Emergency Medical Responder, SixthEditionChapter 3: Lifting and Moving Patients
Chapter 3
Lifting and Moving Patients
Unit Summary
After students complete this chapter and the related coursework, they will understand the mechanics of patient movement, types of patient-moving devices, patient movements for emergency and nonemergency situations, techniques for moving patients as a team, and ways to protect themselves from injury when moving patients.
National EMS Education Standard Competencies
Preparatory
Uses simple knowledge of the emergency medical services (EMS) system, safety/well-being of the EMR, and medical/legal issues at the scene of an emergency while awaiting a higher level of care.
Workforce Safety and Wellness
• Standard safety precautions (p 34)
•Personal protective equipment (Chapter 2, Workforce Safety and Wellness)
• Stress management (Chapter 2, Workforce Safety and Wellness)
• Dealing with death and dying (Chapter 2, Workforce Safety and Wellness)
• Prevention of response-related injuries (pp 34-35)
• Lifting and moving patients (pp 35-42; pp 44-56)
EMS Operations
Knowledge of operational roles and responsibilities to ensure safe patient, public, and personnel safety.
Knowledge Objectives
1. Describe the general guidelines for moving patients. (p 34)
2. Explain the purpose and indications for use of the recovery position. (pp 34-35)
3. Discuss the components of good body mechanics. (p 35)
4. Explain how emergency medical responders should decide when emergency movement of a patient is necessary. (p 35)
5. Describe the purpose of each of the following pieces of equipment:
- Wheeled ambulance stretcher (p 44)
- Portable stretcher (p 44)
- Stair chair (p 44)
- Long backboard (p 45)
- Short backboard (p 45)
- Scoop stretcher (p 46)
Skills Objectives
1. Demonstrate the components of good body mechanics. (p 35)
2. Demonstrate the steps needed to perform the following emergency patient drags:
- Clothes drag (p 35)
- Blanket drag (p 36)
- Arm-to-arm drag (p 36)
- Fire fighter drag (p 36)
- Emergency drag from a vehicle (p 37)
3. Demonstrate the steps needed to perform the following carries for nonambulatory patients:
- Two-person extremity carry (p 38)
- Two-person seat carry (p 38)
- Cradle-in-arms carry (p 39)
- Two-person chair carry (p 39)
- Pack-strap carry (p 39)
- Direct ground lift (pp 40-41)
- Transfer from a bed to a stretcher (pp 40-41)
4. Demonstrate the steps needed to perform the following walking assists for ambulatory patients:
- One-person walking assist (pp 41-42)
- Two-person walking assist (pp 41-42)
5. Demonstrate the steps in each of the following procedures for patients with suspected spinal injuries:
- Applying a cervical collar (pp 47-48)
- Moving the patient using a long backboard (p 45)
- Assisting with a short backboard device (pp 45-46; pp 49-50)
- Log rolling (pp 49-52)
- Straddle lifting (p 52)
- Straddle sliding (p 52)
- Strapping (pp 52-53)
- Immobilizing the patient’s head (pp 53-54)
Readings and Preparations
Review all instructional materials, including Emergency Medical Responder, Sixth Edition, Chapter 3, and all related presentation support materials.
• Review the local protocol for the use of restraints.
• Practice patient moves prior to teaching this lesson. Ensure you are familiar with the proper and safe operation of all equipment used for this lesson.
Support Materials
• Lecture PowerPoint presentation
• Skill Drill PowerPoint presentations
-Skill Drill 3-1, Direct Ground Lift PowerPoint presentation
-Skill Drill 3-2, Using a Scoop Stretcher PowerPoint presentation
-Skill Drill 3-3, Applying a Short Backboard Device PowerPoint presentation
-Skill Drill 3-4, Four-Person Log Roll PowerPoint presentation
-Skill Drill 3-5, Preparing a Blanket Roll PowerPoint presentation
-Skill Drill 3-6, Applying the Blanket Roll to Stabilize the Patient’s Head and Neck PowerPoint presentation
• Patient-moving devices available in the local area (wheeled stretcher, stair chair, scoop stretcher, flexible stretcher, long backboard, short backboard)
• Patient-securing devices (eg, straps, cravats, tape, belt)
• Cervical collars (assorted sizes)
• Bed sheets and blankets
• EMR life support kit
• Skill Evaluation Sheets
-Skill Drill 3-1, Direct Ground Lift
-Skill Drill 3-2, Using a Scoop Stretcher
-Skill Drill 3-3, Applying a Short Backboard Device
-Skill Drill 3-4, Four-Person Log Roll
-Skill Drill 3-5, Preparing a Blanket Roll
-Skill Drill 3-6, Applying the Blanket Roll to Stabilize the Patient’s Head and Neck
Enhancements
• Direct students to visit Navigate 2.
• Consider inviting a personal trainer to speak to the class about developing an exercise regimen compatible with the type of activity encountered while working as an EMR. Be sure to provide the guest speaker with background information on the physical job requirements well in advance to allow for proper planning.
• Web links:
- The Mayo Foundation for Medical Education and Research weight training exercises for major muscle groups:
- The Mayo Foundation for Medical Education and Research core exercises:
- The Mayo Foundation for Medical Education and Research stretching exercises:
- The Mayo Foundation for Medical Education and Research balance exercises:
- The Mayo Foundation for Medical Education and Research strength training how-to video collection:
• Contact local fire department/rescue squads and ask if they can provide technical expertise on use of patient extrication equipment and techniques.
Teaching Tips
• The emphasis in this chapter is teaching students how to properly and safely move patients. Speed is not the key factor in learning initial patient moves; rather, the safety of the patient and the EMR is paramount.
• This lesson introduces students to the idea that EMS is a team process. For some, this course may be their first time having to cooperate with others when the stakes are as high as patient care.
• After students are comfortably and safely handling a stretcher, stair chair, and other moving devices, have each student role-play as a patient being moved. This activity will allow the student to further understand the patient’s possible feelings of vulnerability and anxiety in being strapped in and carried. Be sure to supervise this activity.
• Make sure students follow the principles of proper lifting and moving when demonstrating their muscle group/exercise projects.
• In small groups or a whole-class format, ask students to recall or discuss a time when they had to lift and move a heavy or awkward object and perhaps a time when this type of task caused discomfort or injury. Lead groups in further thinking: Can they recall the mechanics (proper or improper) of lifting in that incident? What could they have done differently?
• Discuss sports or other disciplines where body position needs to be precise for optimal power and strength, and injury prevention. Some examples include diving, gymnastics, lay-up shots for basketball, serving in volleyball, throwing a javelin, long jump, and hitting a baseball.
Unit Activities
• Writing assignments: Assign a muscle to each student or group and have them research:
- How to increase strength and flexibility in this muscle
- How this muscle can help in lifting and moving patients or equipment
• Student presentations: Have students present the muscle research paper to the class and come up with at least two exercises for strengthening or stretching that muscle (they should be able to perform the exercise in class).
• Group activities: Have students pantomime a patient lift, equipment lift, or move, and have the rest of the class identify:
- Proper or improper technique
- Muscles used
- Exercises that might be used to develop more strength and flexibility for this lift
• Medical terminology review: Assign student groups to prepare a “commercial” to present one of the pieces of equipment from this chapter. Allow 15 minutes for groups to create their commercials. The guidelines should be that they have to demonstrate all ranges of motion for the equipment and all moving parts, positions, and straps. In addition, they should use the vocabulary list to incorporate as many terms as possible.
• Visual thinking:
- Present pictures to each group or PowerPoint slides to the whole class showing a variety of locations where the patient or the patient’s surroundings may make getting into a proper lift position more difficult and create challenges for safe lifting and moving (eg, furniture-cluttered rooms, narrow stairways, dark locales, construction pits, a rowboat, bathtubs). The groups should brainstorm for a few minutes to identify ways to possibly lift and move the patient while maintaining healthy and safe body mechanics. Have groups present their ideas to the whole class or as a brief list for a homework assignment that can then be displayed for sharing and discussion.
- Prepare index cards ahead of time, listing one type of lift on each card. Divide students into groups of four or five, and give the team “leader” the card. Without speaking,the leader must direct all team members to correctly perform the lift on the card. The entire set of directions must be acted out without using any verbal communication. Team members will need to watch their leader carefully for instructions. The other groups should watch for errors.
Pre-Lecture
You are the Provider
“You are the Provider” is a progressive case study that encourages critical thinking skills.
Instructor Directions
1.Direct students to read the “You are the Provider” scenario found throughout Chapter 3.
2.You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions.
3.You may also use this exercise as an individual activity and ask students to turn in their comments on a separate piece of paper.
Lecture
I. Introduction
A.As an EMR, you must:
1.Analyze the emergency situation.
2.Quickly evaluate the patient’s condition.
3.Carry out effective, lifesaving emergency medical procedures.
B.Emergency medical procedures may include lifting, moving, or positioning patients and assisting other emergency medical services (EMS) providers in moving patients and preparing them for transport.
C.In some cases, your knowledge of emergency movement techniques may help save patients’ lives.
II. General Principles
A.Every time you move a patient, keep these general guidelines in mind:
1.Do no further harm to the patient.
2.Move the patient only when necessary.
3.Move the patient as few timesas possible.
4.Move the patient’s body as a unit.
5.Use proper lifting and moving techniques to ensure your own safety.
6.Have one rescuer give commands when moving a patient (usually the rescuer at the patient’s head).
B.Also consider the following recommendations:
1.Delay moving the patient, if possible, until additional EMS personnel arrive.
2.Treat the patient before moving him or her unless the patient is in an unsafe environment.
3.Do not step over the patient (your shoes may drop sand, dirt, or mud onto the patient or you might fall onto the patient).
4.Explain to the patient what you are going to do and how.
C.There is usually no reason to hurry the moving process.
1.If you suspect the patient has sustained trauma to the head or spine, keep the patient’s head and spine immobilized so he or she does not move.
D.Keep the rules of good body mechanics in mind:
1.Know your own physical limitations and capabilities.
2.Keep yourself balanced when lifting or moving a patient.
3.Maintain a firm footing.
4.Lift and lower the patient by bending your legs, not your back.
5.Try to keep your arms close to your body for strength and balance.
6.Move the patient as few times as possible.
III. Recovery Position
A.Unconscious patients who have not suffered trauma should be placed in a sidelying or recovery position to help keep the airway open.
1.This position also allows secretions to drain from the mouth.
IV. Body Mechanics
A.Your top priority as an EMR is to ensure your own safety.
1.Improper lifting or moving techniques can result in injury to you or to the patient.
2.Good body mechanics reduce the possibility of injury.
a.Use the strength of the large muscles in your legs to lift patients instead of using your back muscles.
b.Keep your back straight as you lift.
c.Lift without twisting your body.
d.Ensure that you have firm footing before you start to lift or move a patient.
e.Assess the weight of the patient.
f.Know your physical limitations and do not attempt to lift or move a patient who is too heavy for you to handle safely.
g.Call for additional personnel if needed.
h.Communicate with the other members of the lifting team.
i.Practice lifts and moves.
V. Emergency Movement of Patients
A.Move a patient immediately in the following situations:
1.Danger of fire, explosion, or structural collapse exists.
2.Hazardous materials are present.
3.The emergencyscene cannot be protected.
4.It is otherwise impossible to gain access to other patients who need lifesaving care.
5.The patient has experienced cardiac arrest and must be moved so that you can begin CPR.
B.Emergency drags
1.If the patient is on the floor or ground during an emergency situation, you may have to drag the person away from the scene instead of trying to lift and carry the patient.
a.Pull the patient in the direction of the long axis of the body to provide as much spinal protection as possible.
2.Clothes drag
a.The simplest way to move the patient in an emergency
b.If the patient is too heavy for you to lift and carry:
i.Grasp the patient’s clothing in the neck and shoulder area.
ii.Rest the patient’s head on your arms for protection.
iii.Drag the patient out of danger.
c.Cardiac patients and the clothes drag
i.In most situations, you can easily determine whether emergency movement is necessary; cases involving cardiac arrest patients are the exception.
ii.You must judge whether BLS or ALS can be provided in a small space.
iii.If the room in which you find the patient is not large enough, move the patient as soon as you have determined that he or she has experienced cardiac arrest.
iv.Drag the patient from the tight space and quickly move furniture out of the way so you have room to work.
3.Blanket drag
a.If the patient is not dressed or is dressed in clothing that could tear easily during the clothes drag, move the patient by using a large sheet, blanket, or rug.
i.Place the blanket, rug, sheet, or similar item on the floor and roll the patient onto it.
ii.Pull the patient to safety by dragging the sheet or blanket.
b.The blanket drag can be used to move a patient who weighs more than you do.
4.Arm-to-arm drag
a.If the patient is on the floor, you can place your hands under the patient’s armpits from the back of the patient and grasp the patient’s forearms.
b.The arm-to-arm drag allows you to move the patient by carrying the weight of the upper part of the patient’s body as the lower trunk and legs drag on the floor.
c.This drag can be used to move a heavy patient and offers some protection for the patient’s head and neck.
5.Fire fighter drag
a.The fire fighter drag enables you to move a patient who is heavier than you are.
b.Tie the patient’s wrists together with anything that is handy, being careful not to impair circulation.
c.Get down on your hands and knees and straddle the patient.
d.Pass the patient’s tied hands around your neck, straighten your arms, and drag the patient across the floor by crawling on your hands and knees.
6.Emergency drag from a vehicle
a.Emergency drags are used in life-threatening situations when no equipment is immediately available.
b.The basic movement principles apply, but the techniques are slightly modified because the patient is not lying down.
c.One rescuer
i.Grasp the patient under the arms and cradle the patient’s head between your arms.
ii.Pull the patient down into a horizontal position as you ease him or her from the vehicle.
iii.Prevent excessive movement of the patient’s neck.
d.Two or more rescuers
i.One rescuer supports the patient’s head and neck while the second rescuer moves the patient by lifting under the arms.
ii.The patient can then be removed in line with the long axis of the body, with the head and neck stabilized in a neutral position.
iii.Use a long backboard if time permits.
C.Carries for nonambulatory patients
1.Patients who are unable to move because of injury or illness must be carried to safety.
2.Two-person extremity carry
a.Can be performed by two rescuers with no equipment in tight or narrow spaces
b.Uses the patient’s extremities to move the patient
i.The rescuers help the patient sit up.
ii.Rescuer One kneels behind the patient, reaches under the patient’s arms, and grasps the patient’s wrists.
iii.Rescuer Two then backs in between the patient’s legs, reaches around, and grasps the patient behind the knees.