Teaching safe stretcher operations right the first time

It's difficult to understand the concept of safe stretcher handling just by watching a video or reading a policy. There are many components of safe patient handling, such as, a review of proper body mechanics, choosing the right equipment, lifting techniques, and employee wellness that must be covered first.

It is the responsibility of an agency to teach employees how to stay off the injured list, while doing no harm to their patients. However, in most organizations, hands-on training usually consists of watching a video, lifting the stretcher up, and down and pressing the buttons.

Situational training

Situational training takes hands-on training to a new level. It puts EMS providers through many of the challenging scenarios they may encounter when moving a patient.

At Sunstar Paramedics, our training starts with a 180-pound manikin that is lying on the ground. Two recruits work together to determine the best way to move the “patient” to the stretcher using a variety of devices such as slide mats, friction-reducing devices, backboards and scoop stretchers. Next, they must demonstrate the ability to lift the “patient” and stretcher using good body mechanics. If they use unacceptable or dangerous techniques, the recruits are remediated in real time.

We then have them maneuver through a stretcher obstacle course that takes them to an ambulance. The stretcher course is an area designed to have multiple surfaces and grades. We planned the course so that the stretcher must travel over gravel, dirt, sand, grass, mud, and hard-packed surfaces like cement, and asphalt. We also place obstacles for them to maneuver around and lift over. A piece of plywood that doubles as a wheelchair ramp and an uneven grade is added to evaluate their problem-solving skills.

As they maneuver the stretcher through the course, the trainer watches for any safety problems that may occur, such as, not keeping two hands on the stretcher. As they change surfaces, they are questioned about what problems might arise and how they may compensate to keep their patient and themselves safe.

The recruit uses critical thinking skills rather than just being told solutions. When the stretcher is on an uneven surface, we surprise them by pushing on the side of the stretcher to show how easily it is tipped if the stretcher is not being supported with two hands on each end.

As they approach the ambulance we demonstrate how reaching to open the back doors while the stretcher is still in motion can affect the gravitational force of the stretcher. We listen to how they interact with each other and the patient and advise them on the most common mistake that most recruits make, which is assuming rather than verbally communicating with each other.

We have found that training for situational awareness and critical thinking is the most important aspect of patient handling and safety.

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Charlene Cobb is the Special Services Manager for Sunstar Paramedics in Pinellas County, Florida. She also is a member of the NAEMT Safety Committee that developed the new NAEMT EMS Safety Course.