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(3)
Principles of Moving Patients.
A.
General considerations
1). In general, a patient should be moved immediately
(emergency move) only when:
a.) There is an immediate danger
to the patient if not moved.
1. Fire or danger of fire.
2. Explosives or danger of explosion.
3. Inability to protect the patient from other hazards at the scene.
4. Inability to gain access to other patients in a vehicle who
need life-saving care.
b.) Life-saving care cannot
be given because of the patient's location or position, e.g.,a cardiac arrest patient sitting in a chair or lying
on a bed.
2). If there is no threat to life, the patient
when ready for transportation should be moved by the EMS crew.
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B. Emergency
moves
1). The greatest danger in moving a patient quickly
is the possibility ofaggravating a spine injury.
2). In an emergency, every effort should be made to pull the patient
in the direction of the long axis of the body
to provide as much protection to
the spine as possible.
3). It is impossible to remove a patient from a vehicle quickly
and at the same time provide much protection
to the spine.
4). If the patient is on the floor or ground, he can be moved by
:
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a.)
Pulling on the patient's
clothing in the neck and shoulder area.
b.) Putting the patient on a blanket and dragging the blanket.
c.) Putting the Rescuer's hands under the patient's armpits (from
the back),grasping the patient's forearms and dragging the patient.
d.) Never pull the patient's head away from the neck and shoulders.
C.
Non-urgent
moves performed with other responders.
1). Direct ground lift (no suspected spine injury)
a.)
Two or three rescuers line up on one side
of the patient.
b.) Rescuer kneel on one knee (preferably the same for all rescuers).
c.) The patient's arms are placed on his/her chest if possible.
d.) The rescuer at the head places one arm under the patient's
neck and shoulder and cradles the patient's head. The rescuer places his/her other arm under the patient's
lower back.
e.) The second rescuer places one arm under the patient's knees
and one arm above the buttocks.
f.) If a third rescuer is available, he should place both arms under
the waist and the other
two rescuers slide their arms either up to the mid-back or down to the
buttocks as appropriate.
g.) On signal, the rescuers lift the patient to their knees and
roll the patient in toward their chests.
h.) On signal, the rescuers stand and move the patient to the stretcher.
i.) To lower the patient, the steps are reversed.
2). Extremity lift
(no suspected extremity injuries)
a.) One rescuer kneels at the patient's head and
one kneels at the patient's side by the knees.
b.) The rescuer at the head places one hand under each of the patient's
shoulders while the rescuer
at the foot grasps the patient's wrists.
c.) The rescuer at the head slips his/her hands under the patient's
arms and grasps the patient's wrists.
d.) The rescuer at the patient's foot slips his/her hands under the
patient's knees.
e.) Both rescuers move up to a crouching position.
f.) The rescuers stand up simultaneously and move with the patient
to stretcher.
3). Transfer of supine patient from bed to stretcher
a.) Direct carry
1. Position cot perpendicular to bed with head end of cot at foot
of bed.
2. Prepare cot by unbuckling straps and removing other items.
3. Both rescuers stand between bed and stretcher, facing patient.
4. First rescuer slides arm under patient's neck and cups patient's
shoulder.
5. Second rescuer slides hand under hip and lifts slightly.
6. First rescue slides other arms under patient's back.
7. Second rescuer places arms underneath hips and calves.
8. Rescuers slide patient to edge of bed.
9. Patient is lifted/curled toward the rescuer's chests.
10. Rescuers rotate and place patient gently onto cot.
b.) Draw
sheet method
1. Loosen bottom sheet of bed.
2. Position cot next to bed.
3. Prepare cot: Adjust height, lower rails, unbuckle straps.
4. Reach across cot and grasp sheet firmly at patient's head, chest,
hips and knees.
5. Slide patient gently onto cot.
D. Patient positioning
1). An unresponsive patient without trauma should
be moved into the recovery position by rolling the patient
on
to his/her side (preferably
the left).
2). A patient with trauma should not be moved until additional EMS
resources can evaluate and stabilize the patient.
3). A patient experiencing pain or discomfort or difficulty breathing
should be allowed to assume a position
of comfort.
4). A patient who is nauseated or vomiting should be allowed to remain
in a position of comfort; however.
The Rescuer should be positioned
appropriately to manage the airway
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