World`s Best Stair Chair: Options for Getting People Up Stairs

“EMS Reruns” is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. But it offers you a luxury you don’t have on scene: plenty of time to think. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we’ll pay you $50. We don’t know everything, but we do know a lot of smart people. If we need to, we’ll contact just the right experts and share their advice with you. Send ideas c/o emseditor@aol.com.

One of our crews recently responded to an elderly diabetic female patient who was found on the bottom level of a split-level residence. The patient had altered LOC with hypoglycemia. An entrance to the lower level from the outside was available, but it was raining heavily, and the crew did not want to track mud on the carpet.

The stairs were too steep and tight to be negotiated with the stretcher, backboard or scoop. Therefore, the crew determined that a properly executed knee-shoulder lift and carry would be the best way to move the patient up the stairs to the stretcher waiting out of the rain at the front entrance. The crew had a stair chair available in the unit, but decided not to take the time to go get it.

The patient was carried to the stretcher, and appropriate treatment was administered en route to the hospital. At the hospital, the patient began to complain of left arm and shoulder pain. X-rays revealed a non-displaced left clavicle fracture. The point of concern on this call was the decision to carry an elderly patient, susceptible to osteoporosis and bone degeneration in general, rather than utilize the available stair chair, which would have been much easier on the patient. What do you think?

Dennis W. Huie, BS, NREMT-P
Operations Officer
Forsyth County EMS
Forsyth County, NC

Wow, I love this question. I don’t have any criticism of the crew, because I wasn’t there. But it brings up several interesting points:

Would a wheelchair have helped?

If this patient had her own wheelchair, that might have been a great tool for the job. Lots of folks don’t realize it, but a wheelchair makes a better stair chair than a stair chair. Its big wheels are much better for negotiating rough terrain. It’s extremely maneuverable, and it’s the only kind of chair that doesn’t have to be carried up stairs with a patient loaded. (Most stair chairs are designed for descent, not ascent. But the fact is, we sometimes do have to get people up flights of stairs.)

Is it really a good idea to chair-carry elderly patients, especially women who are at special risk of osteoporosis?

A lot depends on what this crew thought about immediacy and the weight of the patient. Sometimes an easy one-minute carry of a lightweight patient makes more sense than a trip back to the rig. I do have to say that chair-carrying people up stairs would never be my favorite option, because the person on the top side would need to look behind himself several times during the carry. That’s really hard on an EMT’s back.

A chair-carry also depends on the integrity of the patient’s shoulder girdle. You might consider that an unknown, but experience has shown that if the patient is not especially heavy, his or her comfort level is a reliable indicator.

What about using surgical shoe covers to protect the carpet?

I know a plumbing company whose people put disposable surgical shoe covers (the kind you see in the OR) on their feet before they enter a customer’s home. They change the shoe covers every time they go out to their trucks. These cost about 25 cents a pair and are waterproof. You could fit a pair in any small pocket, including the thigh pockets on the dock-style uniform pants most of us use. They might have given this crew an extra option. I was able to get a case of them with a single call to one of our local EMS equipment dealers.

Should this crew have avoided chair-carrying an elderly female?

That’s easy to say, in retrospect. But it’s not fair. Hundreds of EMTs are probably performing the same carry described in this article, and nobody will criticize them because their patients will do just fine. Thousands of us have used chair-carries for 20 years or more without a single untoward effect on a patient. In their respect for the patient’s home, this crew risked their own backs and encountered a rare consequence that should not be used to invalidate their judgment.

I hope they’re feeling OK about this lady, and I think it would be a good idea to ask them about it individually.