VFIS Participant Guide Lifting and Moving
Contents
1. Patient Handling z LJ LE sq J Pa ja d Lifting and Moving Done Right Participant Manual Please Read Carefully The information contained in this program is intended for educational purposes only VFIS specifically disclaims any liability for any act or omission by any person in connection with the use or implementation of any information contained in this program VFIS does not make any representations or warranty expressed or implied with respect to the results obtained by the use adherence or implementation of information as obtained in this program This course is intended for educational and training purposes and does not promote or ex clude any patient moving device intentionally 02000 VFIS All rights reserved No part of this work covered by the copyright hereon may be reproduced or used in any form by any means graphic electronic or mechanical including photocopying recording taping or information storage and retrieval systems without the written permission of VFIS 2 VFIS PATIENT HANDLING Immobilizing Lifting and Moving for the Patient Care Provider Table of Contents duc B rA aA 5 PTO OCLC LOTES NERONE TUNE TERMES on UNIUS eee 7 1 Patient Drop Information ecce c cee eee e eite eee eee eee 8 Identifying the Problem Improper use of equipment Improper balance strength Improper maintenance of equip2. Oil 4 How often should a wheeled stretcher be inspected Every day Once a week At least monthly Annually TA gt 5 Last the classifications of the three types of engineering controls l 25 VFIS 5 6 List at least five key elements of a good work practice program l 2 7 Your partner is six inches and fifty pounds larger than you are You need to move a patient utilizing a stairchair Who should be at the head end 8 Name two suggested exercises to increase your strength and or flexibility l 2 9 You are called to the scene of ill person You are directed to the second floor of the resi dence The patient appears to be having a brain attack You need to get the patient down the stairs and to your stretcher for transport You would use The chair patient is sitting on Your stairchair which 1s still 1n the ambulance Your muscles and strong arm her Nothing you would make her walk onw 10 List as many advantages and disadvantages of a backboard Advantages Disadvantages 6 VFIS INTRODUCTION Every day we are called to scenes involving patient movement from simply putting a patient back in bed to some of the most complex calls which challenge even the most experienced EMS provider We have a variety of patient moving devices available to transfer patients from point A to point B safely Why do we continue to drop patients This program is intended to make patient care providers mor
3. conclusive evidence that back injuries are prevented by the use of a back belt other than the awareness it provides to the person lifting to keep their back straight For additional information on back belts please refer to the references cited in the back of this publication Communications How many times have we heard the problem around here is no one communicates This goes for patient movement too Whether we work with the same partner on every call or this is the first time clear concise communication is of the utmost importance to aid in the reduction of patient drops and provider injuries How often has it been said whatever you learn in the class room forget it this is the real world and we do it differently The stress of clear communication with the person at the head giving the commands is essential for safe patient movement just like it is taught in the classroom Adequate Footing Two EMS crewmembers were suspended after they were advised not to wear sandals on calls One of the crewmembers was injured from stretcher rolling over their foot while wearing their sandals on a call Patient care providers find themselves on a variety of terrain involving patient handling For ex ample removing patients from vehicles climbing ladders descending and ascending stairways lifting patients in obscure positions and walking on surfaces less than optimal It is imperative for personnel to choose foot protection to aid in t
4. muscles working together that allows us to lift in a safe manner When the back and abdominal muscles contract together the back locks into a normal lordosis to maintain the lordosis throughout the lift The legs buttocks and thighs work actively to raise and lower the body and the weight The far ther away the weight is from the body the harder the muscles have to work It is imperative you keep the weight as close to the body as possible Lift in a smooth continuous motion never with fast jerking motions Bending over to lift is extremely dangerous to the spine especially if one bends and twists simultaneously VFIS 27 The Rules of Lifting 1 Know the weight ask the patient s weight if you can and add to the weight of the equip ment 2 Know your physical abilities and limitations and also those of your partner 3 Keep your back locked in a normal lordosis 4 Use your leg abdominal and back muscles 5 Keep the weight close to your body 6 Communicate clearly and frequently with your partner Breathing Weightlifters optimize their lifts by exercising proper breathing techniques Never hold your breath or grunt when lifting patients When you do it causes additional strain Exhaling force fully and evenly during a lift can actually add power to your effort Personal Limitations Lifting is an essential part of everyday patient care Patient care providers must be in proper con dition to perform a variety of
5. passages where stretchers may not fit There are a variety of stairchairs on the market VFIS 39 including some which convert to a portable stretcher and a new model which allows the pa tient to be wheeled up and down the stairs Inspection cleaning repair and maintenance follow the manufacturer directions as listed in the owner manual 3 Stretchers Advantages enables movement without carrying accommodates positions heights and lengths safe traversal of curbs can be lifted or lowered from end or sides durable mechani cally simple comfortable Disadvantages difficult to load and unload by two rescuers x ray opacity the center of gravity becomes an issue when the stretcher is in the up position Inspection cleaning repair and maintenance follow the manufacturer directions as listed in the owner manual 4 Scoop stretchers Advantages can be used in confined areas in which other stretchers will not fit allows easy application of restraints integrates well with various other equipment Disadvantages must be carried requires padding of head and bony prominence should be pre warmed if air temperature is cold not recommended for patients with suspected spinal injury consumes considerable space Inspection cleaning repair and maintenance follow the manufacturer directions as listed in the owner manual 5 Short boards Advantages include able to immobilize someone in a sitting position useful for pat
6. OG for each of these areas overnight The development of SOPs and SOGs is not a one time event Careful planning and review is critical to ensure the appropriate SOP or SOG is in effect There are key words which delineate SOPs from SOGs Here are some examples of these words SOG May Should Can The first step is to decide as an organization what topic you feel is the most critical Training and maintenance may be a good topic to start with By implementing this training program you have actually started the process You need to make it into a SOP SOG at this point Utilizing a Standard Operating Guideline provides more flexibility when certain conditions arise The ability of personnel to be able to make decisions is essential given the latitude of the unusual situations emergency service providers encounter To begin your development process start with a core group of individuals Utilize the talents of the members of your organization Educators managers attorneys and accountants are a few of the professionals you may consider as part of your team Don t forget about your personnel who 36 VFIS are in the trenches on a daily basis doing the job Keep your group to a manageable number so you can accomplish the task at hand When you begin start by gathering information pertinent to the topic There are a variety of de partments who already have SOP SOGs in place There is no need to reinvent the wheel If you do use anot
7. ate We encounter patients on upper levels of buildings who need to be extricated down stairways We find ourselves at motor vehicle accidents where the patient needs to be carried up an embankment or moved down a steep slope Weather also plays a role when we need to transport patients across icy or slick sur faces Improper maintenance of equipment The patient was being transported to the hospital in a fowler s position on the stretcher The stretcher suddenly fell back startling the patient The patient sustained back injuries e Lack of scheduled maintenance e Improper maintenance e Lack of documentation e Alteration of equipment Each piece of equipment comes with a user manual that describes proper use of equipment war ranty information parts and components and the maintenance of the device How many times have we looked at the front cover glanced through a few pages and finally filed it in a safe area where we can retrieve it for further referencing when needed An individual within the depart ment needs to be designated to bean charge of portable equipment The same person should also be responsible for the manuals and documents regarding the portable equipment The manual is usually discarded or filed and never seen again We need to familiarize ourselves with the equipment manuals The manuals prescribe a maintenance schedule for the device It is also important to maintain a log documenting the maintenance performed on equ
8. cise is one of the few exercises that specifically work to strengthen the dia mond shaped area between your shoulder blades the rhomboid muscles Proper Technique l Lie on your stomach with your arms extended out like a swan dive Lift your arms up like a bird flying with your palms down 2 Lift your hands toward your chin while exhaling Keep your elbows pointed up and out Hold this position for a moment and lower slowly Hand held weights can be added for additional strengthening Perform two sets of 12 with a one minute rest be tween sets Advanced Stick out your thumbs like a hitch hiker point thumbs up toward the ceiling while doing the exercise There are a variety of programs which promote strength and flexibility exercises designed for personnel who handle patients You may also contact VFIS for information on available back safety programs These programs are designed specifically for fire and EMS personnel and the proper lifting techniques coupled with the exercises designed to decrease your risk of back injury We encourage you to find a program and begin your strength and flexibility improvement pro gram today 34 VFIS Summary Lifting and moving is involved in virtually all of our patient transfers As a patient care provider you need to understand the dynamics that lifting and moving patients have on your body It 1s imperative you communicate with all members involved in moving the patient Clear concise c
9. cles are most frequently injured The spine consists of thirty three bones called vertebrae The shape of the spine is aligned in a gentle S curve which allows shock reduction from our normal activities of walking running jumping and riding ina car The first seven bones comprise our cervical vertebrae They have a slight inward curve The cervical spine has a greater risk for injury due to the lack of any signifi cant protection The next twelve vertebrae are the thoracic vertebrae They have a gentle outward curve which 1s called the thoracic kyphosis The posterior points of the ribs connect to the thoracic vertebrae which provide more protection to this portion of the spine The lumbar vertebrae consist of the next five vertebrae This portion of the spine is the most vul nerable when it comes to spinal injuries The inward curve of the lumbar is called the lordosis Any abnormal curvature of this portion of the spine can result in low back pain and injury Main taining this normal curve while sitting standing or lifting helps to prevent injuries VFIS 25 There has been a lot of discussion on the reduction of back injuries from wearing a lumbar sup port device or back belt The use of back belts by weightlifters has increased awareness of the potential aid the back belt may contribute to reduction of lower back injuries One of the reasons weightlifters use back belts is to serve as a reminder to maintain normal lordosis There is no
10. defects Wheeled stretchers should be inspected at least once a month or more frequently by a certified mechanic or certified crewmember Confirm that inspections and follow up are effective by look ing for wear cracks missing parts and the use of substandard parts on manufacturer specific equipment Equipment logs are maintained to define a maintenance schedule record maintenance performed and the results of tests carried out in accordance with manufacturer specifications A quality as surance program should be identified that uncovers repetitive specific manufacturer areas 1 e straps wheels etc VFIS recommends annual training in each device the service utilizes for patient movement and transfer An EMS crew had to move the patient from the ambulance stretcher to the bed at a patient s residence by means of a draw sheet In the process the sheet slipped from the head causing pa tient to drop to the floor The patient sustained right flank and lower back pain Provider haste e Improper lifting e Utilizing the wrong device 14 VEIS e Provider s excitement level Provider haste can be both detrimental to the patient being moved and to the careprovider Care providers don t always take the appropriate amount of time to regulate lift and operate the mechanisms of the patient moving device correctly This poor procedure can cause patient inju ries as well as provider injuries Therefore it may affect both the agency s liabi
11. e proper piece of equipment must be used for the specific situation We all know of those whose adrenaline may elevate a little higher than others It may even be you We have heard those old adages Haste makes waste Take a deep breath first Check your pulse These may sound silly but they make you remember you need to slow down Mis takes are often made when we try to rush things The only time speed is a factor at all is in a life threatening rescue when you need to remove a patient expediently from a hazardous environ ment Even in these situations we need to ensure safety first then attempt the rescue VFIS 15 Slow down take in the whole picture use your equipment properly andatmay prevent a patient drop or an injury to a crewmember Scenarios Student Activity 3 As we look at some examples of incidents involving patient moving and transfer identify whether you believe it was equipment failure or personnel failure that caused the incident 16 VFIS e The patient was dropped from the stretcher upon arrival at the hospital The patient com plained of a sore shoulder e While transferring Mr Smith from bed to the stretcher a lamp was knocked over and broken e The ambulance crew bumped into a china cabinet resulting in broken china e The patient was being transported back to their home on a stretcher The patient was being carried up the steps when the stretcher tipped and the patient fell onto the gro
12. e aware of the issues surrounding patient transfer and prevent patients from being dropped As you progress through the program consider the various devices you carry on your vehicle and the purpose of their design There are many opportunities to improve and design new patient moving devices for our industry When devices that have not been tested and approved for pa tient moving are used you are putting yourself your crew and the patient at risk The liability exposure for dropping patients escalates when proper training and equipment are not used VFIS 7 Chapter 1 Patient Drop Information Identifying the Problem Student Activity 1 List situations where patient movement is required Situation Device you would use RY Lippincott Williams amp Wilkins LifeART 8 VFIS The EMS industry estimates 28 million ambulance calls are received each year in the United States Out of these an estimated 42 000 patients are dropped which is about 115 patients dropped each day or one patient dropped every 12 minutes How extensive is the problem If we look at the problem statistically we see in a three year pe riod the frequency amount of times a patient was dropped was at a rate of 8 out of 100 claims and the severity the portion of the claim dollars paid was at a rate of 13 out of 100 of the dollars paid out for claims FREQUENCY SEVERITY average 7 8 per year 13 per year VFIS Statistics Risk Control The freq
13. e the patient and are there enough personnel on the scene to safely and properly move the patient Management cannot make the decision for you however they need to provide the support for you to make the best judgment for the situation Management needs to consider agreements with other agencies for lift assist Many agencies are concerned with their liability 1n subjecting their personnel to lifting injuries and are reluctant to assist The time you need assistance is not the time to determine who to call and who will help 22 VFIS Work Practice Controls The last area of concern for an effective program for hazard prevention and control includes pro cedures for safe work practices Officers staff and line personnel must understand and follow the established work practice controls Key elements of a good work practice program include e Size up of scene e Proper work techniques e Training e Personnel body conditioning e Regular monitoring e Feedback e Adjustments e Modification e Maintenance repair Personnel must be trained in work practice controls that consist of demonstrations and practice time The following examples show work practice controls e Proper scene size up and evaluation e Appropriate partner pairing and utilization of abilities e Task approach to improve posture and reduce stress on extremities and spine VFIS 23 e Proper lifting techniques e Proper use and maintenance of patient li
14. eering the next two options are administrative and work practice controls These methods are not as reliable We need to provide constant monitoring to ensure that administrative controls are followed Administrative Controls Management enacts or approves administrative controls that make them an important element of our injury prevention program The following examples illustrate some administrative controls that can be used VFIS 21 e Increase the number of personnel assigned to the task Adequate staffing is a critically important consideration for decreasing personnel injury rates as the work is spread out over a larger base This will aid in the reduction of stress when lifting heavy patients e Use personnel rotation of assigned tasks when functioning at the scene of an incident For example rotate staff by having the crew switch carrying the patient from one floor to the next EMS crewmembers must understand that sometimes it is impossible for management to match members evenly It is not management s responsibility but the EMS crew s responsibility to 1 Size up the scene 2 Identify the needs by matching crew members capabilities with the needs 3 Call for more help if needed The EMS crew when arriving on the scene needs to take the whole scene into consideration The crew needs to think about how they are going to get the patient from the scene to the ambu lance for transport Do they have the right equipment to mov
15. ent care provider to be more comfortable by adapting the work environment Unfortunately this 1s not always appropriate since we are called into situa tions where the work area or scene 1s beyond our control Two EMS workers were assisting a patient down an ice covered stairway They lost their footing and slid down the entire flight of stairs Both sustained lower back injuries and were off work for more than a month 20 VFIS Examples e Patient down over embankment Patient on third floor Patient in a bathtub Plush carpeting on stairs e ce covered surfaces Work method 1s the second area of engineering controls We need to be aware of equipment de sign prior to purchase We must ensure that our personnel use the equipment appropriately Examples e Equipment has proper handles e Backboards have proper strapping The patient slid off the stretcher The patient sustained a shoulder injury Was the patient prop erly strapped on the stretcher The third engineering controlas tool design For example at one time there were backboards with an adequate amount of grip holes However when lying on a smooth surface there was no place to grasp since there were no runners to elevate the board far enough off the ground to give ample room to grasp the board The boards are designed with runners on the bottom or are contoured to allow easy grasping of the hand holds on the board If the hazard cannot be controlled through engin
16. feART Exercise 6 Carries Lifts Setting 1 The patient is sitting in a chair and needs to be transferred to the stretcher Movement Extremity lifts Do a cross arm on the patient s upper torso second rescuer reaches under both knees and lifts the patient to the stretcher uer Lippincott Williams amp Wilkins LifeART 44 VFIS Setting 2 The patient is lying on the stretcher and needs to be transferred to the bed Movement Loosen bottom sheet and grasp the sheet at the top The second rescuer grasps the sheet at the bottom Lift the patient to the bed Then reverse the process Ideally the surface you are lifting from should be higher than the surface you are lifting to Exercise 7 Use of any other devices If there are any other devices your agency uses now is the time to get them out and practice Use the manufacturer recommendations for proper use during your training program VFIS 45 Bibliography EMS Safety Techniques and Applications Federal Emergency Management Agency United States Fire Administration EMT Injury Free Ferno 70 Weil Way Wilmington OH 45177 9371 800 73 FERNO Fire and Emergency Medical Services Ergonomics Federal Emergency Management Agency United States Fire Administration Brady Prehospital Emergency Care 5 e Brady Hafen Karren Mistovich Chapter 39 pages 732 738 The Basic EMT Mosby McSwain White Paturas Metcalf Chapter 10 pages 152 176 Aehlert s EMT Basic Study Guide Ae
17. fting devices e Use of ergonomically designed equipment Work practice controls need to be monitored with frequent feedback provided to personnel To ensure proper feedback the following questions should be asked e Are specified procedures being used e Are the procedures an improvement over the previous method e Is re training necessary e Are the maintenance programs satisfactory e Were SOGs followed Summary A combination of the three ergonomic controls Engineering Controls Administrative Con trols and Work Procedure Controls are essential to maintain a well balanced program in the reduction of personnel injuries and patient drops It is imperative the program is monitored up dated and revised as necessary 24 VFIS Chapter 3 Lifting and Moving Dynamics There are a variety of motions that put stress on our backs lifting carrying pushing pulling and reaching These repetitive motions also are the most common causes of back injuries When the weight of the object being lifted and an imbalance of the force being generated by the muscles occur damage is incurred Correct body mechanics good task design and a healthy back provide a solid foundation for preventing back injuries according to ergonomic studies Lippincott Williams amp Wilkins LifeART The anatomy of the back is a complex system of ligaments muscles bones nerves and interver tebral discs The intervertebral discs the ligaments and the mus
18. ght An example is a spine board that allows the patient to be x rayed without moving the patient from the board The bony structures that make up the spine The back is made up of 7 cervical vertebrae 12 thoracic vertebrae 5 sacral vertebrae and 1 coccygeal vertebrae 47 48 VFIS Patient Handling Post Quiz 1 What is the result of removing the 3 point harness on the wheeled stretchers vios Makes it easier to secure a patient It has no negative or positive effect It negates the manufacturer s warranty It provides extra straps for other purposes 2 What are the three components of a preventive maintenance program Ww Cleaning Licensing Lubrication Alteration Inspection Lubrication C Cleaning Inspection Loosening D Cleaning Inspection Lubrication 3 How often does VFIS recommend training on lifting and moving devices A At least monthly B Atleast annually C Atleast every five years D Once 4 Identify three work hazards we move patients in l 2 E 5 Which of the following is an administrative control TA gt Matching crew size to move the patient safely To size up the scene and request appropriate resources Assuring adequate staffing to aid injury reduction Calling for help when their crew needs assistance in lifting 6 Which muscles of the body allow you to lift effectively and safely when used together VFIS 49 Legs Back Abd
19. gonomics is the practice of making the work environment safer and more productive for the worker We need to identify the ergonomic haz ards involving our activities in EMS In relation to patient movement we can easily identify three work hazards 1 Moving victims from e Multistory buildings or homes using stairways e Up and over embankments or inclines e Down sloping terrain 2 Moving patients e On to and off of stretchers gurneys e Loading stretchers gurneys into ambulances 3 Moving victims in any other situation we may encounter It is important for us to understand that this subject really has a twofold purpose One is to reduce the number of injuries to patient care providers from lifting and moving patients which in turn helps to decrease the number of patient drops We can begin by putting an injury prevention program together for our personnel There are three basic types of ergonomic controls we can institute Engineering controls 2 Administrative controls 3 Work practice controls VFIS 19 amt AS AN hy is in c F ud Lippincott Williams amp Wilkins LifeART Engineering Controls Engineering controls are defined as the changing of the work place or equipment used in the work place to reduce or eliminate ergonomic hazards Engineering controls are generally classi fied as three types 1 Workplace environment 2 Work method design 3 Tool design Workplace environment allows the pati
20. he assurance of adequate footing It is recom mended that personnel wear a sturdy ankle high shoe with steel toes and slip resistant soles Good ankle support decreases the risk of turning an ankle and steel toe shoes reduce the chance of fractured toes should a heavy object fall on your foot The tread should provide a non slip oil resistant material to aid in footing A keen awareness of your surroundings is also vital Assuring proper footing with each step you take will help reduce the chances of personnel slipping and patients being dropped A crewmem ber designated as the safety leader should be in place to back each patient handler to help reduce the amount of patient drops Example A safety person should be behind the lower individual carrying a stairchair to aid 1n sta bility 26 VFIS Balance and Weight Positioning In much the same manner as weightlifters position themselves to lift weights patient care pro viders must do the same If the load shifts the crew leader should stop the procedure The crew members need to reposition and re establish their proper balance As discussed earlier personnel need to position themselves to optimize their strengths Distribution of the weight load is essen tial to maintain the balance needed to move patients in a safe manner The Lift Legs v Back v Arms How many times have we heard lift with your legs not your back It 1s the combination of the legs back and abdominal
21. her department s SOP SOG use it as a guideline The SOP SOG needs to be relevant to your department s needs The SOP SOG should follow the standard format of the other SOP SOGs of your department A guideline to follow would be a title section which would include e Subject e Guideline number e Adopted date e Effective date e Revised date e Due for revision date e page of The body of the SOP SOG needs to include e Policy e Requirements e Procedures Policy should be a statement of what management intends the SOP SOG to accomplish Requirements are items needed to make the SOP SOG work Procedures describe what to do in a particular situation The Internet has become an integral part of life It is a means for departments to communicate and share information There are a number of departments with web pages it is just a matter of finding them There are a variety of bulletin boards and other links with Internet access For further information on the development of SOPs and SOGs please contact your VFIS repre sentative to schedule a training session devoted to this topic VFIS also provides consulting VFIS 37 services devoted to developing and reviewing SOPs SOGs Contact your VFIS representative or call VFIS at 1 800 233 1957 3 VFIS Chapter 5 Patient Transfer and Movement Devices There are a variety of patient transfer and movement devices we identified at the beginning of the program Let s take a look a
22. hlert Chapter 6 pages 106 117 Back Reaction Program Grennan Stryker EMS Rugged Stretchers 6300 Sprinkle Road Kalamazoo MI 49001 9799 800 RUGGED6 VFIS Education and Training Services WWW Vfis com 46 VFIS Administrative Controls Engineering Controls Ergonomics EMS Fowlers Dynamics Haste Lordosis Ligaments Intervertebral disc Thoracic Kyphosis Translucent Vertebrae VFIS Glossary of Terms A written standard operating policy or guideline governing equip ment used the number of personnel utilized and or procedures em ployed to reduce the potential for injury Standardized equipment used to prevent injury while performing the essential functions of the job These can include workplace environment work method design tool design The science of fitting the job to the worker Emergency Medical Services A patient who is in the sitting position with knees bent A branch of mechanics that deals with forces and their relation primarily to the motion but sometimes also to the equilib rium of the body To move or act quickly The natural inward curvature of the lumbar spine A tough band of tissue that connects bone to bone A jelly filled sponge like tissue located between each vertebrae that acts like a shock absorber for the spine The disks also add flexibility of movement to the spine The natural outward curve of the thoracic spine Permitting the passage of li
23. ients in cars and confined spaces Disadvantages include time to put the device on the patient Features include available in wood aluminum or plastic Inspection cleaning repair and maintenance follow the manufacturer directions as listed in the owner manual 40 VFIS Lippincott Williams amp Wilkins LifeART 6 Flexible Stretcher Advantages especially useful for narrow and restricted hallways can be carried from sides or ends Disadvantages must be carried Inspection cleaning repair and maintenance follow the manufacturer directions as listed in the owner manual VFIS 41 Chapter 6 Hands on Exercises Lippincott Williams amp Wilkins LifeART Exercise 1 Proper immobilization with a backboard Setting The patient needs to be immobilized on a backboard with proper sized cervical collar in place The patient needs to be secured to the board with an appropriate amount of straps Movement Have providers move the board with patient from the ground and carry a few feet then place the board onto wheeled ambulance stretcher Lippincott Williams amp Wilkins LifeART 42 VFIS Exercise 2 Proper use of a stairchair Setting Have patient securely fastened to stairchair Ensure that hands and legs are secured Movement Have crewmembers move the patient down one flight of stairs and then up one flight of stairs Ensure proper safety measures when working on a stairway A minimum of three crew member
24. ipment It is 1m perative to remove the device from service for necessary repairs any time you discover an unsafe device mechanical problem or physical defect which jeopardizes the safe movement of the pa tient It also has been noted that the wrong lubrication is frequently used to lubricate the mechanical moving parts For example one manufacturer recommends the only lubricant to be used on their products should either be 30W Motor Oil or Lithium Grease on all moving parts They further state that using the wrong lubricant may cause damage to the product The latches hinges straps wheels and bearings are essential components and must be properly inspected and maintained on a regular basis You need to remember altering the device or using the wrong materials on the device usually negates any warranty by the manufacturer A common alteration on wheeled stretchers 1s removal or non use of the 3 point harness strap A manufac turer can and in most instances will negate any warranty or refuse to assume any liability for 12 VFIS devices if it has been altered malfunctions or is not used in concert with the design by the manu facturer Additionally acts such as this will increase your organization s exposure to liability It is essential to clean lubricate inspect and document the various devices we utilize following the same procedure we do with our vehicles Remember the vehicle 1s used to transport patients and crewmembers howeve
25. kward Fly exercise helps strengthen the triceps The triceps are not strengthened in your day to day activities Proper Technique l Lie on your stomach with your arms at your side and palms toward your body 2 Lift your arms backward and lower them slowly Perform two sets of 12 with a one minute rest between sets VFIS 3l THE KNEE TO CHEST The Knee to Chest exercise lengthens muscles that keep your lower back stable and flexible Proper Technique l Lay on your back with both legs bent and your feet flat on the floor 2 Grasp one thigh behind one bent Knee and slowly pull it to your chest while keeping your other foot on the floor Hold for 5 10 seconds and then switch to the opposite leg Repeat five times for each side 32 VFIS THE QUADRICEP FEMORIS STRETCH The Quadricep Femoris stretch lengthens the front thigh muscles Leg extensions will help the muscle stabilize your knees and assist you in climbing stairs Proper Technique l Stand on one foot and grasp the ankle of the foot in the air Pull your heel to your but tocks and hold for 10 15 seconds Release and repeat with the opposite leg Perform this exercise three times on each leg 2 A good adjunct to this stretch is leg extensions Sit on a chair and extend your leg Hold for azymoment and return to the neutral position Perform two sets of 10 for each leg Ankle weights can be used in this exercise VFIS 33 REVERSE FLY The Reverse Fly exer
26. le exercises three to five times a week When done properly these exercises can modify strength fitness and risk taking behavior Exercises It is important to note that stretching is an integral part of any exercise program People vary in range of flexibility The goal is to rid you of the tightness and stiffness within the muscle groups When done properly you will not feel as much tension in those muscles Stretching should be done at a slow pace When done properly stretching will feel good Be care ful not to overstretch and do not bounce to stretch a muscle you risk hurting yourself Stretch for 15 seconds in a position where you feel slight tension The pressure will start to be reduced Stretching consistently over a period of time can only help you Remember this is for you Enjoy it VFIS 29 Specialized Exercises for the Out of Hospital Care Provider Stretching and Strengthening Exercises THE CAT BACK STRETCH The Cat Back Stretch improves flexibility of the entire spinal column Flexibility of the spine improves its range of motion thus limiting the chances of injury Proper Technique 1 Position yourself on your hands and knees Allow your back to sag sway back and extend your head back Hold for a moment 2 Bend your head forward and arch your back upward like a cat Hold in this position for a moment Perform two sets of 20 with a one minute rest between sets 30 VFIS THE BACKWARD FLY The Bac
27. leg The patient alleges a spinal injury due to improper handling An EMS crew pushed the stretcher up to the patient s house and the loading wheel struck the glass on the storm door and broke the win dow The patient suffered a broken arm when the crew tried to get the patient into a wheelchair for transport The patient suffered injury to the right side including a hematoma to the head and pain in the right shoulder when the patient s weight shifted as the EMS crew was placing the pa tient on the stretcher and the stretcher tipped over A crewmember fell on the patient while unloading the patient from a stretcher VFIS 17 Summary The number of patient drops and injuries to patient handlers can be significantly reduced if we take into consideration a few generalized areas First we need to use the proper patient moving device for the specific situation Second we need to take into account the strength of the care providers and concentrate on maintaining our balance Third we need to assure our patient mov ing devices receive the appropriate maintenance Fourth equipment that is maintained will help reduce the potential for equipment failure And last as patient care providers we need to slow down and take planned actions when moving a patient 18 VFIS Chapter 2 Injury Prevention Ergonomics is a developing science aimed at enhancing the healthy interrelationship of humans machines and the work environment Simply put er
28. lifts and moves Every person is different and abilities change self awareness is imperative for patient care providers to realize when exhaustion minor illness or dwindling energy from a busy shift make certain lifting tasks risky It is never appropriate to Jeopardize the safety of yourself the patient or other crewmembers by overextending yourself to prove your capabilities It should never be considered wrong to ask for additional assistance to lift or move patients Three considerations need to be decided in addition to the weight load prior to performing a lift ing procedure First 1s the position of the load For example the 220 pound person who has fallen in the shower Second what is the distance and terrain the load is to be carried over For example the patient who needs to be removed from the third floor down a narrow staircase And third you need to consider the repetition factor For example is this the thirteenth patient you have lifted today or 1s it the first 28 VFIS Strength and Flexibility Exercises There 1s one thing for certain you only get one body What you do with it depends solely on you As discussed lifting and moving take both strength and flexibility When we think of strength and flexibility improvement we tend to think of joining a health club or buying a variety of commercially advertised body improvement devices It is not necessary to go to this level of body improvement We can do a few simp
29. lity policy and the worker s compensation policy A patient was having chest pain The EMS crew dropped the patient while removing them from their residence The patient sustained injuries to their head and back Proper lifting begins with a conscientious effort every time we lift If we practice lifting objects with our legs and not our back it will become common practice to use our legs when we lift pa tients on patient moving devices The equipment is designed for lifting 1n a certain manner we need to have personnel properly trained on the lifting technique for each of the devices available An EMS provider suffered back injury when lifting a patient from the ground to the stretcher on a backboard The EMS provider said it was uncomfortable lifting using their knees and bending at the back was so much easier The EMS provider is permanently disabled from working due to a back injury EMS providers sometimes become complacent after running call after call There are instances when using a patient s chair such as their dining room chair seems easier than going back to the unit to get a stairchair What happens when the dining room chair fails and the patient is dropped We have now created a situation that easily could have been avoided if we had taken just a few minutes to go back to get the proper equipment The patient s furniture is not designed as a patient moving device and should never be substituted as a patient moving device Th
30. ment Equipment failure malfunctions Provider haste Scenarios 2 Injury PEOCV MUON iss eo nicer Tener norra erea aain 19 e Engineering controls e Administrative controls e Work practice controls 3 La i amd MOVIDE 6o es eea ero aeo e a REP EE oER Coe EON SENS EOS eEEEL ERI e abo aee 25 VFIS Dynamics Communications Adequate Footing Balance and Weight Positioning The Lift Legs v Back v Arms The Rules of Lifting Breathing Personal Limits strength and Flexibility Exercises 4 SOP and SOG 5aieiiiteittissest a cid vi eben tei eee coles ee ivi eds cod edo 36 5 Patient Transfer and Movement Devices e eee eee eee eee oce 39 Backboards Stairchairs Stretchers Scoop Stretchers Short Boards Flexible Stretcher 6 Hands on Exercises cca ecce eere e ree ee eue e e e eee uue 42 iliac gui d rd we ec dep E 46 Glossary of TeEIS see eee igpes es P RISE Qoa EN ER oiae pera eoni are iai 47 licer H 49 Eval a lOa sssi a TT TETTE S1 4 VFIS Patient Handling Pre Quiz 1 How many patients are estimated to be dropped each year 12 000 25 000 42 000 54 000 sperei 2 Patient moving devices are designed to carry any patient needing to be moved or transported True False 3 What lubricant is typically recommended to be used to lubricate moving parts on stretchers A WD 30 B 30W Motor Oil C Graphite D Vegetable
31. ogram What other programs would you like to have offered through VFIS Additional Comments VFIS would like to thank you for participating in this class session With more than 25 years experience in providing insurance to emergency service organizations VFIS takes pride in providing training and educa tional materials to emergency services Properly using these materials may help to prevent injuries and or possibly death while you are protecting your community as emergency responders If you would like further information on what VFIS has to offer please do not hesitate to contact us at 1 800 233 1957 Thank you On the reverse side of this form is the Optional Authorization and Consent to Use Testimonial If you should choose to complete this form please read the following instructions VFIS 51 If you choose to complete this portion of the VFIS Evaluation Form please print testimony legibly print your name where applicable and sign your name below Thank you Testimonial Comments Optional Authorization and Consent to Use Testimonial The undersigned intending to be legally bound hereby authorizes Arthur J Glatfelter Agency Inc T A Glatfelter Insurance Group and all of its subsidiaries and affiliates their agents and associates to use for any lawful purpose including illustration advertising and publication in any manner written comments of the undersigned shown above The undersigned hereby irrevocably consents to the
32. ominal All of above ons 7 Fill in the blanks of the six rules of lifting 1 Know the of the patient 2 Know your abilities and and also those of your partner 3 Keep your locked in a normal lordosis 4 Use your and muscles 5 Keep the weight close to your l 6 clearly and frequently with your partner 8 Name two suggested exercises to increase your strength and or flexibility l 2 9 You are called to the scene of an ill person You are directed to the second floor of the resi dence The patient appears to be having a brain attack You need to get the patient down the stairs and to your stretcher for transport You would use The chair patient is sitting on Your stairchair which is still in the ambulance Your muscles and strong arm her Nothing you would make her walk onw 10 List as many advantages and disadvantages of a stairchair as you can Advantages Disadvantages 50 VFIS EDUCATION AND TRAINING SERVICES PROGRAM EVALUATION FORM Program Title Location Instructor s Name Date s COMMENTS Instructor s knowledge about subject Very good Average Program content What I expected Not what I expected O me Agree Somewhat agree Disagree o quate Agree Somewhat agree Disagree Audio visuals were adequate es SS CC What did you like most about this program What did you like least about this program Do you have any suggestions to improve this pr
33. ommunication will help reduce the potential for injury and the potential for dropping a patient Adequate footwear can be the best investment you can make for yourself Adequate footwear protects and supports you and gives you the traction and footing necessary to assist i the patient move Keep in mind balance weight positioning using your legs versus your back breathing techniques and knowing your personal limitations are all essential components that enable you to perform a proper lift and carry patients over less than adequate terrain Finally strength and flexibility exercises should be incorporated into your daily activities You only get one body do what you can to keep it in shape VFIS 35 Chapter 4 SOPs and SOGs Many companies do not have Standard Operating Procedures SOPs or Standard Operating Guidelines SOGs which address the proper training operations maintenance and inspection of their patient moving transfer devices A SOP and or SOG should be developed to address each of these areas During an open house for a Boy Scout Troop a visitor volunteered to be a patient and the crew dropped him while on the stretcher The visitor now became a patient with a cut on the nose A SOP SOG should also be considered for e Physical fitness of EMS personnel e Procedures if a patient drop should occur e Injuries to EMS personnel Where do you start It is not practical to think you can develop implement and enforce an SOP S
34. ortment of devices available for use in any given situation The most fundamental precaution we can start with is proper training in the use of each piece of equipment we have available for patient movement Let s begin by listing the equipment cur rently available for patient movement transfer Student Activity 2 List all pieces of equipment available for transport transfer of patients and identify their practical uses DEVICE USES We will discuss each device in more detail as we progress through the program Improper balance strength e Difference in crew members strength height and weight e Pati nt height and weight e Scene conditions Every individual has a unique physical design We need to be able to utilize the strengths and identify the weaknesses of each patient care provider The ideal crew would consist of a mini mum of two individuals with compatible strength height and weight to allow proper balance and lifting of patient movement devices We know this is not always possible The crew needs to be able to recognize the abilities of the other member and strategically place themselves in a proper lifting carrying position For exam ple Two individuals of unequal height may want to have the taller individual at the foot end of a 10 VFIS stairchair to offset the height difference Or if one individual has more strength capability the stronger of the two is best suited for the head end of the stretcher The
35. r it takes a patient moving device to get the patient to and from the vehicle There are companies who specialize in the service and repair of patient handling equipment and will perform this on a contractual basis Examples of some of the services they provide are a Preventive Maintenance e Cleaning e Inspection e Lubrication a Equipment Tune up e Hardware tightening e Alignment adjustments a Equipment Evaluation e Reveals needed repairs e Detects potential problems a Usage Evaluation and Training VFIS 13 e Reveals improper usage a Report e Documentation of preventive maintenance Additionally they may include all frame repairs and the replacement of all parts of the wheeled stretcher Equipment failure malfunctions Two EMS unit s crewmembers were moving the patient from the unit into the Emergency Room and the stretcher collapsed to the ground The patient suffered a back injury e Equipment inspection and documentation e Lack of training The lack of equipment maintenance and inspection may lead to equipment failure malfunction In turn this almost always leads to litigation It will be the organization s burden of proof to demon strate that the failure or malfunction was not a result of their negligence The service will need to show proof of competency and training in the device The device will need to be immediately removed from service for proper inspection and to identify any malfunctions or
36. s is essential for safe movement Exercise 3 Utilizing wheeled stretchers Setting Begin with an empty stretcher and proceed through the exercise After completion of the exercise repeat with an individual properly secured on the stretcher Movement Move stretcher out of the ambulance Raise the stretcher to the highest point Move the stretcher a few feet Lower the stretcher to the lowest point and move it a few feet Perform a four person carry with an individual at each corner of the stretcher Load the stretcher back into the vehicle Exercise 4 Use of a scoop stretcher Setting Have a person lie in a supine position Place person in a variety of settings start by hav ing the person lie on the floor then have the person lie in a narrow hallway Movement Practice putting a person on a scoop stretcher moving the stretcher then transferring the patient to the stretcher and taking the patient off of the scoop stretcher Lippincott Williams amp Wilkins LifeART VFIS 43 Exercise 5 Proper immobilization with a short board Setting The person is in a sitting position Begin by immobilizing the person sitting on a chair continue by placing the person in a vehicle and immobilizing them sitting in a vehicle first as the passenger then as the driver Movement Immobilize the person on a short board then place that person on a backboard and properly secure from the above settings Lippincott Williams amp Wilkins Li
37. se unequal physical attributes of crewmembers should not be viewed as negatives but identi fied as potential problems should we not utilize the individual in the most suitable position We also need to have crews recognize when a situation is beyond the capabilities of the providers on the scene and require additional help Some examples may include Overweight patients Icy or slick surfaces Extrication on an incline or decline Inability of crewmembers to safely move a patient The patients we transport are just like us They are different heights and weights Our devices are designed for a standard size person We need to adjust to the patient who is taller than the length of our moving devices and compensate for the additional height of the patient Each device also has a manufacturer s weight limit for that particular device We must be aware of the limitations of our equipment We also must be sensitive to the height of the patient moving device during patient transfers The higher the wheeled stretcher is during transit the greater the chance for the stretcher to tip over Also the higher we carry someone the greater the chance our center of bal ance will be thrown off This may cause us to drop the patient As the EMS crew was lowering the patient to the ground the police officer lost footing causing the patient to slide off of the board to the ground VFIS 11 The situations we are called to can involve any given terrain or clim
38. t some of the aspects of each device 1 2 Lippincott Williams amp Wilkins LifeART Backboards Advantages good spinal immobilizer good lifting device can float light compact can serve as a CPR surface mechanically simple x ray translucent can be carried and loaded from ends or sides integrates well with various other equipment Disadvantages must be carried usually must be left with patient unstable for moves up or down inclines uncomfortable may weaken with time Features available in a variety of styles from different manufacturers Usually have holes spaced along the ends and sides of the board for handholds and insertion of straps Usually six to seven feet in length Inspection cleaning repair and maintenance follow manufacturer directions as listed in the owner manual Stairchairs Advantages good for use on stairways narrow corridors and doorways small elevators can be used in narrow aisles in aircraft or buses Some models can be converted into portable Stretchers Disadvantages must be carried does not accommodate trauma patients should not be used for patients with altered mental status fairly complex consumes considerable space should not be used when lower extremity injury or neck or spinal injury patient must be transferred from stairchair to stretcher prior to loading patient into ambulance Features ability to move patients up and down staircases through narrow halls and in small
39. uency of the problem seems minimal however if we look at the severity we can see the magnitude of the problem Insurance considers a severity percentage greater than 10 a signifi cant problem and loss control measures need to be implemented The statistics clearly identify the need for us as an industry to take a closer look at how we are handling patient movement What can we do better to prevent the amount of patient drops occur ring each year in our industry After all our community s perspective of a professional patient care provider is a person arriving on scene in a timely fashion to treat them in a proper fashion and to move them in a safe manner We can attribute the incidence of patient drops to a few generalized areas e mproper use of equipment e Improper balance strength e mproper maintenance of equipment e Equipment failure malfunctions e Provider haste Improper use of equipment An EMS crew was carrying a patient downstairs on an ordinary chair The chair broke and the patient fell to the floor The patient sustained back injuries There are various types of patient moving devices on the market We are inundated with new pieces of equipment coming on the market every day Each piece of equipment has been designed with a specific purpose for the pre hospital setting We need to remember there is not one device VFIS 9 that is so versatile that it can be utilized in any situation Therefore we must have an ass
40. und striking the right side of her body The patient had to be transported back to the hospital e During transport the ambulance stopped suddenly causing the patient s ventilator to fall on the EMS crew The patient sustained a laceration on the left thigh e The patient was being transported for Black outs The EMS crew placed the patient on the board and dropped her twice on the way to the ambulance The patient sustained a back in Jury e A diabetic patient was being transported out of an apartment building the EMS crew bumped the patient s face on the stairway ceiling causing three teeth to be knocked out e The fire chief s personal vehicle suffered a broken mirror when the EMS crew was transfer ring the patient on the stretcher and hit the chief s vehicle e While moving the patient from the house on a stretcher the husband got in the way and the patient was dropped e While removing the patient from the ambulance on a sloping ramp at the hospital the head of the stretcher rolled and the stretcher tipped and the patient fell to the ground The patient suffered a broken clavicle e While transporting a patient from a nursing home the EMS crew caught the patient s leg un der the wheelchair and broke it The patient later died causes unknown There are many many more examples Some scenarios play out the same way Here are a few others to think about The patient was dropped during a transport and sustained a broken
41. unrestricted repetitive use of such testimonials and waives the right to inspect or approve any finished product or advertising copy that may be used in connection therewith Print your name Your signature Date Please have one person witness your signature above and have them sign below Witness signature 52 VFIS VFIS
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