EMS World

NOV 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | NOVEMBER 2018 37 to get up by themselves, document it. Even before stepping out of the ambu- lance, you can begin a patient movement size-up. Are there steps? Is the sidewalk narrow with edges on the sides that might catch a wheel of the gurney? Is the ground level? Slippery? Prepare fully before starting any patient movement. Move obstacles out of the way, retrieve and set up equipment, explain to the patient what you're doing and what they should do. Don't multitask by asking for the medical history as you're moving the patient—concentrate on the lift and move- ment. The price to be paid sometimes is a slightly longer scene time, but the benefit is greater safety. As part of that scene size-up, plan the transfer path. Ask yourself, "Where is this going to go wrong?" Some patients will reach out and grab things while being wheeled on a gurney. I usually tell them "Give yourself a hug" so they don't reach out and put us off balance. It should not surprise you if a patient on a gurney reach- es out to hug a family member or point to something they need. Control the situation. Stop the move- ment if you have to. Ask family members to wait until you finish carrying Grandma down this flight of stairs. Using shoulder straps limits a patient's movement—that's a good thing throughout the transport. Hon- estly, if you're not using shoulder straps on every call, you are going to get burned. Just get used to it. There are times when we can't say what we're thinking in front of the patient or their family. As an example, you're about to move a patient you're afraid will throw you off bal- ance by thrashing around or grabbing things as you lift. Work out with your partner that if you say their name and a key phrase—e.g., "Jenna, need a minute"—this means you see a threat or don't understand what the team is doing and need to talk before you go further. Before and after the call, discuss the con- cept of lifting with your colleagues. Practice on routine calls when there is time and the patient isn't heavy. With practice you may find that when time is critical, you can move a patient quickly without increased risk of injury. Tips and Techniques Many EMS services have state-of-the-art equipment. The best gurneys have powered lifting and loading. If you have a gurney that will adjust the height at the press of a but- ton, use it. If your service has older gurneys, set the height perhaps a little higher than a seated chair. Once the patient is seated and secured, you simply roll—you don't lift at all. How do you set up your gurney? I'll bet most folks just cover the pad with the fitted cover. But most paper covers have a limited weight capacity and no handles. Perhaps you could place a canvas patient mover with handles under the fitted sheet? The backs of ambulances are often high off the ground. Instead of lifting the gur- ney with the patient, consider lowering the back of the ambulance. Can you position the ambulance with the wheels against the curb? That will reduce this height difference and optimize loading. No matter what type of equipment you have, loading at an angle will not likely be helpful. If the ambulance is tilted right or left as you load or unload, you are in a bad way. Even loading with the ambulance pointed uphill or downhill can produce momentum that catches you off guard. Find another way. Scenario: Your patient is very heavy. You have an obstacle such as steps to traverse but also two healthy, strong-looking fam- ily members who look like they could help. Stop—don't ask them. Call for a lift assist. An amazing array of things can quickly go wrong in such a situation. One family mem- ber will assume they are now directing the lift while not having any clue about objec- tives. Another will find a pinch point. Maybe, rather than lifting together, the "helper" will T h e St a t e o f Yo u r F i t n e s s EMS is a physical and mental activity. Both aspects must be trained for. Stronger, fitter provid- ers are less likely to drop and injure patients. Develop your core strength. If you want to strengthen your back, strengthen your front. That means the dreaded sit-ups and crunches. Many abdominal devices can help ensure proper technique. Crunches help. A regular routine is the solu- tion. Don't ignore weight training for the arms and shoulders. The legs provide major muscles for lifting as well. If the legs aren't devel- oped enough, other muscle groups not meant to take that pressure have to compensate. Stretching throughout the day is also impor- tant. —Dick Blanchet Discuss potential dangers beforehand with your partner.

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