Patient Movement & Stabilization Training - June 13, 2016

1. LAMORINDA CERT Refresher Training Patient Movement & Stabilization June 13, 2016

2. Victim Transport • Why do we need to transport victims? • How do we transport them? • What problems are inherent in moving victims? • How do we mitigate those problems?

3. Need to Transport • Victims need to be moved for a few reasons: • Victim in immediate danger • Current location is unstable • Building unstable • Fire • Water • Other hazards – gas, electrical, explosives, etc. • Victim needs more care than can be given at current location • Victim is blocking access to other victims

4. How to Transport • Several ways to transport • Method depends on situation and victim condition • Walking Assists • Crawls and Drags • Carries • Carried directly by rescuers • Carried on equipment by rescuers • May require immobilization

5. Body Mechanics • Never lift more than you can handle • Feet shoulder with apart & one foot ahead of the other • Make sure ground is stable & clear of obstacles • Keep person as close to your body as possible • Use your abs,back straight, knees/hips bent • Lift with your legs • Do not twist • Don’t work in odds

6. Techniques • Required to evacuate a sick or injured person from an emergency scene to a safe location • Casualties carried carefully and correctly handled, otherwise their injuries may become more serious or even fatal • Situation permitting, evacuation of a casualty should be organized and un-hurried • Each movement should be performed as deliberately and gentle as possible • Manual carries are tiring for the rescuer and involve the risk of increasing the severity of injuries • Choose the technique that will be the least harmful both to rescuer and the victim

20. Patient Packaging • Patient packaging is the process in which a patient is prepared for transport, while providing for comfort and immobilization. This process should not interfere with the patient’s ability to continue with normal bodily function and yet should allow the transporting personnel the ability to maintain an accurate account of the patient’s vital signs, continue with the treatment of any and all illness and injury and provide the appropriate medical care.

21. Why? • Moving a “loose” victim is likely to cause further injury. • A properly packaged patient can be moved easily and transferred from one set of transporters to another seamlessly. • Packaging can be done for the type of movement needed, flat, low-angle, high-angle, vertical lift or descent.

22. Extrication • Your safety is priority • If a victim cannot easily be removed from building/rubble DO NOT try to move them • Victim will need advanced care prior to removal • Crush injuries • Field amputation

23. Types of Transport • Mass transport • BLS transport • ALS Transport • Critical Care Transport • Air transport

24. Equipment • Chair • Stretcher • Improvised stretcher • Cervical Collar* • Backboard

25. Spine Immobilization • Decision Tree • See Handout

26. C-Collar • A Cervical Collar provides: • Temporary support to the head of a sitting or standing patient until the patient can be placed in a supine position. • Frees the hands of rescuers while the patient is being moved & splinted to a Full spine board. • Reduces compression of the cervical spine caused by the head. • Minimizing axial loading / unloading of the spine that takes place during transport.

27. C-Collar limitations • The Cervical Collar:  • Is NOT designed to immobilize the cervical spine, let alone the rest of the spine. • Restriction of movement of the head with a rigid collar is at best 50% of normal movement. • Is NOT designed to provide any traction to the head, but is only designed to support the weight of the head. • Only prevents 50% of cervical spine movement. • Provides no thoracic / lumbar spinal support. • Has not been shown in any study to adequately immobilize the cervical spine.

28. C-Collar Hazards • A number of dangers may be associated with application of a Cervical Collar: • If the jaw support of the collar clamps the teeth together, airway compromise may result if the patient vomits. • Cervical Collars that place pressure on the neck (either via collar design or too small a Cervical Collar being applied), may cause an increase in intracranial pressure.

29. C-Spine Collar • The technique • Should be simultaneous with assessment. • Place collar, if needed, prior to any patient movement • Don’t use force. • More than one manufacturer of collars • One collar does not fit all! • Towel or Blanket rolls alternatives • NO CLOTHING

30. C-Collar • Many manufacturers and many styles • Inexpensive ($6-15 each) These were $7.50 each • Directions are normally printed on package

31. Backboards • Backboards come in many styles • Longboards are full length rigid backboards in either adult or pediatric sizes • Shortboards are used for extrication and go from waist to head.

32. Backboard Hazards • Now…a word about padding • Skin breakdown can begin to occur in as little as 1 hour • Get victim off backboard as soon as possible • Redistribute the weight off of the shoulder blades, buttocks and heels • Padding (not a lot) makes a huge difference • Bending knees flattens the back, flattens the feet to redistribute the weight

33. Backboard Tips • Pad the board prior to placing the patient on it • Leave the appropriate arm/arms accessible to allow therapies and monitoring • Cover over the top of the straps rather than under them • Make sure that the patient will not move side to side if tipped • Use specialty securing devices for little people if they are available

34. Special Positions • Severe closed head injuries • Tilt head of backboard up • Penetrating back injuries • May need to place victim on side • May need to hold direct pressure • Impaled objects • May need to get creative • Pregnant women • Left side down-pad between knee

35. Sleds • Rescue / Evacuation stretchers are rolled plastic sleds that, once unrolled and turned up on the edges, provides a rigid sled that can be dragged, lowered or hoisted • Longboards can be used inside sleds

36. Litters • Litters are baskets, like the ‘Stokes Litter’ that enable rescuers to easily carry, hoist or lower a victim.

37. Stretchers • Pole stretchers have rigid poles, folding poles or breakdown poles (may not have) • Flexible webbing allows compact storage

38. Quick Skills Review

39. Bleeding • Arterial (Away): Spurts and is usually brighter red • Venous (To): Flows • Capillary: Oozes

40. Bleeding Control Direct Pressure on point Elevation A note about tourniquets

41. Wound Care • Goal: • Control Bleeding • Keep Clean (prevent infection) • Treatment: • Clean wound-no scrubbing, no scrubbing, no hydrogen peroxide • Apply clean, dry dressing

42. Dressings • Must be clean and dry • If sterile but expired-considered clean • If active bleeding, DO NOT remove, maintain pressure and apply new, clean dressing over the old dressing • If no active bleeding, • remove dressing every 4-6 hrs • flush/clean wound • apply new dressing

43. Burns • Stop the burning process • ABC’s-look for inhalation!! • Remove clothing and jewelry • Clean wound,saline only • Dress with Clean dressing non-adaptive, burn dressing, or wet to dry. • Maintain body temp

44. Shock • Hypovolemic Shock (most common) • caused by hemorrhage or loss of fluids • s/s: Cold, clammy skin; pale skin, rapid breathing (shallow); • Cardiogenic Shock • Vasogenic Shock • Neurogenic Shock HR BP Confusion Urine Output

45. Splinting • Support the injured area • Assess color, warmth and sensation • Splint injury in the position that you find it • Don’t try to realign bones • Immobilize above and below the injury • After splinting, recheck for color, warmth, and sensation below the injury site • SAM splints are light, can be cut to shape and are well padded ~ $12