Thousands of patients are
lifted and moved by EMTs and many EMTs are injured because they attempt to lift
or move a patient improperly. A wide variety of patient conditions as well as
circumstances affect how the patient is "packaged" for transport.
The expression "Lift
with your legs and not your back." is a very important part of proper body
mechanics. Always get as close to the patient as you can when lifting. Keep your
arms and patient as close to your body as you can to help create leverage and
maintain balance. Bend at the knees while keeping your back as straight as
possible. Recognize your limitations and call for back-up when needed to lift
Guidelines for Safe Lifting
1. Consider the weight of the patient
together with the weight of the stretcher or other equipment being carried and
determine if additional help is needed.
2. Know your physical ability and
limitations. Know your combined ability with your partner. If absolutely
necessary, you can ask bystanders to help. You or your partner must be in charge
and give the orders, not the bystander.
3. Lift without twisting. Avoid any kind
of swinging motion when lifting as well.
4. Position your feet shoulder width
apart with one foot slightly in front of the other. Wear proper boots that go
above the ankle to protect your feet and help keep a firm footing. Boots should
have nonskid soles.
5. Communicate clearly and frequently
with your partner. Decide ahead of time how you will move the patient and what
verbal commands will be used. Also, tell the patient what you will be doing
ahead of time. A startled patient may reach out or grab something and cause a
loss of balance.
Guidelines for Lifting Cots and
Most back injuries to EMTs can be avoided
by following the following guidelines:
- Know or find out the weight to be
- Use a minimum of two people to lift,
even if a one-person stretcher is being used.
- Use an even number of people to
maintain balance during the lift.
- Know the weight limitations of the
equipment you use. Know what to do if the patient exceeds the weight
limitations of the equipment.
- Use the power lift or squat lift
position. Feet are shoulder width apart. Back is tight and the abdominal
muscles lock the lower back in a slight inward curve. Distribute weight to
the balls of the feet. Keep both feet in full contact with floor or ground.
While standing, keep the back locked in, as the upper body comes up before
- Use a power grip to get maximum force
from the hands. Hands should be at least 10 inches apart. Palms face up and
fingers in complete contact with the stretcher bar.
- Lift while keeping your back in the
- When lowering the cot or stretcher,
reverse the steps.
- Avoid bending at the waist.
- Avoid twisting. "Feed" the
stretcher into the ambulance while face across the patient.
Guidelines for Carrying Patients and
- Whenever possible, move patients on
devices that can be rolled.
- Minimize the distance needed to carry
- Know the weight to be carried.
- Work in a coordinated manner with your
- Keep the weight as close to your body
- Keep your back in a locked-in position
and refrain from twisting.
- Flex at the hips, NOT the waist, and
bend at the knees.
- Do not hyperextend your back (do not
lean back from the waist).
- Try to lift with a partner that has
similar height and strength.
Guidelines for Safe Carrying on Stairs
One of the most
difficult carries an EMT must do is carry a patient backwards up a stairway. Try
to carry heavy patients up a stairway with two people at the top, shoulder to
shoulder, and two at the bottom of the stretcher.
- Always carry patients head first up
the stairs and feet first down the stairs.
- Try to use a stair chair if the
patient's condition allows it. If a stair chair is not available, use a
light but sturdy kitchen chair. If neither are available, use the extremity
- Keep you back in the locked-in
- Flex at the hips, NOT the waist, and
bend at the knees.
- Keep the weight and your arms as close
to your body as possible.
Guidelines for Reaching
- Keep your back in locked-in position.
- Avoid stretching or overreaching when
- Avoid twisting.
- Keep your back straight when leaning
- Lean from the hips.
- Use shoulder muscles with log rolls.
- Avoid reaching more than 15-20"
in front of your body.
- Avoid reaching and strenuous activity
for more than 1 minute.
Guidelines for Pushing and Pulling
- Push whenever possible rather than
- Keep your back locked-in.
- Keep elbows bent with arms close to
- Keep the line of pull through the
center of your body by bending your knees.
- Keep weight close to body.
- Push at a level between your waist and
- Use kneeling position if weight is
below waist level.
- Avoid pushing and pulling from
Principles for Moving Patients
A patient should be
moved immediately by an emergency move only when there is an immediate danger to
the paitnet or the EMTs including:
- Fire or danger of fire.
- Danger of explosives or other
- Inability to protect patient from
other hazards at the scene.
- Inability to gain access to other
patients who need lifesaving care.
- Inability to provide care due to
location or position.
1. Tie the patient's wrists together if
you have something quickly available. If nothing is available, tuck the hands
into the waist band to prevent them from being pulled upwards.
2. Clutch the patient's clothing on both
sides of the neck to provide a support for the head.
3. Pull the patient towards you as you
back up, watching the patient at all times. The pulling force should be
concentrated under the armpits and NOT the neck.
1. Fold or twist a sheet or large towel
2. Place the narrowed sheet across the
chest at the level of the armpits.
3. Tuck the sheet ends under the armpits
and behind the patient's head.
4. Grasp the two ends behind the head to
form a support and a means for pulling.
5. Pull the patient toward you while
observing the patient at all times.
1. Lay a blanket lengthwise beside the
2. Kneel on the opposite side of the
patient and roll the patient toward you.
3. As the patient lies on their side
while resting against you, reach across and grab the blanket.
4. Tightly tuck half of the blanket
lengthwise under the patient and leave the other half lying flat.
5. Gently roll the patient onto their
6. Pull the tucked portion of the blanket
out from under the patient and wrap it around the body.
7. Grasp the blanket under the patient's
head to form a support and means for pulling.
8. Pull while backing up and while
observing the patient at all times.
Bent Arm Drag
1. Reach under the patient's armpits from
behind and grasp the forearms or wrists.
2. Use your arms as a cradle for the
patient's head and keep the arms locked in a bent position by your grasp.
3. Drag the patient towards you as you
walk backwards, observing the patient at all times.
Sometimes a patient
must be moved more quickly than usual due to reasons of an urgent nature.
Weather conditions, hostile bystanders, uncontrolled traffic, and rapidly rising
flood waters are some examples of situations requiring an urgent move.
Procedure for Rapid Extrication
- One EMT should be stationed behind the
patient. Place one hand on each side of the patient's head to stabilize the
neck in a neutral position. It is done as you begin evaluation of the
- The second EMT quickly applies a
cervical spine immobilization device while doing a rapid primary survey.
- A third EMT simultaneously places the
long backboard onto the seat and, if possible, slightly under the patient's
- The second EMT supports the chest and
back as the third EMT frees the patient's legs from the pedals and floor
- The patient is rotated in several
short coordinated moves until the patient's back is in the open doorway and
feet are on the backboard.
- Another EMT supports the patient's
head until the first EMT gets out and takes control of the cervical spine
immobilization device from outside the vehicle.
- The EMT team lowers the patient and
slides the patient onto the board in short coordinated movements. Straighten
the patient's legs and make sure the neck and back do not bend. Secure
patient to backboard after the patient is brought back to the ambulance.
This is the most
frequent type of move and the best way to make the move depends on the illness
or injury, factors at the scene, and equipment and personnel resources
Direct Ground Lift
- 2-3 EMTs line up on the same side of a
- The EMTs all kneel on one knee.
- Cross the patient's arms on the chest
if injuries don't prevent it.
- The EMT at the head places one arm
under the patient's head and shoulders, cradling the head. The other arm is
placed under the patient's lower back.
- The second EMT places one arm directly
below the first EMT's arm in the small of the patient's back. The second arm
is placed under the patient's knees.
- The third EMT (if available) slides
both arms under the patient's waist. The other EMTs adjust their arms
- On signal, the EMTs lift the patient
to their knees and roll the patient in toward their chests.
- On signal, the EMTs stand and move the
patient to the stretcher.
- On signal, the patient is lowered onto
the stretcher, which has been positioned at waist level.
This is only used when
a spinal injury is not suspected. It is best used for short distances.
- One EMT kneels at the patient's head
and the other EMT kneels at the patient's side by the knees.
- The EMT at the head reaches under the
patient arms at the shoulders and grasps the patient's wrists. If the
patient is unresponsive or uncooperative, the other EMT may assist by
lifting the patient's wrists to within the reach of the partner. To improve
stability, the patient's left wrist may be grasped by your right hand and
their right wrist by your left hand. This crosses the patient's arms over
their chest creating a more secure hold with less give.
- The second EMT reaches under both
knees with one arm and under the buttocks with the other arm.
- The EMT's rise to a crouching
position, then simultaneously stand and move with the patient to the
Transfer of Supine Patient from Bed to
- Position the stretcher at a right
angle to the patient's bed with the head end of the stretcher at the foot of
- Prepare the stretcher by unbuckling
the straps, removing other items, and lowering the closest railing.
- Both EMTs stand between the stretcher
and the bed, facing the patient.
- The EMT at the head end of the
stretcher slides one arm under the patient's neck and shoulders, cupping the
far shoulder with his or her hand and cradling the head.
- The second EMT slides one arm under
the small of the patient's back, slides the arm under the buttocks and lifts
slightly to allow the first EMT to slide an arm under the waist.
- The second EMT reaches under the
patient's lower legs.
- The patient is pulled to the edge of
the bed, then lifted and curled toward the EMT's chest.
- The EMTs rotate to be in line with the
stretcher, then place the patient gently on to it.
Draw Sheet Method
- Loosen the bottom sheet on patient's
- Adjust stretcher to height of bed,
unbuckle straps, lower both rails, and remove all items from stretcher.
- Place the stretcher against the side
of the bed.
- Both EMTs reach across the stretcher
and grasp the sheet firmly beside the patient's head, chest, hips and knees.
- Slide the patient gently across and
onto the stretcher. If enough personnel are available, the patient may be
lifted by grasping the sheet on both sides of the patient at the chest and
Equipment for Moving Patients
basic types of stretchers are used: the two-person and the one-person. The
two-person requires two EMTs to lift and load in the ambulance, whereas, the
one-person stretcher has special loading wheels at the head that allows one EMT
to load it into the ambulance. Stretchers are usually adjustable to different
heights and different angles. Some can be adjusted to elevate the legs (Trendelenberg
position). Additional equipment may be attached to the stretchers including
oxygen, IV lines, and cardiac monitors or defibrillators.
Guidelines for Moving Stretchers
- Stretchers should be handled by two
EMTs with both hands on the stretcher. Other personnel or bystanders may be
asked to help carry additional equipment if necessary.
- Never leave the patient alone on the
- Load the stretcher with the foot end
first or going upstairs.
- Position one EMT at the foot and one
EMT at the head of the stretcher when rolling it. The EMT at the foot should
pull while the EMT at the head should push.
- Always maintain a firm grip on the
stretcher when rolling to prevent a tipover.
- Lower the stretcher and carry end to
end if the ground is to rough to roll the stretcher safely.
- Use four EMTs, one at each corner,
when moving a stretcher across extremely rough terrain.
- Turn corners slowly and squarely,
avoiding sideways movements that might make the patient dizzy.
- Lift the stretcher over rugs, grates,
door jams, and other such obstacles on the ground or floor.
- Keep the patient secured with belts at
all times while on stretcher even if the stretcher is not being moved.
Loading the Ambulance
- Place the head end of the two-person
stretcher close to the bumper of the ambulance, and make certain it is
locked at its lowest level.
- The EMTs stand on opposite sides of
the stretcher, bend at the knees while keeping their backs straight, and
grasp the lowest bar of the stretcher.
- Hands are positioned at each end of
the lowest bar with both palms facing up.
- On signal, both EMTs stand and move
toward the rear of the ambulance until the front wheels rest on the floor at
the back of the ambulance.
- Roll the stretcher forward and guide
it into the front of the stretcher catch. Then the foot end of the stretcher
is locked into place.
- NOTE: Load hanging and portable
stretchers before the wheeled stretcher. Obstetrics patients may be loaded
feet first so that it is easier to manage an impending delivery. Make sure
that all patients and stretchers are secure before moving the ambulance.
Unloading the Ambulance
- Unlock the latch at the foot end of
the stretcher catch and pull the stretcher until the rear wheels are at the
lowest end of the floor.
- Grasp the lowest bar on each side of
the stretcher with palms facing upwards as it is rolled out.
- Once the head end of the stretcher is
clear of the ambulance, keep the stretcher level and lower it to the ground
by bending at the knees while keeping the back straight. The stretcher may
then be raised by triggering the appropriate release handle.
- Alternative. Once the head end of the
stretcher is level and clear of the ambulance, the driver's side EMT may
trigger the handle release and allow the base of the stretcher to slide down
the legs of the EMTs. This method avoids the extra lift from the ground but
requires the use of the main stretcher bar for lifting and simultaneous
release of the handle.
- Portable stretchers, or
"folding stretchers" weigh 8-15 pounds and can carry a patient up
to 350 pounds. They are more easy to use when carrying patients down stairs,
down hill, or over rough terrain. It can be suspended from the ceiling with
special brackets, placed on the floor, or secured to the squad bench.
These are designed for
patients that can sit up while being carried. They are useful for taking
patients up or down stairs, or through narrow passageways. The patient must be
transferred to the stretcher once back at the ambulance.
The extremity lift is
used to place the patient in the stair chair. All belts and straps must be
secured before moving patient. The patients wrists may be loosely tied to
prevent grabbing onto fixtures and causing loss of balance when moving
them. The chair is tilted slightly backwards to allow movement with the wheels
on the chair.
There are several
styles of backboards:
- Ohio is coffin-shaped to fit easily
into a basket stretcher or helicopter.
- Farrington is rectangular with rounded
- Aluminum are usually foldable but they
can be uncomfortable in cold weather and prevent x-rays from being taken.
- Miller is made of molded plastic and
is strong and buoyant.
- Vacuum molds to the patient once they
are positioned in it.
The importance of a
backboard is in spinal immobilization and moving the patient, especially during
rapid extrication, and providing secondary support when using a short spineboard.
This is used when a
spinal injury is suspected and the patient is in a seated position. They made be
made from wood, aluminum, or plastic. A vest type is also used when a patient is
found inside a small car or place. It wraps around the patient and has all the
straps attached or enclosed.
Scoop (Orthopedic) Stretcher
This is designed
to easily lift supine patients. The stretcher is made of a rectangular aluminum
tube with V-shaped lifts to "scoop" patients from the floor or ground
without changing their position. Its greatest advantage is that it can be used
in confined spaces where other stretchers cannot fit.
The scoop may be used
to initially lift the patient with a suspected spine injury. The patient should
then be placed immediately on a long backboard for immobilization. If no spine
injury is suspected, the scoop can then be placed with patient onto the
stretcher for transport.
The following steps
are used with the scoop stretcher:
- Adjust the length of the scoop
stretcher on the ground beside the patient to accommodate the patient.
- Separate the stretcher halves and
place one half on each side of the patient. Do not lift equipment over
- Slightly lift the clothing on one side
of the patient while another EMT slides one half of the scoop under the
patient's side. Repeat on the other side. If a spine injury is suspected,
another EMT must maintain cervical spine support at all times.
- Lock the head end of the scoop in
place, then bring the foot end together until the assembly is locked. If any
resistance is met, have an EMT gently lift one side of the patient. This
move prevents the patient's clothing from being caught or their skin from
- Attach the padded head strap. Use at
least three straps to secure the patient to the scoop stretcher before
Do not use the
flexible, or "pole" stretcher if spine injury is suspected. It is
designed for the following uses:
- limited access space
- on stairs or around cramped corners
- when other equipment is not available
EMTs should consider
not only the best equipment to use but the position of the patient. The
following general rules apply:
- Unresponsive patients without
suspected spine injury should be placed in the recovery position on
their left side.
- Patients with chest pain or difficulty
breathing should NOT be walked to the ambulance.
- Patients with suspected spine injury
should be fully immobilized on a long backboard.
- Patients with signs and symptoms of
shock should have their legs elevated 8-12 inches.
- Place the pregnant patient with
hypotension on her left side.
- Load the pregnant patient whose
delivery is imminent feet first into the ambulance to allow for more room to
- An infant's own car seat should be
used if possible. It can be secured to the stretcher with the straps. It can
also serve as an immobilization device with padding and taping.
- Patients with head injury and no
suspected spine injury should be transported in a semi-sitting position at
about a 45 degree angle. This reduces pressure inside the skull and risk for
- Trauma patients with multiple injuries
should always be transported on the long backboard to provide full body
- Use discretion when moving and
positioning a disabled patient. Increased communication is necessary with
visually or hearing impaired patients. Take extra care when securing
patients with physical deformities. Use pillows, rolled towels, or other
supports and padding to create a more comfortable position.
- Elderly patients should be placed in a
position that will be as comfortable as possible for their condition. Extra
time and care with patients with conditions such as arthritis, osteoporosis,
or other conditions is important to reduce risk of further injuries.
1. What part of the body has the most
powerful muscles for lifting?
2. List the seven guidelines for carrying
patients and equipment.
3. A situation that presents an immediate
and urgent threat to the patient or rescuers calls for which kind of move?
4. Which piece of equipment would be used
to lift and transport a multiple trauma patient and why?