(Continued from Part 2.)
This log-rolling procedure maintains the patient’s entire body in neutral alignment, minimizing any untoward movement of the spine. (Procedure assumes any upper and lower extremity injuries are already immobilized). Then:
1. Prepare the spine board or stretcher with straps, placing the board next to the patient’s side. The straps are to be positioned for fastening later across the patient’s thorax (chest), just above the iliac crests (hip-bones), thighs, and just above the ankles. Straps or tape may be used to secure the patient’s head and neck to the long board.
2. If you have a cervical collar, apply it now how you have been taught to. If you don’t, you won’t.
3. Gently straighten the patient’s arms and place them (palm-in) next to the torso.
4. Carefully straighten the patient’s legs, placing them in neutral alignment with the patient’s spine. Gently, yet firmly, tie the patient’s ankles together with roll-type bandaging (or if you need to improvise, a scarf or belt will work).
5. Assistant 1 continues to maintain alignment of the patient’s head and neck, and monitors.
Assistant 2 reaches across the patient grasping the patient at the shoulder and wrist.
Assistant 3 reaches across the patient grasping the patient’s hip just distal to the wrist with one hand and with the other hand firmly grasps the roller bandage or tie that is securing the ankles together.
6. At the direction of Assistant 1, the patient is cautiously log-rolled as a unit toward the Assistant(s) at the patient’s side, but only to the minimal degree necessary to position the board under the patient.
a. Assistant 1 (at the patient’s head) closely observes the log-rolling process and maintains neutral alignment of the patient’s head and neck with the torso, avoiding any flexion or hyperextension of the patient’s neck.
b. Assistant 2 controls movement of the patient’s torso and maintains neutral alignment of the thoracolumbar (chest and back) spine.
c. Assistant 3 helps to maintain neutral alignment of the patient’s thoracolumbar spine and pelvis with his hand on the patient’s hip. Additionally, the legs are maintained in neutral alignment with the torso by firmly grasping the tie securing the patient’s ankles together with the other hand, and elevating them approximately 4 to 6 inches. This latter maneuver helps to maintain neutral alignment of the lumbar spine and avoid pelvic tilt.
7. Assistant 4 places the long spine board beneath the patient.
8. All assistants carefully log-roll the patient back as a unit onto the long board. Extreme care is exercised by all during this step to avoid untoward movement and maintain neutral alignment of the patient’s spine.
9. The patient is then secured to the long board.
a. Assistant 1 continues to maintain in-line immobilization of the patient’s head and neck.
b. Assistant 2 securely tightens two straps – one across the patient’s upper arms and thorax, and a second just proximal to the iliac crests. The wrists are secured to the patient’s sides by this second strap.
c. Assistant 3 securely tightens two straps – one across the patient’s thighs, and one just above the ankles. Blanket rolls, placed on the outer sides of the patient’s lower legs, may be required to prevent lateral movement of the lower extremities.
d. Assistant 4 places padding or a pillow under the patient’s head as necessary to avoid hyperextension and flexion of the neck.
e. Padding, rolled blankets, or similar bolstering devices can secure and ‘buffer’ either side of the patient’s head and neck against unwanted rockin’ and rollin’. Secure the head firmly to the board by tightening a strap over the lower part of the forehead or using tape – BTW, painters’ / masking tape is good for this and much kinder than duct tape. Another piece of tape can be placed over the bolstering devices and cervical collar, further securing the patient’s head and neck to the long board.
So – now we have our informed and hopefully cooperative patient, on / in a good (basket) stretcher and ready to move.
Reminder: During the course of this type of training all y’all are going to be in the stretcher or lying on the transport platform LARPing as the patient. You’ll quickly feel uncomfortable. Because, being immobilized on a hard surface for any length of time is first uncomfortable, and then painful. When I conduct this training myself I usually pretend to ‘forget’ about a volunteer who I leave strapped on a hard board for a half-hour or until they complain… They get the message!
Indeed if a patient is left immobilized for any length of time on a hard board they may develop pressure sores at the points of most contact i.e. the back of their head, their shoulders, their lower back, and their heels. Bear this in mind if your patient is going to be immobilized for hours while you move them… because you know what they’re going through.
HOW TO SECURE PATIENT INSIDE THE STRETCHER
There are many different methods for securing patients onto or into a (basket) stretcher. Mistakes may lead to tragic results – if the patient should fall out especially while lowering or lifting the stretcher. The basket stretcher is my preferred platform because the patient will tend to stay inside it and not slide out even if I have been sloppy with the harness, belts and attachments – which I must not be!! whereas a patient on a flat platform with open sides can easily slide in any direction if not really carefully restrained across all quadrants and directions.
Our patient has to remain secure in any of five different positions; 1) horizontal, 2) on their side, 3) feet down, 4) head down, or 5) face down.
The easiest position to achieve, and the one that gives the best ride for the patient, is when the litter platform is horizontal with the patient in a supine position (flat on their back). In theory, no restraint straps are required as the basket and its frame keep the patient from falling downward to the ground. But we don’t rely on theory. In practice, we use all the restraint straps supplied by the manufacturer (and they work very well both to secure the patient in this position and to keep the patient from sitting up or falling / sliding out).
To repeat: securing the patient from in the stretcher is of critical importance for patient safety. And, remember if the patient may vomit, you will need to turn the stretcher on its side during transport to prevent the patient aspirating their vomit. This isn’t just as unpleasant as it sounds, it can be lethal.
An occasional orientation is vertical with the head up and feet pointing down (for confined space and ladder rescues).
The position vertical with the head down and horizontal with the face down, are a good indication that something has gone seriously wrong with your plans!
HOW TO CARRY AS A TEAM
The aims of carrying a patient by stretcher are to move him/her without harm, without unnecessary pain, and without unnecessary delay. To do this we must work as a team under the guidance of your team leader.
– carry the stretcher without bumping it; so line up either side of stretcher and use your left or right hands as indicated to grasp the carry handles set into the orange plastic at the top DO NOT USE THE ROPE FOR HAND GRIPS AS THE ROPE WILL ‘TRAP’ YOUR HANDS AS SOON AS YOU LIFT THE STRETCHER.
– a stretcher should promote a sense of well-being, and feel both comfortable and safe to the patient. Therefore we always lift together, smoothly, upon an audible command from our team leader that the patient could also hear if he is conscious, and warn the patient what we are about to do. (Think about your feelings if you were the patient; when you have just experienced some accident or emergency, the last thing you want immediately afterwards is to feel that you have also become the victim of an insecure or uncomfortable stretcher ride…).
The way we place a casualty in the stretcher, the way we handle the casualty while he is in our care, should inspire confidence in our patient.
– the FERNO plastic stretcher is robust enough to remain undamaged even if handled roughly but the patient is not; therefore never drop, bounce or ‘crash’ the stretcher.
– when going through a doorway, use four carriers (one at each ‘corner’) while half of the remaining team goes through the doorway ahead of the stretcher to take the weight once half of the stretcher is through the doorway, so that there are never less than four, and usually six people taking the weight.
(To be concluded tomorrow, in Part 4.)
