Administration and Leadership, Operations, Patient Care, Rescue & Vehicle Extrication, Training

Handles for People: Revisiting the Montana Blanket Roll

Issue 7 and Volume 34.

Last summer, my friends and I were doing some drills at my house. The topic was residential extrication, and we practiced ways to get people out of bed, around corners, up and down stairs, and out of bathtubs. You know, the kinds of things you’d better be able to do every day, but you don’t exactly learn in any classroom.

That bathtub part can be a real back-breaker, and this column has discussed at least three strategies for it over the years. My friend Steve Rollert brought up what has to be the best one. It’s a quick, safe and easy answer to dealing with slippery people. It was published in June 1987 (on p. 34), but I had forgotten all about it.

Between the two of us, Mike Smith and I have been doing Tricks for 30 years. I haven’t asked Mike about this, but I think some of the best ideas we’ve ever published have come from Montana. In the early 1980s, an EMT named Hank Harshner sent us two ideas: one for using a pair of sheets to rig a Swiss Seat on a scoop stretcher so you could move a patient vertically, even with C-spine precautions in place. The other was a modification of the same idea that you could use to convert a scoop into a traction splintƒfor one or both lower extremities. (Hank, you out there? You’re a legend, buddy. Thanks!)

I first heard about this bathtub idea from some medics in Durango, Colo., when I lived in California. Sure enough, they got it from a guy in Montana. Nobody knew who that person was, so we named it the Mysterious Montana Blanket Roll. Who knows? Maybe it came from ol’ Hank himself.

People who get stuck in bathtubs can be really sick by the time you find them, Life-Saver. Not only do they quickly become hypothermic, but they can suffer fractures, especially in old cast iron tubs. Plus, they can be stuck for a long time — both urinating in and drinking their own soapy bath water — before someone finally discovers them. Don’t know about you, but I can remember at least a couple who died in that sad predicament.

To extricate a patient like that, remove any glass shower doors and put them on a bed (so they’re out of your way, but they don’t fall and break while you’re working). Remove or wrap the shower curtain around its rod. Next, drain the tub completely before refilling it with fresh, warm water. That eliminates excreta, and it helps you rewarm the patient while you get your Os and IVs going.

Meanwhile, lay a bulky blanket on the floor and fold it into a double-ply triangle. (It’s OK if the apex of the triangle has two points instead of one; most blankets aren’t perfectly square.) Now, roll it snugly from the longest (creased) edge toward the apex, so it forms a long snake. You can use a few pieces of Transpore tape, if you like, to keep it together and tight.

The thickest part of this roll will be in the middle, because there will be more blanket there. You’re going to use that thick part to stabilize the C-spine. Approaching from behind, place the middle of the roll behind the patient’s neck and bring it forward on both sides. Cross it snugly in front of the neck and route the two “tails” beneath the armpits on both sides. These will be your two “handles.” Instruct the patient to give himself a hug.

This is more of a lifting tool than a carrying device. If you try to carry someone even a short distance, the roll will eventually lift the patient’s arms and loosen up. But it’s a very good lifting device, and it does a pretty good job of stabilizing the patient’s head in the process. It would be a good idea to have the cot or other transfer device handy once you get the patient airborne. Or, lay out some towels on the floor, lay the patient down and then transfer them to a scoop.

Once you get the patient on a stretcher, you can either incorporate the roll into your C-spine strategy or remove it altogether (depending on the patient’s shape). Also, there’s no reason why you should consider it only in bathtubs. You could use it in almost any extrication scenario.JEMS

Thom Dickhas been involved in EMS for 39 years, 23 of them as a full-time EMT and paramedic in San Diego County. He’s currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at[email protected]

Acknowledgement:The author would like to thank Brighton Firefighter Travis Hahl, NREMT-B, for his help in illustrating this trick.