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.