EMR Chapter 6 PDF

Notes & Highlights Flashcards John Mackay Copied Content Figure 6–25 Long backboard with straps and head blocks....

Notes & Highlights Flashcards John Mackay Copied Content Figure 6–25 Long backboard with straps and head blocks. John Mackay Figure 6–27 A pneumatic device that can be filled with air to help move a heavy patient. Low-Friction Devices Synthetic flat sheet systems may be used for lateral transfers. Reducing friction allows rescuers to move a patient from surface to surface on the same horizon- John Mackay tal plane (Figure 6–28). Figure 6–26 A bariatric board and an LBS stretcher accessory. Pneumatic Devices Air-filled devices, like the HoverJack Rescue Mat, can be used to elevate a patient for transfer to an ambu- lance cot (Figure 6–27). Before inflating the device, John Mackay the patient can be log-rolled back and forth to be positioned atop the mat. Once air is injected, the device can easily be slid horizontally around corners or even down stairs. Patients should always be secured to the device before inflating according to user Figure 6–28 A low-friction flat sheet used to help instructions. horizontal moves. Next Page 81 Go  Notes & Highlights John Mackay Flashcards Copied Figure 6–21 Traditional wooden long backboard. Content John Mackay Figure 6–23 Vest-type immobilization device. John Mackay Figure 6–22 Short backboard. John Mackay A vest-type immobilization device is also available (Figure 6–23). Both the long and short backboards feature handholds and straps. Most are made of synthetic material that will not absorb blood and are easy to clean (Figures 6–24 and 6–25). Regardless of whether you use a long or a short backboard, always Figure 6–24 Synthetic short backboard with straps. maintain manual support of the patient’s head and neck in the normal, neutral position. Maintain that support until the patient isfully secured to the Large Body Surface (LBS) Bariatric backboard. Cot Accessory Motorized stretchers use electricity to lift an extremely obese patient. When a patient is too heavy to lift Bariatric Equipment manually, he or she might also be larger than a stand- Several devices are available to assist with patients ard size cot. An LBS accessory can be affixed to an who cannot otherwise be lifted or moved safely due electric stretcher to accommodate the oversized to their size and weight. patient (Figure 6–26). Next Page 80 Go  Notes & Highlights John Mackay Flashcards John Mackay Copied Content Figure 6–20b Moving a patient up steps with a third rescuer as spotter. Figure 6–20a Stair chair. John Mackay Figure 6–20c Moving a patient down steps with a third rescuer as spotter. are ahead. A spotter can also place a hand on the back of the rescuer who is moving backward to help steady Backboards him or her. There are both long and short backboards. A long Rescuers carrying a patient in a stair chair should backboard is approximately 2 m long, which means it keep their backs in a locked position. They should flex can stabilize the patient’s entire body (Figure 6–21). at the hips instead of at the waist, bend at the knees, It is used for patients with suspected spinal injury and keep the arms (and the weight of the chair) as who are lying down. close to their bodies as possible. Once off the stairs, the A short backboard is 1 to 1.25 m long and can patient can be transferred to a conventional stretcher. stabilize the patient down to the hips (Figure 6–22). Stair chairs work well for patients in respiratory It is used to stabilize a patient with suspected spinal distress who need to be moved up or down stairs. injuries who is in a sitting position. A short board The sitting position does not worsen the patient’s may also be placed under a patient receiving CPR in breathing problems. order to facilitate more effective compressions on a cot. Next Page 79 Go  the blanket. It should be about 60 cm from the first pole and parallel to it. Notes & 4. Fold the remaining side of the blanket over the Highlights second pole. When the patient is placed on the blanket, the weight of the body secures the poles. Flashcards Cloth bags or sacks may be used as stretchers. Make holes in the bottoms of the bags or sacks so that the poles pass through them. Enough bags John Mackay Copied should be used to get the required length. Content A stretcher can also be made from three or four coats or jackets. First, turn the sleeves inside out. Then button the jacket with the sleeves inside the Figure 6–18 Scoop, or orthopedic, stretcher. coat. Place a pole through each sleeve. Stair Chairs fitted around a patient who is lying on a relatively Moving patients up or down stairs dramatically flat surface. It is used in confined areas where larger increases the potential for rescuers to be injured. The stretchers will not fit. Once secure in a scoop safest way to do it is with a stair chair (Figure 6–20a). stretcher, the patient can be lifted and moved to a A stair chair is a lightweight folding device. It has standard one. To operate a scoop stretcher, split it straps to secure the patient, wheeled legs, a grab bar apart lengthwise. Adjust its length to accommodate below the patient’s feet, and handles that extend the patient. Carefully slide it under the patient from behind the patient’s shoulders. both sides. Then lock the brackets at each end and When you use a stair chair (Figures 6–20b and lift the patient. 6– 20c), make sure as many people as necessary are A stretcher can also be improvised with a blan - helping. A spotter is needed to help manoeuvre the ket, canvas, brattice cloth, or strong sheet and stair chair down the stairs. He or she should continu- two 2.5 m (metre) poles. To improvise a stretcher ally tell how many stairs are left and what conditions IMPROVISED STRETCHER John Mackay John Mackay John Mackay Figure 6–19a Fold the short Figure 6–19b Fold the Figure 6–19c The weight of side of the blanket over the first remaining side over the second the patient should secure the pole. pole. poles. Next Page 78 Go  and the resources available. Generally, the best way to move a patient is the easiest way that will not cause Notes & Highlights injury or pain. Let your equipment do the work whenever pos- sible. Drag or slide the patient (not lift) whenever Flashcards you can. If you must lift a patient, do it with a device designed for that purpose. As a rule, carry a patient Copied only as far as absolutely necessary. Make sure you John Mackay Content have adequate help. If you do not have it, get it. Never risk injuring yourself. Typical equipment used in EMS includes various types of stretchers, the stair chair, the tarp, scoop stretcher, and backboards. Figure 6–16 Power-assisted bariatric stretcher. Stretchers A standard stretcher, or cot, has wheeled legs. It also has a collapsible undercarriage that makes it possible to load it into an ambulance (Figure 6–15). This stretcher is also made with a power-assisted lift for very heavy (bariatric) patients (Figure 6–16). A portable stretcher is lightweight, folds com- pactly, and is easy to clean. It does not have an under- carriage and wheels. It is comfortable to rest on, especially if the head is padded. It is valuable when there is not enough space for a standard stretcher or John Mackay when there are many patients. There is a variety of styles (Figure 6–17). The most common, the No. 9 cot, has an aluminum frame with canvas fabric and is often used aboard air ambulances. A scoop, or orthopedic, stretcher splits into two Figure 6–17 Portable ambulance stretcher or four sections (Figure 6–18). Each section can be (“No. 9”). Next Page 77 Go  Notes & Highlights Flashcards Copied Content John Mackay John Mackay Figure 6–14b Straight lift with a tarp. Figure 6–14c Chair lift with a tarp. Positioning the Patient ◆ Unless there is a life-threatening emergency, a How you position a patient depends on the patient’s patient who has been injured should not be moved. condition. General guidelines include the following: As necessary, the paramedics will evaluate, stabi- lize, and move the patient. ◆ An unconscious patient who is not injured should ◆ A patient who shows signs of shock may be placed be placed in the lateral recumbent position. This is in the shock position. This is done by elevating the done by rolling the patient onto one side. The left supine patient’s legs 20 to 30 cm if this will not side is preferable. aggravate injuries to the legs or spine. Next Page 76 Go  Notes & Highlights John Mackay John Mackay Flashcards Copied Figure 6–12c Slowly turn the patient toward Figure 6–12d In unison, rise to a standing Content you. position. EXTREMITY LIFT John Mackay John Mackay Figure 6–13a Get in position at the head Figure 6–13b From a crouching position, and feet of the patient. rise to a standing position. Next Page 75 Go  John Mackay Notes & Highlights Flashcards Figure 6–11c Pull the patient over one shoulder. John Mackay Copied Content Figure 6–11d Pass an arm between the patient’s legs and grasp the arm nearest you. Extremity Lift (Fore and Aft Lift) 3. The second rescuer should slip his or her hands under the patient’s knees. The extremity lift is another complete lift. It differs 4. On signal, both rescuers rise to a standing posi- from the straight lift in that rescuers make use of the tion and then move the patient to the desired patient’s extremities rather than the thorax for lifting. location. Do not use the extremity lift if the patient has injuries to arms or legs. Use this lift to move an unconscious patient from a chair to the floor. Two rescuers are needed to perform the lift (Figure 6–13): TIP 1. One rescuer takes a crouching position at the Aside from back injuries, another possible danger is body fluid patient’s head. The second rescuer crouches by that a patient may be lying in as you attempt a move. A tarp spe- the patient’s knees. cifically designed for lifting can minimize contact with contami- 2. The rescuer at the head places one hand under nants and encourage you to lift with your legs instead of your back each of the patient’s arms, reaching through to (Figure 6–14). grab the patient’s wrists. Next Page 74 Go  the patient’s armpits from the back (Figure 6–9). If and clear any equipment off the mattress. Tell the you must drag the patient a long distance and need a patient what you are going to do. Warn him or her to Notes & Highlights better grip, perform a forearm drag. Position yourself remain still in order for you to preserve your balance. as you would in a shoulder drag. After you slip your If possible, place the patient’s arms on his or her chest. hands under the armpits, grasp the forearms and drag To perform a straight lift, follow these steps Flashcards the patient toward you. Use your own forearms as a (Figure 6–12): support to keep the patient’s head, neck, and spine in Copied Content alignment. 1. Line up on one side of the patient. If at all pos- sible, line up on the least injured side. 2. Kneel on one knee, preferably the same side for Other Emergency Moves all rescuers. Other emergency moves include the piggyback carry, 3. Have the first rescuer cradle the patient’s head by one-rescuer crutch, cradle carry, firefighter’s drag, placing one arm under the neck and shoulder and and others (Figures 6–10 and 6–11). the other arm under the patient’s lower back. 4. Have the second rescuer place one arm under the patient’s knees and the other arm above the buttocks. 5. If a third rescuer is available, have him or her place both arms under the patient’s waist. The other two rescuers should slide their arms up to the middle of the back and down to the buttocks, as appropriate. 6. On signal, all rescuers lift the patient together to the level of their knees. Then, with a gentle rock- ing motion, together they roll the patient toward their chests until he or she is cradled in the bends of their elbows. The patient’s head should be tucked in toward the first rescuer’s chest. John Mackay 7. On signal, the rescuers stand up and carry the patient to the stretcher. 8. To lower the patient onto the stretcher, the steps Figure 6–9 Shoulder drag. are reversed. Next Page 72 Go  tocols. patient. The pulling should engage the patient’s arm- In general, when there is no threat to life, provide pits, not the neck (Figure 6–7). Notes & emergency medical care and wait for the paramedics Highlights to move the patient. Make an emergency move only when there is an immediate danger to the patient. Blanket Drag Flashcards The following are conditions in which you may make To perform a blanket drag, do the following. First, an emergency move: spread a blanket alongside the patient. Gather half of Copied it into lengthwise pleats. Roll the patient away from Content ◆ Fire or threat of fire. Fire should always be consid- you onto his or her side, and tuck the pleated part of ered a grave threat, not only to patients but also to the blanket as far under him or her as you can. Then rescuers. roll the patient back onto the centre of the blanket, ◆ Explosion or the threat of explosion. preferably onto his or her back. Wrap the blanket ◆ Inability to protect the patient from other hazards at securely around the patient. Grabbing the part of the the scene. Examples of hazards include an unstable blanket that is under the head, drag the patient building, a rolled-over car, spilled gasoline or other toward you (Figure 6–8). hazardous materials, an unruly or hostile crowd, and extreme weather conditions. ◆ Inability to gain access to other patients who need life-saving care. For example, this may occur at the scene of a car crash involving two or more patients. ◆ When life-saving care cannot be given because of the patient’s location or position. For example, a patient in cardiac arrest must be supine on a flat, hard sur- face in order for you to perform CPR properly. If that patient is sitting on a chair, an emergency move must be made in order for you to provide life-saving care. John Mackay The greatest danger in an emergency move is the possibility of worsening a spinal injury. To pro- vide as much protection to the spine as possible, Figure 6–7 Shirt drag. Next Page 71 Go  Notes & Highlights 70 PART 1 PREPARATORY Flashcards and arches of your feet. Your upper body should come up before your hips do. Copied 9. Reverse these steps to lower the object. Ears, shoulders, and hips Content are in vertical alignment. Posture and Fitness Posture is a much overlooked part of body mechan- ics. When people spend a great deal of time sitting or standing, poor posture can easily tire the back and Pelvis is slightly stomach muscles. This can only make back injury tucked forward. more likely. One extreme of poor posture is the swayback (Figure 6–4). In this example, the stomach is too far forward and the buttocks too far back, causing extreme stress on the lower back. Another extreme is the slouch. The shoulders are rolled forward, putting increased pressure on every region of the Knees are slightly bent. spine. Be aware of your posture. While you are stand- ing, your ears, shoulders, and hips should be in verti- cal alignment. Your knees should be slightly bent and your pelvis tucked slightly forward (Figure 6–5). When you are sitting, your weight should be evenly distributed on both ischia (the lower portion of your pelvis) (Figure 6–6). Your ears, shoulders, and hips should be in vertical alignment. Your feet should be flat on the floor or crossed at the ankles. If Figure 6–5 Proper standing position. Page 70 Go  Notes & Highlights Flashcards John Mackay Copied Content Figure 6–2c Stand straight, making sure your back remains locked. manage, with your head facing forward in a neutral position. This means that the head is not turned to the side, tilted forward, or tilted back. 5. Keep your feet flat with your weight evenly dis- tributed and just forward of the heels. 6. Place your hands a comfortable distance from each other to provide balance to the object as it is lifted. This is usually at least 25 cm (centimetres). 7. Always use a power grip to get maximum force from your hands. Your palms and fingers should come in complete contact with the object, and John Mackay all fingers should be bent at the same angle (Figure 6–3). 8. As the lifting begins, your back should remain locked as the force is driven through the heels Figure 6–3 The power grip. Next Page 69 Go  Lifting and moving a patient is an important responsibility. Many lifts and moves are routine, while others require quick thinking and skill. Consider this Notes & Highlights patient as you read this chapter. Is it within the EMRs’ scope of care to move her? If so, how can they do it without causing further injury? Flashcards Copied Content correct alignment of the spine. Keep a normal inward The Power Lift curve in the lower back. Keep the wrists and knees in normal alignment. Whenever possible, let the equip- The power lift is a technique that offers you the best ment do the lifting for you. defence against injury. It also protects the patient on In an emergency, teamwork is essential. Just as a a stretcher with a safe and stable move. It is especially football coach positions players according to ability, useful for rescuers who have weak knees or thighs. rescuers should position themselves that way too. Remember, when performing the power lift, keep Doing so can help them use their abilities to ensure your back locked and avoid bending at the waist (Fig- the best outcome in any emergency. ure 6–2). Follow these steps: All members of a team should be trained in the proper techniques. Problems can occur when team 1. Place your feet a comfortable distance apart. For members are greatly mismatched in strength. The the average-sized person, this is usually about stronger partner can be injured if the weaker one fails shoulder width. Taller rescuers might prefer a lit- to lift. The weaker one can be injured if he or she tries tle wider stance. to do too much. Ideally, partners in lifting and mov- 2. Turn your feet slightly outward. Most people find ing should have adequate and equal strength and that this helps them feel more comfortable and height. Know your physical ability and limitations. more stable. Respect them. Consider the weight of the patient and 3. Bend your knees to bring your centre of gravity what you are capable of lifting. Recognize when help closer to the object. As you bend your knees, you is needed. should feel as though you are sitting down, not Team members also need to clearly and fre- falling forward. quently communicate during a task. Use commands 4. Tighten the muscles of your back and abdomen that are easy for team members to understand. to splint the vulnerable lower back. Your back Verbally coordinate each lift from beginning to end. should remain as straight as you can comfortably Next Page 68 Go  Notes & Highlights CHAPTER 6 LIFTING AND MOVING PATIENTS 67 Flashcards INTRODUCTION Copied Content After receiving emergency care, a patient may need to be moved or transported. If this is done improperly, the patient may be injured further. It is your responsibility to see that the patient is not subjected to unnecessary pain or discomfort. Each EMS system defines if and when EMRs may move patients. Generally, you may move only patients who are in immediate danger. You may position patients to prevent further injury. You also may assist other EMS workers in moving patients. Learn and follow your local protocols. Section 1 buttocks, plus the contracted muscles of your BODY MECHANICS abdomen. These muscles let you safely generate a lot of power. Never use the muscles in your back to help you move or lift a heavy object. Basic Principles ◆ Keep the weight of the object as close to your body as As an EMS worker, you may be asked to lift and carry possible. Try to reach only across a short distance to either patients or heavy equipment. If you do it incor- lift a heavy object (Figure 6–1). Back injury is rectly, you could cause yourself injury, strain, and life- much more likely to occur when you reach across a long pain. With planning, good health, and skill, you long distance to lift an object. can do your job with minimum risk to yourself. ◆ “Stack.” Visualize your shoulders stacked above Apply the principles of proper lifting and moving your hips and your hips above your feet. Then every day. Practise enough so that they become auto- move as a unit. If your shoulders, hips, and feet are matic. Make them a habit that increases your safety not aligned, you could create twisting forces that and performance, even in the most stressful emer- can harm your lower back. gency situations. ◆ Reduce the height or distance you need to move the Body mechanics refers to the safest and most object. Get closer to the object, or reposition it Page 67 Go