Emergency Care Textbook Professional Responders-Part 19 PDF

19 Reaching, Lifting, and Extricating Patients Key Content Gaining Entry to Buildings..... Motor Vehicles........................ Stabilizing Vehicles.............. Accessing the Patient........... Moving Patients...................... Body Mechanics................... Stretchers and Lifting Devices...

19 Reaching, Lifting, and Extricating Patients Key Content Gaining Entry to Buildings..... Motor Vehicles........................ Stabilizing Vehicles.............. Accessing the Patient........... Moving Patients...................... Body Mechanics................... Stretchers and Lifting Devices............................... Lifting and Moving a Stretcher............................ Bariatric Patients.................. 338 338 339 339 340 341 344 346 346 As a responder, you may encounter emergencies where you are unable to treat the patient because he or she is inaccessible. A patient may be unresponsive inside a locked vehicle, or may be able to call EMS from a residence but unable to unlock the door for responders. In these cases, you must gain access quickly and safely so that care can be provided. REACHING, LIFTING, AND EXTRICATING PATIENTS Introduction 337 GAINING ENTRY TO BUILDINGS If the patient is in a building, the door may be locked. Larger buildings such as office or apartment buildings may have multiple stages of entry: You may have to first enter the lobby with an electronic pass card, and then enter the patient’s apartment with a key. Some buildings may require a pass for the elevator or stairwells as well. If you respond to a call at a building, you will have to gain access to the patient before you can perform any assessments or interventions. Because of the legal implications of breaking into a building, the procedure you must follow is often very specific but may vary widely between responders or locations. In many cases, responders will contact their dispatcher, who will attempt to contact the person who placed the emergency call to see if he or she can open the door or consent to forcible entry. In some cases, law enforcement personnel should be requested, as they may have legal authority to perform forcible entry in emergencies. In other cases, responders may be authorized to perform forcible entry as well, especially in life-threatening situations. Always confirm that a door is actually locked before initiating forcible entry procedures: This simple step can often be overlooked. REACHING, LIFTING, AND EXTRICATING PATIENTS MOTOR VEHICLES 338 Patients involved in motor vehicle collisions may be inaccessible inside their vehicles. Doors may be locked or crushed, and the windows may all be rolled up. A vehicle that has been involved in a collision may also be in an unstable position, meaning that it could move or shift during extrication, putting occupants and responders at risk. In other instances, fire, downed power lines, or other factors may prevent you from accessing the patient. When a patient is unable to exit the vehicle, this is sometimes referred to as patient entrapment. Extricating patients from vehicles often requires specialized qualifications and equipment. If your training does not cover an extrication situation you encounter, request specialized personnel. Do not put yourself and the patient at risk by attempting an extrication you are not trained or equipped for. In cases of patient entrapment, you must immediately strategize how to safely gain access to the patient before you can begin providing care. During any extrication, or while attempting to gain access to a patient, it is important that all team members communicate clearly. Develop a plan so that each team member knows what role he or she will play. Multiple agencies may respond to an MVC. For example, fire and police personnel may both be on scene. It is important to establish Emergency Scene Management (ESM) or Incident Scene Management (ISM) protocols to ensure that all personnel on the scene can coordinate their efforts effectively. Consider your own safety (often referred to as rescuer safety) when attempting to reach a patient; act only within your training and use the appropriate equipment and PPE. Remember to practise precautions that prevent further injury to the patient. When assessing the scene of an MVC, ensure that you have walked around the vehicle(s) involved. Look carefully for hazards, such as leaking fuel, and for patients who are not in the vehicles (e.g., pedestrians who may have been struck, or occupants who were ejected in the collision). One technique is to have two responders circle the vehicle in opposite directions, one looking inwards to the vehicle and the other looking outwards at the area around it. This helps to ensure that the area is clear of hazards and that all patients have been identified. Equipment that will help you safely navigate the scene and keep it under control may include markers, flares, or flashlights. Perform a full scene assessment and check for flammable materials (e.g., leaking fuel) before lighting equipment such as flares. If available, use electric lights instead (as they do not create the risk of a fire). Gaining access may be a lengthy and unnerving process for the patient. Stay with the patient and try to keep him or her calm by explaining what is happening. Stabilizing Vehicles Stabilizing a vehicle helps to ensure that the vehicle does not slide, shift, or roll into a position that could injure the responders or patient(s). All vehicles should be stabilized before any attempt is made to access occupants. Depending on a vehicle’s position, environmental factors, and other elements, stabilizing a vehicle can be either a simple or a highly technical task. Environmental factors influencing the stability of a vehicle include ice, water, snow, or inclined surfaces or embankments. The simplest stabilization technique is called chocking. Any vehicle that has any chance of rolling (i.e., any vehicle that has its tires on the ground) must be chocked. Chocking involves placing blocks or wedges against the wheels of a vehicle to reduce the chance of it rolling backwards or forwards. MVCs that involve overturned vehicles or multiple vehicles may require more technical stabilization techniques and tools. To reduce the risk of injury, avoid the path of any vehicle that could move (i.e., do not stand in front of it or behind it). To further stabilize the vehicle, have a responsive occupant place the vehicle’s gearshift in park, turn off the ignition, and activate the emergency brake, if possible. A vehicle with a manual transmission should be placed in neutral gear, rather than park, with the emergency brake on. Once the vehicle’s ignition is off, the keys should be placed on the dashboard or, if possible, handed to the officer in charge of the extrication. If the vehicle has no responsive occupants, or if none is able to perform the steps above, chock the vehicle thoroughly and access the interior as described below. Once you have access, put the gearshift in park, turn off the ignition, and activate the emergency brake. Use extra caution around vehicles equipped with proximity keys. The ignition in these vehicles can be activated by pressing a button in the vehicle so long as the keys are within a certain range. Accessing the Patient Once you are certain that the vehicle is stable, check the doors to see if any are unlocked—it is easy to forget this simple, time-saving step. If the doors are locked, the patient(s) inside (if responsive) may be able to unlock at least one door for you. If the windows are open, you may be able to unlock the door yourself. If glass needs to be broken in order to access the patient, choose a window as far from the occupant(s) as possible. In addition to the hazard created by shards of glass, glass dust created when the window breaks can be inhaled and cause respiratory issues. Instruct any responsive patients to cover their faces before you break the window. Wear appropriate PPE (e.g., respiratory mask, eye protection, and thick leather gloves—ideally extrication gloves). In non-emergency situations, consider alternative options such as calling a towing company or auto association. Sometimes, locked or jammed doors require you to enter the vehicle through a window. If the window is open or can be rolled down by someone inside the car, this can provide an entry point. In some cases, gaining access to the patient is more challenging and requires specific extrication equipment and knowledge. Each jurisdiction will have specific protocols outlining patient extrication. Airbags Airbags can pose serious risks for responders. Airbags must deploy in the fraction of a second between when a collision occurs and when the force causes occupants to strike the vehicle’s interior. Their deployment is carefully controlled to reduce the risk of injury to occupants who are seated properly and wearing seatbelts. If they deploy during patient extrication, they can strike a patient or responder with enough force to cause serious injury or even death. REACHING, LIFTING, AND EXTRICATING PATIENTS Gaining access to a vehicle can be a stressful process, especially if patients inside have lifethreatening injuries: You may be tempted to rush the process. Always follow the proper procedures, taking all necessary safety precautions. Attempting to perform an uncontrolled extrication creates major risks for both the patient and the responder. 339 Never place a hard object between the patient and an airbag deployment zone. Avoid placing yourself or a patient where you could be struck by a deploying airbag. Even once the vehicle is turned off and the battery is disconnected, responders should assume that any airbags are live and could deploy at any moment. Some modern airbags have more complex deployment systems: Even an airbag that has deployed in the collision could still redeploy during extrication using a secondary charge. The number and location of airbags varies between vehicle models, ranging from two airbags (one each for the driver and passenger) to complex systems with 10 or more deployment zones throughout the vehicle. REACHING, LIFTING, AND EXTRICATING PATIENTS Look for any electronic devices (e.g., mobile phones, GPS, computers) that are plugged into the vehicle’s electrical system. These should be disconnected as soon as possible, as these devices can cause power feedback (i.e., reverse power to the vehicle’s safety devices, including the airbags), leading airbags to deploy unexpectedly. 340 There are many other supplemental restraint systems (SRS) used in modern vehicles: Convertibles, for example, may have pop-up style roll bars that deploy rapidly when the vehicle reaches a certain angle or is in a certain type of collision. Any responder performing vehicle extrications should remain aware of innovations in vehicle safely technology and understand how they can be accommodated with safe extrication practices. Hybrid and Electric Vehicles Hybrid and electric vehicles pose an additional risk for professional responders because of their unique electrical systems. They may have highvoltage power cables running through their bodies: These are usually orange. Damage to these cables from the collision, or subsequent damage caused by the extrication process, can result in electrocution. Some hybrid and electric vehicles produce little or no noise, so it may not be obvious whether the ignition is on. Damaged electric or hybrid vehicles may restart independently. Keep in mind that some hybrid vehicles do not have an ignition key and instead have an on-off switch that must be pressed. Therefore, some models may remain live for up to 10 minutes after the vehicle is shut off or disabled. Always follow the manufacturer’s emergency response guidelines for the specific make and model of vehicle. MOVING PATIENTS Moving a patient involves certain risks. For example, moving someone with a closed fracture of the leg without taking the time to splint it first could result in an open fracture, which could then lead to soft tissue damage, nerve damage, blood loss, and infection. That said, there are situations in which a patient must be moved, but this decision must always be balanced against the risks involved. Three general situations require you to move a patient in an emergency: 1. The scene becomes unsafe: If changing conditions make the scene unsafe, you will need to extricate the patient quickly. 2. You must gain access to other patients: A patient with minor injuries may need to be moved quickly so that you can reach other patients with life-threatening conditions. 3. You cannot provide proper treatment: A patient with a medical emergency, such as cardiac arrest or heat stroke, may need to be moved to provide proper treatment. For example, a person in cardiac arrest requires CPR, which should be performed on a firm, flat surface. If the patient collapses on a bed or in a small bathroom, the surface or space may not be adequate to provide appropriate care; you may have to move the patient in order to properly treat him or her. A patient in the rapid transport category will also need to be moved quickly. Before you move a patient, you must consider the nature of the situation. Consider the following factors: Dangerous conditions at the scene The size of the patient Your own physical ability Whether others can assist you The patient’s condition Follow these general guidelines when moving a patient: Attempt to move a patient only when you are sure you can comfortably handle the rescue. Walk carefully, using short steps. Walk forwards (rather than backwards) to safety with the patient wherever possible. Always take the shortest, most direct route to safety, unless there are hazards along that path. Before moving, scan the extrication pathway to identify potential hazards (e.g., uneven terrain, slip hazards, poor lighting). Body Mechanics Using proper technique when lifting or moving a patient will reduce the risk of injury both to the patient and to yourself. If you become injured during an extrication, you may be unable to move the patient and risk making the situation worse. Musculoskeletal injuries can occur as a result of lifting and carrying a great deal of weight during an emergency. If this happens at a scene, you have become part of the problem that other responders will have to address. The situation will have become more complicated because you have become another patient who requires treatment. To reduce the risk of personal injury, as well as injury to another team member, everyone involved in a lift or carry should use proper body mechanics. The basic principles of body mechanics that can be used for all lifts and moves include the following: Use your legs, not your back, to lift: Use the muscles of your legs, hips, and buttocks, as well as your abdomen. Never use the muscles of your back to move or lift a heavy object. Keep the weight as close to you as possible: Reduce the distance you have to reach. Keep your body aligned: Imagine a straight line from your shoulders through your hips and down to your feet, and always move them as a unit. This will reduce twisting forces. Reduce the height or distance you need to move: Lift in stages, if necessary. Use as many personnel as necessary: The more people lifting, the lighter the load will be for each responder. The person at the patient’s head directs the actions of the team. If performed incorrectly, reaching can also lead to back injuries. When reaching, keep your back locked (i.e., avoid hyperextending it) and never twist it. You should avoid reaching more than 15 to 20 cm (6 to 8 in.) in front of you, as the muscles in the upper back and shoulders can stay stretched in that position for only a few seconds before they become fatigued and the risk of injury increases. There are many different ways to move a patient to safety. Some are more suitable for some situations than others, but as long as you can move the patient to safety without injuring yourself or the patient, the move is successful. Moves used by responders include assists, carries, and drags. The most common of these moves include the following: Walking assist Two-person seat carry Clothes drag Blanket drag Extremity lift All of these moves can be performed by one or two people and without equipment. This is important because, with most moves, equipment is often not immediately available and time is critical. It is often easier for a responder to assist a patient of approximately the same height, so if more than one responder is available, consider who might be best suited. REACHING, LIFTING, AND EXTRICATING PATIENTS Some extrications will present unique challenges or require special training and equipment—for example, when the patient is in a confined space. In these situations, specialized personnel are required. 341 WALKING ASSIST The walking assist is a simple manoeuvre suitable for moving a responsive patient. The move may be performed by either one or two responders and is usually used to help patients who require simple assistance with walking. To perform a walking assist: 1. Ensure the patient is standing up and position yourself on the patient’s injured or weaker side. 2. Place the patient’s arm across your shoulders and hold it in place with one hand. 3. Support the patient with your other hand around the patient’s waist (Figure 19–1). Your body acts as a crutch, supporting the patient’s weight while you both walk. If present, a second responder can support the patient in the same way from the other side (Figure 19–2). TWO-PERSON SEAT CARRY REACHING, LIFTING, AND EXTRICATING PATIENTS The two-person seat carry requires two responders. It is suitable for a responsive patient who may be unable to walk. 342 Figure 19–1: A walking assist with one responder. To perform a two-person seat carry: 1. Position yourself so that you and the second responder are standing on either side of the patient. 2. Put one arm under the patient’s thighs and the other across the patient’s back. 3. Interlock your arms with those of the second responder under the patient’s legs and across the patient’s back (hold on to the second responder’s wrists or forearms). 4. Lift the patient in the seat formed by your joined arms (Figure 19–3). CLOTHES DRAG The clothes drag is an emergency move that is appropriate for someone suspected of having a head and/or spinal injury, as it helps maintain basic manual SMR during the move. It may be used for a responsive or an unresponsive patient. To perform a clothes drag: 1. Gather the patient’s clothing, such as a jacket or shirt, behind the patient’s neck. 2. Cradle the patient’s head using both the clothing and your hands, and keep the Figure 19–2: A walking assist with two responders. patient’s head, neck, and back as straight as possible (Figure 19–4). 3. Pull the patient to safety, ensuring that the clothing does not compromise the patient’s airway. BLANKET DRAG The blanket drag is an appropriate emergency move if a stretcher is not available. It can be used on a responsive or an unresponsive patient. It works best on a smooth surface. To perform a blanket drag: 1. Gather half a blanket and place the gathered side alongside the patient. 2. Roll the patient toward you (away from the blanket), moving the patient’s body as one unit. 3. Tuck the gathered half of the blanket under the patient as far as you can, and then roll the patient back onto the blanket. 4. Wrap the blanket around the patient and then drag the patient by pulling the part of the blanket at the patient’s head (Figure 19–5). Figure 19–3: A two-person seat carry. EXTREMITY LIFT (FORE-AND-AFT LIFT) To perform an extremity lift: 1. Carefully move the patient into a seated position. 2. Crouch at the patient’s head and support the patient in the seated position. Have the second responder kneel either beside or between the patient’s knees. 3. Place one hand below each of the patient’s underarms and reach through to grab the patient’s opposite wrist. Ensure that the patient’s back is close to your chest and fold your arms across the patient’s chest. 4. Have the second responder place his or her hands under the patient’s knees. 5. Signal the second responder and lift in unison, using proper body mechanics. Figure 19–4: A clothes drag. Figure 19–5: A blanket drag. REACHING, LIFTING, AND EXTRICATING PATIENTS The extremity lift (also called a fore-and-aft lift) is performed with a partner. The extremity lift is not appropriate when the patient has a suspected head and/or spinal injury, or injuries to the pelvis, arms or legs (Figure 19–6). This move can be used to lift an unresponsive patient from the floor to a chair or stretcher. This move requires a measure of physical strength, so it is not suitable for patients larger than the responders. 343 SCOOP STRETCHER The scoop stretcher (also called a clamshell) is a rigid stretcher that can be separated into two pieces (Figure 19–7). These pieces can then be placed on either side of a patient and reconnected underneath the body: This allows you to scoop a patient off of the ground without rolling him or her (ideal for suspected spinal injuries). A scoop stretcher is suitable for lifting a patient from the ground to another kind of stretcher or backboard. The length of a scoop stretcher can be adjusted quickly to match the height of the patient: This should be done before the patient is on the stretcher. BACKBOARD Figure 19–6: An extremity lift (fore-and-aft lift). Stretchers and Lifting Devices REACHING, LIFTING, AND EXTRICATING PATIENTS Today, there are many kinds of stretchers and lifting devices used by professional responder agencies. The more common types are: Scoop stretcher (clamshell) Backboard (longboard) Basket stretcher Multi-level stretcher (wheeled ambulance-type cot) Stair chair 344 All of these stretchers will carry the patient’s entire body. The backboard (also referred to as the spine board or long board) is a long, rigid board used primarily for extrication purposes. Many types are available, including floating models for water extrications. Backboards are either rectangular or tapered at one end. The board has slots along the sides through which straps may be placed to secure the patient’s body to the board. Most boards are approximately 1.8 metres (6 feet) long. If a backboard is used with a basket stretcher, the board must fit inside the stretcher. BASKET STRETCHER The basket stretcher, also called the Stokes basket, is a long, rectangular metal or plastic frame with a wire mesh or plastic liner. It has slightly raised sides, so a patient on another stretcher (such as a scoop stretcher or backboard) can be placed directly into the basket stretcher for transportation. Basket stretchers are commonly To ensure stability, every organization should have regular inspection and maintenance programs in place for all stretchers and lifting devices. Rust, cracks, severe discoloration, and bent frames are all signs of damage. Plastic stretchers can be damaged by exposure to prolonged sunlight and corrosive material. Many variations on these general types of stretchers and lifting devices exist: Always follow the manufacturer’s recommen-dations, along with your local protocols for moving patients. Figure 19–7: A scoop stretcher (clamshell). used for rescues and as lifting devices. The patient can be secured to the stretcher if it is to be carried over a long distance or if the patient is to be lowered or raised off the ground, as in a low- or high-angle rescue. MULTI-LEVEL STRETCHER STAIR CHAIR A stair chair is used for transporting a patient in a seated position (Figure 19–9). It is used to extricate a patient from a location that is not accessible to a multi-level stretcher. Once you reach a multi-level stretcher, the patient will usually be transferred from the stair chair to the multi-level stretcher. Stair chairs are especially useful when there is a small elevator or staircase in which a longer stretcher will not fit. The wheels swivel to manoeuvre around tight corners and landings. Some stair chairs have caterpillar-style treads that make navigating stairs or steep terrain easier. Figure 19–8: A multi-level stretcher. HELICOPTER STRETCHER A helicopter stretcher is a flat backboard. Helicopters are usually equipped with one of these stretchers. The helicopter stretcher is hinged in the middle and folds in half for ease of storage. The responder must ensure that the stretcher is open with the correct surface up so that it will not accidentally fold in half during use. A backboard may be secured on top of the helicopter stretcher. Make sure you are aware of the air flight regulations for the service you are working with: You may need to select a backboard that will fit the helicopter stretcher, for example. FLEXIBLE LITTER A flexible litter has no rigid structure of its own. These devices are made of synthetic materials that require some type of spinal immobilization device to provide rigidity. Because they are flexible, they work well when moving patients through narrow passageways. They wrap around the patient, so the litter is little more than the circumference of the patient’s body. Flexible litters also have the advantage of being useable with patients of various sizes, including those for whom a basket stretcher may be restrictive. Figure 19–9: A stair chair. REACHING, LIFTING, AND EXTRICATING PATIENTS This type of stretcher can be lowered or raised manually using release handles found at the end or side (Figure 19–8). Some may be powered electrically as well. This device is equipped with wheels. It has adjustable upper-body and leg sections. Each side of the stretcher has a safety rail. The stretcher should not be lifted using these rails. This stretcher is commonly used in transportation vehicles, such as ambulances. Some are designed for larger or bariatric patients. Multi-level stretchers also have features that allow them to be secured inside an ambulance. 345 ARMY-TYPE STRETCHER These stretchers consist of two wooden poles with canvas or plastic stretched between. The canvas must be checked regularly for wear (e.g., tears, rot). The stretcher is usually stored collapsed. To open, undo the straps and open the stretcher. Once open, the spreader bars should be locked into place. The centre part of the hinge can be further secured using a triangular bandage or tape. The stretcher should be tested before being used with a patient. Lifting and Moving a Stretcher REACHING, LIFTING, AND EXTRICATING PATIENTS As with all lifts and carries, proper body mechanics are important when lifting a patient onto a stretcher or when loading or unloading a stretcher from a vehicle. When lifting or moving a stretcher, follow these guidelines: Use enough responders to help with lifting. Ensure that the appropriate securing devices are in place and are always used. Carry the patient feet first on a level slope, down stairs, or down inclines, as this keeps the abdominal organs away from the diaphragm. When going uphill or up stairs, move the patient headfirst. Move the stretcher based on the area’s terrain, the patient’s condition, and relevant safety factors. Never run with a stretcher. Load the patient headfirst into the ambulance. 346 Figure 19–10: Examples of bariatric stretchers. Use padding if the patient is going to be on the carrying device for a long period of time, or if the travelling surface is going to be rough. Secure the stretcher to the transport vehicle to ensure that it doesn’t move during transport. There are many ways to position a patient onto a stretcher. Always follow local protocol. It can be difficult to transfer a patient from a bed to a multi-level stretcher (or vice versa). One piece of equipment that can make this easier is a transfer board. Transfer boards are sheets of strong, semi-rigid plastic. They can slide beneath a patient (and beneath the sheet below the patient if he or she is on a bed), allowing you to easily transfer the patient without rolling him or her. Bariatric Patients Due to a bariatric patient’s size and weight, responders need to take extra precautions to avoid the risk of injury (both to the patient and to themselves). Moving, lifting, and transporting a bariatric patient requires appropriate personnel and equipment. Standard equipment, such as a stretcher, may not be rated to accommodate the patient’s size and weight. Bariatric patients should be moved utilizing additional help and resources. At no time should a patient who weighs more than 135 kg (298 lb.) be can assist in lifting the stretcher. Often, bariatric stretchers are battery-powered and can be raised or lowered electronically, decreasing the amount of manual lifting required. Responders should also be aware of other procedures and equipment available to them. The responder may need to employ a bariatric multi-level stretcher (Figure 19–10), which has a wider patient surface and wheelbase, providing increased stability during transport, and is rated for a higher weight load. Many also have additional hand-holds so that more responders When moving a bariatric patient on a stretcher, choose a route that is level and easy to navigate. If you must move the stretcher across uneven terrain, lowering the stretcher will create a lower centre of gravity, reducing the risk of tipping the patient. REACHING, LIFTING, AND EXTRICATING PATIENTS moved without at least four individuals to assist. Other trained staff or safety personnel may be able to assist if necessary. A good guideline is that for every 20 to 45 kg (44 to 99 lb.) by which a patient’s weight exceeds 135 kg (298 lb.), an additional person should assist with moving the patient. 347 SUMMARY Stabilizing Vehicles—Chocking Technique When to use technique: if the vehicle has any chance of rolling How to use technique: ◆ Place blocks or wedges against the wheels. ◆ If possible, ensure the gearshift is in park or neutral, the ignitions is off, and the  emergency brake is activated. ◆ Have the car keys placed on the dashboard or handed to the officer in charge of  extrication. ◆ Avoid the path of any vehicle. ◆ Follow your jurisdiction’s protocol for extricating a patient. WHEN IT’S REQUIRED TO MOVE A PATIENT The Scene Becomes Unsafe If changing conditions make the scene unsafe, you will need to extricate the patient quickly. Gaining Access to Other Patients A patient with minor injuries may need to be moved quickly so that you can reach other patients with life-threatening conditions. Providing Proper Treatment A patient with a medical emergency may need to be moved to provide proper treatment.  A patient in the rapid transport category will also need to be moved quickly. MOVING A PATIENT Considerations Before Moving REACHING, LIFTING, AND EXTRICATING PATIENTS 348 Dangerous conditions at the scene The size of the patient Your own physical ability Whether others can assist you The patient’s condition General Guidelines For Moving Attempt to move a patient only when you are  sure you can comfortably handle the rescue. Walk carefully, using short steps. Walk forward to safety with the patient,  instead of walking backwards wherever  possible. Always take the shortest, most direct route  to safety, unless there are hazards along  the path. Before moving, scan the extrication pathway  to identify potential hazards. General Body Mechanics Use your legs, not your back, to lift. Keep the weight as close to you as possible. Keep your body aligned. Reduce the height or distance you need to  move as much as possible. Use as many personnel as necessary. Lifting and Moving a Stretcher Use enough responders to help with lifting. Ensure that the appropriate securing devices are  in place and are always used. Carry the patient feet-first on a level slope, down  stairs, or down inclines; when going uphill or up  stairs, move the patient head-first. Move the stretcher based on the area’s terrain, the  patient’s condition, and relevant safety factors. Never run with a stretcher. Load the patient headfirst into the ambulance. Use padding if the terrain is rough or if the  patient will be on the device for a long period. Secure the stretcher to the transport vehicle.