Operations, Patient Care

It’s Important to Know How to Handle Wheelchairs

Issue 7 and Volume 37.

You ever think about wheelchairs, Life-Saver? We see them so often I reckon most of us rarely give ’em much thought, but so many of the people you meet every day are totally dependent on them. Some chairs are pretty sophisticated and weigh more than you can lift. And some of their owners have had names as big as Itzhak Perlman, Christopher Reeve, and Stephen Hawking. Franklin D. Roosevelt was often popularized with a wheelchair during WWII, and actor Raymond Burr’s award-winning Ironside character never appeared without one.

But famous or not, the U.S. Fire Administration has estimated as recently as 1999 that 1.8 million Americans depend on wheelchairs (1). The World Health Organization currently estimates that 1% of the world’s population—some 65 million—are in need of wheelchairs (2). And to many of the people we transport in ambulances, their wheelchairs are absolutely essential. So how do you load a wheelchair? Where do you stow one safely in an ambulance, and what do you do if you simply can’t take one with you? You don’t exactly know those things when you start out as a new EMT, do you?

To be sure, you simply can’t transport some kinds of chairs in an ambulance. A powered wheelchair or scooter is non-collapsible, and its motor, batteries and heavy wheels can raise its weight to several hundred pounds. But fortunately, people who depend on those devices also tend to have one or more standard wheelchairs, and they can get by with them for a short time.My first EMS employer was affiliated with a medical equipment supplier, and I learned my lessons early about wheelchairs from them. You can expect a basic folding wheelchair to have a mass of 20 kg. Its weight increases depending on its optional attachments and the size of the patient it’s designed to accommodate.

Types of attachments might include adjustable footrests, removable handrails, reclining backrests, head supports and oxygen racks; and each of those adds weight. Many attachments can be removed prior to loading a wheelchair, and they should be. You can stow them under the bench seat. Of course, if you’re in a Type I or Type III ambulance, the outboard compartments might be better.

Before you handle any wheelchair, consider that wheelchairs can be dirty. They’re subject to spills and bathroom accidents, and many of them aren’t cleaned often. I think it’s a good idea to glove up before you handle one, and clean your hands afterward. Also, make it a habit to lock the brakes every chance you get. That’s a must before you help someone into a wheelchair or out of one. It’s also necessary to lock the brakes before you lift a wheelchair because you’ll need to grip one of its main wheels to do so.

Collapsing and expanding a wheelchair is easy if you know what you’re doing, but you can look pretty silly otherwise. To collapse one, grip the front and rear edges of its seat and lift abruptly (thus the gloves). To expand it, push downward with both hands simultaneously on the rigid supports attached to the right and left edges of the seat. Any time you stow a chair, make sure it’s folded and firmly secured with a buckle strap (such as the safety harness on your captain’s chair, for instance). Even a lightweight wheelchair can turn deadly and bounce around the inside of your compartment.

Finally, if you’re transporting a chair from a patient’s home, there’s a good chance it’s not clearly identified as their property. Do them a huge favor. Attach a piece of two-inch cloth tape to the rear-facing surface of the seat back, and print their name on it with a felt marker. Apply the tape at an oblique angle, so you attract more attention. Even manual wheelchairs are expensive (up to $500 a pop), and they can get lost in hospitals. You wouldn’t want that to happen on your shift if you could so easily prevent it, would you? JEMS

1. USFA. Oct. 1999. Fire Risks for the Mobility Impaired. In Ogilvy Public Relations Worldwide. Retrieved April 29, 2012, from www.usfa.fema.gov/downloads/pdf/publications/fa-204-508.pdf.
2. Disabilities and Rehabilitation: Guidelines on the provision of wheelchairs in less-resourced settings. In World Health Organization. Retrieved April 29, 2012, from www.who.int/disabilities/publications/technology/wheelchairguidelines/en/.