Lifting and moving patients

1. You findThere is an immediate danger to life at the scene: fire, collapse, toxic gas. Or you must reach other patients, or you need a flat surface for CPR or bleeding control.You doEmergency move. There is no time for spinal precautions, so drag the patient from the shoulders along the long axis of the body, which keeps the spine as close to in line as the situation allows.
2. You findThe scene is safe, but the patient has an immediate life threat that needs treatment: poor breathing, shock, altered mental status, or fast decline from heat or cold.You doUrgent move. Use abbreviated spinal precautions, for example a log roll onto a backboard, and move quickly.
3. You findThere is no life threat.You doNonurgent move. Complete the assessment and treatment first, then move the patient normally with full precautions as needed.
4. You findYou are about to lift.You doPlan before anyone touches the patient: judge the weight, be honest about your limits and your partner's, call for help if needed, and agree who lifts, who counts and where the patient is going.
5. You findYou take the weight.You doFeet shoulder-width apart on a firm, level surface. Squat, do not bend at the waist. Lift with the legs, keep the back locked and the weight close to your body, and never twist.
6. You findYou suspect a spinal injury and need to get the patient onto a device.You doStart with manual stabilization of the head and neck, apply a cervical collar, and restrict motion of the spine for the move. A patient who can move under their own power is assisted, not lifted or rolled.
7. You findThe patient is on the stretcher and ready to go.You doSecure the patient to the device first, then secure the device to the ambulance. Choose the riding position by the patient's condition.

• Power lift (squat lift): squat to the load, weight close and between your feet, feet flat and apart, back locked from start to finish. Power grip: as much of the hand as possible on the handle, all fingers bent at the same angle, hands at least 10 inches apart.
• Even numbers lift a device. Two rescuers take the head and foot ends; four take a corner each, which is best for rough ground or a long carry. Never three: an odd number unbalances the device.
• Reaching, pushing and pulling: do not reach more than 20 inches in front of you, push in preference to pulling, kneel if the weight is below your waist, keep elbows bent and arms close to your sides, and never push or pull overhead.
• Devices: the wheeled stretcher for standard transport (safest at its lowest level, tips on rough ground); the stair chair for stairs, tight corners and patients short of breath, but not for a spine injury, an unresponsive patient, altered mental status or a patient who needs airway care; the basket (Stokes) stretcher for rough terrain; the flexible (Reeves) stretcher for narrow hallways; the scoop stretcher, which splits to slide under a patient without a log roll.
• The long backboard is for extrication and moving a patient, not for routine spinal motion restriction during transport. The scoop stretcher and vacuum mattress are accepted alternatives. Check a device's weight rating before you commit to a lift.
• Four transfers, only when no spine injury is suspected: extremity lift, direct ground lift, draw-sheet method (the choice for bed transfers) and direct carry.
• Positions: unresponsive, breathing adequately and no spine injury: recovery position, on the side, so fluid drains and is not aspirated. Chest pain, nausea or breathing difficulty: position of comfort, often sitting up. Shock: supine. Trauma or spine injury: do not lower the head or raise the legs.

The wrong idea: Any trauma patient must be collared and strapped to a long backboard before being moved at all.

What is actually true: The move depends on the threat. With an immediate danger such as fire, you drag the patient out along the long axis with no spinal precautions, because staying would kill him. And the long backboard is now a tool for extrication and moving, not for routine spinal motion restriction during transport.

The move follows the threat. An immediate danger at the scene means an emergency move: a long-axis drag with no time for spinal precautions. A life threat that needs treatment means an urgent move with abbreviated precautions. With no life threat, a nonurgent move waits for full assessment and care. Protect your back on every lift: plan and communicate, squat with feet apart, lift with the legs, keep the back locked and the weight close, never twist, push in preference to pulling, and lift devices with an even number of rescuers. Match the device to the job, and remember the long backboard is for moving, not routine transport. Position by condition: recovery position for the unresponsive patient who is breathing adequately and has no spine injury, position of comfort for chest pain or breathing trouble, supine for shock.

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