The EMS roundtable: Expert insights on patient handling
EMS1 columnists offer their views on new products, current trends and what the future may hold
Despite all of the advances in technology and medical knowledge in EMS, one of our baseline functions is still to move patients around. To that end, it's surprising how little attention we pay to lifting and moving patients. With many EMS providers being injured during this essential phase of an EMS call, we asked experts from our roster of columnists to share their thoughts on this fundamental aspect of the job.
Let's get this edition of the EMS roundtable under way by looking at the current state of the market for patient handling products. There seems to be more and more innovations around today to aid EMS providers in delivering both better care to patients and better protecting themselves.
Meet the Experts
Dan White, EMT-P, runs Arasan, LLC, a company dedicated to commercializing innovative EMS products. He has been certified as an emergency paramedic since 1977, and a certified EMT, paramedic, and ACLS instructor since 1981
Art Hsieh teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS.
Bryan Fass is the author of "Fit Responder," a comprehensive wellness plan for the first responder and the Fit Responder Blog. He was a paramedic for over eight years, and has authored four books regarding fitness, wellness and human performance.
The patient handling market today is dynamically innovative. In recent years the two big patient handling companies have brought us powered self-lifting stretchers and stair chairs on rotating tracks. Both of these developments have increased costs and weight, but they probably do reduce injuries.
Back injuries are a common problem among EMS providers; they are a leading cause of lost productivity. Calculate the costs of your staff being injured. I'll bet many of these modern innovations are really quite inexpensive investments in workplace safety.
We've seen some advances in the market for patient carrying and transportation devices, namely the powered gurneys that are in widespread use.
They do come at a cost — they are heavier and can be more clumsy to use for some. Broadly speaking, there hasn't been much change in carrying devices since the 1970s.
Sadly, most providers are still lifting backboards and other rigid devices off the ground by using their backs and shoulders, rather than legs and hips. There does seem to be some innovative strapping devices now entering the market, some of which were on display at the EMS World Expo trade show in New Orleans recently, but it could be a while before they are in widespread use.
As a consultant and trainer, I am privileged to see it all. What I consistently witness is degradation in the quality and consistency of safe patient handling training.
Other than a class on how to use a product, responders simply do not get good training on how to use their bodies to properly use the product.
On the positive side, there are a lot more options on the market that will reduce the load, strain and repetitive trauma t soft tissue that cause the majority of patient handling injuries.
What do agencies need to be aware of when selecting new equipment? What are the main considerations they need to factor?
The key things EMS agencies need to remember when selecting new patient handling products are maybe not the most obvious ones. First, there is no single magic bullet. A powered stretcher will reduce only a limited number of risks. Specifically they are the risks of lifting and perhaps, more importantly, lowering patients at the back of the ambulance. A powered stair chair will only reduce injuries carrying patients down or up stairs.
Second, by defining the real risks more specifically, you can select individual solutions. Take a hard look at each individual EMS lifting task: there are many, and consequently there are many specific solutions.
The good news is that there have been many new developments, each targeting a specific injury risk. The bad news is that our patients are getting heavier. Once obesity was a fairly rare condition. Those with young children see how bad things are getting.
When I was a kid, there was one obese child in the class. When my youngest was in Middle School and I went to her events, I was shocked to see that maybe one-third of her class was obese.
The EMS industry has matured, and so has the workforce. The average age of an EMS provider gets older every year. Overall I see this as an incredibly positive development. At the end of the day, experience matters.
But we are part of the culture and subject to the same patterns and trends as the general population. One is that we are all getting older and heavier at the same time our patients are getting heavier. This is a near perfect storm already upon us.
The obesity challenge is one that has been recently addressed with specialized bariatric equipment. Today EMS providers have a wealth of solutions available. We have much larger bariatric stretchers like the Ferno LBS Bariatric Board and Stryker MX-Pro Bariatric, powered loading systems like the Stryker Power-LOAD, and winch and ramp systems like the Transafe and Rx Fabrications Bariatric Ramps.
However, these new loads place a huge strain on standard equipment. Since many areas don't have bariatric ambulances or equipment always available, this increased wear will deteriorate standard equipment if you don't keep up an aggressive regular maintenance program.
Once the only tools we had were patient stretchers, simple stair chairs, scoops and portable stretchers. A lot of the real work was done with our hands. While I am an advocate for modern patient handling devices, there has been an erosion of hands-on lifting skills. Many of the basic techniques we used in the early days of EMS have been lost.
The answer to this problem is to do better basic patient handling education. Ferno has a wealth of this kind of information, for years contained in a series of instruction videotapes.
Unfortunately, few ever actually watched the product videotapes. So they have brought all this plus a lot more information together in one place online at www.FernoInjuryFree.com.
There is also an excellent online pdf from Delmar Learning. The best resources are EMTs and paramedics from different eras and geographies. These are the people that can introduce you to techniques from different time periods in EMS and other EMS systems.
Sometimes patient handling techniques are very regional. In one area they always use a scoop, in others they always use a stair chair, some use the Reeves Stretcher. You can learn something from them all.
Since money for capital expenses such as patient handling devices is tight, many services don't look much beyond the cost in making a purchase decision.
Calculate the cost of an injury due to a poorly designed device that puts undue strain on wrists, shoulders, backs and knees — it may be more expensive to treat these injuries than to buy lifting devices that are better at protecting the EMS provider.
Obviously the product needs to reduce injury while still being cost effective. However, with a back injury averaging $18K, almost any product is cost effective. Agencies also need to consider responder compliance with the product.
I am constantly working with departments that have some of the best tools on the market to reduce injury that are never used. Case in point was a department that has a Hover Jack and the crews do not call for it on bariatric runs because they do not understand the product.
What are the most common mistakes medics make and the pitfalls they need to be aware of when it comes to patient handling?
One common mistake is to try to use one device for too many different applications. The classic case in point is the backboard. What was once used only for suspected spinal injuries has become a low-cost portable stretcher.
But the traditional backboard actually is a pretty lousy portable stretcher. They are not stretchers, they are splints. The Hartwell Medical Combicarier II is one of the few immobilization products that actually can do more than one thing very well. It is both a handy rugged scoop stretcher and a long spine board in one.
I think many EMS providers assume that they are constrained by the limitations of the device. Make the equipment work for you, not the other way around.
Are there better ways to use the device — any ergonomic changes or assuming a different position in order to increase leverage? Too often we end up muscling through — and injuring ourselves in the process..
As technology changes and engineering solutions emerge for the common pre-hospital ergonomics we encounter, we as a profession must come to terms that the "old way" of lifting, moving, transferring and carrying patients also has changed.
For example, look at an object we all have on our units — the transfer tarp. There is no point in only using it for bariatric runs; we can use it on all calls.
It can become the perfect device to move patients with especially if it's also a friction reducing tarp.
Often the best product is one that has multiple uses like the tarp or even the new EZ Lift Rescue system, which can be a traditional spine board, act as a Stokes-type device, sled etc. Multiple uses in the same product makes both financial sense and ergonomic sense.
What are the current main trends in the patient handling market — and what does the future hold for both EMS providers and manufacturers?
The latest trend is the introduction of new patient-handling products that are becoming much more specialized. I see a day soon when medics will use a wide range of devices to meet each individual lifting challenge.
For example, one big challenge is lifting backboards. The problem is they need to be lifted from ground level, exposing the rescuer to potential lower back injury. The obvious solution is raising the lifting point.
One product solution is the Thomas EMS Lifting Handles. They attach with simple loop straps to your existing backboard and raise the lifting point from ground level to 12 inches higher. Another more sophisticated solution is the new EZ Lift Rescue Backboard.
The EZ Lift features retractable end handles. The solid removable top and bottom lifting bars extend on hidden straps that raise the lifting point 15 inches.
When you are done moving the patient to your cot, they then can be used to transfer from cot to bed without using the extensions. It also has some really advanced construction and is also one of the strongest backboards I have ever seen.
When a backboard is not required, we have some new ways to basically put handholds on your patient. I saw some cool new ideas at EMS World Expo. This is probably the one area where I have seen the most progress lately. Clever folks, often experienced EMTs and paramedics, are developing new and better tools for safer lifting.
It is a versatile lifting tool with more than one application. Think of it as a strong ladder sling with many handholds, made from rugged webbing. It can be folded or unfolded for use full length for or shortened to partial length for seated patients.
Another tool for moving seated patients is the Rescue Buddy. The Buddy is a rescue stretcher that, when stored, is about the size of a phone book.
It allows two rescuers to carry a seated patient in confined spaces or on uneven terrain. The shoulder straps allow you to transfer the weight from your back to your legs. The Rescue Buddy Pro Model can be unfolded for use as a full-length fabric stretcher with transfer handles.
As I mentioned earlier, I think we are starting to see efforts to improve the ergonomics of traditional lifting devices such as backboards.
Straps that allow you to lift from a standing position, rather than squatting, should be better in reducing back injuries. I think that powered gurneys and lift assist devices into the back of ambulances will improve. Still, I think that we are a long ways off in tackling the wider issues and the hazards EMS providers face.
On the other hand, I do think the industry is finally beginning to realize that EMS as a young person's game is a terrible way to look at it. Our counterparts in Europe and Australia have figured this out some time ago.
Changes in lifting practices and philosophy have reduced the rate of injury in their ranks. U.S. providers would do well to research what is being done overseas.
The current trend is powered devices, letting the tool do the job. But as we all know, they weigh more so we will be seeing the next generation of cots being able to get themselves into the ambulance without the responder having to lift anything.
We already have a powered stair chair and tracked stair chairs that do an awesome job; we will see more "tracked" devices that also take the load off the responder. With the majority of injuries still occurring in getting the patient off the floor/bed/toilet and onto the chair/cot, we will also be seeing more tools to get that done with less strain on the responder.
Final thoughts time: What's your takehome message for the roundtable?
As we see and sort through all these new specialized patient handling products, I see a bright future. More of our unique field challenges have recently been addressed. Once we figure out and train with a more varied range of patient handling solutions, we can better address a myriad of problem situations.
Rather than trying to use one device for everything, in the future I see us using many different devices, each targeted to address an individual challenge. The benefits of expanding our patient handling toolbox should be fewer injuries to both patients and staff.
There have been some changes, and we still have a long way to go. Safety is everyone's business, and we need to work together to develop equipment, lifestyles and physical ability training to keep ourselves safe.
Is the tool using you or are you using the tool? The engineered solution or the device is only as good as the training you invest in using the product.
Old ergonomic habits die hard, so training and reinforcing the use and SOPs of these new tools is paramount. On top of that, one thing we can't overlook if the fact EMS/Fire-Rescue is a physical job and responders must have a basic level of job specific physical ability.
Without the strength to do the job safely, no tool will ever offer the ROI and injury reduction that we are all looking for. As I am fond of saying, you're a power lifter! You pick things up and you put them down. Without a strong base to work from, the tool will never be as effective as we all desire.