Medic 8, respond to a 34-year-old female with a chief complaint of dyspnea, time out 0435.
Medic 8, be advised the patient is thought to weigh 415 pounds, we have toned out additional manpower but no one has checked en-route yet.
You arrive to find a well over 415 lb. patient in mild respiratory distress, the patient is laying on the middle of a king size mattress which is on the floor in the back bedroom of a ranch style home.
We have all dealt with calls of this nature, a patient that is not emergent but they need transport to the ER. The patient due to whatever limitation is unable to ambulate out the door to the cot and they will not fit on a stair chair. So what options are left?
Soft tissue trauma is the leading cause of career ending injury and the primary driver for workers compensation costs staggering rise. Data supports that less than 1 percent of responders will end their career without an injury. The only profession with an injury rate that high is professional football.
There are many reasons for these high injury rates, but to keep this article in check let us focus on patient handling injuries.
With the new millennium came a new entry into the patient handling market, powered stretchers. The powered stretchers were all designed to do one thing: reduce lower back injury from lifting and lowering the stretcher.
There is one issue with these new powered cots, however, in that they can be heavy. On average they are 25 to 30 lbs heavier than the traditional manual lift cots.
So SOPs had to change. We could no longer take the cot into the house; we had to bring the patient to the cot. Enter into the game the tracked stair chair, in this author’s opinion one of the best patient handling tools to hit the market.
Now we had a tool that really took the load and strain off the responder — those tracks are awesome!
But (and there is always a but) the injury rates remained around the same! Sure, the area of injury changed from lower back to more upper extremity and torso soft tissue injuries, but the rate, severity and cost of the injury really did not change all that much.
All indications are that major players in the market are planning second generation devices as so many injuries are caused when getting the patient on and off the cot.
But, in the meantime, what if your patient came with lifting handles? As I walked the floor at EMS World Expo in New Orleans recently, there was the usual assortment of spine boards, cots, baskets etc.
However there were some surprises on the floor this year:
1. The EZ Lift Rescue System
We all know that one of the most strenuous lifts we must do is lift a spine board. It is the deepest and most dangerous lift as it places excessive load and torque on the spine and knees.
The folks at EZ Lift have designed, tested and perfected a spine board “system” that eliminates almost all of the strain on the responder. I wish I had thought about designing a board with handles that extend out of the board, make a four-person lift easy and safe and turn the traditional board into a basket, litter, board and total rescue/transportation tool.
2. The PowerTraxx power stair chair from Ferno
I know from my ergonomics consulting that there are a lot of times responders must pull a patient up the stairs. From a basement or on a return trip from the hospital, it’s often the case you need to get the patient up a few flights of stairs. The PowerTraxx will do that with no load or strain on the responder.
3. The HoverJack:
I was amazed to realize that this great tool has been around for a while now. It’s an air system that will lift and move an obese patient to the cot using air and reduced friction. If every EMS department/system had just one of these on a bariatric unit or on a QRV/supervisor’s, truck then responders can call for the HoverJack to be used on so many calls. Simple and very effective.
The list above is just a few of the engineered solutions to the issue of patient handling that caught my eye at the show. However, one thing that bothered me — though maybe I just didn’t see them – was a lack of the least sexy but most versatile tool we should be using on every single call.
I did not see a big variety of friction reducing transport/transfer tarps on the show floor. It constantly amazes me that EMS has not made the mandatory; for example, a SOP to never move a patient unless they are on a friction reducing transfer device.
Think of it this way — by placing your patient who weighs 300 lbs on a friction reducing tarp, your patient now has handles and we cut their weight in half.
Now we have a device that allows us to lift, pull, transfer and carry the patient with a distributed load across the tarp, allowing four to six responders to safely and efficiently get the patient to the cot.
Plus it also doubles as a rescue seat so two responders can get a patient out of the chair. In addition, we longer have to lift the patient off the floor -- the tarp does that for us.
During one of my classes at EMS World Expo, I the audience a simple question: Should we ever have to touch the patient to move them? The answer is no. If the patient comes with handles then we are able to use good body mechanics to move the patient with little to no strain on the responders.
So how do you extricate and transport your patient? Your SOP should give clear guidelines on what tools to use and when. But no matter what tool or device you use, you are still the ultimate tool. As a responder you must get your body set to complete the task.
However, products can help reduce injury and make our jobs easier — we just have to use them and use them correctly.
