Patient transport: let's talk about portable stretchers
About portable stretchers: on the battlefield, when medics required a device that was easily deployable, strong enough to carry a patient over rough terrain, yet compact enough to be carried in one medic’s gear, the portable stretcher was born
It was foldable, often made of sturdy wood and canvas, and was operated by two people to remove a wounded soldier from the immediate danger of battle to be treated in a warm or cold zone. Explorers developed similar equipment even before this.
When navigating hazardous terrain, such as a car crash down an embankment, the rescue term “low angle” refers to any slope that does not require hands to maintain balance (<40 degrees.)
High angle rescue is considered to be a terrain that has a slope angle of 50 degrees and higher. Rescuers are totally dependent upon the ropes used to keep them and the victims from falling and to gain access to and egress from the rescue location.
Portable Stretchers
The modern portable stretcher serves the same purpose–to efficiently carry a patient over unknown or unforgiving terrain and to be easily deployable.
Modern-day portable stretchers come in many different forms and include any number of stretchers or patient movement devices that can be carried and/or do not rely on wheeled movement.
Just a few specific types of portable stretchers designed for use in certain situations are
- BASKET STRETCHERS: used in wilderness rescues, and allow for a patient to be pulled up steep terrain;
- FLEXIBLE STRETCHERS: allow for tight quarters maneuverability and for an adequate number of personnel to lift the patient from many points;
- SCOOP or ORTHOPEDIC STRETCHERS: allow for patients who cannot otherwise be lifted due to injury to be removed from a scene and prepared for further treatment and transport.
Flexible Stretchers
Flexible stretchers are a type of patient movement device that can be utilized whenever tight quarter conditions are encountered in the field, preventing patients from being extricated by a long spine board or another rigid device.
As with all patient care and patient movement devices in EMS, only professionals that have been trained and are comfortable with the flexible stretcher should be involved in the use of the device.
Flexible stretchers consist of several rigid flat rods embedded into a sheet of sturdy plastic or other material–flat metal pieces seven feet long, about four to six inches apart, secured inside a tarp, combining to form a rollable, sheet-like, rigid but maneuverable device with multiple handles for EMS professionals to grab.
A patient requiring spinal immobilization can be log rolled and this device placed underneath the patient as if the EMS professionals were placing a sheet for a draw sheet move.
CONTRAINDICATIONS:
- the possibility of extrication by other means(flexible stretchers’ ability to provide spinal immobilization is much more limited than other devices, due to their construction);
- claustrophobia; and
- certain injuries to the torso that can be worsened by compression (i.e., flail chest, chest wall instability, crepitus, etc.).
IMPLEMENTATION: Movement to the flexible stretcher is performed by
- a patient being properly log-rolled to one side, and the flexible stretcher rolled up, is unrolled toward the low side of the patient, coming to rest against the patient’s posterior side.
- Then the patient is rolled to the opposite side, over the rolled-up flexible stretcher, allowing for the flexible stretcher to be unrolled further, thus covering all area behind the patient and allowing for the flexible stretcher to be lifted, encompassing the patient.
Once the flexible stretcher is placed,
- two or more team members take up positions on opposite sides of the patient and grasp the handles. It is imperative to make sure as little slack as possible is present when unrolling the device to prevent unnecessary flex once the patient is lifted while in the device. Flexible stretchers’ ability to provide spinal immobilization is much more limited than other devices, due to their construction.
- It is recommended that at least four EMS professionals are involved when using the flexible stretcher, and more if movement must be facilitated up or down steep gradients or stairs.
- Two EMS professionals will be on each side of the patient, and while using proper body mechanics and employing the power grip on the handles closest to them, all EMS professionals will lift at once and allow the sides of the device to encompass the patient.
Imagine, if you will, a pencil and a tortilla. The pencil represents the patient and the tortilla represents the flexible stretcher.
If the pencil is placed in the center of the tortilla, and then the sides of the tortilla are lifted, what happens?
The pencil remains at the lowest point and the sides of the tortilla extend vertically above the pencil. This is the same as the flexible stretcher and the patient.
It is important that EMS professionals maintain a handhold as close to the patient as possible to prevent the patient from resting on the ground.
A fifth EMS professional, when practical or needed, will be the spotter of the team and guide the group one step at a time, to the point that the patient can be safely lowered and transferred to a safer and more practical means of patient movements, such as a long spine board.
THE BEST STRETCHERS ON THE MARKET? THEY ARE AT EMERGENCY EXPO: VISIT THE SPENCER BOOTH
Scoop (Orthopedic) Stretchers
Another type of patient movement device that is very similar to a long spine board is the scoop stretcher or orthopedic stretcher.
As with all devices in EMS, only professionals that have been trained and are comfortable with the scoop stretcher/orthopedic stretcher should be involved in the use of the device.
The scoop stretcher/orthopedic stretcher consists of two pieces that connect together underneath a patient (who cannot be log rolled due to injury) to form a basket-style carrying device, complete with at least three straps to secure the patient and multiple handles for EMS professionals to carry from along its length.
The inner portion of the scoop stretcher/orthopedic stretcher is shaped like a wedge that contacts the patient first, allowing both sides of the device to be pushed together, and this action alone positions the device correctly behind the patient.
The scoop stretcher has the same ability as the long spine board and can be used for immobilization, and has the same types of straps to secure the patient.
The scoop stretcher will have a release mechanism at both ends of the device that consists of a clasp and button-type activator–this is the female side of the mechanism; the opposite end of the scoop stretcher will have the male side of the mechanism.
IMPLEMENTATION:
If the patient requires spinal immobilization,
- EMS professional number one will be maintaining manual in-line cervical stabilization (with a cervical collar applied) while
- EMS professionals numbers two and three apply the scoop stretcher/orthopedic stretcher.
When it has been decided that the patient is in need of a scoop stretcher/orthopedic stretcher (usually due to multiple traumatic injuries or pelvic instability), at least two EMS professionals are required to apply the device and three are recommended: EMS professional number two will have one full side of the device that is detached from the other side, and position himself/herself on one side of the patient.
The scoop stretcher/orthopedic stretcher may be designed to fit under the patient in only one configuration (tapered at one end for the feet of the patient and wider at the other end for the torso and head of the patient), so it is important that the EMS professional positions himself/herself on the correct side.
Once at the correct side of the patient, EMS provider number two will place his/her side of the scoop stretcher/orthopedic stretcher on the ground close to and parallel with the patient.
EMS provider number three will position himself/herself in the same way on the opposite side of the patient.
All three EMS professionals will be on their knees.
When both EMS professional numbers two and three are in position, they will maintain proper body mechanics, keeping their heads up and backs straight, and push both portions that make up the scoop stretcher/orthopedic stretcher together one end at a time, making sure the locking mechanisms latch and hold against negative pressure.
This same maneuver applies to the other end of the scoop stretcher/orthopedic stretcher.
When both ends are securely fastened together and the patient is correctly positioned on the device, the patient’s body should be secured to the device.
Typically, as with on a long spine board, the torso is secured with straps first, then the abdomen or waist and then the lower body.
If a cervical collar has been placed on the patient, the patient’s head is secured to the scoop stretcher/orthopedic stretcher by placing commercial styrofoam head blocks or rolled-and-taped towels on either side of the patient’s head, and then taping the patient’s head and block devices to the board.
EMS professional number one will continue to hold manual in-line cervical stabilization while EMS professional number two will place one end of the tape (either traditional duct tape or tape that comes with the commercial head blocks) on one side of the scoop stretcher, then guide the remaining length of tape underneath and against the chin of the patient/c-collar, and finally to the remaining side of the scoop stretcher/orthopedic stretcher. The second piece of tape will be applied in the same fashion, just across the patient’s forehead.
All extremities should be assessed for circulation, motor function, and sensation prior to, and after, immobilization to a scoop stretcher/orthopedic stretcher.
It is at this time that EMS professional number one can release manual in-line stabilization of the patient’s cervical spine.
Any voids or obvious spaces of distance between the patient and the scoop stretcher/orthopedic stretcher will be padded with towels or bulky dressings.
The scoop stretcher/orthopedic stretcher can be utilized without the cervical collar if no suspicion of neck injury exists. Full immobilization may not be necessary, either. It is often that patients are placed onto and secured to a scoop stretcher/orthopedic stretcher only to facilitate movement up or down stairs or through other circumstances where the patient cannot be initially loaded onto the mainly-used wheeled stretcher.
Bariatric Stretchers
Some patients are much larger and heavier than the main population and require specialized equipment to facilitate safe movement and transport. Bariatric stretchers are utilized when the patient is expected to be well over or close to the weight limit or size constraints of conventional stretchers.
Most bariatric stretchers are wheeled stretcher devices, consisting of a metal frame that is weight-approved for approximately 1,000 pounds, includes a patient mattress, and several straps to secure the patient to the device (at minimum, a legs strap, a waist or abdomen strap, and chest strap, often with vertical shoulder harnesses) and may come equipped with an IV stand, storage area on the back (for oxygen, sheets, etc.) and usually allows for the patient to be placed in multiple different positions:
- flat on their back or supine–180º,
- sitting up or Fowler’s position–90º, and multiple angles in between.
Bariatric stretchers may also have the ability to raise the feet of the patient at a preset angle known as
Patients are moved and secured to bariatric stretchers in the same ways that non-bariatric patients are moved to non-bariatric stretchers.
The bariatric stretchers can be lowered to preset heights allowing able patients to walk unassisted to the device and also allowing EMS professionals to use the draw sheet method to pull a patient over to the device from a bed.
Most bariatric stretchers also have additional extendable handrails, found midway between the front and back of the stretcher, that allow for better control during movement by multiple EMS providers
Bariatric stretchers have the same loading styles as other modern-day stretchers and can come with several other tools such as winch systems or elevator systems to facilitate loading into the ambulance.
WINCH systems allow for the patient and stretcher to be pulled into the back of the ambulance by a mechanical steel wire and motor, allowing for much more control and preventing injuries to EMS professionals.
ELEVATOR systems extend from the back of the ambulance and lower to the ground, allowing a bariatric stretcher and patient to be secured on a platform which is then lifted to the height of the ambulance box for securement inside the unit prior to transport.
Bariatric stretchers are much heavier than other devices and require adequate personnel to use safely.
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