Chapter 35

Lifting and Moving

Patients

KANNANKUZHIYIL ANUJ
JAYAPRAKASH
 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 (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 (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 (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)
 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.
 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.
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.
Hazardous for uneven
terrain or stairs

Source: Courtesy of Stryker

Medical
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 (2 of 2)
Remember, an injured rescuer cannot help anyone.