Your Captain Speaking: Lift With Your Head Too

Just about everyone will tell you to lift with your legs. The number of lifting-related injuries to EMTs and paramedics remains unacceptable, though, so maybe we’re doing it wrong. Let’s consider a different approach:

Lift with your head. 

What this means is to think through and plan your lift carefully before beginning it and keep the movement environment sterile (i.e., free from distractions and obstructions) as you execute it. Often, through communication and planning the transfer, you can avoid not only the need for a second unit but any heavy lifting at all. 

From the Beginning

Let’s do a little outside-the-box thinking. If we keep doing what we currently practice in the field, the injury rate will not magically get better. When should improvement start? Right at the beginning of the shift!

You set the tone from the outset with a discussion of crew resource management (CRM) and threat and error management (TEM). What are the threats for today? Driving through intersections, fatigue, distractions, weather, dropping a patient, and hurting yourself are a few possibilities. What do we do if we see one of these developing? Say something! 

When you get dispatched, are there bits of information that could help you? Does dispatch routinely ask the patient’s approximate weight as well as the age? If not, why not? Patient weight is not terribly important to dispatch, but it is to you.

Once on scene gauging safety isn’t just a onetime evaluation. Expand your scene size-up to where the dangers of lifting or hurting yourself or your patient might be. The biggest question to ask yourself is, “Do we need to lift that person or object in the first place?” If you don’t lift it, it won’t hurt you. If a patient can safely rise and ambulate under their own power, let them. It is OK to let some people stand up on their own if they can. If they are unable to get up by themselves, document it.

Even before stepping out of the ambulance, you can begin a patient movement size-up. Are there steps? Is the sidewalk narrow with edges on the sides that might catch a wheel of the gurney? Is the ground level? Slippery? 

Prepare fully before starting any patient movement. Move obstacles out of the way, retrieve and set up equipment, explain to the patient what you’re doing and what they should do. Don’t multitask by asking for the medical history as you’re moving the patient—concentrate on the lift and movement. The price to be paid sometimes is a slightly longer scene time, but the benefit is greater safety. 

As part of that scene size-up, plan the transfer path. Ask yourself, “Where is this going to go wrong?” Some patients will reach out and grab things while being wheeled on a gurney. I usually tell them “Give yourself a hug” so they don’t reach out and put us off balance. It should not surprise you if a patient on a gurney reaches out to hug a family member or point to something they need. 

Control the situation. Stop the movement if you have to. Ask family members to wait until you finish carrying Grandma down this flight of stairs. Using shoulder straps limits a patient’s movement—that’s a good thing throughout the transport. Honestly, if you’re not using shoulder straps on every call, you are going to get burned. Just get used to it.

There are times when we can’t say what we’re thinking in front of the patient or their family. As an example, you’re about to move a patient you’re afraid will throw you off balance by thrashing around or grabbing things as you lift. Work out with your partner that if you say their name and a key phrase—e.g., “Jenna, need a minute”—this means you see a threat or don’t understand what the team is doing and need to talk before you go further. 

Before and after the call, discuss the concept of lifting with your colleagues. Practice on routine calls when there is time and the patient isn’t heavy. With practice you may find that when time is critical, you can move a patient quickly without increased risk of injury.

Tips and Techniques

Many EMS services have state-of-the-art equipment. The best gurneys have powered lifting and loading. If you have a gurney that will adjust the height at the press of a button, use it. If your service has older gurneys, set the height perhaps a little higher than a seated chair. Once the patient is seated and secured, you simply roll—you don’t lift at all. 

How do you set up your gurney? I’ll bet most folks just cover the pad with the fitted cover. But most paper covers have a limited weight capacity and no handles. Perhaps you could place a canvas patient mover with handles under the fitted sheet? 

The backs of ambulances are often high off the ground. Instead of lifting the gurney with the patient, consider lowering the back of the ambulance. Can you position the ambulance with the wheels against the curb? That will reduce this height difference and optimize loading.

No matter what type of equipment you have, loading at an angle will not likely be helpful. If the ambulance is tilted right or left as you load or unload, you are in a bad way. Even loading with the ambulance pointed uphill or downhill can produce momentum that catches you off guard. Find another way.

Scenario: Your patient is very heavy. You have an obstacle such as steps to traverse but also two healthy, strong-looking family members who look like they could help. Stop—don’t ask them. Call for a lift assist. An amazing array of things can quickly go wrong in such a situation. One family member will assume they are now directing the lift while not having any clue about objectives. Another will find a pinch point. Maybe, rather than lifting together, the “helper” will just decide to do a clean-and-jerk power lift on his side of the gurney. First responders are OK to use, but be clear and tell them what you want them to do. 

The lower to the ground the gurney, the lower its center of gravity—keep it low. If you’re moving sideways with a higher center of gravity and something blocks a wheel, your patient’s going over. With a lower center of gravity and slower travel speed, you’re less likely to crash. Any gurney tip-over will involve an enormous amount of postaccident paperwork, explaining, testifying, and apologizing. 

Moving patients to and from beds is something we do frequently that can often go better. Lifting the patient with your hands, even if they are only 95 lbs., is the worst option. Instead, if possible, raise the bed just about as high as it will go (many long-term care facilities have beds low to the ground to minimize fall risk). If your equipment includes a slider, use it, but also just ask, “Are you able to slide over by yourself?” Be prepared, as they may start the process before you’re ready. Put their answer in your report to better reflect mobility. Facilities may also have sliders you can use. 

As a last resort, use the bed sheet to lift the patient. While better than trying to lift by hand, this is not a preferred option. It creates lots of friction and requires one person to lift while the other pulls. Expect the patient to reach out to steady themselves and put you off balance. 

If you have a device such as a Binder Lift that wraps around the patient and has lots of handles, use it. We have lots of different devices we don’t typically bring in as we arrive. Devices like this take a bit more time and mean more stuff to carry in and out and clean up afterward, but avoiding an injury to yourself or partner far and away compensates for the extra time. 

When to Call for Help

A light person in an awkward place can be just as much of an injury threat as a heavier patient with good access. Consider calling for additional help if:

• The patient must be carried up a flight of stairs. Moving up is harder than down. The person at the bottom of the stair chair might not be able to maintain a good position.
• When carrying a patient on a stretcher down three or more steps. Stretcher wheels will normally span two steps; three seem to be much harder.
• When the terrain is rough, sloped, or has obstructions. Plan your route before you have the patient in the air. Plywood on the ground is a no-go area.
• The patient is on a backboard and must be carried more than a few steps. Lifting a patient from floor level is high risk. The patient, regardless of how many straps you use, is often frightened and can suddenly reach out.
• You or your partner is inexperienced or you haven’t worked together before. Communicate well and know your strengths and limitations. 
• Your patient is heavy. A heavy patient who cannot move from the bed to the stretcher on their own is a red flag. 
• It will enhance patient comfort. Additional crew members can help minimize pain by providing extra stability.

If you think you need a lift assist, say so. Your partner might be thinking the exact same thing. 

Conclusion

Hopefully this discussion has sparked additional thoughts. Talk about it with others. It’s about both you and your partner. Remember, lift with your head before you lift with anything else.

Sidebar: The State of Your Fitness

EMS is a physical and mental activity. Both aspects must be trained for. Stronger, fitter providers are less likely to drop and injure patients. 

Develop your core strength. If you want to strengthen your back, strengthen your front. That means the dreaded sit-ups and crunches. Many abdominal devices can help ensure proper technique. Crunches help. A regular routine is the solution. 

Don’t ignore weight training for the arms and shoulders. The legs provide major muscles for lifting as well. If the legs aren’t developed enough, other muscle groups not meant to take that pressure have to compensate. Stretching throughout the day is also important. 

Dick Blanchet, BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Mo., and Illinois for more than 22 years. He was also a captain with Atlas Air and an Air Force pilot. Reach him at acls911@aol.com.