In the previous scenario, you responded to a call for a 65-year-old obese woman who has been sitting in the bathtub for three hours and is unable to stand up. She denies any pain or other complaints, and says she simply wants help out of the tub.
Assessment
Calls to 911 for lift-assists are common but are also scenarios potentially filled with risk. Depending on state and local requirements, these patients may be entitled to a full medical assessment.
Regardless of those requirements, they should be accurately assessed prior to completing patient movements or treating and releasing them. For lift-assists particularly, any possible underlying causes should be evaluated. An important question to ask is: “Is this situation different than the baseline?”
For a patient who fell from his wheelchair while transferring to bed, ask whether he can normally transfer on his own. If the answer is yes, then the follow up question should be: “Why is today different?”
If the patient normally requires assistance to transfer and chose not to wait for his home health nurse, then it is possible that nothing is different from his baseline. The subsequent assessment and treatment of that patient depends on determining if today is consistent with his normal level of activity.
Also consider that potential underlying medical conditions for fall patients are numerous. At a minimum, EMS providers should be screening for cardiac, neurologic and diabetic symptoms.
Assessment tools like ECG (if available), stroke scale and blood glucose should all be performed. Vague complaints “like general weakness” or “just not feeling well” may be a presentation of an underlying infection or possibly sepsis.
Completing a patient history, physical exam and vital signs on fall patients can assist in ruling out some of these diseases. Particular emphasis should be paid to questions about infection, especially respiratory and urinary symptoms.
Treatment
Once a patient has been screened for medical and traumatic complaints, the focus of the call turns to moving her from her present location.
Before attempting to move a patient, it is important to ensure that there are enough resources on scene. For overweight and obese patients, it may be necessary to request additional units or agencies.
In most cases, it is far better for a patient to remain in the current situation for several extra minutes than to risk a career-ending injury by attempting a lift with an inadequate number of personnel.
Once you have adequate resources available, discuss a plan of attack. Think carefully about what devices (if any) will be used, and where each provider will be positioned.
Consider where the patient will wind up after the lift. Will it be on the gurney, a wheelchair or simply standing? Think about how each responder will need to move to get the patient to the final location. What is the abort plan if something goes wrong?
When preparing to actually lift the patient, one responder should communicate a count to the others. Make sure that directions are simple and clearly stated. Ask if anyone has a concern about the plan.
Be sure to explain the plan to the patient and ask if she has any questions. Caution the patient against reaching out or making any sudden movements; the patient shifting her weight during the lift could cause injury to one of the responders.
Above all, maintain sympathy and compassion for the patient; this is not an ideal situation for her either. There will be time after moving her to coach about prevention of future falls, but right before lifting her out of her bathtub is not an appropriate time to do so.
After moving the patient to the final location, reassess or perform any additional assessments which may be indicated. If appropriate, and consistent with your medical direction, perform any necessary paperwork or ready your patient for transport.
Outcome
While you continue to assess the patient, your partner calls dispatch and requests that an engine company respond to the residence for manpower.
The patient’s assessment is normal and she does not appear to have any underlying medical conditions. She denies any dizziness or weakness before her fall and states that she “just got tired.”
She acknowledges that she needs to purchase a shower chair but has been putting it off. Her daughter states that she will buy the chair today.
Once the engine company arrives, you discuss your plan with everyone present. The patient states that she thinks she will be able to support her own weight if she is assisted to a standing position. You ask her daughter to position her walker (which she normally uses to ambulate) in the hallway for her to use once she is standing.
Using a bed sheet under her arms, you determine that four responders should be able to lift the patient to a standing position. The patient confirms that she understands the plan and is comfortable with it. After she is standing, you assist the patient in stepping out of the tub and into a seated position on her walker.
After assisting her in getting a bathrobe on, you complete your assessment and find no complaints or apparent medical conditions. You and your partner thank the engine crew for responding and clear them from the scene.
You complete the refusal paperwork and contact online medical control for a consultation. After being thanked by the patient and her daughter you clear the scene and go available with dispatch.
