Reality training: Every patient move is a high-risk move
Have you recently reviewed lifting techniques, stretcher operations and teamwork to avoid a patient drop?
Incident Date: Unknown
Department: FDNY EMS
What happened: A patient was dropped as two EMS providers attempted to move the loaded stretcher from the street into their ambulance.
A video, uploaded to the Loudlabs News NYC YouTube channel on Feb. 19, 2021, shows the stretcher tipping as the EMS providers attempted to raise the stretcher undercarriage. The patient braces for the fall with an outstretched arm as the stretcher catches on the compartment floor or bumper.
The videographer, reported to be a former EMT, sets down the camera and assists the EMS crew in untangling the patient from the stretcher. The patient, who doesn’t appear to be acutely ill or injured, is able to stand and step into the ambulance.
The two-minute video is embedded below.
A moment for empathy: As I watch any stretcher drop video, my first though is, “There but for the grace of God go I,” because I know the move is more difficult than it looks and there are several chances a lift can go wrong.
Lifting and moving a patient-loaded stretcher might feel routine for the crew, but it is a novel experience for the patient – one that is complicated by the variables of patient weight, movement, terrain and more. Lifting the stretcher into the ambulance should be treated as a high-risk moment for the patient and the crew. I can’t help but feel sympathy for the patient and empathy for the crew.
Discussion points: Lifting a loaded stretcher into the ambulance
I am hopeful that this video could serve as a training opportunity and learning experience for both students and experienced providers. As you watch the video, ask yourself or discuss with your partner, company, class or squad the following questions:
- How can weather and road conditions complicate the stretcher lift? It looks like the (patient’s) right side of the stretcher might have been on the pavement and the left side wheels in slushy snow.
- If the loading area terrain behind the ambulance is uneven, what modifications can be made by altering the terrain or by moving the ambulance? If conditions allow, move the ambulance forward or to a different location.
- Are there circumstances supported by policy, protocol or procedure that make it acceptable, if not preferable, to allow the patient to walk to the ambulance rather than using the stretcher? Letting patients walk to the ambulance can be controversial, with a range of opinions from “NEVER” to “Any patient that can walk to the ambulance should walk to the ambulance.” How the patient got from the scene to the patient care compartment should be documented in the patient care report, especially if anything unusual happened or if circumstances forced a deviation from normal procedures.
- How can PPE (e.g., turnout gear, helmets, face masks, goggles and gloves) compromise motor skills and communication during a patient lift and move? I feel for these providers having to wear turnouts, helmets and goggles for an EMS call. Perhaps this is part of a severe weather kit or COVID-19 precautions. I can easily imagine a glove slipping on the cot handles or a face mask muffling communication between the providers.
- After the EMS provider at the patient’s head hooks the stretcher to the safety hook on the floor of the patient care compartment, how should they assist? It appears that the EMS provider attempted to lift the wheel assembly before it had been unlocked or tried to support the lateral side of the stretcher as their partner at the foot end lifted the cot off the ground. Maybe this, accompanied with some patient movement, inadvertently tipped the cot. I’d prefer my partner not touch the stretcher until the wheels are clearly lifted off the ground and the cot weight is supported by the floor of the patient care compartment.
- After the drop, what do you do to make the scene safer for the patient? Remember, the scene size-up is dynamic and ongoing. Once the patient is entangled in the sideways cot or on the ground, the role of the EMS providers is to extricate the patient, perform a new lift or move and reduce risk of additional harm or injury to the patient. Reassess the patient, including a head-to-toe physical exam, if indicated, after moving the patient into the ambulance or back onto the cot.
- Why should you apologize to the patient? Some people worry or have been told an apology is an admission of guilt. The video doesn’t lie. The stretcher tipped over. The patient was on the ground. You are not compromising your future defense by saying, “I am sorry.” Apologizing to the patient, reassuring the patient, treating the patient with kindness and compassion, documenting what happened and reporting the incident are likely better protection against future investigation or litigation than pretending it didn’t happen or withholding an apology.
- How do you report a stretcher drop in your organization? It is important that your immediate supervisor or your supervisor’s supervisor learns about this incident from you and not the patient, the patient’s lawyer, the media or the insurance company, as soon as practically possible.
- How do you interact with, engage with or ignore bystanders that are filming an EMS response? At this point, it is safest to assume a bystander with a smartphone, police officer body-worn camera, security camera, dash camera or doorbell camera is filming every EMS response. This incident is particularly interesting in that the videographer set down his camera to help extricate the patient. Assume your actions are always being filmed, act in the best interests of the patient, follow your department’s policies, procedures and protocols, and use the tools and training available to your scope of practice to the best of your abilities.
I’d like to know how you’ll use this video as a training tool. Share your ideas in the comments about training for patient moves, improving processes to lower the risk of injury and how to best communicate with patients before and during moves (e.g., from the street to the ambulance).