It’s your Friday, and no sooner than you clock in, your tones go off for a motor vehicle crash (MVC) a few blocks from your station involving a motorcycle and a motor home.
On scene, you find a helmeted guy lying in a residential intersection behind a motor home. There’s a crotch rocket under the rear end of the motor home, and you can see the biker moving his extremities. A witness approaches you and says it seemed like something was wrong with the bike’s accelerator because both vehicles had nearly stopped at the intersection when the bike’s motor suddenly revved up, and the bike slammed into the motor home from a distance of about 15 feet.
The guy on the bike bounced off of the motor home and was moving right after the impact but couldn’t seem to get up. There’s a big dent in the motor home’s rear panel, and you’re thinking it’s a helmet imprint. The patient’s name is Mike.
Mike has no recall of the incident, and you patiently answer his repeated inquiries about who you are and where he is. You think about the body position of a rider on a ninja-style bike, with his head and torso low and leaning forward, and you’re glad to see this guy moving. But he’s complaining of paresthesia in his extremities, and even before you get him onto your backboard, you can’t help noticing he’s at least six inches taller than the length of the board.
Mike’s a dangerous patient to lift, Life-Saver. An NAEMT survey published in January 2006 revealed that of 1,300 EMSers who responded, 47% said they had sustained back injuries on the job. You’re looking at one nowƒunless you have a strategy for keeping those long legs out of your way (or you’re lucky enough to have a self-lifting cot).
Most of us don’t own enough uniform shirts to carry a clean spare all the time. So, lifting at the foot end of the cot, we instinctively protect our shirts from shoe imprints by arching our backs at least a little during those lifts.
Of course, that’s really hard on our backs. Even a simple drawing would suggest that your back is well designed for bearing weightƒbut„only if you keep it straight.
Fortunately, you can accomplish this in several ways. We talked about using ˙Detox ReeboxÓ a few years ago (May 2004„JEMS)ƒputting a pair of those disposable surgical shoe covers on the patient’s feet before you lift. Of course, if you have the luxury of an extra lifter at the foot end of the cot, a pair of EMTs can lift from there. In that case, the feet simply aren’t an issue. (That’s just about your only choice if you’re dealing with a traction device.)
If the patient’s lower extremities are intact, another option is to flex the patient’s knees and use the foot-end buckle strap on your cot as a temporary 45_ binder to keep the knees bent and the feet out of your way. That’s especially helpful if the patient is cooperative or unresponsive, and you need to traverse an incline, like a hill or a few stairs. You simply keep the patient’s foot end down. If the patient is cooperative, you can instruct them to exert a small amount of muscular force against the strap, thus using the mattress and the strap as a braking system.
Probably the simplest technique comes to us from former„Grady„Memorial„Hospital (Atlanta) superstar paramedic, Henning Plesner, and his„Colorado counterpart, Melissa Lunt. These two make up their sheet with an extra fold in it, about 12 inches proximal to the foot end of their mattress. When they encounter a jumbo-length patient, they simply unfold that end of the sheet and wrap it around the patient’s feet.
At least one side benefit is it also offers you and your ambulance some protection from the effects of Toxic Socks Syndrome. Of course, the ultimate protection from that phenomenon is a 30-gallon trash bag you can keep folded and tucked under the pillow.The author would like to thank Tony Garcia, USMC, H. F. Plesner, NREMT-P, and Melissa Lunt, NREMT-P, for their help in the preparation of this article.