Which lifting technique offers you the best defense against injury and protects the patient with a safe and stable move?

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.

Injuries due to improper lifting are common and costly. Each year several thousand Canadian workers are permanently disabled by low back injuries. Many others are unable to return to their former jobs.[i] Whether it is your job to handle heavy materials like boxes, bags and equipment, lifting or transferring people in and out of chairs, washrooms or beds, using proper lifting techniques and ensuring adequate rest between lifts is essential in mitigating the risk of injury.

In this article, we will demonstrate proper lifting techniques for manual material handling as well as special considerations for caregivers and healthcare providers.

Manual Material Handling

Manual material handling is the most common cause of occupational fatigue and low back pain and affects 75% of people who are required to do manual material handling as part of their job. In fact, this type of back injury accounts for approximately one third of all lost work time, and one third of compensation costs.

Performing these tasks continually, without adequate rest breaks, causes an accumulation of mechanical stress in the worker’s body and increases their risk for injury. As a result, fatigue and pacing, along with the weight and location of the load being lifted, are important considerations when assessing the risk of injury.[ii]

Follow these proper lifting techniques to reduce your chance of injury:

Steps for Proper Lifting:

1. Keep the weight as close to your body as possible
2. Squat down low, bending through your hips and knees, you can also take a staggered stance, with one foot half kneeling in front
3. Keep your back straight and shoulders back
4. Lift the weight by straightening your hips and knees, rather than pulling up through your back
5. Take small steps to change direction while walking with the weight
6. Avoid reaching or twisting your body while lifting or holding a heavy weight
7. Take breaks between lifting to prevent fatigue, and avoid rushing

Temperature is another consideration that can increase the risk of injury when lifting loads. Hot, humid conditions often make the worker tire more easily, leading to fatigue, while cold conditions cause muscle and joint stiffness, increasing the risk of a musculoskeletal injury.[iii]

Special Considerations for Caregivers and Health Care Providers

Patient handling refers to lifting, transferring, or repositioning patients and it can often lead to musculoskeletal injuries to caregivers and healthcare workers due to gradual and cumulative stress on the body or a sudden exertion due to high forces or awkward postures.

These injuries are common and costly, and prevent health care workers and caregivers from providing care to their patients, clients and loved ones. As a result, special considerations need to be made for the health and safety of long-term caregivers and health care professionals.[iv]

When lifting a box or other inanimate object, it is easy to get close to the object. However, when transferring a person, there is often an additional 10 to 14.5 inches of horizontal space that needs to be accounted for when determining safe lifting limits, and which increases the load on the caregiver’s spine.

Based on these conditions, the recommended weight limit for patient handling is 35 pounds. This assumes the most ideal, low risk situation for the caregiver, but is not realistic for most caregiver relationships.

Other factors that make the transferring situation less ideal or safe include: lifting with extended arms, lifting when near the floor, lifting when sitting or kneeling, lifting with the trunk twisted or the load off to the side of the body, lifting with one hand or in a restricted space, or lifting during a shift lasting longer than eight hours. Based on these realistic scenarios, the safest form of transfer for the client and the caregiver is a mechanical transfer using a lift whenever possible.[v]

For the purposes of this discussion, a distinction needs to be made between a patient transfer and a patient lift:

Patient transfer: a dynamic effort in which the patient aids in the transfer and is able to bear weight on at least one leg. [vi]

Patient lift: involves moving a patient who cannot bear weight on at least one leg. Lifts should always involve mechanical lifting devices.v

Injuries to caregivers during transfers typically occur when a patient transfer suddenly or unexpectedly becomes a patient lift and the caregiver needs to accommodate for increased load.5

When it is not possible to use a mechanical lift, caregivers and health care professionals should have extensive training in transfer and repositioning techniques to minimize the risk of injury to themselves and to the client.

Steps for Safe Pivot Transfer

Below is an example of a pivot transfer. This client is able to weight bear on their right lower extremity and has limited use of their left lower extremity. The transfer is set up so the client is moving toward their stronger side, and they are able to weight bear to pivot on their leg and assist with the transfer. The therapist is bending through their hips and knees and keeping their back straight to prevent excessive load through their spine.

The steps for completing this pivot transfer from chair to bed are as follows:

1. Set up the chair as close as possible and parallel to the bed, and at roughly the same height
2. Lock the brakes on the wheelchair and move footrests out of the way so their feet are flat on the floor
3. Help the client position themselves at the edge of the chair and angle the client’s legs so they are in a better position when you go to sit them down on the bed
4. Place your hands at the client’s hips and have them lean toward you, looking over your left shoulder
5. Place your knees in front of the client’s knees to keep them stable
6. Have the client push through their feet to stand up, then pivot and gently sit them down on the bed
7. Reposition their feet and move them back on the bed if needed.

This transfer can also be performed with a sliding board, in which case you can have the client pause halfway across the board to rest before performing the rest of the transfer.

Our therapists have extensive training in lifting biomechanics and patient transfers, and we use these techniques daily in our work. If you are having difficulties with lifting or transfers, the therapists at Propel Physiotherapy can help you with finding and perfecting the proper lifting technique to protect your body and prevent injuries.

Reach out today to book a 15-minute complimentary consultation to discuss your needs or book in with one of our therapists for an initial assessment. 

References

[i] MMH Health Hazards, OSH Answers Fact Sheets, Canadian Centre for Occupational Health & Safety

[ii] MMH Health Hazards, OSH Answers Fact Sheets, Canadian Centre for Occupational Health & Safety

[iii] Client handling in health care, Occupational Health & Safety Compliance, Province of Ontario

[iv] Safe Patient Handling and Mobility (SPHM), The National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention

[v] Ergonomic Safe Patient Handling Program, OSH Answers Fact Sheets, Canadian Centre for Occupational Health & Safety

[vi] Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Patient Safety Center of Inquiry (Tampa, FL), Veterans Health Administration and Department of Defense