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(3) Principles of Moving Patients.
A. General
Considerations
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 patients in a place who need life-saving
care.
b) Life-saving care cannot be given because of the
patient's location/position,
for example, a cardiac arrest
patient sitting in a chair or lying on a bed.
If there is no threat to life, the patient when ready for
transportation should be moved by the ERT members.
B.
Emergency Moves
1) The greatest danger in moving a
patient quickly is the possibility of aggravating 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 quickly from an enclosed space
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 :
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 (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 & shoulders to firmly hold the
patient's head. The first 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 above mentioned steps are reversed.
2)
Extremity lift (no suspected extremity injuries)
a) One rescuer kneels at
the patient's head & 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 and unbuckle straps.
4.
Reach across cot & 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 onto his/her side (preferably the
left).
2) A patient with trauma should
not be moved until additional ERT resources
can evaluate and stabilize the patient.
3) A patient experiencing pain,
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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