Lifting and Moving Patients

Body Mechanics Safety Precautions

• Using specific methods to lift large weights without injury

• Safety Precautions• Use legs, not back to lift

• Largest bone/muscle group

• Keep weight close to body

• Shifts center of gravity to patient

• More leverage

Body MechanicsCondiserations

• Guidelines for lifting/carrying • Consider pt weight• Know your limitations• Lift without twisting• Position feet one in front of the

other• Communicate with partner• Keep back locked and don’t twist• Flex at hips (not at waist)• Bend at knees• Keep elbows bent with arms close

to sides• Don’t hyperextend your back • Avoid reaching more than 15”-20”

in front of your body• Push rather than pull• Keep line of pull through midline

Power Lift

• Know/find out pt weight• Consider pt exceeding limitations• “Power lift”

• Keep back locked in normal curvature

• Place your feet a comfortable distance apart

• Tighten your abs and lock back into a slight inward curve

• Bring center of your body over object

• Vertical lift• Distribute your weight to the balls

of your feet OR just behind them• Lock your back and allow upper

body to rise before the hips as you lift

Power Grip

• “Power Grip”• Maximizes force from

hands• Palm and fingers are in

contact with object• All fingers are bent at the

same angle • Hands at least 10” apart

CarryingOne-handed carrying technique

• One-handed carrying technique

• Multiple providers positioned around pt

• Keep back in locked position

• Don’t lean to either side• Lift as normal

Stairs…

• Whenever possible use stair chair

• Keep back locked• Flex at hips (not waist)• Bend at knees (not with

back)• Keep your weight close to

the device• Have stronger rescuer at

the bottom

Log Rolling

• Log rolls• Movement of a supine/prone pt

• EMT 1: Maintain C-spine• EMT 2 & 3: Position kneeling at pt

side• EMT 2: Raise pt nearest arm over

pt head• EMT 2: Place 1 hand on pt shoulder

the other on pt hip• EMT 3: Place 1 hand on pt waist

and the other at knees• EMT 2 & 3: On count of 3 from EMT

1, roll pt onto side• Place pt on backboard, transport

Emergency Moves

• Fastest move• No spinal immobilization • Immediate danger to pt if not moved

• Fire or danger of fire• Explosives or other hazardous materials• Inability to protect pt from other hazards• Inability to access other pts in a vehicle who need life saving care• Life saving care cannot be given due to pt position

• Examples: • Clothes drag• Blanket drag• Torso drag

Urgent Moves

• Fast• Spinal immobilization• Scene is safe, immediate threat to pt life

• Altered Mental Status (AMS)• Inadequate breathing• Shock/Hypoperfusion

• Example• Rapid extrication

• Moving pt from MVA with constant spinal immobilization

Rapid Extrication

• Rapid extrication from vehicle• 1 EMT provides manual C-Spine support• 2nd EMT applies C-Collar• 3rd EMT places back board near door and moves to the

passengers seat• 2nd EMT supports thorax as 3rd EMT frees pt feet from

pedals• At direction of 2nd EMT he and 3rd EMT rotate pt so that pt

back is not in doorway• Tx C-Spine control• 1st EMT exits vehicle and supports head from outside• Back board is places against pt buttock• 1st EMT and 2nd EMT lower pt to back board• 2nd and 3rd EMT slide the pt onto the board • Rapid Extrication Demo

Non-Urgent Moves

Scene Safe Stable pt Suspect spinal injury Examples:

– Direct Ground Lift– Extremity Lift– Direct Carry– Draw Shift

Direct Ground Lift

• Direct Ground Lift (No spine injury)• Two or more rescuers lifting a patient from the side -Cradle

• 2-3 rescuers line up on one side of pt• Rescuers kneel on one knee• Pt arms placed on pt chest• Rescuer @ head places one arm under pt neck and cradles head.

He places other hand under pt lower back• Second rescuer places one under the pt knees and the other under

the pt buttock• On signal the rescuers lift pt to their knees and roll pt towards their

chest • On signal the rescuers stand and tx pt to stretcher• Steps are reversed to lower pt

Extremity Lift

• Extremity Lift (No extremity injuries)• Two rescuers lifting the patient by the extremities• One rescuer in the armpit-forearm drag position and the other

holding the patient behind the knees. • 1 EMT kneels at the pt head, another kneels at pt side by the knees • EMT at the head places 1 hand under each of the pt shoulders • EMT at the knees grasps the wrists• EMT at head slips his hands under the pt arms and grasps pt wrists• EMT at feet slips his hands under the pt knees• Both EMT’s move to a crouching position• EMTs stand simultaneously and move pt to stretcher

Direct Carry

• Similar to direct ground lift except the pt is carried• Tx of supine pt from bed to stretcher

• Place cot perpendicular to bed with head of cot at foot of bed• Both EMTs stand between stretcher and bed facing pt• 1st EMT slips arm under pt neck and cups pt shoulders• 2nd EMT slips hand under hips and lifts slightly• 1st EMT slips other arm under pt back• 2nd EMT places arms under pt hips/calves• EMTS slide pt to edge of bed• Pt is lifted/curled towards EMTs chest• EMTs rotate and place pt on stretcher

Draw Sheet

• Loosen sheets from bed• Place stretcher next to

bed• Reach across and firmly

grasp sheet• Head• Chest• Hips• Knees

• Slide pt gently onto stretcher

Stretchers

• Most commonly used• Easy to tip over

• High center of gravity

Stretchers

• Rolling• Restricted to smooth terrain • Pulled by foot end• One person guides the head

• Carrying • Two EMTs

• EMTs face each other from opposite ends of stretcher• Ideal for small spaces • Requires more strength

• Four EMTs• One EMT on each corner• Requires less strength• Safer of rough terrain

• Loading into ambulance• Use sufficient lifting power• Follow manufacturers directions• Ensure all pt and stretchers are secure before moving

Portable Stretchers

• Lightweight, foldable• Permits tx of pt

• Down stairs• Over rough terrain

• Carried end to end

Scoop/Orthopedic Stretcher

• Function• Splits apart to scoop up the

patient on the ground from either side

• Facilitates easy lifting of supine pt

• Form• Aluminum frame• Splits lengthwise in half • Allows pt to be “scooped” off

ground• For spinal injury pt,

• Cervical immobilization is maintained

Scoop/Orthopedic Stretcher

• How to use it…• Measure and adjust the length of the device to be just

longer than the pt• Slide the stretcher under both sides of the pt• Lock the head first• Lock the feet• Strap the pt in place• Place pt on a secondary device and secure

• Ex. LBB

Stair Chair

• Designed to move pt who are able to assume sitting position

• Not used for• Pt with spinal injuries• Unconscious

• Extremity lift is preferred to load pts

• Best to have a spotter behind EMT at feet while descending stairs

Backboards

• Long Spine Boards • Function:

• Rigid support for spinal column to prevent further injury

• Types: • Wooden• Plastic

• Uses:• Primary device for

supine/recumbent pt • Rapid extrications• Secondary support in assoc

with short spine board

Short Spine Boards

• Function• Extends from base of the buttock to

just above pt head• Attached by straps or cravats Support

of spinal column to prevent further injury

• Types• Wooden• Vest type

• Kendrick Extrication Device (KED)• Uses

• Extricate pt in MVA who are in sitting position

Stokes Basket

• Function• Movement of pt over rough

terrain

• Form• Large basket • Flat bottom• LBB can fit • Pt can be immobilized as

normal

Patient Positioning

• Unresponsive pt (non traumatic)• Rolled into recovery position (Left side)

• Pt with dyspnea or chest pain• Position of comfort• As long as hypotension doesn’t occur

• Suspected spine injury• Immobilized to long backboard

• Pregnant Pt• Left lateral recumbent• Supine= Fetus on vena cava

• Shock• Elevated legs 8”-12”

• Nausea/Vomiting • Position of comfort• EMT in position to control airway