Chapter 5. Learning Objectives. Learning Objectives 9/18/2012. Lifting and Moving Patients. Define body mechanics

Transcription

1 Chapter 5 Lifting and Moving Patients Learning Objectives Define body mechanics Discuss guidelines/safety precautions to follow when lifting patient Explain rationale for properly lifting/moving patients Learning Objectives Describe safe lifting of cots/stretchers Describe guidelines/safety precautions for carrying patients/equipment Discuss one-handed carrying techniques 1

2 Learning Objectives Describe correct/safe carrying procedures on stairs State guidelines for reaching & applications Describe correct reaching for log rolls Learning Objectives State guidelines for pushing/pulling Discuss general considerations of moving patients Describe 3 situations that may require emergency moves Learning Objectives Identify carrying devices Wheeled ambulance stretcher Portable ambulance stretcher Stair chair Scoop stretcher Long spine board Short spine board (vest-type device) Basket stretcher Flexible stretcher 2

3 Body Mechanics Lifting techniques Guidelines for lifting Know physical capabilities/limitations Seek help when needed Do not attempt to move patient if you believe you cannot Body Mechanics Safety precautions Never lift with back Use legs, keeping back straight Communicate clearly/frequently Get close to person/device Keep arms close to body Body Mechanics 3

4 Body Mechanics Safety precautions Safe lifting of cots/stretchers Support combined weight of device/patient Use more than 2 people to execute lift Team balanced Body Mechanics Power lift/squat lift Lifting extremely heavy device When lowering, use power lift in reverse Skill 5-1: Power Lift Power lift Keep back locked Feet comfortable distance apart Tighten abdominal muscles Body center over object 4

5 Skill 5-1: Power Lift Power lift Raise upper body before hips Straighten legs as lifting Keep back in locked position Body Mechanics Carrying General guidelines Adhere to during transport Similar to lifting Specific techniques One-handed carrying technique Locked-in position Body Mechanics Carrying patient up/down stairs Keep back in locked-in position Flex at hips, not waist Bend knees, not waist Keep weight/arms close to device Stronger personnel positioned at bottom Use stair chair whenever possible 5

6 Body Mechanics Reaching Good body mechanics Keep back in locked-in position Avoid hyperextended position when reaching overhead Avoid reaching more than 15 to 20 in front of your body Avoid situations where prolonged strenuous effort needed Body Mechanics Reaching Good body mechanics Keep weight close to body Push from area between waist/shoulder If weight below waist level, use kneeling position Avoid pushing/pulling from overhead position Keep elbows bent, arms close to sides Body Mechanics Reaching Log roll Keep back straight while leaning over patient Lean from hips Use shoulder muscles to execute 6

7 Body Mechanics Pushing & pulling Pushing safer, more effective than pulling Keep back in locked-in position Keep line of pull through center of body Keep weight close to body Push from area between waist/shoulder If weight below waist level, use kneeling position Avoid pushing/pulling from overhead position Keep elbows bent, arms close to sides Principles of Moving Patients General considerations Technique selected to move patient depends on several factors Careful planning before moving patient in immediate danger Weigh potential risks vs. need for specific interventions Principles of Moving Patients Emergency moves When immediate threat of death exists Patient moved before assessment Move patient along long axis of body Patient being moved from vehicle 7

8 Principles of Moving Patients Emergency moves Drag techniques Clothes drag Principles of Moving Patients Emergency moves Drag techniques Foot drag Principles of Moving Patients Emergency moves Drag techniques Blanket drag 8

9 Principles of Moving Patients Emergency moves Lifting/supporting torso Principles of Moving Patients Urgent moves Critically ill/injured Surgical intervention Rapid extrication procedure Skill 5-2: Rapid Extrication 1 st EMT immobilizes head from back 2 nd EMT sizes, places neck collar 9

10 Skill 5-2: Rapid Extrication 3 rd EMT prepares stretcher, places backboard under patient s leg Skill 5-2: Rapid Extrication In unison: 2 nd EMT controls patient s neck 1 st EMT rotates patient on backboard 4 th EMT moves patient s leg across seat Skill 5-2: Rapid Extrication Place patient flat on backboard Maintain control of head & neck 10

11 Skill 5-2: Rapid Extrication Strap patient to backboard, secure to stretcher Principles of Moving Patients Nonurgent moves Wheeled cot stretcher Principles of Moving Patients Nonurgent moves Transferring patient from bed to wheeled cot stretcher Direct ground lift Extremity lift Direct carry Draw sheet method 11

12 Skill 5-3: Direct Ground Lift 2 to 3 EMTs line up on side of patient, drop to 1 knee Skill 5-3: Direct Ground Lift Fold patient s arms across chest 1 st EMT places arm under neck & shoulder, cradles head, places other arm under lower back 2 nd EMT places arm under buttocks region and the other arm below patient s knees Skill 5-3: Direct Ground Lift On command, both lift onto elevated thighs Load patient onto stretcher in unison 12

13 Skill 5-4: Extremity Lift 1 EMT at patient s head, 2 nd at knees 1 st EMT lifts patient s shoulders; 2 nd EMT straddles patient s knees & grasp wrists Pull to sitting position in unison Skill 5-4: Extremity Lift 1 st EMT grasps patient under armpits, supports wrists 2 nd EMT: Supports patient with 1 hand behind each knee Skill 5-4: Extremity Lift Both rise smoothly to upright position 13

14 Skill 5-4: Extremity Lift EMT holding legs turns 180 Skill 5-5: Direct Carry Place stretcher at 90 angle Release stretcher belts Slide hands under patient s back; provide support to shoulders, head, pelvis, legs Skill 5-5: Direct Carry Pull patient toward EMTs & lift patient from bed Carry to stretcher Gently place on stretcher, cover, secure 14

15 Skill 5-6: Draw Sheet Method 1 EMT on each side of patient Release stretcher belts, lower to height of bed Untuck bedding, gather toward patient Skill 5-6: Draw Sheet Method EMTs grab sheet/blanket under patient 1 hand at shoulders, 1 hand below hips At same time, slide patient onto stretcher Cover, secure Wheeled stretcher Multilevel cot Two-level stretcher Equipment 15

16 Equipment Wheeled stretcher Moving stretcher Equipment Moving the stretcher Foot end should always go first, except when loading into ambulance Stretcher rolled along ground with 1 EMT at each end of stretcher Maintain firm grip Moderately rough terrain End carry Extremely rough terrain Side carry Equipment 16

17 Skill 5-7: Loading the Ambulance 2 EMTS wheel raised, stretcher to back of ambulance EMT at patient s head guides front wheels into back of ambulance Skill 5-7: Loading the Ambulance EMT at head of stretcher ensures locking bar slides over locking bracket mounted on ambulance floor Skill 5-7: Loading the Ambulance EMT at foot of stretcher lifts stretcher and squeezes mechanism to release wheels; 2 nd EMT raises wheels EMT at foot walks forward 17

18 Skill 5-7: Loading the Ambulance Once stretcher in ambulance, slide into locking mechanism Skill 5-8: Unloading the Ambulance Push release handle on locking mechanism and slide stretcher out of locks EMT at foot of stretcher walks backward, keeping stretcher level Skill 5-8: Unloading the Ambulance 2 nd EMT ensures locking bar catches on bracket to keep stretcher from falling EMT at foot releases wheels; 2 nd EMT lowers wheels. Verify wheels are locked in place 18

19 Skill 5-8: Unloading the Ambulance 2 nd EMT releases locking bar 2 nd EMT takes control of head of stretcher Equipment Portable stretchers Equipment Stair chair Designed to move patients able to assume sitting position Descending stairs, EMT at patient s head should support chair firmly with hands at outermost portions of bar, always be at top position of carry Whenever possible, spotter should be positioned below EMT at foot 19

20 Skill 5-9: Using a Stair Chair Move patient into chair using extremity lift Skill 5-9: Using a Stair Chair Secure patient s hands, if necessary; tilt device Skill 5-9: Using a Stair Chair Tilt chair back to move to ground level Use a spotter to move downstairs 20

21 Equipment Scoop/orthopedic stretcher Facilitates easy lifting of supine patients Adjust scoop stretcher to length just longer than patient Skill 5-10: Using a Scoop Stretcher Measure & adjust length of device next to patient Carefully slide stretcher under both sides of patient; lock head & feet sections of stretcher Strap patient in place & move to secondary device; secure patient Equipment Long spine board Provides rigid support for spinal column Removes patients lying supine/laterally recumbent 21

22 Equipment Short spine board/vest-type device Equipment Basket stretcher Removing patient on rough terrain/high level rescue Equipment Flexible stretcher/rescue stretcher Through narrow corridors/difficult terrain 22

23 Patient Positioning Body positioning Erect Supine Prone Patient Positioning Body positioning Lateral recumbent/recovery Trendelenburg Fowler s Patient Positioning Body positioning Shock 23

24 Patient Positioning Factors dictate device/position chosen Airway maintenance Comfort Suspected spinal injury Shock Patient Positioning Patients with dyspnea/chest pain Transport semireclining/fully upright position Sleepy/lethargic - supine position Patient Positioning Unresponsive patient without suspected spinal injury Recovery/left lateral recumbent position If patient needs positive-pressure ventilation/cpr - supine position 24

25 Patient Positioning Patients with abdominal pain Supine/lateral recumbent position with knees bent Patient Positioning Patients in shock Supine position Legs elevated 8 to 12 Patients with suspected spinal injury Transferred on long spine board Patient Positioning Pregnant patients Women in 3 rd trimester - left lateral recumbent position If uncomfortable, semireclining position Suspected spinal injuries long board; tilt left 25

26 Patient Positioning Nausea/vomiting Position of comfort Summary Safe lifting involves legs not back, lifting as close to device as possible Guidelines for lifting include considering weight to be lifted/need for additional help Summary When lifting cots/stretchers, use even number of people Power/squat lift, ideal for individuals with weak knees/thighs, should be performed in locked-in back position 26

27 Summary Power grip used with hands at least 10 apart When carrying on level ground, use devices that can be rolled; for stairs, use stair chairs Summary When carrying, consider weight to be lifted, need for additional help When reaching, keep back in locked-in position When pushing/pulling, push rather than pull Summary Move patients immediately, using emergency moves when in danger Move patients quickly, using rapid extrication procedure when immediate life-threatening condition 27

28 Summary Move patient along long axis of body Urgent moves out of vehicles - rapid extrication procedure Nonurgent movement done with direct ground lift, extremity lift, direct carry, draw-sheet lift Summary Devices for transporting patients include: Cot stretchers Folding stretcher Spine boards Stair chairs Scoop stretchers Flexible stretchers Summary Transport patients in position appropriate to condition Recovery Comfort Immobilized Legs elevated 8 to 12 Left side/tilted on long spine board 28

29 Questions? 29