section 6: scene techniques

Section 6: Scene Techniques

Chapter 27

Rescue Techniques:

Lifts and Loads

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Chapter 27: Rescue Techniques: Lifts and Loads

• Discuss the guidelines and safety precautions that need to be followed when extricating and transferring a patient.

• Describe the safe lifting of immobilization devices, cots, and stretchers.

• Describe correct and safe carrying procedures on irregular terrain.

• Describe correct techniques for log rolls.

Objectives (1 of 4)

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Objectives (2 of 4)

• State the guidelines for pushing and pulling.• Discuss the general considerations of

moving patients.• Identify the following devices: immobilization

devices, transfer devices, transportation devices.

• Explain the rationale for properly lifting and moving patients.

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• With another rescuer, prepare each of the following devices, transfer a patient to the device, and properly position the patient on the device:• Long backboard

• Short backboard

• KED

• Scoop stretcher

• SKED

• Stokes

Objectives (3 of 4)

• Commercial or improvised stretcher

• Cots

• Toboggan

• Overland wheeled stretcher

• Stair chair

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Objectives (4 of 4)

• With another rescuer:• Demonstrate techniques for the transfer of

a patient from a long backboard to a toboggan.

• Move a patient (not on a backboard) from the ground to a toboggan.

• Transfer a patient from a toboggan to a cot or gurney.

• Transfer a patient to an automobile.

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Rescue Process• Note patient’s location and any

hazards. • Always consider your protection!• Avoid approaching the scene from

directly above or below. • Extrication is the process of safely

moving a patient, from entrapment or danger, to provide further care.

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Basic Anatomic Positions (1 of 3)

• Position 1 – Patient supine– Anatomically neutral– Straight back

• Position 1a – Patient supine– Head, neck, back, or

extremities not anatomically neutral

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• Position 2– Patient on side– Anatomically neutral

• Position 2a – Patient on side– Head, neck, back, or


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• Position 3 – Patient prone– Anatomically neutral– Head usually turned

to the side

• Position 3a– Patient prone– Head, neck, back, or


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Patient Positioning

• Three spinal reference points: head, shoulders, and hips

• Rescuer at each point

• Movements are in short increments (6” to 12”).

• All movement is directed by a single leader.

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Patient Positioning• Align head and neck first to provide and

protect airway (except in patients in position 3a).

• Limbs should be aligned one joint, one plane at a time.

• Align the patient using the fewest moves.• Align a patient in increments, ie, from

position 3 to position 2, then position 1.• Patients may have to be moved before

alignment.

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Specific Techniques

• Recovery position – Also known as NATO position

• One-rescuer side roll– Used to help prevent aspiration

• Log roll– Used to place patient onto a

backboard

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Rescuer Body Mechanics• Lifting should be done using the hips

and legs.• Keep your back straight.• Do not twist or bend forward or to the

side.• Grasp with your palms up (power grip).• Weight should be kept close to your

body.

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Lifting Anatomy • Shoulder girdle rests on vertebrae.• The sacrum is the weight-bearing base

and connection with pelvis. • Lifting with hands is reflected onto

shoulder girdle. • Position of shoulder girdle will direct force.

– Anterior to pelvis will exert force across spine.– Over pelvis will exert force in line with spine.

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Power Lift • Tighten your back in an upright position. • Spread your legs apart about shoulder

width. • Use power grip and hold close to your

torso. • Center your balance between both arms. • Ensure firm and balanced footing. • Straighten your legs and lift, keeping your

back straight and upright.

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Power Grip • Place hands about 10” apart with

palms up and thumb on top. • Curl your fingers and thumb tightly

over top of handle. • Handle should rest in your palm,

not on fingers. • Curl your biceps to maintain grip.

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Weight and Distribution

• Be aware of the effect of ski and snowboard boots on lifting.

• 68% to 78% of a patient’s weight is in the torso.

• Patient should be carried feet first.

• Ensure that patient is secured to device.

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Directions and Commands• Moves must be coordinated. • Direction must come from a single leader. • Start with a preparatory command:

– “Ready to stop.”• Give command of execution:

– “STOP.”• Use a count for lifting:

– “Lift on three. One, two, THREE.”

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Lifting and Carrying Guidelines• Ideally, use four rescuers to lift or

carry a patient on a backboard or stretcher.

• Communicate with other rescuers when lifting or carrying.

• Consider patient size, route, terrain, and rescuer strength and size when positioning rescuers.

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Safe Reaching and Pulling• Use the same body mechanics as when

lifting or carrying. • Your back should be locked and upright. • Do not twist. • Kneel or bend the knees.• Do not overextend your reach—15” to 20”

is sufficient.• Avoid repositioning yourself while moving a

patient.

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Long-Axis Drag (1 of 2)

• Sliding a patient in-line with the spinal column

• Do not move a patient sideways!

• Maintain cervical stabilization throughout the drag.

• Avoid excessive cervical traction or compression.

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Long-Axis Drag (2 of 2) • Patient can be dragged either head-

first or feet-first. • Usually three rescuers are needed:

– One at patient’s head – One at each side of patient’s torso or

ankles

• Some injuries may preclude using this technique.

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Emergency Moves (1 of 3)

• Used when hazards pose a risk of serious harm or death to rescuer or patient

• Primary risk is aggravating an existing spinal injury.

• Use a drag to pull the patient along the long axis of the body.

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• Techniques include:

– Clothes drag

– Blanket drag

– Arm drag

– Arm-to-arm drag

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• When spinal injuries are unlikely, techniques include:– Front cradle – Firefighter’s drag – One-person walking assist – Firefighter’s carry – Pack strap carry

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Nonurgent Moves

• Used when scene and patient are stable

• Three general methods include: – Bridge lift – Direct ground lift – Extremity lift

• Can be adapted to each situation

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Bridge Lift (1 of 2)

• Rescuers form a bridge by bracing head against other rescuer’s shoulder.

• Allows lifting with arms and shoulders instead of back.

• Patients with spinal injuries will require at least 4 rescuers for the lift.

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Bridge Lift (2 of 2)

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Direct Ground Lift (1 of 2)

• Usually not used on patients with suspected spinal injuries.

• Used to lift and carry a patient for some distance.

• Number of rescuers needed depends on size of patient and strength of rescuers.

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Direct Ground Lift (2 of 2)

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Extremity Lift

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Transfer Moves

• Direct carry—a variation of the direct ground lift

• Blanket lift—can use blanket, sheet, or jackets

• Backboard

• Scoop stretcher

• Two-rescuer assist to vehicle

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Transfer Devices (1 of 7)

• Backboards

• Short boards or extrication vests (KED)

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• Backboards – Plastic or wooden boards with slots along sides

for straps and hand holds – 6’ to 7’ long – Must adhere to infection control guidelines

• Short boards or extrication vests– Used for extrication in confined spaces – Vest-type devices (KED) immobilize patients in

a sitting position.

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Flexible stretcher

(SKED)

Scoop stretcher Stokes

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• Stretchers– Flexible type—used in confined

space extrication, wilderness, and search and rescue operations (SKED)

– Scoop stretcher or split litter – Stokes or rigid basket stretcher

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• Scoop stretchers– Designed to be split into 2 or 4 pieces– Allow access to both sides of patient – Avoid trapping clothing, skin, hair, or

straps in the closure area. – Consult local protocols regarding

transfer of patients with spinal injuries.

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• Stokes – Used to carry or move patients in

rough terrain, during technical rope rescue, and during water rescue

– Made of plastic or metal – Basket (wire mesh) needs additional

padding for long-term use.

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• Cots – Wheeled ambulance stretcher or pram – Clinic gurney – Usually a specific head end and foot end – Has specific carrying handles – Four rescuers needed for maximum

security moving over rough terrain.

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Transportation Devices • Toboggan (various brands and types)

– Most common device at ski areas – Two or four fixed handles – Can be towed by snowmobiles with a

rigid hitch– Consult NSP’s transportation text for

more information about use and procedures

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Positioning Guidelines (1 of 2)

Head downhill: • Cardiac arrest • Shock • Hypothermia • Lower extremity and

pelvis injury • Abdominal injuries

without respiratory distress

Head uphill:• Injury to head, eye,

face, neck, or upper extremity

• Shortness of breath • Suspected AMI • Steep terrain • Unresponsiveness

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Positioning Guidelines (2 of 2)

• No rule is absolute; in some cases, let patient comfort dictate the position:– Chest injury – Dislocated upper extremity

• Use recovery position in patients with non-traumatic unresponsiveness and nausea and vomiting.

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Transportation Devices

• Overland wheeled stretchers:– Single wheel for use on trails – Multiple wheel for towing behind ATV

• Folding stretchers, often carried by ambulance crews

• Stair chair, designed to move a seated patient up or down stairs

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Improvised Devices

• Toboggans can be made with skis, shovels, ski poles, pads, and rope.

• Stretchers can be built from packs, paddles, poles, rope, and jackets.

• Devices may not be sufficiently rigid for spinal injuries.

• May be only option!

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Moving Patients

• Protect rescuers’ health and safety.

• Protect the patient.

• Training and practice is required for proficiency.

• Maintain equipment.

• Review procedures.

section 6: scene techniques

Documents

rescue techniques

edition aaosnspchapter

neutral outdoor emergency

correct techniques

loadsoutdoor emergency

neutraloutdoor emergency

patient supinehead

transfer devices