The Conscience of EMS
THE JOURNAL OF EMERGENCY MEDICAL SERVICES
JEMS Article 12/20/2019
ARE LIFT ASSISTS BREAKING YOUR BACK? HERE'S THE SOLUTION.
Across the country fire and EMS departments are experiencing an increase in 911 calls from those who fell and need a lift assist. Although there are many theories about how to reduce the volume of these calls, we as EMS providers, should acknowledge that it’ll always be our job to respond to individuals who need help. In fact, the evidence suggests that we’ll continue to see an increase of lift assist calls in the years to come. Americans are living longer and are at a higher risk of obesity. Combine these two factors and that points to the most common lift assist patients: geriatric and bariatric patients. These data points toward the fact that the number of lift assist incidents will
only continue to grow as the average American becomes older and larger.
Since the field of EMS was established, there haven’t really been many changes to the way providers lift patients, despite the ever-increasing volume and size of patients. Back in the old days, prehospital providers used nothing but a bed sheet and a little ingenuity to lift patients.
But today, those practices are not only antiquated, but also dangerous for EMS providers. Musculoskeletal injuries from lifting a patient is the most common injury sustained by EMS professionals since the CDC started publishing injury data in 2008. Lifting patients is quite literally breaking the back of EMS, and if we don’t change how we lift patients, rates of injury to patient and provider will persistently climb.
The good news is that making these slight adjustments to how to respond to these calls can protect EMS staff from lifting injuries. Here’s how:
The prehospital environment will always have wide variability, uncertainty, and at times chaos. These kinds of dynamic environments coupled with the limited amount of resources that can fit on an ambulance require EMS professionals to have a knack for doing more with less. Unfortunately, this innate ability to improvise has led many EMS professionals to pride themselves as the “Kings of Improvisation.”
When EMS providers assume the ironic title of being professional improvisers,
what they are really doing is patting themselves on the back for being professionally unprepared.
Don’t get me wrong, improvisation is an extremely useful skill, especially in the dynamic field that we work in, but when it comes to carrying out task that could put you at high risk: planning to improvise isn’t planning at all.
Plan to move safely
According to EMS1 columnist Bryan Fass, “EMS are in the moving business; we are movers!”
As such, we should have a plan for every type of patient movement that we’ll perform. If you look through all of the patient handling equipment in the back of your ambulance during your next shift you’re sure to find multiple devices that are designed for pushing,
pulling, dragging, transferring, and carrying patients.
Backboards, soft stretchers, rescue seats, transfer aids, stair chairs, and stretchers are all great examples of standard patient handling equipment that most providers have access to. All this equipment is crucial in helping providers perform these patient movements safely,
but do you have a device that is specifically designed to help lift patients?
For most, the answer is probably not.
Of course, we lift patients on nearly every shift, but most providers don’t have access to
equipment that is specifically designed to help them lift.
There is a common misconception that soft stretchers are designed for lifting. This idea has continued to perpetuate partially because soft stretchers are often referred to by providers as “lift sheets.” However, if you read the training manual or examine nearly any of the manufacturer’s recommendations you won’t find soft stretchers advertised for lifting. Instead, you’ll find words like carry, or transfer. This is because the manufacturers made these devices specifically for carrying, dragging, sliding, and transferring patients – not lifting.
Before providers can develop a plan for lifting patients, they first need to have access to equipment that is specifically designed to help them lift. Remember, planning to improvise isn’t planning at all, so using sheets or soft stretchers with improvised techniques doesn’t count as a plan. Seven years ago, there was virtually no equipment on the market that was specifically designed to help EMS providers lift patients.
But today there are many options, so providers now have the luxury of choice.
Here’s what you should look for when choosing a device to help you lift patients:
Patient lifting equipment can be separated into two categories; nonmechanical and mechanical. Both types of patient lifts have pros and cons, so it’s important to consider the following before deciding which product to incorporate into your plan.
Nonmechanical: Nonmechanical lift aids are devices that usually attach handles to the patient. It is impossible for providers to use proper ergonomics when lifting if there are not handles attached to the patient. Having a lift device that just attaches a handle or two to the patient isn’t good enough. There is a lot more to consider when choosing which product to go with.
Before choosing a specific piece of equipment, make sure it meets at least five out of the nine following criteria:
Mechanical: Mechanical patient lifts have been proven to reduce up to 43% of lifting related injuries within hospital systems that adopt “no lift” policies. These mechanical lifts are therefore widely used in the hospital setting, but they can’t be relied upon in the prehospital setting due to the constraints of space on the ambulances and dynamic environment in which we work. There are a few options on the market specifically designed for our industry that can offer great value to some departments. But EMS departments need to ensure their providers have access to nonmechanical lifting devices before investing in mechanical lifts. There isn’t a single portable mechanical lift on
the market that can consistently lift morbidly obese patients from confined spaces – such as a bathtub.
As such, mechanical lifts will always have limited usability in the prehospital setting. When they can’t be used,
providers need to be able to have a nonmechanical lifting device to fall back on.
We really shouldn’t be too surprised that the most common injury in EMS is from lifting patients, because this is the only patient movement that providers will perform without having a tool that is specifically designed to help with the movement.
Rather than relying on improvised lifting “tips” and “tricks” that have been passed down from one generation to the next,
providers need to have access to equipment that is specifically designed to help them lift.
Departments first need to equip their ambulances with a non mechanical lift device that is proven to help providers utilize
better ergonomics and matches at least five of the nine nonmechanical lift criteria mentioned in this article.
After every ambulance is equipped with nonmechanical lifting aids further evaluation should be done to
determine the need for mechanical lifting aids as well.
Lifting patients will forever be the responsibility of prehospital providers.
These lifts will continue to break our backs until we stop improvising and
start planning and investing in equipment that is proven to help.
Files coming soon.