Moving patients from point A to point B ... safely
Know when and how to use the tools in your ambulance to safely transport a patient from their home
Call it a cot, stretcher, gurney (or even a pram) ... there’s no doubt that the battery-operated, power-lifting, color-friendly, and all-but 4-wheel drive capabilities of these staple items in our industry have gained some weight over the past decade. Despite our best efforts to make these pieces of equipment perform the same tasks as the prior silver frame relatives of their past, it’s time that we (as providers) adapt to keep the same premise in mind as their manufacturers do ... lifting safely.
The fact is, the vendors are right. EMS cots aren’t designed to be lifted or carried. They’re designed to securely transport a patient from point A to point B, with attendants guiding their movement – and not at a fully-extended loading height, either. In fact, even though many are battery-powered and auto-lifting, they’re still designed to have at least one provider at both the patient’s head and feet ends to help to guide the cot higher and/or lower (not just simply press a button and let the machine do the work).
So, if lifting and moving a patient out of their second story bedroom, basement den or even a four-step porch isn’t supposed to be done on a cot, then what other options do we have to accomplish this task safely?
Safe patient handling
The combination of brain and brawn is important here ... using direct (wo)manpower and critical thinking to safely, ergonomically, lift and carry patients is still a viable option.
While the fireman’s carry isn’t an ideal option, utilizing some sort of a commercial device with grab handles and clips certainly is (or even your KED board). Even when a commercial device isn’t available, performing a two-person carry by having one provider approaching from behind the patient to lift their torso, while the other is lifting the patient’s legs, still can be done in a fairly safe manner (provided we effectively communicate in the process, too).
Keeping your joints bent, body close and using straight and smooth motions (rather than twisting, jerking motions) can improve both your use of strength and ergonomic techniques. Focusing a bit on the use of brawn, a key component in this direction is also knowing your limitations ... as well as when it’s time to think of a plan B (switching to another device).
Lifting sheets and scoop stretchers
Disposable lifting sheets have entered the market within the past couple of decades and serve a greater purpose than solely aiding in the lifting/movement of obese patients – they can be used for any patient.
Imagine your crew having to carry a hypoglycemic patient to the outside of a single-story residence. You find the patient with snoring respirations and lying on their bed. You attempt treatment, but don’t get the results that you were anticipating, so you decide that it’s time to begin transporting. Your cot won’t fit into the front door – let alone down the hallway to the patient’s room – so you need to think of something else: a lifting sheet.
One advantage of lifting sheets over scoop stretchers is their flexibility. As long as the patient can tolerate it, they can be sandwiched a little bit in order to navigate through tight twists and turns within narrow hallways and around dressers, vanities and other household obstacles.
For situations where your patient might be a bit more fragile (e.g., your suspicion of a pelvic fracture or hip dislocation) the flexible lifting sheet may not provide the sense of stability that they’re looking for. In these situations, your scoop stretcher can be your best friend.
Scoop stretchers (preferred over longboards) allow you to scoop the patient off of the floor – without having to roll them – and carry them to wherever your cot may be located. Will a traditional longboard work? Yes, but it isn’t ideal, and in instances like this, it could actually do more harm than good. Because of this, it’s important to take a few seconds to plan the lifting and moving of your patient before you actually start the act. If that means that you need to go back to your ambulance to retrieve the most appropriate piece of equipment, then so be it. That is entirely acceptable (and it’s the right/best thing to do for your patient!).
The most underutilized ... stair chair
In most other situations, I would bet that the device-of-choice that we should be utilizing is the almighty stair chair. Packed with wheels, tracks, extending handles and cup holders (on some deluxe models), this piece of equipment is one of the most underutilized items on our ambulance, especially if you interact with any patient in their home.
Once again, cots aren’t designed to be lifted (any more than two-three steps) into a patient’s home and not all patients may appreciate being sandwiched in a lifting sheet to be carried out of their residence. Because of this, the stair chair should be brought into the home much more than we often bring it.
Yes, they’re a little heavy when you have to carry them (from the ambulance to the residence), but they make a world of a difference when you need to maneuver your patient inside a cramped apartment, tight-spaced mobile home, or even down from the second story of nearly any colonial, cape cod or traditional two-story residence.
This device often should be our go-to patient movement piece of equipment. It allows us to wheel, glide and carry from multiple different directions and points – safely – and keeps our patients secured in the process.
As EMS providers, we’re good with thinking on our feet and adapting to nearly any situation that you put us into. Adding-in the element of safety, moreover, shouldn’t be a hindrance ... it should be the expectation. This concept (like it or not) shouldn’t go away when it comes to lifting and moving patients.