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Welcome to my bad habits: Moving patients in EMS

EMS1.com News

April 8, 2013


First in Fitness
by Bryan Fass

Welcome to my bad habits: Moving patients in EMS

The old ways of lifting and moving can really hurt us

By Bryan Fass

It's your first shift; you're nervous and not quite sure what to do. Your new partner walks into quarters, complete with street swagger and just enough attitude to make you cringe. As a new medic it's only natural to watch this guy like a hawk, to learn from him, to emulate him because he possesses the knowledge that you crave.

The tones go off. It's your first call, a priority response to a skilled nursing facility for a patient with altered mental status. After arriving on scene and stabilizing the patient, your partner instructs you to climb into bed on your knees. It's time to move the patient from the bed to the stretcher; on the count of three, you will grab the sheet and half yank and half fall forward two "help transfer" the patient onto the cot.

You noticed the patient groan as they were violently dragged onto the cot and somewhere in the back of your mind you may have wondered if this is the best way to do it.

Unknowingly, we have handed down bad patient handling techniques, outright dangerous biomechanics and ergonomics from one generation of EMS responders to another. I can personally recall countless instances where I was poorly trained by a seasoned responder to lift, carry and transport patients and use patient handling tools with techniques that would outright cause injury.

How many of you, just like me, were taught to pick up the stretcher in one big movement going from the floor to the full load position? We have been taught to do it wrong!

Often the bad habits that we are taught exist because our industry is full of myths and misinformation on the safest way to do things. Instead we cut corners, move too fast and often do things in one uncontrolled movement where two smaller movements are far superior and safer.

Let's examine three of the top patient and equipment handling tips that will immediately reduce your chance of injury and reduce patient anxiety too.

  • Use a friction reducing device. Using a traditional sheet drag is a classic example of knowing what we know but that we know wrong. Let's say our patient is 300 pounds and we need to move them from the bed to the cot. The way we were taught is that one EMS provider leans over the stretcher and grabs a hold of the sheet, while the other has to climb into bed with the patient to assist movement. With the added friction of a sheet drag, our 300 pound patient will now weigh somewhere around 330 pounds. Additionally, we only have the limited advantage of one responder generating the force to pull a patient onto the cot.

A friction reducing device such as a transfer tarp, mega mover, slide board or even a simple trash bag will all suffice to make your job easier and reduce your chance of injury. A tarp has the added benefit of handles, which means that both responders can get on the same side of the stretcher and pull a patient from the bed onto the stretcher using minimal force, while applying good body mechanics and reducing patient anxiety.

  • Raise the stretcher. I can recall being very intimidated by the mechanics of raising or lowering the cot. Factor in the weight of the patient, what's happening on scene, environmental factors plus the patient's status and stretcher use now becomes a very complicated thing.

Like most of you I was taught to lift the stretcher from the floor to the full up position, referred to as the load height, in one big movement. Maybe the technique is a carryover from the old days of the dead lift stretcher, but it has to go away.

Not only is it biomechanically dangerous to raise something from the floor to the full load height position, it also puts the patient at risk. One of the most common causes of a dropped or tipped stretcher is moving the patient at the full load height; it is your highest chance of the stretcher tipping.

We can reduce liability from patient handling and reduce our chance of injury simply by using our tools better. That's right responders; the stretcher should be raised in two steps. The first step is from the low position to transport height. Only then, at the back of the unit, is the stretcher raised to the final load height and moved into the ambulance.

  • Don't use the wrong tool. I can clearly recall finding a patient in an awkward and dangerous position, one of those calls where you knew your chance of getting hurt was very high. We had only brought in our standard gear, yet in the truck were a number of tools that if used correctly would have reduced the physical strain on the crew and possibly increased patient comfort.

Another example is getting the patient out of a chair. I was taught to simply grab a hold of whatever fabric or body part I could get a grip on and to just get it done. Or, we were taught have the patient put their hands around our neck so we could assist them out of a seated position at home. While it may be quick, just grabbing the patient is inefficient and can be downright biomechanically dangerous. Often many of the injuries that we see are simply because we did not take the time to use a tool such as a KED, a rescue seat or a transfer tarp as a lifting tool.

EMS injury rates can be compared to those found in the National Football League. We owe it to ourselves to stop passing down dangerous and bad habits from generation to generation.

After teaching a class on patient and equipment handling a few weeks ago, a very seasoned medic approached me and offered his hand. He thanked me for putting the pieces together and holding up the mirror to show him and his peers that there is a better and safer way to have a career in EMS. He then asked where I was three back injuries ago, so that they could have prevented. 

About the author

Bryan Fass is a leading expert on public safety injury prevention. As the president and founder of Fit Responder, Bryan’s company works nationally with departments, corporations, and state and local governments to design and run targeted injury prevention and wellness programs. He is frequently contacted for expert opinion and content contribution for all aspects of public safety fitness, ergonomics and wellness. He authored the Fit Responder book used by departments and schools, and writes for numerous web and peer-reviewed journals including the NSCA-TSAC journal, officer.com, JEMS, ems-1.com & best practices in EMS.

Bryan holds a bachelors’ degree in sports medicine with more than 17 years of clinical practice, was a paramedic for more than 8 years, and is certified as an Athletic Trainer (ATC, LAT), Strength Coach (CSCS) and the Functional Movement Screen (FMS). Fit Responder developed the nation’s first validated pre-hire Physical Abilities Test for EMS. Bryan is a sought-after speaker on a variety of topics including risk reduction, employee self-care, real world wellness and How to Eat on the street. Fit Responder also offers a mobile app and program for Fire-Rescue fitness. Contact Bryan at bryan.fass@ems1.com.
Comments
The comments below are member-generated and do not necessarily reflect the opinions of EMS1.com or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Frank Willis Frank Willis Wednesday, April 10, 2013 4:05:03 AM This is a good start for a discussion about working without injury.
Bryan Fass Bryan Fass Wednesday, April 10, 2013 6:41:29 AM Next months column will expand on this topic even more!
Tammy Ballance Tammy Ballance Wednesday, April 10, 2013 3:50:00 PM We must remember this is a hard labor job and having a strong core helps tremendously I've been in the field 17 years and healthcare total of 23 never an injury cause I won't think myself into one . Nowadays people think they can handle the job but end up being injured due to weak core and no confidence and should have never been in the hard labor field in the first place these devices are great but could in fact hinder the strength of an individual so use caution in my opinion.
Rodney Ballance Rodney Ballance Wednesday, April 10, 2013 7:12:36 PM And they somehow manage to pass there physicals! It's amazing how some even manage to lift there sorry asses out of bed every morning!
Benjamin Perez Benjamin Perez Friday, April 12, 2013 3:29:35 PM this is a subject that I wish I had more knowledge and positive techniques, while during my workout regime before I started in my lifes true calling to become a firefighter-paramedic and I sustained a bulging disc between L3-4 by deadlifting 405lbs. (i was young and impulsive.) it hurt not only physically having to go to class everyday, but emotionally when days I couldn't sit and had to lay down and was ridiculed by my other classmates, but I persevered and graduated! I had soooo much shit done to my spine even up till that point, needles, PT, adjustments, pain medications.....are the devil, so I was very very excited when I got a job as a medic for a ambulance service in a rough part of my state, and got an internship with a local fire department. like in the authors story of being a newbie and looking up to his partner, or in my case my higher ranking FF, and one night we get a call at 4am and arrive to a very large woman who seemed DOA, but we worked her and during transition onto the stryker, another improper lift, a sharp pain, and my dream of protecting ans serving my community is gone, along with L3-4 to L5-S1 which are now fused. so this is a lesson to all you young future PM/FF's, you are going into a career which requires you to use your body mechanics and I cannot stress this enough! BE SMART, WAIT FOR HELP, YOU ARE THERE TO HELP, NOT TO STEAL THE SHOW BUT TO BE A STRONG TEAM PLAYER, AND BE AID TO THE PATIENT IN THEIR TIME OF NEED, YOU DO NO ONE ANYGOOD IF YOU JUMP THE GUN AND HURT YOURSELF. If there are any newbies or students with questions, I am here to spread the word of increasing the importance of body mechanics in EMS academies. after 4 spinal surgeries, and a life stopped dead, I'm filled with alot of energy to have this ever happen to another kid, ever again!
Juana Silva Juana Silva Friday, April 12, 2013 6:24:44 PM You are an inspiration to all, Ben.
Michael McClenon Michael McClenon Saturday, April 13, 2013 6:45:35 PM Very nice write up. I still await the invent of the hover gurney and Harry Potter Levitation wand before my 2038 retirement.
Lynnda Blaze Blazedelle Lynnda Blaze Blazedelle Saturday, May 04, 2013 11:33:26 AM I've done construction most of my working life. There was a lot things I had to learn as the direct result of that. I learned how to not only lift, but also carry heavy objects. I had to learn unique ways of doing it. I learned to work with my body in order for it to be advantageous for me. Most importantly, I learned the it wrong way, now I know how to do it the right way
Bryan Fass Bryan Fass Thursday, May 09, 2013 6:07:10 AM As a whole we need to learn to use common tools many of us already have to reduce injury. We need to be fit, it is a physical job. We also need to be trained hands on every few months on ergonomics just like everything else we do.

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