Lifting And Moving Position

FROM NURSING DEGREE PROGRAM

CONTENTS TITLE

PAGES

INTRODUCTION

1

OBJECTIVE

2

PURPOSES

3

BASIC PRINCIPLES

3

TYPE OF MOVES

4

PRINCIPLES FOR MOVING PATIENTS

6

EQUIPMENT FOR MOVING PATIENTS

9

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

1.

To discuss the purposes of lifting and moving using proper technique

2.

To know the principles of lifting and moving

3.

To discuss three categories of moving

4.

To apply the proper technique in lifting and moving patient

5.

To appreciate the important of using the proper technique in lifting and moving

6. To know the guidelines for lifting and moving position.

PURPOSES OF LIFTING AND MOVING POSITION

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To encourage patient’s mobility

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To promote patient’s comfort

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To promote blood circulation

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To maintain skin integrity

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To transfer patient safely

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To avoid injury whenever a patient is moved.

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To practice using equipment.

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To know that certain patient conditions call for special techniques.

BASIC PRINCIPLES OF LIFTING AND MOVING PATIENTS 1) Keep the weight of the object as close to the body as possible. 2) To move a heavy object, contract your abdominal muscles and lift with the leg,

hips, and gluteal muscles. 3) When lifting, align your shoulders, hips and feet in a vertical line. 4) Reduce the height or distance through which the object must be moved.

TYPE OF MOVES . 1) Urgent moves –Non-urgent moves – no immediate threat to life exists and the patient can be moved in a normal manner when ready for transport. 

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. 4. Three reasons to use an emergency move: 

There is an immediate environmental danger to the patient or rescuer such as fire, exposure to explosives, toxic fumes, etc.



You cannot gain access to other patients who need life-saving care.



You cannot render life-saving care due to the patient’s location or position.

5. Three types of emergency moves: i. Bent Arm Drag ii.

Clothing Drag.

iii.

Blanket Drag.

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. Example: Crutch Method-patient leaning on you while walking 4) Extremity lift is the most popular non-urgent move

PRINCIPLES FOR MOVING PATIENTS 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. ii) Blanket Drag 1. Lay a blanket lengthwise beside the patient. 2. Kneel on the opposite side of the patient and roll the patient toward you. 3. As the patient lies on their side while resting against you, reach across and grab the blanket.

4. Tightly tuck half of the blanket lengthwise under the patient and leave the other half lying flat than gently roll the patient onto their back. 6. Pull the tucked portion of the blanket out from under the patient and wrap it around the body. 7. Grasp the blanket under the patient's head to form a support and means for pulling. 8. Pull while backing up and while observing the patient at all times.

iii) Bent Arm Drag 1. Reach under the patient's armpits from behind and grasp the forearms or wrists. 2. Use your arms as a cradle for the patient's head and keep the arms locked in a bent position by your grasp. 3. Drag the patient towards you as you walks backwards, observing the patient at all times. 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.

EQUIPMENT FOR MOVING PATIENTS i )Wheeled Stretcher Two basic types of stretchers are used: the two-person and the one-person. The twoperson 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. ii) 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 balance when moving them. The chair is tilted slightly backwards to allow movement with the wheels on the chair.

iii) 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. iv) 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. 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 Guidelines for Safe Lifting •

Consider the weight of the patient together with the weight of the stretcher or other equipment being carried and determine if additional help is needed.

•

Know your physical ability and limitations. Know your combined ability with your partner. If absolutely necessary, you can ask bystanders to help. You or your partner must be in charge and give the orders, not the bystander.

•

Lift without twisting. Avoid any kind of swinging motion when lifting as well.

•

Position your feet shoulder width apart with one foot slightly in front of the other. Wear proper boots that go above the ankle to protect your feet and help keep a firm footing. Boots should have nonskid soles.

•

Communicate clearly and frequently with your partner. Decide ahead of time how you will move the patient and what verbal commands will be used. Also, tell the patient what you will be doing ahead of time. A startled patient may reach out or grab something and cause a loss of balance.

Guidelines for Lifting Cots and Stretchers Most back injuries to EMTs can be avoided by following the following guidelines: •

Know or find out the weight to be lifted.

•

Use a minimum of two people to lift, even if a one-person stretcher is being used.

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Use an even number of people to maintain balance during the lift.

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Know the weight limitations of the equipment you use. Know what to do if the patient exceeds the weight limitations of the equipment.

•

Use the power lift or squat lift position. Feet are shoulder width apart. Back is tight and the abdominal muscles lock the lower back in a slight inward curve. Distribute weight to the balls of the feet. Keep both feet in full contact with floor or ground. While standing, keep the back locked in, as the upper body comes up before the hips.

•

Use a power grip to get maximum force from the hands. Hands should be at least 10 inches apart. Palms face up and fingers in complete contact with the stretcher bar.

•

Lift while keeping your back in the locked-in position.

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When lowering the cot or stretcher, reverse the steps.

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Avoid bending at the waist.

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Avoid twisting. "Feed" the stretcher into the ambulance while face across the patient.

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.

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Never leave the patient alone on the stretcher.

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Load the stretcher with the foot end first or going upstairs.

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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.

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Always maintain a firm grip on the stretcher when rolling to prevent a tipover.

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Lower the stretcher and carry end to end if the ground is to rough to roll the stretcher safely.

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Use four EMTs, one at each corner, when moving a stretcher across extremely rough terrain.

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Turn corners slowly and squarely, avoiding sideways movements that might make the patient dizzy.

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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

COMPONENT SKILL FOR MOVING AND LIFTING A. MOVING TO THE SIDE OF THE BED 1. Stand facing patient at the side of the bed. 2. Assume a broad stance, one leg forward of the other with knees and hips flexed, bring arms to the level of the bed. 3.

Place one arm under shoulders and neck of patient and another arm under small of patient’s back.

4. Shift body weight from front to back foot, rock backward to a crouch position, bringing patients towards his side. Nurse’s hips come downwards as he rocks backwards. Patient should be pulled. B. HELPING THE PATIENT TURN ON HIS SIDE 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. C. RAISING SHOULDERS OF THE HELPLESS PATIENT 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. D. RAISING THE SHOULDERS OF TH SEMI HELPLESS PATIENT 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. E. MOVING THE HELPLESS PATIENT UP IN BED 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. Patient flexes knees, bringing heels up to his buttocks. 2. Stand at the side of the bed, turn slightly towards patient’s head. One foot is stepped in front of the other foot closer to bed. Feet are directed towards the head of the bed. 3. Place one arm under patient’s shoulders, one arm under thighs. Flex knees to bring arms to the level of the surface of the bed. 4. Patient places chin on his chest and pushes with his feet. Nurse shifts weight from rear foot to forwarded foot. Patient grasps the head of the bed with his hands to pull on his own weight.

G. HELPING THE SEMI HELPLESS: PATIENT RAISE HIS BUTTOCKS 1. Patient flexes knees and brings heels towards the buttocks. 2. Nurse faces the side of the bed and stands opposite to the patient’s buttocks. Assume a board stance. 3. Flex knees to bring arms to the level of the bed, place one hand under sacral area of the patient. The elbow is resting firmly on the 3 bed. 4. As the patient raises his hips, the nurse comes to a crouching position by bending his knees while his arms act as a lever to help support the patient’s buttocks. Nurse’s hips come straight down. While supporting patient in this position, free hand can place bedpan under the patient’s sacral area. H. ASSISTING THE PATIENT TO A SITING POSITION ON THE SIDE OF THE BED 1. Patient is turned to the side towards the edge of the bed. 2. The nurse ensures that the patient does not fall out of the bed by raising the head of the bed.

3. Face the far bottom corner of the bed, support the shoulders of the patient with one arm and the other arm helps patient extend lower legs over the side of the bed top the rear of the other foot. 4. Bring patient to a natural sitting position on the bed; support the patient’s shoulders and legs over the side of the bed. Pivot body to lower legs of the patient. Patient’s legs are swung downward. Nurse’s weight is shifted form front to rear leg.

I. ASSISTING THE PATIENT TO GET OF BED AND INTO A CHAIR 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. Learning to move a patient without jeopardizing further injury requires a thorough understanding of any existing injury and what, if any, movement is allowable in the presence of that injury. There will be times where the scene of this emergency will dictate that an urgent (immediate) move is necessary and, in such cases, it may be necessary to weigh the possibility of additional injury as a result of the move against the possibility of additional injury from the unstable scene. If an urgent move is indicated every possible attempt must be employed to safeguard the patient, and again, a thorough understanding of any existing injury is a must. 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 5) Kozier. B. et al.(2008).Fundamentals of Nursing: Concepts, Process and

Practice.(8th ed.).Prentice Hall: New Jersey.

EXAMPLE OF QUESTION

1) Types of emergency moves: a) Bent Arm Drag

(T)

b) Clothing Drag.

(T)

c) Blanket Drag.

(T)

d) Feet Drag

(F)

e) Pillow case Drag

(F)

2) The purpose of assessing tasks and surroundings for risk factors is to a)Take steps to protect yourself

(T)

b) Slow down your work pace

(F)

c) Delay care to the patient

(F)

d) Distribute the workload to staff (F) e) To transfer patient safely

(T)

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)