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Lifting and Moving Position
Lifting and Moving Position
CONTENTS
TITLE PAGES
INTRODUCTION 1
OBJECTIVE 2
PURPOSES 3
BASIC PRINCIPLES 3
TYPE OF MOVES 4
GUIDELINES 11
CHECKLIST 13
DISCUSSION 18
CONCLUSION 19
REFENCES 20
EXAMPLES OF QUESTION 21
INTRODUCTION
Thousands of patients are lifted and moved by EMTs and many EMTs are injured
because they attempt to lift or move a patient improperly. A wide variety of patient
conditions as well as circumstances affect how the patient is "packaged" for transport.
Lifting and moving the patient is a critical skill and can range from a simple
procedure to a complex operation. We must move the patient, keep the patient from being
injured further, and protect themselves from any unnecessary injuries. Lifting and moving
skills can be developed and improved through practice in a nonemergency environment,
but some patient moving requires quick thinking and ingenuity. Engaging in practical
scenarios involving patient lifting and moving from a variety of emergency situations is
important to hone a first responder’s skill level. You also need to be aware that you may
have to devise an “out-of- the norm” plan on scene, and devise it quickly. Even the most
exceptional first responder treatment can be rendered ineffective if the patient is lifted or
moved improperly.
When lifting and moving, transferring or positioning patients, the most important
consideration is safety. Any of these procedures need to be undertaken with it in mind.
This safety is inclusive of both the patient and the health care worker. Communication is
an important part of the lifting and moving process as the nurse should elicit information
from the client to find out how and when they prefer to be moved. This allows the patient
to be involved in the decision making process and be fully aware of what is occurring. By
communicating with the client, the nurse is also aware of whether or not the patient is
experiencing any discomfort during or after the lift or move.
The actions of lifting and moving, transferring or positioning need to be
completed for numerous reasons, including relief of pressure points. Due to the patient
being in one position continuously, they are prone to the development of pressure areas.
In terms of patient needs, being in the same position constantly is physically
uncomfortable. However, mentally, a change in the immediate surroundings is also
beneficial for the patient. It is also necessary for the patient to be moved for completion
of their self care needs. This includes their hygiene needs, which include, bathing or
showering, elimination, hair, oral and nail care.
OBJECTIVE
Emergency moves
This used when there is immediate danger to the patient or to threscuer
1. Top priority in emergency care is to maintain the patient’s ABCs. Generally, you
will control any life-threatening problems and stabilize the patient before moving
2. If scene is unstable or unsafe and there is threat to the life or well-being of the
patient or of you, the above priority changes.
3. Emergency moves are a last resort. Do only when you run out of options.
An Urgent Move
This used when the patient is suffering from an immediate threat to life.
1) A patient in an MVA must be quickly moved from the vehicle for
emergency care and immediate transport
2) In this case, fully immobilizing the spine would take too much time.
A non-urgent Move
1) When there is no immediate threat to life, take the time to choose the best
equipment and positioning for moving the patient safely
2) The best way to move a patient is the easiest way that will not cause injury
or pain
3) There are many ways to move patient’s, you are only limited by your
imagination and the safety and comfort of the patient.
Emergency Moves
A patient should be moved immediately by an emergency move only when there is an
immediate danger to the patient or the EMTs including:
• Fire or danger of fire.
• Danger of explosives or other hazardous materials.
• Inability to protect patient from other hazards at the scene.
• Inability to gain access to other patients who need lifesaving care.
• Inability to provide care due to location or position.
i) Clothing Drag
1. Tie the patient's wrists together if you have something quickly available. If nothing is
available, tuck the hands into the waist band to prevent them from being pulled upwards.
2. Clutch the patient's clothing on both sides of the neck to provide a support for the head.
3. Pull the patient towards you as you back up, watching the patient at all times. The
pulling force should be concentrated under the armpits and NOT the neck.
Urgent Moves
Sometimes a patient must be moved more quickly than usual due to reasons of an
urgent nature. Weather conditions, hostile bystanders, uncontrolled traffic, and rapidly
rising flood waters are some examples of situations requiring an urgent move.
Procedure for Rapid Extrication
• One EMT should be stationed behind the patient. Place one hand on each side of
the patient's head to stabilize the neck in a neutral position. It is done as you begin
evaluation of the airway.
• The second EMT quickly applies a cervical spine immobilization device while
doing a rapid primary survey.
• A third EMT simultaneously places the long backboard onto the seat and, if
possible, slightly under the patient's buttocks.
• The second EMT supports the chest and back as the third EMT frees the patient's
legs from the pedals and floor panel.
• The patient is rotated in several short coordinated moves until the patient's back is
in the open doorway and feet are on the backboard.
• Another EMT supports the patient's head until the first EMT gets out and takes
control of the cervical spine immobilization device from outside the vehicle.
• The EMT team lowers the patient and slides the patient onto the board in short
coordinated movements. Straighten the patient's legs and make sure the neck and
back do not bend. Secure patient to backboard after the patient is brought back to
the ambulance.
Non-urgent Moves
This is the most frequent type of move and the best way to make the move depends on
the illness or injury, factors at the scene, and equipment and personnel resources
available.
i ) Direct Ground Lift
• 2-3 EMTs line up on the same side of a supine patient.
• The EMTs all kneel on one knee.
• Cross the patient's arms on the chest if injuries don't prevent it.
• The EMT at the head places one arm under the patient's head and shoulders,
cradling the head. The other arm is placed under the patient's lower back.
• The second EMT places one arm directly below the first EMT's arm in the small
of the patient's back. The second arm is placed under the patient's knees.
• The third EMT (if available) slides both arms under the patient's waist. The other
EMTs adjust their arms accordingly.
• On signal, the EMTs lift the patient to their knees and roll the patient in toward
their chests.
• On signal, the EMTs stand and move the patient to the stretcher.
• On signal, the patient is lowered onto the stretcher, which has been positioned at
waist level.
ii )Extremity Lift
This is only used when a spinal injury is not suspected. It is best used for short
distances.
• One EMT kneels at the patient's head and the other EMT kneels at the patient's
side by the knees.
• The EMT at the head reaches under the patient arms at the shoulders and grasps
the patient's wrists. If the patient is unresponsive or uncooperative, the other EMT
may assist by lifting the patient's wrists to within the reach of the partner. To
improve stability, the patient's left wrist may be grasped by your right hand and
their right wrist by your left hand. This crosses the patient's arms over their chest
creating a more secure hold with less give.
• The second EMT reaches under both knees with one arm and under the buttocks
with the other arm.
• The EMT's raises to a crouching position, then
simultaneously stand and move with the patient to
the stretcher.
i )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.
v) Flexible Stretcher
Do not use the flexible, or "pole" stretcher if spine injury is suspected. It is designed
for limited access space, on stairs or around cramped corners, or when other equipment is
not available
GUIDELINES FOR LIFTING AND MOVING
1. Stand at the side of the bed towards which patient is to be turned. Place patient’s
far arm across his chest and far leg over near leg, near arm is lateral to and away
from his body.
2. Stand opposite to the patient’s waist and face side of the bed with one foot a step
in front of the other.
3. Place one hand on patient’s far shoulder and one hand on his far hip.
4. Shift weight from forwarded leg to rear leg, patient is turned towards the nurse
hips come downward.
5. Patient is stopped by nurse’s elbows, which come to rest on mattress at the edge
of the bed.
1. Stand at side of the side of the bed and face patient head.
2. Assume a wide stance with foot next to bed behind the other foot.
3. Pass arm over the patient’s near shoulders and rest hand between patient’s
shoulder blades.
4. Rock backward, shift weight from forwarded foot to rear foot, hips coming
straight down.
1. Stand at one side of the bed facing the head of the patient. Foot next to bed is to
rear and the other foot forward. Provide wide base of support.
2. Bend knees to bring arm next to bed down to a level with a surface of the bed.
3. With elbow on the patient‘s bed grasps the nurse’s arm in the same manner.
4. Rock forward, shift weight from forwarded foot to rear foot to bring hips
downward. Elbow remains on bed, which serves as fulcrum.
1. Stand at the side of the bed and face the far corner of the foot of the bed.
2. Flex knees so that arms are leveled with the bed. Put arm under patient, one arm
under patient’s head and shoulders, one hand under small of his back.
3. Rock forward. Shift weight from forwarded foot to rear foot, hips coming
downward. Patient will slide diagonally across the bed towards the head and side
of the bed.
4. Repeat from tuck and legs of patient.
5. Go to the other side of the bed and repeat number 1 – 3. Continue this process
until patient is satisfactorily positioned.
F. MOVING THE SEMI HELPLESS PATIENT UP IN BED
1. The patient assumes a suiting position on the edge of the bed, put on shoes/slipper
and gown.
2. Place the chair at the side of the bed with back towards foot of the bed.
3. Stand facing patient with foot closer to the chair and a step in front of the other to
give the nurse a wide base of support.
4. Place patient’s hands on the nurses shoulders and the
nurse grasps patient’s waist.
5. Patient steps on the floor and the nurse flexes her
knees, forwarded knee is against the patient knee.
This provides patient’s knees bending involuntarily.
6. Turn with the patient while maintaining a wide base
of support. Bend knees as the patient sits on chair.
J. LOGROLLING PATIENT
Logrolling is a technique used to turn a patient whose body must at all times be kept
in a straight alignment (like a log). This technique is used for the patient who has a
spinal injury for the patient who must be turned in one movement, without twisting.
Logrolling requires two people, or if the patient is large, three people. The techniques
involved are:
1. Wash your hands and approach and identify the patient (by checking the
identification band) and explain the procedure (using simple terms and pointing
out the benefits).
2. Provide privacy. Position the bed should be in the flat position at a comfortable
working height. Lower the side rail on the side of the body at which you are
working.
3. Position yourself with your feet apart and your knees flexed close to the side of
the bed.
4. Fold the patient's arms across his chest. Place your arms under the patient so that
a major portion of the patient's weight is centered between your arms. The arm of
one nurse should support the patient's head and neck.
5. On the count of three, move the patient to the side of the bed, rocking backward
on your heels and keeping the patient's body in correct alignment.
6. Raise the side rail on that side of the bed and move to the other side of the bed.
7. Place a pillow under the patient's head and another between his legs.
8. Position the patient's near arm toward you. Grasp the far side of the patient's body
with your hands evenly distributed from the shoulder to the thigh.
9. On the count of three, roll the patient to a lateral position, rocking backward onto
your heels.
10. Place pillows in front of and behind the patient's trunk to support his alignment in
the lateral position.
11. Provide for the patient's comfort and safety which is position the call bell and
place personal items within reach. Also be sure the side rails are up and secure.
12. Report and record as appropriate.
DISCUSSION
By the health care worker implementing the correct lifting techniques, the nurse
and the patient's safety is not compromised in any way. Nurses should be constantly
aware of any new methods of lifting or transferring which arise, so they are able to
maximize the level of safety for themselves as well as for the patients. By the nurse using
the correct lifting and moving techniques, and not dragging the patient, the risk of the
patient sustaining further injury, such as pressure areas, is reduced. By communicating
with the client, the nurse is also made aware of any problems the client has with any
aspect of the lift.
Regular maintenance of equipment is essential so that the equipment does not
breakdown frequently. Hooks, straps and slings need to be constantly checked to ensure
optimum working order, as well as ensuring client safety.
Staff needs to be educated on the use of the lifters and regular testing would
ensure that the staffs are confident and competent in their use. This may lead to a
decrease in the amount of mismatched clients and nurses in terms of weight, as if staffs
are more confident of using the lifters there may not be as much manual lifting necessary.
Education about manual handling is also vital to ensure correct lifting techniques
are used. Constant re-evaluation of the staff's abilities and methods would ensure safety
for both parties involved. This would make staff aware that the least amount of strain
placed on the muscles and joints as possible is beneficial to them.
The re-evaluation is also important in the fact that it allows the health care worker
to be constantly up to date on any new procedures which may be developed.
CONCLUSION
When it comes to Lifting and Moving our main concern is to lift, move, and
ultimately deliver the patient to a healthcare facility without causing any further harm to
the patient, and without injuring any of the providers involved. It's a “common sense”
operation. In this section we will discuss the basics of lifting and moving a patient, and
will review some extrication procedures.
This tends to highlight the interaction of different skills learned during an EMT
course. In order to have an 'understanding' of the existing injuries, the provider must be
able to perform a quick, thorough assessment of the scene, have a solid understanding of
the possible injuries secondary to that scene assessment, be able to verify the presence (or
absence) of the suspected injury by observing the patient, decide on a proper method for
moving the patient, and ultimately be able to document the actions taken and justify them
in a concise but complete written report. So, the statement above about "common sense"
is probably not so 'common' for the everyday man, but will become 'common' for the
properly trained EMT.
More 'common' to the everyday man, are those techniques that we employ to
protect the providers. It's common knowledge that our legs are stronger than our backs,
and with our backs properly positioned, that our arms are capable "lifting tools." All
lifting maneuvers must be started with a 'straight back,' and that 'straight back' posture
must be maintained until the lift is completed.
REFERENCES
1) http://nursingcrib.com/checklist-for-moving-and-lifting/
2) http://www.alsindependence.com/Lifting_Moving_and_Handling.htm
3) http://www.emergencymedicaled.com/221Introduction.htm
4) http://www.hopperinstitute.com/lessons.html
3) When there is potential danger, which of the following method should be used to
move a patient before initial assessment and care are provide
a) Alternate move (F)
b) Emergency move (T)
c) Non-urgent move (F)
d) Rapid extremity technique (F)
e) Urgent move (F)