6: Lifting and Moving Patients

Cognitive Objectives (1 of 4)

1-6.1 Define body mechanics.

1-6.2 Discuss the guidelines and safety precautions that need to be followed when lifting a patient.

1-6.3 Describe the safe lifting of cots and stretchers.

1-6.4 Describe the guidelines and safety precautions for carrying patients and/or equipment.

Cognitive Objectives (2 of 4)

1-6.5 Discuss one-handed carrying techniques.

1-6.6 Describe correct and safe carrying procedures on stairs.

1-6.7 State the guidelines for reaching and their application.

1-6.8 Describe correct reaching for log rolls.

Cognitive Objectives (3 of 4)

1-6.9 State the guidelines for pushing and pulling.

1-6.10 Discuss the general considerations of moving patients.

1-6.11 State three situations that may require the use of an emergency move.

Cognitive Objectives (4 of 4)

1-6.12 Identify the following patient-carrying devices:– Wheeled ambulance stretcher– Portable ambulance stretcher– Stair chair– Scoop stretcher– Long spine board– Basket stretcher– Flexible stretcher

Affective Objectives

1-6.13 Explain the rationale for properly lifting and moving patients.

Psychomotor Objectives (1 of 2)

1-6.14 Working with a partner, prepare each of the following devices for use, transfer a patient to the device, properly position the patient on the device, move the device to the ambulance, and load the patient into the ambulance:

– Scoop stretcher– Long spine board– Basket stretcher– Flexible stretcher

– Wheeled ambulance stretcher

– Portable ambulance stretcher

– Stair chair

Psychomotor Objectives (2 of 2)

1-6.15 Working with a partner, the EMT-B will demonstrate techniques for the transfer of a patient from an ambulance stretcher to a hospital stretcher.

Moving and Positioningthe Patient

• Take care to avoid injury whenever a patient is moved.

• Practice using equipment.

• Know that certain patient conditions call for special techniques.

Body Mechanics

• Shoulder girdle should be aligned over the pelvis.

• Lifting should be done with legs.

• Weight should be kept close to the body.

• Grasp should be made with palms up.

Proper Lifting

Performing the Power Lift (1 of 3)

• Tighten your back in normal upright position.

• Spread your legs apart about 5".

• Grasp with arms extended down side of body.

• Adjust your orientation and position.

• Reposition feet.• Lift by

straightening legs.

Performing the Power Lift (2 of 3)

• A power grip gets the maximum force from your hands

• Arms and hands face palm up.• Hands should be at least 10" apart.• Each hand goes under the handle with the palm

facing up and the thumb extended upward.

Performing the Power Lift (3 of 3)

• Curl fingers and thumb tightly over the top of the handle.

• Never grasp a litter or backboard with the hands placed palms-down over the handle.

Weight and Distribution

• Patient will be heavier on head end.

• Patients on a backboard or stretcher should be diamond carried.

Diamond Carry

• Four EMT-Bs lift device while facing patient.

• EMT-B at foot end turns around to face forward.

• EMT-Bs at sides turn.

• Four EMT-Bs face same direction when walking.

One-Handed Carrying

• Face each other and use both hands.

• Lift the backboard to carrying height.

• Turn in the direction you will walk and switch to using one hand.

Carrying Backboard or Cot on Stairs

• Strap patient securely to the backboard.

• Carry patient down stairs foot end first, head end elevated.

• Carry patient up stairs head end first.

Wheeled Ambulance Stretcheror Cot

Stair Chair

Backboard

Directions and Commands

• Anticipate and understand every move.

• Moves must be coordinated.

• Orders should be given in two parts.

Additional Guidelines

• Find out how much the patient weighs.• Know how much you can safely lift.• Communicate with your partners.• Do not attempt to lift a patient who weighs over

250 lbs with fewer than four rescuers.• Avoid unnecessary lifting or carrying.

Using a Stair Chair

• Secure patient to stair chair with straps.• Rescuers take their places: one at head, one at

foot. • Rescuer at the head gives directions.• Third rescuer precedes.

Principles of Safe Reaching and Pulling (1 of 3)

• Back should always be locked and straight.• Avoid any twisting of the back.• Avoid hyperextending the back.• When pulling a patient on the ground, kneel to

minimize the distance.

Principles of Safe Reaching and Pulling (2 of 3)

• Use a sheet or blanket if you must drag a patient across a bed.

• Unless on a backboard, transfer patient from the cot to a bed with a body drag.

• Kneel as close as possible to patient when performing a log roll.

Principles of Safe Reaching and Pulling (3 of 3)

• Elevate wheeled ambulance cot or stretcher before moving.

• Never push an object with your elbows locked.

• Do not push or pull from an overhead position.

General Considerations

• Plan the move.

• Look for options that cause the least strain.

Emergency Moves

• Performed if there is some potential danger for you or the patient

• Performed if necessary to reach another patient who needs lifesaving care

• Performed if unable to properly assess patient due to location

Emergency Drags (1 of 2)

• Clothes Drag

• Blanket Drag

Emergency Drags (2 of 2)

Arm-to-Arm Drag

Arm Drag

One-Person Rapid Extrication

One-Rescuer Drags, Carries, and Lifts (1 of 3)

Front cradle Fire fighter’s drag

One-Rescuer Drags, Carries, and Lifts (2 of 3)

One-person walking assist

Fire fighter’s carry

One-Rescuer Drags, Carries, and Lifts (3 of 3)

Pack strap

Urgent Moves

• Used to move a patient who has potentially unstable injuries

• Use the rapid extrication technique to move patients seated in a vehicle.

When to Use RapidExtrication Technique

• Vehicle or scene is unsafe.• Patient cannot be properly assessed.• Patient requires immediate care.• Patient’s condition requires immediate transport.• Patient is blocking access to another seriously

injured patient.

Rapid Extrication (1 of 3)

• Provide in-line support and apply cervical collar.

Rapid Extrication (2 of 3)

• Rotate patient as a unit.

Rapid Extrication (3 of 3)

• Lower patient to the backboard.

Nonurgent Moves (1 of 2)

• Direct ground lift

Nonurgent Moves (2 of 2)

• Extremity lift

Transfer Moves

Direct carry

Draw sheet method

Scoop Stretcher

• Adjust stretcher length.

• Lift patient slightly and slide stretcher into place, one side at a time.

• Lock stretcher ends together.

• Secure patient and transfer to the cot.

Geriatrics

• Emotional concerns– Fear

• Skeletal concerns– Osteoporosis– Rigidity– Kyphosis– Spondylosis

• Pressure sores• Use special immobilizing techniques.• Be compassionate.

Bariatrics

• “Care of the obese”• Increase in back injuries among EMTs• Manufacturing of higher capacity equipment • Use proper lifting techniques.

Wheeled Ambulance Stretcher

• Most commonly used device

• Has specific head and foot ends

• Has a folding undercarriage

• EMT-B must be familiar to specific features of cots used in the ambulance.

Loading the WheeledAmbulance Cot

• Tilt the head of the cot upward.– Place it into the patient compartment.

• Release the undercarriage lock and lift.• Roll the cot into ambulance.• Secure the cot to ambulance clamps.

Patient-Moving Equipment (1 of 3)

Portable stretcher Flexible stretcher

Patient-Moving Equipment (2 of 3)

Backboard

Basket stretcher

Patient-Moving Equipment (3 of 3)

Scoop stretcher

Stair chair

Review

1. What is the first rule of lifting?

A. Twist slowly when you lift

B. Keep your back in a straight position

C. Bend at the waist to pick something up

D. Use your arms to do most of the lifting

Review

Answer: B

Rationale: The first rule of lifting is to always keep your back in a straight, upright, position and use the powerful muscles of your thighs. Never twist while lifting.

Review

1. What is the first rule of lifting?

A. Twist slowly when you lift

Rationale: You should never twist your back.

B. Keep your back in a straight position

Rationale: Correct answer

C. Bend at the waist to pick something up

Rationale: You should never bend at the waist. Your back should be properly maintained in an upright position.

D. Use your arms to do most of the lifting

Rationale: Use your leg muscles since they are well developed and very strong.

Review

2. When lifting a stretcher using the power lift, you should:

A. bend at the hips, knees, back, and arms.

B. bend at the waist and keep your back straight.

C. place your hands palms up on the litter handle.

D. place your hands palms down on the litter's side bars.

Review

Answer: C

Rationale: When lifting any heavy object, your hands should be facing palms up; this provides better lifting power and is not as stressful on the wrists.

Review

2. When lifting a stretcher using the power lift, you should:

A. bend at the hips, knees, back, and arms.

Rationale: When lifting, keep your back and arms straight. Always bend at the knees.

B. bend at the waist and keep your back straight.

Rationale: When lifting, always keep your back straight. Never bend at the waist.

C. place your hands palms up on the litter handle.

Rationale: Correct answer

D. place your hands palms down on the litter's side bars.

Rationale: Your hands have the greatest strength when your palms are facing up.

Review

3. It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:

A. takes too long to correctly apply.

B. does not fully immobilize the spine.

C. cannot be used on patients who are in their car.

D. does not provide adequate c-spine stabilization.

Review

Answer: A

Rationale: It takes several minutes to correctly apply a vest-style extrication device. This is too much time to waste when treating a critically-injured patient. A long spine board would be more appropriate. Vest-style immobilization devices, when applied correctly, provide adequate spinal motion restriction and are ideal to use in stable patients who need to be removed from their vehicle.

Review

3. It is impractical to apply a vest-style extrication device on a critically-injured patient to remove him or her from a wrecked vehicle because it:

A. takes too long to correctly apply.

Rationale: Correct answer

B. does not fully immobilize the spine.

Rationale: When applied correctly, the vest provides adequate restriction of the spine.

C. cannot be used on patients who are in their car.

Rationale: When a patient is stable, the vest is a beneficial device for vehicle extrications.

D. does not provide adequate c-spine stabilization.

Rationale: The vest provides adequate restriction of the spine.

Review

4. Proper guidelines for correct reaching include all of the following, EXCEPT:

A. avoiding twisting your back.

B. avoiding hyperextension of your back.

C. keeping the back in a locked-in position.

D. reaching no more than 30” in front of your body.

Review

Answer: D

Rationale: When reaching, you should keep your back in a locked-in position, and avoid twisting or hyperextending your back. Do not reach more than 15” to 20” in front of your body.

Review

4. Proper guidelines for correct reaching include all of the following, EXCEPT:

A. avoiding twisting your back.

Rationale: Never twist your back while reaching or lifting.

B. avoiding hyperextension of your back.

Rationale: Never bend or hyperextend your back.

C. keeping the back in a locked-in position.

Rationale: Always keep your back straight in a locked position.

D. reaching no more than 30” in front of your body.

Rationale: Correct answer

Review

5. An injured hang glider is trapped at the top of a large mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use?

A. Stair chairB. Stokes basketC. Scoop stretcherD. Long spine board

Review

Answer: B

Rationale: A basket stretcher, also called a “stokes” basket, should be used to carry patients over rough or uneven terrain that is inaccessible by ambulance. Its closed-ended sides protect the patient from falling out of the device.

Review5. An injured hang glider is trapped at the top of a large

mountain and must be evacuated to the ground. The terrain is very rough and uneven. Which of the following devices would be the safest and most appropriate to use?

A. Stair chairRationale: This is used to transfer a patient up and down stairs.B. Stokes basketRationale: Correct answerC. Scoop stretcherRationale: This is designed to split into 2 or 4 pieces. It must

have access to both sides of patient and the patient should be lying on a relatively flat surface.

D. Long spine boardRationale: There is no protection for the patient from falling off

or out of the device.

Review

6. When two EMT-Bs are lifting a patient on a long backboard, they should:

A. lift the patient from the sides of the board.

B. make every attempt to lift with their backs.

C. position the strongest EMT-B at the foot of the board.

D. position the strongest EMT-B at the head of the board.

Review

Answer: D

Rationale: Since more than half of the patient's weight is distributed to the head end of a backboard or stretcher, you should always ensure that the strongest EMT-B is at that position. This will reduce the risk of injury to less stronger personnel as well as the risk of dropping the patient.

Review

6. When two EMT-Bs are lifting a patient on a long backboard, they should:

A. lift the patient from the sides of the board.

Rationale: This may cause the backboard to tip since the upper torso is heavier.

B. make every attempt to lift with their backs.

Rationale: Never lift with your back. Always use your legs.

C. position the strongest EMT-B at the foot of the board.

Rationale: The strongest EMT should be at the patient’s head, where the patient’s weight is greater.

D. position the strongest EMT-B at the head of the board.

Rationale: Correct answer

Review

7. Which of the following techniques is considered to be an emergency move?

A. Extremity lift

B. Supine transfer

C. Firefighter's drag

D. Direct ground lift

Review

Answer: C

Rationale: The firefighter's drag is a one-person technique that is used when a patient must be removed from a life-threatening situation immediately.

Review

7. Which of the following techniques is considered to be an emergency move?

A. Extremity lift

Rationale: This is a nonurgent move, helpful in narrow spaces.

B. Supine transfer

Rationale: This is not considered to be an emergency move.

C. Firefighter's drag

Rationale: Correct answer

D. Direct ground lift

Rationale: This is a nonurgent move, used to carry a patient long distances to the cot.

Review

8. To extract a patient from the basement of a building, you must transport the patient up a flight of stairs. In doing this, you must ensure that:

A. the elevated head of the backboard goes first.B. the backboard with the elevated foot end goes first.C. the backboard is slightly tilted to the left to

distribute weight.D. the patient's feet are higher than his or her head,

whichever end is carried first.

Review

Answer: A

Rationale: When you carry a patient upstairs or up an incline, you must ensure that the elevated head of the backboard or stretcher goes first. This will help to equally distribute the weight.

Review8. To extract a patient from the basement of a building, you must

transport the patient up a flight of stairs. In doing this, you must ensure that:

A. the elevated head of the backboard goes first.Rationale: Correct answerB. the backboard with the elevated foot end goes first.Rationale: Always try to carry the head higher to distribute the

weight.C. the backboard is slightly tilted to the left to distribute weight.Rationale: Backboards are designed to carry a patient flat and the

weight is best distributed when the head is slightly elevated.D. the patient's feet are higher than his or her head, whichever end

is carried first.Rationale: Carries are easier with the patient’s head first and

elevated for distribution of the patient’s weight.

Review

9. If an injured patient needs to be moved but is not in immediate danger from fire or building collapse, you should first:

A. order the equipment you need for extrication.B. check the patient’s airway, breathing, and

circulation.C. remove the patient with the rapid extrication

technique.D. determine the number of people you will need to

move the patient.

Review

Answer: B

Rationale: The only time your attention should be directed away from the initial assessment of the patient is when the patient’s life or your life is in immediate danger.

Review9. If an injured patient needs to be moved but is not in

immediate danger from fire or building collapse, you should first:

A. order the equipment you need for extrication.Rationale: This is not the first thing you should do.B. check the patient’s airway, breathing, and circulation.Rationale: Correct answerC. remove the patient with the rapid extrication technique.Rationale: The patient is not in immediate danger, so this is not

needed.D. determine the number of people you will need to move the

patient.Rationale: After the ABC’s have been checked, then the EMT

can determine the safest method of extrication.

Review

10. The rapid extrication technique is a:

A. nonurgent move to remove a patient from a vehicle.

B. technique used to transfer a patient from a bed to a stretcher.

C. technique used to lift a patient with no suspected spinal injury onto a stretcher.

D. technique used to quickly remove a patient from a vehicle and onto a backboard.

Review

Answer: D

Rationale: By using the rapid extrication technique, a seriously injured patient can be moved from a sitting position in a vehicle to a supine position on a backboard while protecting the spine at the same time.

Review10. The rapid extrication technique is a:

A. nonurgent move to remove a patient from a vehicle.Rationale: This is considered to be an urgent move.B. technique used to transfer a patient from a bed to a stretcher.Rationale: This is used to move a patient from a vehicle to a

backboard.C. technique used to lift a patient with no suspected spinal injury

onto a stretcher.Rationale: This is not a lifting technique. The patient is placed

on a backboard and not a stretcher.D. technique used to quickly remove a patient from a vehicle

and onto a backboard.Rationale: Correct answer