Paramedic Steve Steele and his partner, Stephen Begay, were called to a skilled-nursing facility a few weeks ago. There, they encountered a 300-lb., 5'2" woman in respiratory distress.
Steele has been a medic for more than 30 years—long enough to know that sick people are getting heavier. And certainly long enough to understand how dangerous this woman’s body habitus was for any EMS crew. Why was it dangerous? Because not only was she heavy, but she also had no bony “handles.” So she defied the system of leverages one normally applies when they lift people. And this particular woman was neither able to move herself nor able to help the crew.
Like so many of us, Steele has suffered numerous back injuries in the past related to lifting with cold joints, ligaments and muscles. It’s likely that at least some of those injuries were because, like most of us, he was taught in his early days not to let sick people walk. That meant he did a lot of unnecessary lifting and carrying.
I know, Life-Saver. You’re thinking of stair chairs. They’re essential tools. But if the early ones had made perfect sense, we’d have used them more. Even the ones we use today are primarily descent devices. Not only that, but not all people fit in stair chairs, and stair chairs are still not always the best conveyances. Their small wheels and upright designs are simply not suitable for moving anyone much farther than a few feet (certainly not over irregular terrain). So using one still presupposes lifting, weight-bearing, carrying and dragging maneuvers by you-know-who. And that’s a problem. Think about all those other professional power-lifters. Before they attempt a potential maximum-capacity lift, they get to warm up for at least 20–30 minutes. We don’t.
But that 30-year background should tell you that Steele’s a very smart guy. Steele and Begay applied an “Aha!” strategy. Noticing their patient was already lying on a Hoyer sling, they asked a certified nursing assistant (CNA) at the facility if they could access the facility’s lift.
A Hoyer Lift is a transfer device composed of a soft, reinforced sling and a small, portable crane that works like an auto mechanic’s engine hoist. In fact, when R.R. Stratton applied for a U.S. patent (#2706120) for the first one in 1955, the patent application specifically referred to it as “an automotive engine hoist.”1
A Hoyer Lift’s operation is simple. You situate the lift’s horizontal boom directly over the patient. Then you attach the sling to a yoke on the lift, and the lift does all the work. In fact, in this situation, a pair of CNAs operated the lift themselves and put the patient on the ambulance cot.
The two Steves transported their patient to a community hospital, where the hospital staff then used their lift to move the patient from the ambulance cot to their bed. The medics then returned the sling to the discharging facility. Neat, huh?
To perform all their other duties, CNAs have to move sick people just like we do—only they don’t have access to a lot of help. They’re routinely required to get people onto and off of commodes and into and out of showers. They also need to move people between beds and wheelchairs, pretty much by themselves. It makes sense that every skilled-nursing facility would have one or more Hoyer lifts (or similar transfer devices) and use them all the time.
In the past, Hoyers (also called sling lifts) were designed around a manual hydraulic jack. You can still find the manual ones online, but most now have motors that are battery-powered. Hospitals typically have not one, but several. We were able to borrow one from a small community hospital so we could train with it.
On the subject of training, ample resources are available online, including step-by-step narrated videos. Hoyer specifies that it takes a minimum of two people to operate one of their lifts. Configurations include wall-mounted and ceiling-mounted lifts, as well as mobile ones. You can get slings from various manufacturers in a range of sizes for about $50 (disposable) to $500 (reusable).
Appreciation for CNAs is even cheaper. That’ll cost you between $10 (for an occasional dozen donuts) and nothing at all (for hugs).
They could really use both. JEMS
1. IP.com. (2009-2011). Floor Crane with Adjustable Legs. In Intellectual Property. Retrieved Oct. 5, 2011, from http://ip.com/patent/US2706120.
This article originally appeared in November 2011 JEMS as “Bring a Sling: Humble Hoyer deserves an EMS look.”