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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Page 38 of 51

38 NOVEMBER 2018 | EMSWORLD.com ISSUE FOCUS: PATIENT AND PROVIDER SAFETY just decide to do a clean-and-jerk power lift on his side of the gurney. First responders are OK to use, but be clear and tell them what you want them to do. The lower to the ground the gurney, the lower its center of gravity—keep it low. If you're moving sideways with a higher center of gravity and something blocks a wheel, your patient's going over. With a lower cen- ter of gravity and slower travel speed, you're less likely to crash. Any gurney tip-over will involve an enormous amount of postacci- dent paperwork, explaining, testifying, and apologizing. Moving patients to and from beds is something we do frequently that can often go better. Lifting the patient with your hands, even if they are only 95 lbs., is the worst option. Instead, if possible, raise the bed just about as high as it will go (many long-term care facilities have beds low to the ground to minimize fall risk). If your equipment includes a slider, use it, but also just ask, "Are you able to slide over by yourself?" Be prepared, as they may start the process before you're ready. Put their answer in your report to better reflect mobility. Facilities may also have sliders you can use. As a last resort, use the bed sheet to lift the patient. While better than trying to lift by hand, this is not a preferred option. It creates lots of friction and requires one per- son to lift while the other pulls. Expect the patient to reach out to steady themselves and put you off balance. If you have a device such as a Binder Lift that wraps around the patient and has lots of handles, use it. We have lots of differ- ent devices we don't typically bring in as we arrive. Devices like this take a bit more time and mean more stuff to carry in and out and clean up afterward, but avoiding an injury to yourself or partner far and away compensates for the extra time. When to Call for Help A light person in an awkward place can be just as much of an injury threat as a heavier patient with good access. Consider calling for additional help if: • The patient must be carried up a flight of stairs. Moving up is harder than down. The person at the bottom of the stair chair might not be able to maintain a good position. • When carrying a patient on a stretcher down three or more steps. Stretcher wheels will normally span two steps; three seem to be much harder. • When the terrain is rough, sloped, or has obstructions. Plan your route before you have the patient in the air. Plywood on the ground is a no-go area. • The patient is on a backboard and must be carried more than a few steps. Lifting a patient from floor level is high risk. The patient, regardless of how many straps you use, is often fright- ened and can suddenly reach out. • You or your partner is inexperienced or you haven't worked together before. Communicate well and know your strengths and limitations. • Your patient is heavy. A heavy patient who cannot move from the bed to the stretcher on their own is a red flag. • It will enhance patient comfort. Addi- tional crew members can help mini- mize pain by providing extra stability. If you think you need a lift assist, say so. Your partner might be thinking the exact same thing. Conclusion Hopefully this discussion has sparked additional thoughts. Talk about it with oth- ers. It's about both you and your partner. Remember, lift with your head before you lift with anything else. ABOUT THE AUTHOR Dick Blanchet, BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Mo., and Illinois for more than 22 years. He was also a captain with Atlas Air and an Air Force pilot. Reach him at acls911@aol.com. Communicate and know your limits. Moving up stairs is trickier than down.

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