Chapter 3 of 40
Lifting and Moving Patients
More EMTs are hurt lifting and moving patients than in any other part of the job, and those injuries are almost always preventable. This chapter sets out the body mechanics that keep a lift safe, the devices that carry a patient and what each is suited to, the difference between an emergency move and one that can wait, and the positions a patient should ride in for different conditions.
3.1Patient Lifting & Moving
On the 2025 exam, moving patients falls under Patient Treatment & Transport, and protecting your own back under Operations.
Body mechanics — before lifting
Every lift begins before anyone touches the patient. Consider the weight of what you are about to move and decide honestly whether you and your partner can manage it or whether you need to call for help. Consider your own physical limitations and your partner's as well, because a lift is only as safe as the weaker of the two people performing it. Then communicate the plan, so that everyone knows who lifts, who leads the count and where the patient is going before any weight leaves the ground.
Lifting rules
The rules that keep a lift safe are few, and they do not change with the situation. Set your feet shoulder-width apart on a firm, level surface before you take any weight. Lift with the legs rather than the back, and never twist while lifting; a loaded spine that rotates is the classic mechanism for a career-ending back injury. When a lift has to be made with one hand, resist the temptation to lean to the other side to compensate, and keep the back straight and locked instead.
Keep the weight close to the body throughout. The farther a load sits from your center of gravity, the more leverage it exerts on your spine. Carrying a stair chair down stairs applies the same principles in a different shape: keep the back straight, flex at the knees, and lean forward from the hips rather than bending at the waist.
Lifting devices — even numbers of people
A patient-carrying device is meant to be lifted by an even number of rescuers, and the number matters more than it first appears. With 2 rescuers, one takes the head end and one takes the foot end. With 4 rescuers, one takes each corner, which is the best arrangement for rough terrain or a long carry. A device is never lifted by 3 people: an odd number throws the device off balance, and an unbalanced device tips over.
The lift itself is performed with the power lift, also called the squat-lift. Squat down to the load instead of bending at the waist, keep the weight close to you and straddled between your feet, plant the feet flat and apart, carry the weight on the balls of the feet, and keep the back locked from start to finish.
The hands do their share of the work through the power grip, which puts as much skin as possible in contact with the handle. Every finger is bent to the same angle, and the hands are held at least 10 inches apart.
Reaching, pushing & pulling
Reaching obeys the same rules as lifting. Keep the back locked and do not twist. Do not reach more than 20 in. (50 cm) in front of you, and avoid a prolonged reach while under strain, because the muscles that stabilize the spine fatigue quickly in that position.
When a load has to be moved horizontally, push it rather than pull it whenever you have the choice, since pushing lets you put your body weight behind the load instead of relying on the smaller muscles of the arms and back. Keep the back locked and the line of pull running through the center of your body, bending the knees to bring yourself into that line. Keep the weight close to the body. If the weight is below your waist, kneel rather than stoop to it. Never push or pull overhead. Keep the elbows bent and the arms close to the sides.
Speed and safety are usually in tension, and the situation decides which wins
Patient moves are sorted into three kinds, and which one you perform depends on what is threatening the patient at that moment rather than on what would be ideal. The table below sets out when each move applies and what it allows in the way of spinal precautions.
Table 3.1Speed and safety are usually in tension, and the situation decides which wins
| Move | When | Spinal precaution? |
|---|---|---|
| Emergency | Immediate danger to life (fire, collapse, toxic gas, must reach other patients, need a flat surface for CPR/bleeding control) | NO time — use a long-axis drag to minimize injury |
| Urgent | Immediate life threat needing treatment (poor breathing, shock, altered mental status, rapid decline from heat/cold) | YES — abbreviated, e.g., backboard via log roll |
| Nonurgent | No life threat — normal move after full assessment/treatment | Full precautions as needed |
The long axis is the imaginary line running down the center of the body, from the head through the spine. In an emergency move you drag the patient from the shoulders along that line so that the body falls into its natural alignment and the spine is protected as far as the circumstances allow. It is worth remembering that the long backboard is now regarded chiefly as a device for moving and transporting a patient rather than a means of long-term immobilization.
Patient-carrying devices
The ambulance carries a range of devices, and each of them is built for a particular patient, terrain or doorway. The table below sets out what each device is best suited to and where it should not be used.
Table 3.2Patient-carrying devices
| Device | Best for | Avoid for |
|---|---|---|
| Wheeled stretcher | Standard transport; lowest level = safest | Rough/uneven terrain (tips easily) |
| Power stretcher | Battery/hydraulic lift, up to ~700 lb | — |
| Bariatric stretcher | Obese patients (800+ lb rated) | — |
| Stair chair | Stairs, narrow corners, breathing-difficulty patients (sit-up position) | Spine injury, unresponsive, altered mental status, airway care needed |
| Long backboard | Extrication and moving a patient; not for routine spinal motion restriction during transport | — |
| Portable/folding stretcher | MCIs | — |
| Scoop stretcher | General lifting; splits to slide under a patient without a log roll, and is an accepted device for spinal motion restriction | — |
| Basket/Stokes stretcher | Rough terrain, multi-level moves | — |
| Flexible/Reeves stretcher | Narrow hallways/tight spaces | — |
| Vacuum mattress | Rigid, conforming, more comfortable than a backboard | — |
Whichever device you choose, check its weight rating before you commit to the lift. Secure the patient to the device first, and then secure the device to the ambulance.
Moving a patient onto a device
How a patient is moved onto a carrying device depends first on whether you suspect an injury to the spine.
When you do, begin with manual stabilization of the head and neck, apply a cervical collar, and then restrict motion of the neck and spine for the move itself. If the patient is able to move under their own power, assist them rather than lifting or rolling them, because a patient who moves themselves puts less strain on the spine than any technique you can perform for them. A patient found seated in a vehicle is stabilized first and then either assisted out or transferred onto a long backboard, and from there moved to the stretcher.
When no spinal injury is suspected, 4 transfer methods are available. All of them require that a spine injury has been ruled out first.
- Extremity lift: one rescuer supports the patient at the armpits and wrists while the other supports the knees.
- Direct ground lift: used to bring a patient from the ground onto the stretcher.
- Draw-sheet method: the bottom sheet is loosened and the patient is pulled across on it, which makes it the method of choice for bed transfers.
- Direct carry: used from a bed or another bed-level surface to the stretcher, with the rescuers curling the patient in against their own chests.
Patient positioning
The position a patient rides in is a clinical decision rather than a matter of convenience, and the right one follows from the complaint. The table below sets out the position that suits each of the common presentations.
Table 3.3Patient positioning
| Condition | Position |
|---|---|
| Unresponsive, no spine injury | Recovery position (on side — aids drainage, prevents aspiration) |
| Comfort (chest pain, nausea, breathing difficulty) | Position of comfort, often semi-Fowler/Fowler — monitor airway, switch to recovery if responsiveness drops |
| Shock | Supine (maximizes perfusion) |
| Trauma/spine injury | Do NOT lower the head (breathing) or raise the legs (no proven benefit, may worsen injury) |
Transferring the patient onto the hospital bed at the end of the call is usually done with a modified draw-sheet method.
- Body mechanics – proper body use to lift/move safely.
- Bariatric – significantly overweight/obese patients.
- Power lift / power grip – squat-lift technique; max-skin-contact grip.
- Direct ground lift / direct carry / draw-sheet method / extremity lift – patient transfer methods used only when no spine injury is suspected.
- Long-axis drag = the preferred emergency-move technique.
- Never use 3 people on a lifting device — always an even number.
Key terms in this chapter
- Extrication
- The process of freeing and removing a trapped patient, such as from a wrecked vehicle.
- Perfusion
- The flow of blood through blood vessels to an organ or tissue, delivering oxygen and nutrients.
- Supine
- Lying face-up.
Check your understanding
The question bank covers the ground this chapter does. Answer questions with explanations in practice, or open this chapter in the reader for five drawn from the bank.