Detailed Lesson Plan

Chapter 6

Lifting and Moving Patients

180–200 minutes

Chapter 6 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes / Content Outline / Master Teaching Notes
5 / I.Introduction
A.During this lesson, students will learn about how to lift and move patients using good body mechanics and equipment designed to assist in patient movement.
B.Case Study
  1. Present The Dispatch and Upon Arrival information from the chapter.
  2. Discuss with students how they would proceed.
/ Case Study Discussion
What are the concerns for your safety and the patient’s as you plan how you will get him from his home, to the ambulance, and to the dialysis center?
5 / II.Body Mechanics for Safe Lifting—Four Basic Principles
  1. Body mechanics describe the safest and most efficient methods of using the body to gain mechanical advantage.
  2. There are four basic principles of body mechanics.
  1. Keep the weight of the object close to the body.
  2. Use the leg, hip, and gluteal muscles along with contracted abdominal muscles to move heavy objects.
  3. Move the shoulders, hips, and feet as a stacked unit.
  4. Reduce the distance through which the object must be moved.
  1. Correct alignment of the spine is an important key to avoiding injury.
  1. Maintain a normal inward curve in the lower back.
  2. Keep wrists and knees in normal alignment.
/ Teaching Tip
Use a ball or book to demonstrate the four principles of good body mechanics.
Discussion Question
What are the four principles of good body mechanics?
7 / III.Body Mechanics for Safe Lifting—Posture and Fitness
  1. An important aspect of body mechanics is proper posture.
  2. Poor posture can fatigue back and abdominal muscles.
  1. Lordosis, or swayback, causes excessive stress on the lumbar region.
  2. Kyphosis, or slouch, results in fatigue of the lower back.
  3. Proper standing posture involves ears, shoulders, and hips in vertical alignment with knees slightly bent and pelvis tucked forward.
  4. Proper sitting posture involves evenly-distributed weight, vertical alignment of ears, shoulders, and hips, and feet flat on the floor.
  5. A well-balanced fitness program is necessary for proper body mechanics.
/ Critical Thinking Discussion
How can you apply the principles of good body mechanics in everyday life?
Teaching Tip
Demonstrate proper posture.
8 / IV.Body Mechanics for Safe Lifting—Communication and Teamwork
A.Teamwork and effective communication are essential in an emergency.
B.All team members should be trained in proper techniques.
C.Problems can occur when partners are mismatched.
1.The weaker partner canbe overloaded.
2.The stronger partner can be injured if the weaker partner fails to lift.
D.Partners need to communicate throughout the lifting process.
1.Use commands that are easy to understand.
2.Verbally coordinate each lift.
E.Good teamwork is required for safe lifting.
1.Size up the scene accurately.
2.Consider the weight of the patient.
3.Recognize the need for additional help.
4.Be aware of physical abilities of each team member.
5.Select appropriate equipment.
F.Communication with patient is important. / Discussion Question
What are some of the principles of teamwork and communication in moving and lifting patients?
Class Activity
Have students stand up and use a book to demonstrate proper body mechanics in lifting.
Critical Thinking Discussion
What would you do if you injured your back and were unable to work in EMS or any other occupation that required lifting?
5 / V.General Guidelines for Lifting and Moving—The Power Lift
A.The power lift is a technique that offers defense against injury and keeps the patient safe.
1.Feet about shoulder-width apart
2.Feet turned slightly outward
3.Knees bent
4.Back and abdomen muscles tightened
5.Object straddled
6.Hands about ten inches apart
7.Power grip used
B.Steps of the power lift are reversed to lower an object. / Weblinks
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access web resources onlifting and moving patients.
4 / VI.General Guidelines for Lifting and Moving—The Squat Lift
A.The squat lift is a technique that is useful with a weak leg or ankle.
  1. Weaker leg slightly forward
  2. Squat position
  3. Stronger leg pushes
B.All lifts should be accomplished with leg muscles.
C.Weight should be kept close to the body. / Teaching Tip
Use one or more assistant instructors to demonstrate the power lift and squat lift.
Discussion Question
How do the power lift and squat lift reduce the possibility of injury?
Knowledge Application
Ask students to give examples of how they can use the power lift or squat lift to replace techniques they use to lift things in everyday life?
4 / VII.General Guidelines for Lifting and Moving—One-Handed Equipment Carrying Technique
A.A technique for carrying objects with one hand
B.Back remains in a locked position.
C.Avoid leaning to the opposite side.
D.Steps
1.Stagger your feet.
2.Point one knee up and one toward the ground.
3.Bend at the hips.
4.Drive upward through the arch and heel of the front foot.
5.Drive up through the ball of the back foot. / Teaching Tip
Demonstrate the one-handed equipment carrying technique.
4 / VIII.General Guidelines for Lifting and Moving—Reaching
A.Avoid reaching when possible.
  1. Reposition an object or get closer.
  2. Avoid prolonged strenuous effort (more than one minute).
B.When reaching cannot be avoided, reach no more than 15–20 inches.
  1. Keep the back in locked position.
  2. Avoid twisting.
  3. Use free arm to support upper body when possible.
  4. Avoid hyperextending when reaching overhead.
  5. Lean from the hips and keep back straight to perform a log roll.
/ Discussion Question
How can you reduce muscle fatigue when lifting and moving patients and equipment?
Class Activity
Divide the class into small groups. Have each group demonstrate and explain to the rest of the class one of the techniques discussed in this section: power lift, squat lift, one-handed equipment carrying technique, and safe reaching.
4 / IX. General Guidelines for Lifting and Moving—Pushing and Pulling
A.Push instead of pull an object whenever possible.
B.What to do when an object must be pulled
1.Keep the load between shoulders and hips.
2.Keep the load close to the body.
3.Keep back straight.
4.Keep knees slightly bent.
C.What to do when an object is pushed
1.Push from the areas between the waist and shoulders.
2.Use a kneeling position to avoid bending.
3.Keep elbows bent, with arms close to the sides.
D.Avoid pushing or pulling overhead objects.
20 /
  1. Lifting and Moving Patients—Emergency Moves
A.An emergency move should be performed when there is immediate danger to the patient or rescuer.
B.Take precautions not to become an additional victim of the emergency.
C.Situations that may require emergency moves
  1. Fire or danger of fire
  2. Exposure to explosives or other hazardous materials
  3. Inability to protect the patient from other hazards at the scene
  4. Inability to gain access to other patients who need lifesaving care
  5. Inability to provide lifesaving care because of location or position.
D.Make every effort to provide protection to the spine.
E.Always pull the patient in the direction of the long axis of the body.
F.Three types of emergency moves
  1. Armpit-forearm drag
  2. Shirt drag
  3. Blanket drag
/ Teaching Tip
Use assistant instructors to demonstrate emergency moves on a mannequin (armpit-forearm drag, shirt drag, and blanket drag).
Discussion Question
What are examples of situations in which you should use an emergency move?
20 /
  1. Lifting and Moving Patients—Urgent Moves
A.An urgent move is performed when the patient is suffering an immediate threat to life.
B.Rapid extrication move indications
1.Altered mental status
2.Inadequate respiratory rate or tidal volume
3.Indications of shock
4.Injuries to the head, neck, chest, abdomen, or pelvis
5.Fracture of both femurs
6.Major bleeding
C.Rapid extrication procedure from a motor vehicle
1.The patient’s head is brought into a neutral in-line position.
2.A cervical-spine immobilization collar is applied.
3.The patient’s thorax is supported as the legs are freed.
4.The patient is rotated in short, coordinated moves.
5.The end of a long backboard is placed next to the patient’s buttocks.
6.The patient is slid onto the board while in-line stabilization of the head and neck is maintained.
D.The most critical factor of rapid extrication is speed, without compromising the patient’s spine.
E.The rescuer’s weight must be supported in the vehicle. / Discussion Question
When would you use an urgent move?
20 /
  1. Lifting and Moving Patients—Nonurgent Moves
A.A nonurgent move is one in which no immediate threat to life exists.
B.Walk a patient while supporting him.
C.Reasons not to “walk” a patient
1.Lightheaded
2.Sweaty upon standing
3.Chest pain
4.Respiratory problems
5.Injured lower extremity
6.Suspected spine injury
D.Points to remember when moving, lifting, or carrying a patient
1.Keep the patient’s head and neck in a neutral position.
2.Take all necessary spine precautions.
3.Make sure all rescuers understand what is to be done.
4.Make one rescuer responsible for giving commands.
E.Methods for moving patients
1.Direct ground lift
2.Extremity lift
3.Direct carry method
4.Draw sheet method / Teaching Tip
Use assistant instructors to demonstrate nonurgent moves (direct ground lift, extremity lift, direct carry method, and draw sheet method).
Discussion Question
When would you use nonurgent moves?
Class Activity
Divide students into small groups and assign each group one of the lifting or moving techniques discussed in this section. Each group will demonstrate and explain the assigned technique to the rest of the class.
Knowledge Application
Describe several EMS scenarios. Have students determine whether the situation requires an emergency, urgent, or nonurgent move.
30 /
  1. Packaging for Transportation—Equipment
A.Packaging means readying a patient for transport.
B.General considerations
1.Make sure the carrying device is locked in open position.
2.Use an appropriate lifting, moving, or carrying technique.
3.Place a sheet or blanket on the carrying device.
4.Cover the patient with sheets or blankets.
5.Secure the patient with straps.
6.Tuck straps and ties in position.
7.Be sure patient and carrying device are secured properly in the ambulance.
C.Choose the appropriate equipment.
1.Wheeled stretcher
  1. Accommodates weights up to 400 pounds
  2. Serves to secure and carry equipment with patient
  3. Rolls on smooth surfaces
  4. Can move on rough ground with four rescuers
  5. Types include lift-in cot and roll-in cot.
2.Bariatric stretchers and devices
  1. Accommodates patients up to 1,600 pounds
  2. Have larger wheels, wider cots, and more heavily constructed frames
3.Portable stretcher
  1. Generally lightweight and can be folded
  2. Convenient for removing patients from confined spaces
  3. Can be easily loaded into and off-loaded from an ambulance
4.Stair chair
  1. Useful for narrow corridors, small elevators, and stairways
  2. Not to be used for patients with altered mental status, suspected spine injury, or injuries to lower extremities
  3. Basic procedure
  4. One rescuer stands behind the chair, one at the foot, and a third spotting behind the first.
  5. Rescuer at the head tilts back the chair as the rescuer at the foot grasps the chair by its legs.
  6. Both rescuers lift and carry simultaneously.
  7. Spotter counts out steps and identifies any obstacles.
  8. Tracked stair chair
  9. Track comes into contact with steps.
  10. Allows the chair to glide with minimal effort by the EMT
5.Backboard
  1. Standard operating equipment
  2. Acts as a spine immobilizer
  3. Long and short versions
  1. Farrington is rectangular with rounded corners.
  2. Ohio has mitered corners and tapering sides.
  3. Ferno Kendrick Extraction Device (KED) is a vest-type immobilizer.
  4. Full body vacuum mattress conforms to the shape necessary for the patient.
6.Scoop stretcher
  1. Designed for patients up to 300 pounds
  2. Assembled and disassembled around the patient
  3. Useful in confined areas
  4. Not recommended for patients with spine injuries
7.Basket stretcher
  1. One style has a welded metal frame fitted with a contoured chicken-wire web.
  2. One style has a tubular aluminum frame riveted to a polyethylene shell.
  3. EMT is able to move a patient who is already immobilized on a backboard over any kind of terrain.
8.Flexible stretcher
  1. Made of canvas or synthetic materials
  2. Has six large handles
  3. Useful for narrow hallways
/ Teaching Tips
  • Demonstrate loading and unloading a wheeled stretcher into the ambulance.
  • Demonstrate the use of a stair chair, long backboard, and other devices used in your EMS system.
Knowledge Application
Give several descriptions of patient conditions and locations. Ask students to select the device most suited for packaging the patient.
Critical Thinking Discussion
How would you explain to a patient what you are going to do, and what you would like him to do, when carrying him up or down stairs?
Class Activity
Supervise small groups of students as they practice using the devices you have demonstrated in class.
Discussion Questions
  • When would you use a portable, flexible, or scoop stretcher instead of a wheeled stretcher?
  • Other than carrying patients up and down stairs, when might a stair chair be useful?

15 /
  1. Packaging for Transportation—Patient Positioning
A.An unresponsive patient with no suspected head, neck, or spine injury should be placed in a left lateral recumbent position to face the rescuer once in the ambulance.
B.A patient with chest pain or discomfort or with breathing difficulties should be placed in a position of comfort.
C. A patient with suspected spinal injury should be immobilized on a long backboard.
D.A patient in shock should be placed in a supine position.
E.An alert patient who is nauseated or vomiting should be transported in a sitting or recovery position.
F.A pregnant patient in her third trimester should be positioned on her left side. / Discussion Questions
  • How would you position a patient who is nauseated?
  • How would you position a patient in her third trimester of pregnancy?
Teaching Tip
Allowing students to be packaged helps to develop empathy for the patients they will be caring for.
Critical Thinking Discussion
Why is a patient carried head first up stairs and feet first down stairs?
15 /
  1. Packaging for Transportation—Packaging Patients for Air Transport
A.There are special considerations in packaging patients for air transport.
1.Be sure patient has been decontaminated from hazardous materials if necessary.
2.Have the patient’s airway managed prior to arrival of aircraft.
3.Leave the chest accessible if the patient is intubated.
4.Make sure the backboard can be accommodated in the helicopter.
5.Make sure the patient is well secured to the backboard.
6.Secure all equipment on the patient and at the scene.
7.Communicate to the patient what you are doing.
8.Cover the patient to protect him from the noise and rotor wash.
9.Consider having an engine company wet the landing zone.
10.Have rescuers remove loose articles.
11.Approach the aircraft properly when instructed by the pilot or crew.
12.Lay an IV bag on the patient’s chest instead of holding it up.
B.Follow local protocols for use of air ambulance service. / Teaching Tip
Hand out copies of any local protocols for packaging patients for air medical transportation.
Discussion Question
What are some special considerations when packaging patients for air medical transportation?
5 /
  1. General Guidelines for Carrying a Patient Using a Backboard, Portable Stretcher, or Flexible Stretcher—Two-Person Carry
A.Position one EMT at the head of the patient and the other at the foot, with the stronger person at the head.
B.The EMTs face each other, requiring the EMT at the foot to walk backward.
C.If available, place a third EMT as a spotter to identify hazards or obstacles. / Teaching Tip
Allow students ample opportunity to practice these skills.
5 /
  1. General Guidelines for Carrying a Patient Using a Backboard, Portable Stretcher, or Flexible Stretcher—Four-Person Carry
A.Position one rescuer at the patient’s head, facing forward.
B.Position a second rescuer at the foot, facing forward with his hands behind his body
C.Position two additional rescuers on each side, facing forward. / Knowledge Application
Given several scenarios of patient locations and conditions, students should be able to select the proper device for moving the patient.
5 /
  1. General Guidelines for Carrying a Patient Using a Backboard, Portable Stretcher, or Flexible Stretcher—Carrying a Supine Patient on Stairs
A.Determine if patient must be placed in a supine position.
  1. Be sure the patient is secured to the device.
  2. Be sure to secure the patient’s hands within the device.
B.Place one EMT at the head of the device facing the patient and the other at the foot facing the patient.
C.Use a spotter when available to identify obstacles and call out directions. / Discussion Question
Why is a spotter used when carrying a patient up or down stairs?
5 /
  1. General Guidelines for Carrying a Patient Using a Backboard, Portable Stretcher, or Flexible Stretcher—Neonatal Isolette
A.An isolette is designed to prevent hypothermia.
B.Ensure that the isolette can be secured in the ambulance. / Discussion Question
Why are neonates transported in a neonatal isolette?
10 / XI. Follow-Up
  1. Answer student questions.
  2. Case Study Follow-Up
  1. Review the case study from the beginning of the chapter.
  2. Remind students of some of the answers that were given to the discussion questions.
  3. Ask students if they would respond the same way after discussing the chapter material. Follow up with questions to determine why students would or would not change their answers.
  4. Follow-Up Assignments
  5. Review Chapter 6 Summary.
  6. Complete Chapter 6 In Review questions.
  7. Complete Chapter 6 Critical Thinking.
  8. Assessments
  1. Handouts
  2. Chapter 6 quiz
/ Case Study Follow-Up Discussion
  • What principles of lifting and moving patients were demonstrated by the EMTs?
  • What can you infer from this case study about patients’ concerns when being moved and readied for transport?
Class Activity
Alternatively, assign each question to a group of students and give them several minutes to generate answers to present to the rest of the class for discussion.
Teaching Tips
  • Answers to In Review and Critical Thinking questions are in the appendix to the Instructor’s Wraparound Edition. Advise students to review the questions again as they study the chapter.
  • The Instructor’s Resource Package contains handouts that assess student learning and reinforce important information in each chapter.This can be found under mykit at

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 6 PAGE1