Chapter 35 PPT - Wilco Area Career Center

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Chapter 35
Lifting and Moving
Patients
National EMS Education
Standard Competencies
EMS Operations
Knowledge of operational roles and
responsibilities to ensure patient, public, and
personnel safety.
Introduction
• In the course of a call, EMTs move patients.
• To move patients without injury, you need to
learn proper techniques.
• Correct body mechanics, grips, and devices
are important.
Moving and Positioning the
Patient (1 of 3)
• When you move a patient, take care that
injury does not occur:
– To you
– To your team
– To the patient
• Many EMTs are injured lifting and moving
patients.
Moving and Positioning the
Patient (2 of 3)
• Training and practice are required.
• Special lifting and moving techniques are
necessary for:
– Patients with head injury, shock, spinal injury
– Pregnant patients
– Obese patients
Moving and Positioning the
Patient (3 of 3)
Body Mechanics (1 of 12)
• In lifting:
– Shoulder girdle should be aligned over pelvis.
– Hands should be held close to legs.
– Force then goes essentially straight down spinal
column.
– Very little strain occurs.
Body Mechanics
(2 of 12)
Body Mechanics (3 of 12)
• This is the correct
way to lift.
Body Mechanics (4 of 12)
• You may injure your back:
– If you lift with your back curved
– If you lift with your back straight but bent
significantly forward at the hips
Body Mechanics (5 of 12)
• This is an incorrect method of lifting.
Body Mechanics (6 of 12)
• Power lift
– Legs should be spread about 15″ apart
(shoulder width).
– Place feet so center of gravity is balanced.
– With your back held upright, bring your upper
body down by bending the legs.
– Grasp the patient/stretcher.
Body Mechanics (7 of 12)
• Power lift (cont’d)
– Lift patient by raising your upper body and arms
and straightening your legs until standing.
– Keep the weight close to your body.
– See Skill Drill 35-1.
Body Mechanics (8 of 12)
Body Mechanics (9 of 12)
• Power grip gets maximum force from
hands.
– Palms up
– Hands about 10″ apart
– All fingers at same angle
– Fully support handle on curved palm
Body Mechanics (10 of 12)
Body Mechanics (11 of 12)
• To lift a patient by a sheet or blanket:
– Center the patient.
– Tightly roll up excess fabric on the sides.
– Use the cylindrical handle to grasp fabric and lift
patient.
Body Mechanics (12 of 12)
Weight and Distribution (1 of 9)
• Whenever possible, use a device that can
be rolled.
• When a wheeled device is not available, a
backboard must be used.
Weight and Distribution (2 of 9)
• More of the patient’s weight rests on the
head half of the device than on the foot half.
• Diamond carry and the one-handed carry
use one EMT at head and foot, and one on
each side of patient’s torso.
– See Skill Drill 35-2 and Skill Drill 35-3.
Weight and Distribution (3 of 9)
Weight and Distribution (4 of 9)
• Always secure patient to backboard or
stretcher.
– So patient cannot slide significantly when
stretcher is at an angle
Weight and Distribution (5 of 9)
• Wheeled
ambulance
stretcher weighs
40–145 lb.
– Generally too
heavy for use on
stairs
Weight and Distribution (6 of 9)
• If you must use a backboard or wheeled
stretcher on stairs, see Skill Drill 35-4.
Weight and Distribution (7 of 9)
• A stair chair can be used to bring a
conscious patient down to stretcher
(see Skill Drill 35-5).
Weight and Distribution (8 of 9)
Weight and Distribution (9 of 9)
• Backboard
should be used
instead for
patient:
– In cardiac arrest
– Who must be
moved in supine
position
– Who must be
immobilized
Directions and Commands
(1 of 3)
• Team actions must be coordinated.
• Team leader
– Indicates where each team member should be
– Rapidly describes sequence of steps to perform
before lifting
Directions and Commands
(2 of 3)
• Preparatory commands are used.
• Example:
– Team leader says, “All ready to stop,” to get
team’s attention.
– Then team leader says, “Stop!” in louder voice.
• Countdowns are also used.
Directions and Commands
(3 of 3)
• Estimate patient’s weight before lifting
– Adults often weigh 120–220 lb.
– Two EMTs should be able to safely lift this
weight.
• If patient weighs over 250 lb, use four
rescuers.
– Place strongest EMT at head end.
Principles of Safe Reaching
and Pulling (1 of 4)
• Body drag
– When you use a body drag, same principles
apply as when lifting and carrying.
– Keep back locked and straight.
– Kneel.
– Extend arms no more than 15–20″ in front of
you.
Principles of Safe Reaching
and Pulling (2 of 4)
• Log rolling
• Log roll the patient onto his or her side to
place a patient on a backboard.
Principles of Safe Reaching
and Pulling (3 of 4)
• Log rolling (cont’d)
– Kneel as close to the patient’s side as possible.
– Keep your back straight.
– Roll the patient without stopping.
Principles of Safe Reaching
and Pulling (4 of 4)
• Rolling the stretcher
– Stretcher should be fully elevated.
– Push the stretcher from the head end.
– Never push with arms fully extended.
General Considerations
• Move a patient in orderly, planned,
unhurried manner.
• Carefully plan ahead.
• Select methods that will involve least
amount of lifting and carrying.
Emergency Moves (1 of 5)
• Use when there is potential for danger
before assessment and management.
– Examples: fire, explosives, hazardous materials
• Use when you cannot properly assess
patient or provide immediate care because
of patient’s location or position.
Emergency Moves (2 of 5)
• If you are alone, use a drag to pull patient
along long axis of body.
• Use techniques to help prevent aggravation
of patient spinal injury.
– Clothes drag
– Blanket drag
– Arm drag
– Arm-to-arm drag
Emergency Moves (3 of 5)
Emergency Moves (4 of 5)
• To remove unconscious patient from vehicle
alone:
– First move legs clear of pedals.
– Rotate patient so back is toward open car door.
– Place arms through armpits and support head
against your body.
– Drag patient from seat to a safe location.
Emergency Moves (5 of 5)
Urgent Moves (1 of 2)
• Necessary to move patient with:
– Altered level of consciousness
– Inadequate ventilation
– Shock
• Rapid extrication technique requires team of
knowledgeable EMTs.
– See Skill Drill 35-6.
Urgent Moves (2 of 2)
• Rapid extrication technique is an urgent
move and should only be used if urgency
exists.
• Patient can be moved within 1 minute.
• Technique increases damage if patient has
spinal injury.
• Look at all options before using technique.
Nonurgent Moves (1 of 5)
• Used when both scene and patient are
stable
• Carefully plan how to move the patient.
• Team leader should plan the move.
– Personnel
– Obstacles identified
– Equipment
– Path
Nonurgent Moves (2 of 5)
• Choose between:
– Direct ground lift (Skill Drill 35-7)
• For those with no suspected spinal injury who
are supine.
• Patient will need to be carried distance.
• EMTs stand side by side to lift/carry.
Nonurgent Moves (3 of 5)
• Choose between (cont’d):
– Extremity lift (Skill Drill 35-8)
• For those with no suspected spinal injury who
are supine or sitting
• Helpful when patient is in small space
• One EMT at patient’s head and the other at
patient’s feet
• Coordinate moves verbally.
Nonurgent Moves (4 of 5)
• To transfer a patient from bed to stretcher,
use:
– Direct carry (see Skill Drill 35-9)
• Move supine patient from the bed to stretcher
using a direct carry method.
– Draw sheet method
• Move patient from bed to stretcher using a
sheet or blanket.
– Scoop stretcher (see Skill Drill 35-10)
Nonurgent Moves (5 of 5)
Geriatrics (1 of 2)
• Most patients transported by EMS are
geriatric patients.
• Skeletal changes cause brittle bones, and
spinal curvatures present special
challenges.
• Allay patient’s fears with sympathetic and
compassionate approach.
Source: © Dr. P. Marazzi/Photo Researchers, Inc.
Geriatrics (2 of 2)
Kyphosis
Spondylosis
Bariatrics (1 of 2)
• Refers to management of obese people
• 100 million adults in the US are overweight
or obese.
– Approximately 20% to 25% of children are
overweight or obese.
• Back injuries account for the largest number
of missed days of work.
Bariatrics (2 of 2)
• Stretchers and equipment are being
produced with higher capacities.
– Does not address danger to EMTs of carrying
ever-heavier weights
– Mechanical ambulance lifts are uncommon in
United States.
Patient-Moving Equipment
(1 of 3)
• Stretcher is available in many models with
various features.
• General features
– Head and foot end
– Strong metal frame (to push, pull, lift)
– Hinges at center allow for elevation of
head/back.
– Guardrail prevents patient from rolling out.
Patient-Moving Equipment
(2 of 3)
• General features (cont’d)
– Undercarriage frame allows adjustment to any
height.
– Stretcher has locking mechanism when controls
are not activated.
– Controls are located at the foot end and at one
or both sides of most stretchers.
Patient-Moving Equipment
(3 of 3)
Types of Stretchers (1 of 19)
• Wheeled
ambulance
stretcher
– Also called
a stretcher
or gurney
– Most
commonly
used
device
Types of Stretchers (2 of 19)
• Wheeled ambulance stretcher (cont’d)
– Patient may be secured directly to stretcher
– Or, patient may be secured to backboard first if:
• Suspected spinal injury or multisystem
trauma
• Patient is in need of CPR
Types of Stretchers (3 of 19)
• Bariatric stretcher
– Specialized for overweight or obese patients
– Wider wheel base for increased stability
Source: Courtesy of Stryker Medical
Types of Stretchers (4 of 19)
• Bariatric stretcher (cont’d)
– Some have tow package with winch.
– Rated to hold 850–900 lb
• Regular stretcher rated for 650 lb max.
Types of Stretchers (5 of 19)
• Pneumatic and
electronic-powered
wheeled stretcher
– Battery operated
electronic controls to
raise/lower
undercarriage
• This increases the
weight of stretcher.
Source: Courtesy of Stryker Medical
• Hazardous for
uneven terrain or
stairs
Types of Stretchers (6 of 19)
• Loading a
wheeled
stretcher into
an ambulance
– Ensure the
frame is held
firmly
between two
hands so it
does not tip.
Types of Stretchers (7 of 19)
• Loading a wheeled stretcher into an
ambulance (cont’d)
– Newer models are self-loading, allowing you to
push the stretcher into ambulance.
– Other models need to be lowered and lifted to
the height of the floor of ambulance.
– Clamps in ambulance hold stretcher in place.
– See Skill Drill 35-11.
Types of Stretchers (8 of 19)
• Portable/folding
stretcher
– Strong, rectangular
tubular metal frame
with fabric
stretched across it
Types of Stretchers (9 of 19)
• Portable/folding stretcher (cont’d)
– Some models have two wheels.
– Some can be folded in half.
– Used in areas difficult to reach
– Weigh less then wheeled stretchers
Types of Stretchers (10 of 19)
• Flexible stretcher
– Can be rolled into a
tubular package
– Excellent for storage and
carrying
– Conform around a
patient’s sides
– Useful for confined
spaces
– Uncomfortable, but
provides support and
immobilization
Types of Stretchers (11 of 19)
• Backboard
– Long, flat, and made of rigid rectangular
material (mostly plastic)
– Used to carry and immobilize patients with
suspected spinal injury or other trauma
Types of Stretchers (12 of 19)
• Backboard (cont’d)
– Commonly used for patients found lying down
– 6′ to 7′ long
– Holes serve as handles and a place to secure
straps.
Types of Stretchers (13 of 19)
• Backboard (cont’d)
– Short backboards
or half-boards are
used to immobilize
seated patients
• Example: the
KED vest-type
device
Types of Stretchers (14 of 19)
• Basket stretcher
– Rigid stretcher also
called a Stokes
litter
– Used for remote
locations
inaccessible by a
vehicle, including
water rescues and
technical rope
rescues
Types of Stretchers (15 of 19)
• Basket stretcher (cont’d)
– If spinal injury, secure patient to backboard and
place inside basket stretcher to carry patient out
of location.
– When you return to ambulance, lift the
backboard out of basket stretcher and place on
wheeled stretcher.
Types of Stretchers (16 of 19)
• Scoop stretcher
– Also called orthopaedic stretcher
Types of Stretchers (17 of 19)
• Scoop stretcher (cont’d)
– Splits into two or four pieces
• Pieces fit around patient who is lying on flat
surface and reconnect
– Both sides of patient must be accessible.
– Patient must be stabilized and secured on
scoop stretcher.
Types of Stretchers (18 of 19)
• Stair chair
– Folding aluminum
frame chairs with
fabric stretched
across to form a
seat and back
– Most have rubber
wheels in the back
Types of Stretchers (19 of 19)
• Neonatal isolette
– Also called an incubator
– Neonates cannot be transported on a wheeled
stretcher.
– Isolette keeps neonate warm, protects from
noise, draft, infection, excess handling.
– Isolette may be secured to wheeled ambulance
stretcher or freestanding.
Decontamination
• Decontaminate equipment after use.
– For your safety
– For the safety of the crew
– For the safety of the patient
– To prevent the spread of disease
Medical Restraints (1 of 2)
• Evaluate for correctible causes of
combativeness.
– Head injury, hypoxia, hypoglycemia
• Follow local protocols.
• Restraint requires five personnel.
• Restrain patient supine.
– Positional asphyxia may develop in prone
position.
Medical Restraints (2 of 2)
• Apply restraint
to each
extremity.
• Assess
circulation
after restraints
are applied.
• Document all
information.
Personnel Considerations (1 of 2)
• Questions to ask before moving patient:
– Am I physically strong enough to lift/move this
patient?
– Is there adequate room to get the proper stance
to lift the patient?
– Do I need additional personnel for lifting
assistance?
Personnel Considerations (2 of 2)
• Remember, an injured rescuer cannot help
anyone.
Summary (1 of 13)
• The first key rule of lifting is to always keep
your back in an upright position and lift
without twisting.
• The power lift is the safest and most
powerful way to lift.
Summary (2 of 13)
• Pushing is better than pulling.
• If you do not have a proper hold, you will
not be able to bear your share of the weight,
or you may lose your grasp and possibly
cause a lower back injury to one or more
EMTs.
Summary (3 of 13)
• It is always best to move a patient on a
device that can be rolled.
• You must constantly coordinate your
movements with those of the other team
members and make sure that you
communicate with them.
Summary (4 of 13)
• Ideally, members of the lifting team should
also be of similar height and strength.
• If you must carry a loaded backboard or
stretcher up or down stairs or other inclines,
be sure that the patient is tightly secured to
the device to prevent sliding.
Summary (5 of 13)
• Carry the backboard or stretcher foot end
first, so that the patient’s head is elevated
higher than the feet.
• Directions and commands are an important
part of safe lifting and carrying.
Summary (6 of 13)
• You and your team must anticipate and
understand every move and execute it in a
coordinated manner.
• The team leader is responsible for
coordinating the moves.
• You should try to use four rescuers
whenever resources allow.
Summary (7 of 13)
• You should know how much you can
comfortably and safely lift and not attempt
to lift more than this amount.
• Rapidly summon additional help to lift and
carry a weight that is greater than you are
able to lift.
Summary (8 of 13)
• The same basic body mechanics apply for
safe reaching and pulling as for lifting and
carrying.
• Keep you back locked and straight, and
avoid twisting.
• Do not hyperextend your back when
reaching overhead.
Summary (9 of 13)
• For a nonurgent move, move the patient in
an orderly, planned, and unhurried manner,
selecting methods that involve the least
amount of lifting and carrying.
• At times, you may have to use an
emergency move to maneuver a patient
before providing assessment and care.
Summary (10 of 13)
• You should perform an urgent move if a
patient has an altered level of
consciousness, inadequate ventilation, or
shock, or in extreme weather conditions.
Summary (11 of 13)
• The wheeled ambulance stretcher is the
most commonly used device to move and
transport patients.
• Other devices include portable stretchers,
flexible stretchers, backboards, basket
stretchers, scoop stretchers, and stair
chairs.
Summary (12 of 13)
• Whenever you are moving a patient, you
must take special care so that neither you,
your team, nor the patient is injured.
Summary (13 of 13)
• You will learn the technical skills of patient
packaging and handling through practice
and training.
• Training and practice are required to use all
the equipment that is available to you.
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