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Chapter 11

Chapter 11. Lifting and Moving Patients. Overview. Back Injuries Body Mechanics Planning a Move Packaging the Patient. Back Injuries. Anatomy review Lumbar spine bears weight of body; 85% of back injuries occur there Discs between vertebrae may deteriorate, move, or slip out of place

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Chapter 11

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  1. Chapter 11 Lifting and Moving Patients

  2. Overview • Back Injuries • Body Mechanics • Planning a Move • Packaging the Patient

  3. Back Injuries • Anatomy review • Lumbar spine bears weight of body; 85% of back injuries occur there • Discs between vertebrae may deteriorate, move, or slip out of place • Injuries can result from improper lifting and carrying

  4. Back Injuries • Back care • Most common source of back injuries is twisting while lifting an object • Key to a strong back is exercise • To prevent injury, warm up the lower back before each tour of duty

  5. Back Injuries • Know your limitations • Two key questions • Is there enough help to lift this patient? • Is the right equipment being used? • Failure to answer the questions correctly can cause injury to the patient or EMT

  6. Back Injuries • Is there enough help? • One EMT must be able to lift and carry 125 lbs; two EMTs, 250 lbs • Request assistance for patients over 250 lbs • Factor in the stretcher and equipment

  7. Back Injuries • What is the “right stuff”? • Carefully consider the situation at hand • Mentally visualize the method used for the carry

  8. Back Injuries • Safety first • Back support braces • Must be worn correctly • Must fit correctly • Proper footwear • Closed-toe shoes or boots • Soles should be nonskid • Midcalf boots provide support

  9. Stop and Review • Discuss proper back care.

  10. Body Mechanics • The proper or most efficient way to perform physical activities • The primary goal is to lift and carry without injury to spine

  11. Body Mechanics • Reaching • Never twist and arch the back backward • Never reach more than 18 inches away from the body • Keep elbows close to the body and never farther out than the knees • Bend at the knees, while keeping the back straight

  12. Body Mechanics • Lifting • The power lift • Utilizes the stronger muscles of the leg instead of the weaker muscles of the lower back • The closer the body’s center of gravity is to the object, the more powerful the lift • The feet are the foundation of the power lift

  13. Body Mechanics • Lifting • The power grip • Palms-up grasp utilizes powerful arm muscles • The arms should be locked out • On signal, two EMTs slowly lift together in a fluid motion • Lift is complete when the EMT is upright and the weight suspended directly in front

  14. Body Mechanics • Carrying • A bag or case should be carried by a shoulder strap slung over the shoulder • Carry with a straight back and balance the loads • Pushing and pulling • Always try to push an object rather than pull it

  15. Planning a Move • Survey the scene and determine the priorities • Assess the resources at hand • Communicate the plan • The strongest EMT takes the heaviest end • Know your personal limits

  16. Planning a Move • Emergency moves • A patient may need to be moved immediately • Is the EMT prepared and capable of entering the scene and removing the patient? • Principle reasons for emergency moves • Fire • Explosion • Life-threatening hazards • Patient blocking access to more seriously injured patients

  17. Planning a Move • Emergency drags • The clothing drag • The shirt collar or a handful of clothing is grabbed from behind the neck • Using two hands, the EMT walks backward while dragging the patient along with him • The patient’s head remains cradled between the rescuer’s forearms

  18. Planning a Move • Emergency drags • The arm drag • The EMT grasps the wrists of the patient, crossing them over her chest, and drags her by the arms • Effective if the patient can hold the head up • Do not use if the patient is unconscious

  19. Planning a Move • Emergency drags • The blanket drag • The EMT logrolls the patient onto a blanket and drags the patient backward to safety • When others arrive, there are many handholds to help drag, lift, or carry the body

  20. Planning a Move • Emergency drags • The firefighter’s drag • The EMT secures the patient’s wrists together and drapes the wrists over his neck and shoulders • The patient is dragged while beneath the EMT • The EMT sees where he is going; the patient is protected by the body of the EMT

  21. Planning a Move • Emergency carries • Rescuer assist • EMT acts as a crutch for the walking patient • Advantage—EMT can drag patient to safety if patient becomes weak

  22. Planning a Move • Emergency carries • Pack strap carry • Can convert from the rescue assist • The patient’s weight is on the EMT’s back and the patient’s feet are off the ground • Use only when no other means are feasible • Cradle carry • Only for small adults or children

  23. Planning a Move • Emergency carries • Firefighter’s carry • Very effective but difficult to master • The patient is moved from a supine to a near-standing position and over the EMT’s shoulder • EMT has one hand free to open doors or carry bags

  24. Planning a Move • Emergency carries • Seat carry • Use if patient is able to assist and two EMTs are available • The two EMTs form a seat by grasping wrists • Useful if the patient is unable to walk

  25. Planning a Move • Emergency carries • Chair carry • Uses a standard kitchen chair to move the patient • One EMT, facing forward, grasps the legs of the chair; the other EMT, the back of the chair • Should not be used with unconscious patients

  26. Planning a Move • Nonurgent moves • Take time to prepare for the carry • The primary concern—the patient’s safety and comfort, and the safety of the prehospital team • A number of devices and methods can safely move a patient from the scene

  27. Planning a Move • Nonurgent moves • Command and coordination • Team leader—EMT at the head of the patient • Decides when to lift, turn, or stop • Gives specific orders that are loud and clear • Ensures all team members understand the objectives

  28. Planning a Move • Nonurgent moves • Extremity lift • Transfers patient from bed or floor to stretcher • First EMT slips his hands under the patient’s arms, and grasps the patient’s hands; second EMT slips his hands under the patient’s knees • Does not protect the spine

  29. Planning a Move • Nonurgent moves • Direct lift • Used when only one side of patient is accessible • Moves a patient from the floor to bed or stretcher • Three EMTs • First EMT—patient’s head, neck, and shoulders • Second EMT—patient’s back and buttocks • Third EMT—patient’s knees and ankles • Does not protect the spine

  30. Planning a Move • Nonurgent moves • Scoop stretcher • Designed to fit into tight or confined spaces • Meant to be broken into two halves • The halves slip under the patient from opposite sides and the stretcher is reconstructed • Does not support the spine directly—a temporary transfer device

  31. Planning a Move • Nonurgent moves • Stairchairs • Used if patient cannot tolerate lying flat on a stretcher • Has seat belts for the patient, handles for the EMT • Requires two EMTs to carry

  32. Planning a Move • Nonurgent moves • Stair carry • EMT must concentrate on balancing, carrying, and stepping • Guiding EMT calls out the steps until the bottom is reached • Patient is carried down the stairs feet first • Stairchair is held as close to the body as practical

  33. Planning a Move • Off-road stretchers • Designed to carry patient across uneven terrain and rough ground • Decrease the hazard to the EMT and the patient

  34. Planning a Move • Off-road stretchers • Basket stretcher • Made of fiberglass-plastic composites • Can be pulled across snow and ice like a sled • Heavy to carry—some rescue experts still prefer lighter wire baskets

  35. Planning a Move • Off-road stretchers • Flexible stretcher • Lightweight and can be rolled up • SKED/Reeves stretchers • Use in confined-space, cave, wilderness, and rope rescues • Has multiple handholds and straps to secure patient

  36. Planning a Move • Off-road carries • Decision of which to use is based on • The nature and the distance of the carry • Number of providers available • The patient’s weight • Rescuer fatigue

  37. Planning a Move • Off-road carries • End-to-end carry • Two EMTs grab each end of the litter and lift • If the ground is level and the carry is only a few feet, the two EMTs can face one another • If the carry is more than 20 feet, both EMTs should face forward

  38. Planning a Move • Off-road carries • Diamond stretcher carry • Use when carry is more than 12 feet and ground is uneven • First two EMTs take ends of stretcher; next two take positions at sides • All use a power grip and perform a power lift • EMT at head faces and monitors the patient

  39. Planning a Move • Off-road carries • The four corners carry • Use when carrying a basket over a great distance • Use when carrying heavy patients or equipment • As many as six or even eight EMTs can be involved • Each EMT grabs a corner of the basket or somewhere in the middle

  40. Planning a Move • Off-road carries • The use of slings • Loops of webbing (slings) are used to help even the load • Sling is looped through the handhold and slung over the shoulder to the opposite hand • After lifting, the EMT pulls down on the sling, using the shoulders as a fulcrum

  41. Planning a Move • Off-road carries • Passing over obstacles • EMTs must take care not to drop the patient while overcoming an obstacle • Caterpillar pass passes patient to EMTs waiting on the other side of the obstacle • The key—keep all EMTs standing still • Can use to hand patient off to other EMTs

  42. Stop and Review • State the guidelines for pushing and pulling.

  43. Packaging the Patient • The ambulance cot is part of the plan of treatment • Linens provide comfort and warmth • Care must be taken to conserve the patient’s body heat

  44. Packaging the Patient • Positioning • The decision on positioning the patient must be medically motivated • Feet up—More blood goes to the brain • Head up—Patient breathes more easily

  45. Packaging the Patient • Strapping • First strap secures the upper torso—arms either inside or outside • Middle strap is adjusted over the bony pelvis • Last strap is across the knees • Equipment is secured with the last strap

  46. Packaging the Patient • Transferring to the ambulance • Cot in high position is prone to tipping • Keep loaded cots in low position when moving the patient • If ground is rough or uneven, EMTs should be on both sides of the cot

  47. Packaging the Patient • Loading the ambulance • Depends on manufacturer recommendations • EMT must observe standard principles of lifting • Inspect the cot daily and provide regular maintenance

  48. Packaging the Patient • Transferring to the hospital bed • Roll the cot feet first and in low position • Transfer to hospital gurney • Be sure wheels of gurney are locked • Use a transfer device (backboard) if necessary • Lower side rails that might interfere with the transfer • Two EMTs move the patient as a unit

  49. Packaging the Patient • Transferring to the hospital bed • Carry transfer • Direct carry of patient from the cot to the gurney • Use when a space is too narrow to accept the crew • Take time to plan this move

  50. Packaging the Patient • Transferring to the hospital bed • Draw sheet transfer • Linen is used to pull the patient from the cot to the hospital bed • Four EMTs needed, two on each side • With two stretchers next to each other, each EMT grabs a side of the cot’s linen and slides the patient onto the bed

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