Lifting, Moving, and Patient Transport
Help Questions
NREMT: AEMT Level › Lifting, Moving, and Patient Transport
Which approach is most appropriate for moving and transporting this patient?
Apply four-point hard restraints immediately to prevent potential escalation.
Request chemical sedation from medical control prior to attempting to move the patient.
Use de-escalation techniques and have a police officer ride in the ambulance.
Refuse transport unless the patient is placed in full police custody and handcuffs.
Explanation
The principle of using the least restrictive means necessary applies. Since the patient is not physically violent, verbal de-escalation is the primary strategy. Having law enforcement present in the patient compartment provides an added layer of safety without resorting to premature physical or chemical restraint. Restraints should only be used if de-escalation fails and the patient becomes a danger to themselves or others.
From an EMS operations and safety perspective, what is your immediate responsibility?
Tell your partner to take a short break while you finish securing the patient for transport.
Advise your partner to complete the transport and file an injury report after the call.
Have your partner remain in the driver's seat and manage patient care by yourself.
Request a supervisor and an additional crew to the scene to take over patient care.
Explanation
Any potential provider injury, especially a back injury, compromises the crew's ability to safely care for the patient and operate the ambulance. The immediate priority is to ensure the safety of the crew and continuity of patient care. This requires notifying a supervisor and requesting another unit to either assist or take over the transport, allowing the injured partner to be evaluated.
Which lifting technique would be most appropriate and comfortable for this patient?
Perform a direct ground lift with two providers to place her on the cot.
Assist the patient to a standing position and pivot her to the cot.
Use a draw sheet to slide her from the recliner onto a scoop stretcher.
Use an extremity lift, with one rescuer at the head and another at the knees.
Explanation
For a frail patient with painful joints and spinal deformity, minimizing movement is key. A scoop stretcher, used in combination with a draw sheet, allows the patient to be lifted with very little manipulation of her spine or limbs. An extremity lift could be painful, a direct lift is difficult from a chair, and she is unable to bear weight, making a stand-and-pivot impossible.
What is the most critical operational action to take during this transport to protect the crew and vehicle?
Place a non-rebreather mask set to 15 lpm on the patient over their surgical mask.
Wear a surgical mask yourself to prevent droplet transmission during the transport.
Ensure the patient compartment's exhaust fan is activated and set to high.
Wipe down all surfaces the patient may have touched with a disinfectant wipe.
Explanation
For airborne diseases like tuberculosis, engineering controls are a primary line of defense. Activating the ambulance's exhaust fan to create negative pressure in the patient compartment helps to vent potentially infectious particles outside, reducing the concentration of aerosols within the vehicle and minimizing exposure risk for the provider. While personal protective equipment (an N95 respirator, not a surgical mask) is also crucial, ventilating the space is the key operational step being tested here.
Which modification to the patient's transport position is most appropriate?
Position her in a semi-Fowler's position to reduce pressure on the diaphragm.
Manually displace the uterus to the left side while she remains supine.
Place her in a left lateral recumbent position or tilt the backboard 15-30 degrees to the left.
Place her in a Trendelenburg position to increase blood flow to the brain.
Explanation
The patient is likely experiencing supine hypotensive syndrome, where the gravid uterus compresses the inferior vena cava, reducing venous return to the heart. The standard of care is to position the patient on her left side or, if immobilized, tilt the entire backboard to the left. This displaces the uterus off the vena cava and should improve her blood pressure and symptoms.
To ensure crew safety and proper body mechanics, how should the team be positioned for the lift?
One provider at the head, one at the feet, and one at the side to guide the patient.
The two strongest providers should be at the patient's head and chest, with the third at the feet.
Two providers should be on one side of the bed, with the third provider on the opposite side.
All three providers should position themselves on the same side of the bed to pull the patient.
Explanation
The weight of a patient is not distributed evenly. The head, torso, and pelvis account for the majority of the weight. To ensure a balanced and safe lift, the strongest providers should be positioned at the head and chest area where the greatest load is concentrated. Placing personnel unevenly on the sides can lead to twisting motions and injury.
What is the most important consideration related to the IO line during the move?
Ensuring the pressure bag remains inflated to exactly 300 mmHg at all times.
Pausing the infusion during the move to prevent fluid overload from jostling.
Protecting the IO site from being bumped and securing the tubing to prevent dislodgement.
Positioning the fluid bag below the level of the patient's heart to assist with flow.
Explanation
The primary concern when moving any patient with IV or IO access is securing the site and tubing. Dislodgement of an IO catheter is difficult to correct and would interrupt a critical fluid resuscitation. While pressure is important for flow, the physical security of the device is the most critical consideration during the physical act of moving the patient.
Which type of move is most justified for this patient?
A standard lift, once the fire department has ventilated and cleared the structure.
A non-urgent move, after a full secondary assessment is completed on scene.
An urgent move, performed after assessing the ABCs and addressing any life-threats.
An emergency move, performed before any assessment or treatment is initiated.
Explanation
An emergency move is indicated when there is an immediate, ongoing danger to the patient or responders. An active carbon monoxide leak with a symptomatic patient constitutes such a danger. The patient must be moved to a safe environment before any significant assessment or treatment can take place. Waiting to perform assessments or for the scene to be cleared would cause unnecessary and harmful delay.
What is the AEMT's best action to protect the airway?
Tilt the head of the flexible stretcher downwards to allow for drainage.
Continue the extrication quickly and suction the patient once in a larger space.
Turn the patient's head to the side and use a suction catheter immediately.
Use the stretcher's flexibility to bend the patient into a semi-Fowler's position.
Explanation
A flexible stretcher offers limited ability to reposition the entire patient, but the head can still be turned. The immediate priority is to prevent aspiration. Turning the head to the side uses gravity to help clear the oropharynx, and suction should be used concurrently to remove the vomitus. Delaying airway management is inappropriate.
What is the most critical transport consideration for preventing systemic complications in this patient?
Ensuring the splint is tight enough to prevent any movement during transport.
Applying cold packs to the injury site to reduce inflammation and bleeding.
Elevating the injured leg above the heart to minimize swelling and pain.
Covering the patient with blankets and increasing the ambulance's cabin temperature.
Explanation
Trauma patients, especially those with significant fractures and bleeding, are at high risk for hypothermia. Hypothermia worsens coagulopathy, leading to more bleeding and shock (the 'trauma triad of death'). Preventing heat loss by covering the patient and warming the ambulance is a critical intervention to prevent this cascade, even more so than limb elevation or local cold therapy in the initial phase.