Administration and Leadership, Cardiac & Resuscitation, Columns, Patient Care, Training

Moving a Power Cot without it Tipping

Issue 1 and Volume 39.

EMS is full of nuggets, Life-Saver—tiny bits of insight that can impact our medicine and our safety, all by themselves.

We tend not to hear about them (or at least remember them) during our initial training unless our teachers are real pros.

Dennis Edgerly is one of those; so is Twink Dalton. And so was the late Mike Smith. Mostly though, we sort of discover nuggets in the field.

Consider the following examples.

  • Remember to have an asthmatic rinse his/her mouth with water before you administer inhaled meds. (People with chronic breathing disorders tend to be mouth-breathers whose mucous membranes are therefore dry, and their oral mucosa tend to be coated with the residues of their own inhaled meds. Many of those are aerosolized powders.)
  • Your ambulance can earn you a living or kill you, and it nearly always warns you before it fails. It needs to be able to do the four Ss: Start, steer, stop and stay running. Also, its environmental systems need to work. If any of those things seem hinky, consider yourself out of service.
  • O2 masks are pretty good primary spit catchers.
  • People may forget what you say and they may forget what you do, but they will forever remember how you make them feel. That’s why they sue us, and it’s why they bring us cookies, sometimes.
  • If you ever want to piss somebody off, don’t bother disrespecting them directly. It’s much more effective to diss somebody they love more than anything in the world. (By the way, the inverse principle applies when you’re trying to reassure somebody or earn their trust.)
  • People lie, sometimes; it’s just one of the ways they handle stress. If you take that personally, it will eat you alive.
  • There’s a big difference between the dead and the dying. You know what dead looks like. We try to resuscitate the dying, and if we can’t, they’re dead. When somebody is dead, the real emergency is the family’s, and the best thing we can do for them is to facilitate the bereavement process. (You should almost never perform manual CPR in a moving ambulance.)
  • Try hard not to move a fully elevated ambulance cot anywhere with a sick person on it. And try hard to never, ever move one sideways when it’s loaded. (Even just a few inches.)

You can bet the farm on every one of those perspectives, but the last one has never been more important than it is today. The aluminum cots of the ‘70s, ‘80s and ‘90s weighed something in the neighborhood of 30 kg. Today, equipped with a hydroelectric lifting system, a battery, a stock mattress, a pillow, restraints, linen, a blanket, buckle straps and oxygen, the mass of an ambulance cot can be triple what it once was.

The lion’s share of its mass is in its upper carriage. And most importantly, in its fully raised loading position, the elevation of that upper carriage can be farther above the ground than ever.

The most popular cots today (self-powered or not) incorporate four casters to enable its movement in any direction at any level. An ambulance cot must be able to do that, so at its lowest level crew members don’t have to sacrifice their backs dragging it into position next to a couch or a bed. But think about how a caster works: In order for it to respond when you propel your cot in a desired direction, each of its wheels’ horizontal axles need to trail the vertical pins around which they swivel.

So, when you push your cot sideways, it can become unstable. The point where each wheel bears its share of the cot’s weight actually trails the point where it swivels. Moving sideways at maximal elevation, if you’re pushing on the upper carriage of your cot and either of the two leading wheels encounters an obstruction like a piece of gravel or a seam in the pavement, the inertia of the upper carriage will help to topple it.

You can prevent that from ever happening by developing some simple habits. Move the cot lengthwise—and only lengthwise—whenever you can, not just when you’re traversing an incline. Access its highest level only during loading or unloading. And avoid moving it sideways, loaded or not, unless you’ve first lowered it to an elevation of hand-height or less.