons.
Straps and Strapping
Techniques (2 of 2)
• Once the patient is centered on the board,
secure the upper torso with straps.
• Secure the pelvis and upper legs, using
padding as needed.
© Jones & Bartlett Learning.
Head Immobilization (1 of 3)
• The blanket roll is an improvised device that
works well and is readily available.
– Fold and roll the blanket as shown in
Skill Drill 3-5.
– Stabilization is maintained by the blanket roll, as
shown in Skill Drill 3-6.
Head Immobilization (2 of 3)
• Head stabilization must be maintained
through the entire procedure.
– The blanket roll must be fitted securely against
the patient’s shoulders.
– Secure the blanket roll to the head with two
cravats tied around the blanket roll.
– Use two more cravats to bind the head and the
blanket roll to the backboard.
Head Immobilization (3 of 3)
• Foam blocks are quick to apply and provide
good stabilization of the head and neck.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Summary (1 of 4)
• General guidelines when moving patients
– Do no further harm to the patient.
– Move the patient only when necessary.
– Move the patient as little as possible.
– Move the patient’s body as a unit.
– Use proper lifting and moving techniques.
– Have one rescuer give commands when moving
a patient.
Summary (2 of 4)
• Unconscious patients who have not
sustained trauma should be placed in the
recovery position.
• If a patient is on the floor or ground during
an emergency situation, you may have to
drag the person away from the scene
instead of trying to lift and carry the person.
Summary (3 of 4)
• Do not lift or move a patient if you suspect a
spinal injury, unless it is necessary to
remove the patient from a life-threatening
situation.
• EMS services typically use wheeled
ambulance stretchers, portable stretchers,
stair chairs, long backboards, short
backboards, and scoop stretchers.
Summary (4 of 4)
• A cervical collar prevents excessive
movement of the head and neck.
• Log rolling is the primary technique used to
move a patient onto a backboard.
• Once a patient has been secured to the
backboard, the head and neck must be
immobilized.
Review
1. As an EMR, you may injure your back,
even if it is straight, if you
A. lift with your back bent forward at the hips.
B. align your shoulders over your hips.
C. hold your hands close to your legs.
D. use your leg muscles.
Review
Answer:
A. lift with your back bent forward at the
hips.
Review
2. Patients who should be transported on a
backboard include any patient who
A. is intoxicated.
B. requests it.
C. has an upper extremity injury.
D. has sustained gunshot wounds to the trunk.
Review
Answer:
D. has sustained gunshot wounds to the
trunk.
Review
3. Head immobilization
A. is not required in all patients who are placed
on a backboard.
B. can be achieved using head blocks or towel
rolls.
C. does not need to be maintained during the
backboarding process.
D. can be properly accomplished only with
special equipment.
Review
Answer:
B. can be achieved using head blocks or
towel rolls.