Lift Different. Stop Injuries.
Anyone who has been in the fire and EMS industry for more than a couple years typically knows this: there are tons of needless injury rates among prehospital providers. Studies that date from the 1990s to this day reveal that fire and EMS personnel have consistently more lifting-related injuries than do workers in other industries.
Traditionally there is a minimum of five patient movements that a prehospital worker will perform on a typical transport:
1) Loading the patient onto the stretcher
2) Lifting the stretcher to waist height
3) Loading the stretcher into the ambulance
4) Unloading the stretcher
5) Transferring the patient from the stretcher to the hospital bed
Thanks to Stryker and Ferno, three out of five of those lifting movements can be avoided using a power stretcher system. If power stretchers can eliminate three of the five manual lifts, then it makes sense that the movements that cause the most injuries (such as moving the patient on or off a stretcher) often happen during your average transport call. These movements can be summarized into three categories; lifting, carrying, and transferring.
There are many soft stretchers on the market that are specifically designed for carrying and transferring patients. Many providers have been taught to use soft stretchers as a lifting device, but this is a huge mistake. Using soft stretchers this way has exposed many providers and patients at a higher risk for injury. In fact, the Centers for Disease Control and Prevention tracked injuries suffered by prehospital workers between the years 2008 — 2016 and found that the average number of upper and lower trunk injuries did not decrease over the 8-year period. This goes to show that if we continue to lift patients as we always have, we’ll continue to have the same injury that we’ve always had. It’s time to do something different.
Let’s look at 3 leading reasons why improvised lifting techniques with soft stretchers have failed to reduce lifting related injuries and are unsafe for the provider and patient.
- Soft stretchers aren’t designed for lifting
This first reason may come as a shock for many readers, especially since soft stretchers are often referred to by providers as “lift sheets.” However, if you read the training manual or examine nearly any of the manufacturer’s recommendations you won’t find soft stretchers as advertised for lifting. Instead, you’ll find words like carry, or transfer. This is because the manufacturers made these devices specifically for carrying, dragging, sliding, and transferring patients — not lifting. Soft stretchers do an incredible job at performing the functions that they were designed to do, and there is need for these products on every ambulance. However, every ambulance needs to have the proper tools to help lift patients from the floor or out of a chair as well. Just as you wouldn’t use a Sam splint as a backboard, we shouldn’t be using sheets or soft stretchers for lifting.
- Soft stretchers prevent proper lifting practices and ergonomics
When soft stretchers are used for what they’re designed for — carrying, dragging, or transferring a non-ambulatory patient — they enable proper ergonomics and make it easy for four or more to providers to help with the movement of the patient. However, no more than two providers can effectively help when a soft stretcher is utilized in an improvised fashion to lift a patient to their feet or chair. Additionally, the grip points force bodily motion that puts thousands of pounds of compressive and shear forces on the lifter’s spine. The picture below will illustrate this point:
Red Arrows: When the soft stretcher is used in this improvised fashion, it creates unequal grip points for the lifter. When lifters don’t have handles that are of equal height and in a direct line between themselves and the load, bad lifting ergonomics are sure to follow.
Blue Arrows: Providers are forced to drop their shoulder to grasp the handle by the patient’s knee while bending and rotating their spine to be able to grasp the other handle up by the patient’s shoulder (as illustrated by both providers in the picture above). There isn’t a single gym exercise that teaches this kind of lift when lifting weights. We’d never dream of using this grip when squatting in the gym, so why would we use this grip when lifting much heavier weight in the field?
Yellow Arrow: When the handles aren’t attached to the patient, the grip points end up being too high — this causes the lifter to hyperextend towards the end of the lift. The yellow arrow shows the lifter having to be on her tippy toes to get the patient off the ground enough to be set on a chair. When lifting, it is important to keep the load close to your body (this is impossible to do when using a soft stretcher to lift patients — to prevent needless bending and hyperextending.)
Green Arrows: Again, the handles are too high off the ground and not attached to the patient, which causes the lifter to hyperextend when completing the lift. Both lifters are pinching their shoulders up which is a sure sign of a hyperextended lift.
In summary, when soft stretchers are used as lift devices providers are often limited with the number of people that can help with the lift, and the handle placement causes the providers to go from bent over with a slight twist to hyperextend as they perform the lift. A career spent utilizing these types of improvised lifting techniques will wreak havoc on the lifter’s spine.
- They do not attach to the patient
Whenever a soft stretcher is used to lift a patient either to their feet or chair the lifters have very little control over the patient in the event anything goes awry (see the image below). Unfortunately, patient drops aren’t as uncommon as we’d like to admit, which goes against the core fundamental of our job to do no harm. But should we really be that surprised that there are an estimated 42,000 dropped patients every year when the methods used to lift patients are based off improvised tradition that leave the patient unsecure during the lift?
Where do we go from here?
Loading and unloading a patient from a stretcher poses the most risk for injury for EMS providers during their shifts. There are three primary moves that take place whenever a patient is being unloaded or loaded onto the stretcher; carry, transfer, or lift. If you look in the back of nearly any ambulance there will presumably be a myriad of devices meant for carrying or transferring a patient. However, the same isn’t true for lifting devices — even though lifting patients is an essential part of our roles as EMS providers. Though many progressive EMS agencies are rapidly adding lifting devices to their ambulances due to the increased number of lift assist calls, the industry still has a long way to go.
Until every provider has access to equipment specifically designed for lifting patients, rather than only having carrying devices, we will continue to experience the lifting related injuries that are plaguing our industry. There continues to be more and more manufacturers providing patient lifting equipment — some of which offer a free field trial so you can test the equipment out before committing to a purchase.
So remember this: Lift Different. Stop Injuries.