Section 6: Scene Techniques

1. Section 6: Scene Techniques

2. Chapter 27 Rescue Techniques: Lifts and Loads

3. Objectives(1 of 4) • 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.

4. 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.

5. Objectives(3 of 4) • 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 • Commercial or improvised stretcher • Cots • Toboggan • Overland wheeled stretcher • Stair chair

6. 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.

7. 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.

8. 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

9. Basic Anatomic Positions (2 of 3) • Position 2 • Patient on side • Anatomically neutral • Position 2a • Patient on side • Head, neck, back, or extremities not anatomically neutral

10. Basic Anatomic Positions (3 of 3) • Position 3 • Patient prone • Anatomically neutral • Head usually turned to the side • Position 3a • Patient prone • Head, neck, back, or extremities not anatomically neutral

11. 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.

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.”

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. Emergency Moves (2 of 3) • Techniques include: • Clothes drag • Blanket drag • Arm drag • Arm-to-arm drag

26. Emergency Moves (3 of 3) • When spinal injuries are unlikely, techniques include: • Front cradle • Firefighter’s drag • One-person walking assist • Firefighter’s carry • Pack strap carry

27. 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

28. 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.

29. Bridge Lift (2 of 2)

30. 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.

31. Direct Ground Lift (2 of 2)

32. Extremity Lift

33. 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

34. Backboards Short boards or extrication vests (KED) Transfer Devices (1 of 7)

35. Transfer Devices (2 of 7) • 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.

36. Flexible stretcher (SKED) Transfer Devices (3 of 7) Scoop stretcher Stokes

37. Transfer Devices (4 of 7) • 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

38. Transfer Devices (5 of 7) • 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.

39. Transfer Devices (6 of 7) • 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.

40. Transfer Devices (7 of 7) • 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.

41. 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

42. 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 Positioning Guidelines (1 of 2)

43. 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.

44. 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

45. 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!

46. Moving Patients • Protect rescuers’ health and safety. • Protect the patient. • Training and practice is required for proficiency. • Maintain equipment. • Review procedures.