Lifting and Moving Patients

Thousands of patients are lifted and moved by EMTs and many EMTs are injured because they attempt to lift or move a patient improperly. A wide variety of patient conditions as well as circumstances affect how the patient is "packaged" for transport.

The expression "Lift with your legs and not your back." is a very important part of proper body mechanics. Always get as close to the patient as you can when lifting. Keep your arms and patient as close to your body as you can to help create leverage and maintain balance. Bend at the knees while keeping your back as straight as possible. Recognize your limitations and call for back-up when needed to lift patient.

Guidelines for Safe Lifting

1. Consider the weight of the patient together with the weight of the stretcher or other equipment being carried and determine if additional help is needed.

2. Know your physical ability and limitations. Know your combined ability with your partner. If absolutely necessary, you can ask bystanders to help. You or your partner must be in charge and give the orders, not the bystander.

3. Lift without twisting. Avoid any kind of swinging motion when lifting as well.

4. Position your feet shoulder width apart with one foot slightly in front of the other. Wear proper boots that go above the ankle to protect your feet and help keep a firm footing. Boots should have nonskid soles.

5. Communicate clearly and frequently with your partner. Decide ahead of time how you will move the patient and what verbal commands will be used. Also, tell the patient what you will be doing ahead of time. A startled patient may reach out or grab something and cause a loss of balance.

Guidelines for Lifting Cots and Stretchers

Most back injuries to EMTs can be avoided by following the following guidelines:

Know or find out the weight to be lifted.
Use a minimum of two people to lift, even if a one-person stretcher is being used.
Use an even number of people to maintain balance during the lift.
Know the weight limitations of the equipment you use. Know what to do if the patient exceeds the weight limitations of the equipment.
Use the power lift or squat lift position. Feet are shoulder width apart. Back is tight and the abdominal muscles lock the lower back in a slight inward curve. Distribute weight to the balls of the feet. Keep both feet in full contact with floor or ground. While standing, keep the back locked in, as the upper body comes up before the hips.
Use a power grip to get maximum force from the hands. Hands should be at least 10 inches apart. Palms face up and fingers in complete contact with the stretcher bar.
Lift while keeping your back in the locked-in position.
When lowering the cot or stretcher, reverse the steps.
Avoid bending at the waist.
Avoid twisting. "Feed" the stretcher into the ambulance while face across the patient.

Guidelines for Carrying Patients and Equipment

Whenever possible, move patients on devices that can be rolled.
Minimize the distance needed to carry patients
Know the weight to be carried.
Work in a coordinated manner with your partner.
Keep the weight as close to your body as possible.
Keep your back in a locked-in position and refrain from twisting.
Flex at the hips, NOT the waist, and bend at the knees.
Do not hyperextend your back (do not lean back from the waist).
Try to lift with a partner that has similar height and strength.

Guidelines for Safe Carrying on Stairs

One of the most difficult carries an EMT must do is carry a patient backwards up a stairway. Try to carry heavy patients up a stairway with two people at the top, shoulder to shoulder, and two at the bottom of the stretcher.

Always carry patients head first up the stairs and feet first down the stairs.
Try to use a stair chair if the patient's condition allows it. If a stair chair is not available, use a light but sturdy kitchen chair. If neither are available, use the extremity lift.
Keep you back in the locked-in position.
Flex at the hips, NOT the waist, and bend at the knees.
Keep the weight and your arms as close to your body as possible.

Guidelines for Reaching

Keep your back in locked-in position.
Avoid stretching or overreaching when reaching overhead.
Avoid twisting.
Keep your back straight when leaning over patients.
Lean from the hips.
Use shoulder muscles with log rolls.
Avoid reaching more than 15-20" in front of your body.
Avoid reaching and strenuous activity for more than 1 minute.

Guidelines for Pushing and Pulling

Push whenever possible rather than pull.
Keep your back locked-in.
Keep elbows bent with arms close to sides.
Keep the line of pull through the center of your body by bending your knees.
Keep weight close to body.
Push at a level between your waist and shoulders.
Use kneeling position if weight is below waist level.
Avoid pushing and pulling from overhead position.

Principles for Moving Patients

Emergency Moves

A patient should be moved immediately by an emergency move only when there is an immediate danger to the paitnet or the EMTs including:

Fire or danger of fire.
Danger of explosives or other hazardous materials.
Inability to protect patient from other hazards at the scene.
Inability to gain access to other patients who need lifesaving care.
Inability to provide care due to location or position.

Clothing Drag

1. Tie the patient's wrists together if you have something quickly available. If nothing is available, tuck the hands into the waist band to prevent them from being pulled upwards.

2. Clutch the patient's clothing on both sides of the neck to provide a support for the head.

3. Pull the patient towards you as you back up, watching the patient at all times. The pulling force should be concentrated under the armpits and NOT the neck.

Sheet Drag

1. Fold or twist a sheet or large towel lengthwise.

2. Place the narrowed sheet across the chest at the level of the armpits.

3. Tuck the sheet ends under the armpits and behind the patient's head.

4. Grasp the two ends behind the head to form a support and a means for pulling.

5. Pull the patient toward you while observing the patient at all times.

Blanket Drag

1. Lay a blanket lengthwise beside the patient.

2. Kneel on the opposite side of the patient and roll the patient toward you.

3. As the patient lies on their side while resting against you, reach across and grab the blanket.

4. Tightly tuck half of the blanket lengthwise under the patient and leave the other half lying flat.

5. Gently roll the patient onto their back.

6. Pull the tucked portion of the blanket out from under the patient and wrap it around the body.

7. Grasp the blanket under the patient's head to form a support and means for pulling.

8. Pull while backing up and while observing the patient at all times.

Bent Arm Drag

1. Reach under the patient's armpits from behind and grasp the forearms or wrists.

2. Use your arms as a cradle for the patient's head and keep the arms locked in a bent position by your grasp.

3. Drag the patient towards you as you walk backwards, observing the patient at all times.

Urgent Moves

Sometimes a patient must be moved more quickly than usual due to reasons of an urgent nature. Weather conditions, hostile bystanders, uncontrolled traffic, and rapidly rising flood waters are some examples of situations requiring an urgent move.

Procedure for Rapid Extrication

One EMT should be stationed behind the patient. Place one hand on each side of the patient's head to stabilize the neck in a neutral position. It is done as you begin evaluation of the airway.
The second EMT quickly applies a cervical spine immobilization device while doing a rapid primary survey.
A third EMT simultaneously places the long backboard onto the seat and, if possible, slightly under the patient's buttocks.
The second EMT supports the chest and back as the third EMT frees the patient's legs from the pedals and floor panel.
The patient is rotated in several short coordinated moves until the patient's back is in the open doorway and feet are on the backboard.
Another EMT supports the patient's head until the first EMT gets out and takes control of the cervical spine immobilization device from outside the vehicle.
The EMT team lowers the patient and slides the patient onto the board in short coordinated movements. Straighten the patient's legs and make sure the neck and back do not bend. Secure patient to backboard after the patient is brought back to the ambulance.

Nonurgent Moves

This is the most frequent type of move and the best way to make the move depends on the illness or injury, factors at the scene, and equipment and personnel resources available.

Direct Ground Lift

2-3 EMTs line up on the same side of a supine patient.
The EMTs all kneel on one knee.
Cross the patient's arms on the chest if injuries don't prevent it.
The EMT at the head places one arm under the patient's head and shoulders, cradling the head. The other arm is placed under the patient's lower back.
The second EMT places one arm directly below the first EMT's arm in the small of the patient's back. The second arm is placed under the patient's knees.
The third EMT (if available) slides both arms under the patient's waist. The other EMTs adjust their arms accordingly.
On signal, the EMTs lift the patient to their knees and roll the patient in toward their chests.
On signal, the EMTs stand and move the patient to the stretcher.
On signal, the patient is lowered onto the stretcher, which has been positioned at waist level.

Extremity Lift

This is only used when a spinal injury is not suspected. It is best used for short distances.

One EMT kneels at the patient's head and the other EMT kneels at the patient's side by the knees.
The EMT at the head reaches under the patient arms at the shoulders and grasps the patient's wrists. If the patient is unresponsive or uncooperative, the other EMT may assist by lifting the patient's wrists to within the reach of the partner. To improve stability, the patient's left wrist may be grasped by your right hand and their right wrist by your left hand. This crosses the patient's arms over their chest creating a more secure hold with less give.
The second EMT reaches under both knees with one arm and under the buttocks with the other arm.
The EMT's rise to a crouching position, then simultaneously stand and move with the patient to the stretcher.

Transfer of Supine Patient from Bed to Stretcher

Direct Carry

Position the stretcher at a right angle to the patient's bed with the head end of the stretcher at the foot of the bed.
Prepare the stretcher by unbuckling the straps, removing other items, and lowering the closest railing.
Both EMTs stand between the stretcher and the bed, facing the patient.
The EMT at the head end of the stretcher slides one arm under the patient's neck and shoulders, cupping the far shoulder with his or her hand and cradling the head.
The second EMT slides one arm under the small of the patient's back, slides the arm under the buttocks and lifts slightly to allow the first EMT to slide an arm under the waist.
The second EMT reaches under the patient's lower legs.
The patient is pulled to the edge of the bed, then lifted and curled toward the EMT's chest.
The EMTs rotate to be in line with the stretcher, then place the patient gently on to it.

Draw Sheet Method

Loosen the bottom sheet on patient's bed.
Adjust stretcher to height of bed, unbuckle straps, lower both rails, and remove all items from stretcher.
Place the stretcher against the side of the bed.
Both EMTs reach across the stretcher and grasp the sheet firmly beside the patient's head, chest, hips and knees.
Slide the patient gently across and onto the stretcher. If enough personnel are available, the patient may be lifted by grasping the sheet on both sides of the patient at the chest and hip simultanously.

Equipment for Moving Patients

Wheeled Stretcher: Two basic types of stretchers are used: the two-person and the one-person. The two-person requires two EMTs to lift and load in the ambulance, whereas, the one-person stretcher has special loading wheels at the head that allows one EMT to load it into the ambulance. Stretchers are usually adjustable to different heights and different angles. Some can be adjusted to elevate the legs (Trendelenberg position). Additional equipment may be attached to the stretchers including oxygen, IV lines, and cardiac monitors or defibrillators.

Guidelines for Moving Stretchers

Stretchers should be handled by two EMTs with both hands on the stretcher. Other personnel or bystanders may be asked to help carry additional equipment if necessary.
Never leave the patient alone on the stretcher.
Load the stretcher with the foot end first or going upstairs.
Position one EMT at the foot and one EMT at the head of the stretcher when rolling it. The EMT at the foot should pull while the EMT at the head should push.
Always maintain a firm grip on the stretcher when rolling to prevent a tipover.
Lower the stretcher and carry end to end if the ground is to rough to roll the stretcher safely.
Use four EMTs, one at each corner, when moving a stretcher across extremely rough terrain.
Turn corners slowly and squarely, avoiding sideways movements that might make the patient dizzy.
Lift the stretcher over rugs, grates, door jams, and other such obstacles on the ground or floor.
Keep the patient secured with belts at all times while on stretcher even if the stretcher is not being moved.

Loading the Ambulance

Place the head end of the two-person stretcher close to the bumper of the ambulance, and make certain it is locked at its lowest level.
The EMTs stand on opposite sides of the stretcher, bend at the knees while keeping their backs straight, and grasp the lowest bar of the stretcher.
Hands are positioned at each end of the lowest bar with both palms facing up.
On signal, both EMTs stand and move toward the rear of the ambulance until the front wheels rest on the floor at the back of the ambulance.
Roll the stretcher forward and guide it into the front of the stretcher catch. Then the foot end of the stretcher is locked into place.
NOTE: Load hanging and portable stretchers before the wheeled stretcher. Obstetrics patients may be loaded feet first so that it is easier to manage an impending delivery. Make sure that all patients and stretchers are secure before moving the ambulance.

Unloading the Ambulance

Unlock the latch at the foot end of the stretcher catch and pull the stretcher until the rear wheels are at the lowest end of the floor.
Grasp the lowest bar on each side of the stretcher with palms facing upwards as it is rolled out.
Once the head end of the stretcher is clear of the ambulance, keep the stretcher level and lower it to the ground by bending at the knees while keeping the back straight. The stretcher may then be raised by triggering the appropriate release handle.
Alternative. Once the head end of the stretcher is level and clear of the ambulance, the driver's side EMT may trigger the handle release and allow the base of the stretcher to slide down the legs of the EMTs. This method avoids the extra lift from the ground but requires the use of the main stretcher bar for lifting and simultaneous release of the handle.
Portable stretchers, or "folding stretchers" weigh 8-15 pounds and can carry a patient up to 350 pounds. They are more easy to use when carrying patients down stairs, down hill, or over rough terrain. It can be suspended from the ceiling with special brackets, placed on the floor, or secured to the squad bench.

Stair Chair

These are designed for patients that can sit up while being carried. They are useful for taking patients up or down stairs, or through narrow passageways. The patient must be transferred to the stretcher once back at the ambulance.

The extremity lift is used to place the patient in the stair chair. All belts and straps must be secured before moving patient. The patients wrists may be loosely tied to prevent grabbing onto fixtures and causing loss of balancewhen moving them. The chair is tilted slightly backwards to allow movement with the wheels on the chair.

Long Backboard

There are several styles of backboards:

Ohio is coffin-shaped to fit easily into a basket stretcher or helicopter.
Farrington is rectangular with rounded corners.
Aluminum are usually foldable but they can be uncomfortable in cold weather and prevent x-rays from being taken.
Miller is made of molded plastic and is strong and buoyant.
Vacuum molds to the patient once they are positioned in it.

The importance of a backboard is in spinal immobilization and moving the patient, especially during rapid extrication, and providing secondary support when using a short spineboard.

Short Backboard

This is used when a spinal injury is suspected and the patient is in a seated position. They made be made from wood, aluminum, or plastic. A vest type is also used when a patient is found inside a small car or place. It wraps around the patient and has all the straps attached or enclosed.

Scoop (Orthopedic) Stretcher

This is designed to easily lift supine patients. The stretcher is made of a rectangular aluminum tube with V-shaped lifts to "scoop" patients from the floor or ground without changing their position. Its greatest advantage is that it can be used in confined spaces where other stretchers cannot fit.

The scoop may be used to initially lift the patient with a suspected spine injury. The patient should then be placed immediately on a long backboard for immobilization. If no spine injury is suspected, the scoop can then be placed with patient onto the stretcher for transport.

The following steps are used with the scoop stretcher:

Adjust the length of the scoop stretcher on the ground beside the patient to accommodate the patient.
Separate the stretcher halves and place one half on each side of the patient. Do not lift equipment over patient.
Slightly lift the clothing on one side of the patient while another EMT slides one half of the scoop under the patient's side. Repeat on the other side. If a spine injury is suspected, another EMT must maintain cervical spine support at all times.
Lock the head end of the scoop in place, then bring the foot end together until the assembly is locked. If any resistance is met, have an EMT gently lift one side of the patient. This move prevents the patient's clothing from being caught or their skin from being pinched.
Attach the padded head strap. Use at least three straps to secure the patient to the scoop stretcher before lifting.

Flexible Stretcher

Do not use the flexible, or "pole" stretcher if spine injury is suspected. It is designed for the following uses:

limited access space
on stairs or around cramped corners
when other equipment is not available

Patient Positioning

EMTs should consider not only the best equipment to use but the position of the patient. The following general rules apply:

Unresponsive patients without suspected spine injury should be placed in the recovery position on their left side.
Patients with chest pain or difficulty breathing should NOT be walked to the ambulance.
Patients with suspected spine injury should be fully immobilized on a long backboard.
Patients with signs and symptoms of shock should have their legs elevated 8-12 inches.
Place the pregnant patient with hypotension on her left side.
Load the pregnant patient whose delivery is imminent feet first into the ambulance to allow for more room to work.
An infant's own car seat should be used if possible. It can be secured to the stretcher with the straps. It can also serve as an immobilization device with padding and taping.
Patients with head injury and no suspected spine injury should be transported in a semi-sitting position at about a 45 degree angle. This reduces pressure inside the skull and risk for increased bleeding.
Trauma patients with multiple injuries should always be transported on the long backboard to provide full body immobilization.
Use discretion when moving and positioning a disabled patient. Increased communication is necessary with visually or hearing impaired patients. Take extra care when securing patients with physical deformities. Use pillows, rolled towels, or other supports and padding to create a more comfortable position.
Elderly patients should be placed in a position that will be as comfortable as possible for their condition. Extra time and care with patients with conditions such as arthritis, osteoporosis, or other conditions is important to reduce risk of further injuries.

Review Questions:

1. What part of the body has the most powerful muscles for lifting?

2. List the seven guidelines for carrying patients and equipment.

3. A situation that presents an immediate and urgent threat to the patient or rescuers calls for which kind of move?

4. Which piece of equipment would be used to lift and transport a multiple trauma patient and why?

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