You’ve heard the saying, work smarter, not harder. Nowhere is that more important than in the fire service. Firefighters come in all shapes and sizes. So do patients. And since emergency medical services is 80 to 90 percent of our work, patient packaging and transport can become hazardous to your health unless you use proper equipment and lifting techniques.
Back injuries are the most common on-duty injuriesy sustained by firefighters, but these injuries don’t always take place on the fireground. In fact, more firefighters injure their backs off the fireground.
The older I get, the more risk-benefit analysis factors into every decision I make—even with patient packaging. I have 30 years on the job, and I’d like to squeeze in three or four more before I call it quits. I don’t want to be taken out prematurely because I didn’t wait for help with a nonemergency task.
Personal Service Calls
It is possible for one person to carry a 26-foot ground extension ladder; but it’s easier for two. Many PPV fans have wheels; but carrying a fan strains the lower back. They have two handles—use them with two firefighters. The new hose appliances are all lightweight metal alloys; however, there are still plenty of brass monitors, tri-gated wyes and manifolds around. When it’s time to pick up, the emergency is over. Two firefighters should carry heavy equipment back to the rigs. Save your back.
Some EMS calls we get throughout the shift are personal service-type calls. This includes the I’ve-fallen-and-I-can’t-get-up call. Usually, the people needing help are senior citizens who aren’t injured, but for whatever reason have ended up on the floor. Be careful. Simply bending over in an awkward position to pull someone up can throw out your back. (Those of you who have done this can already feel the pain.)
Make Room For Lifting
Move beds and other furniture out of the way so crewmembers have room to use proper lifting techniques. If the patient is large or obese, call for additional resources so you have enough personnel to lift this person. It’s safer both for the patient and for crewmembers.
Here’s one technique that uses a backboard to lift an obese patient off the floor. It can be done with three firefighters, but it’s easier with four. First, follow your local EMS scene assessment and patient exam protocols. After determining that the patient is not injured and merely requires assistance getting up, this technique is pretty slick.
When an obese patient is in a supine position and is not injured, it’s natural for firefighters/EMTs to grab the patient’s arms and try to pull the patient to his or her feet. This can be painful for large patients, as the heavy weight strains the glenohumeral joint and the rest of the shoulder girdle.
Place the backboard on the floor next to the patient. Put a small wedge, a spanner wrench or a roll of tape under the head of the backboard. This creates a small gap for your fingers so you can get underneath the board after a patient is on it. Next, allow the patient to scoot onto the backboard. The patient’s feet should be as close as possible to the foot-end edge of the backboard. You want to limit the patient’s tendency to slide down the board when you lift them.
Position one firefighter at the foot of the backboard. The firefighter’s boot tips should be on the board’s edge, just enough to prevent the board from slipping. This firefighter will serve as an anchor and pivot point, and is there to provide friction to the board, not to add weight by standing on the board.
The other two firefighters should be at the head of the backboard and on opposite sides facing each other. This is where proper lifting techniques need to be employed. The initial lift requires the most strength and causes the most strain.
Pause At 45 Degrees
Backs should be as straight as possible and all lifting should be done with the legs. The strongest, most fit firefighters should assume the head position and the senior firefighter should assume the foot position.
On the count of three, lift the patient to a 45-degree angle. With gravity, a patient should slide down the board until the patient’s feet touch the floor. This allows the patient to gain some traction and balance on the board. There needs to be a slight pause at this 45-degree angle so the crew can reposition their grips and lifting positions.
Now that the patient has gained some traction and a little stability, the foot-positioned firefighter should quickly shift to the top of the backboard and take the weight at the head position. This allows the other two firefighters to reposition.
Keeping A Grip
Both firefighters need to keep their grip on the board with the hand closest to the head. Their bodies will prevent the patient from sliding off the board to either side. With their free hands, they need to reach lower for the backboard by first sliding their arms underneath the patient’s armpits, then grasping the backboard. Ask the patient to keep both arms and hands firmly at his or her sides. This resistance against the firefighter’s arms will prevent the patient from slipping down the board.
Finally, the firefighter at the head position can use a military press motion and push the board away from him, bringing the backboard to a full vertical 90-degree position. The evolution is now complete.
Wait an extra minute before letting go of the patient. Make sure the patient has completely regained balance and equilibrium and feels confident about standing unassisted. Take the patient’s pulse and blood pressure again in the standing position to make sure there is not a postural drop. That’s it. You’ve saved the day and your back.
With practice, this is a very quick evolution. It’s easier with four firefighters, but it is demonstrated with three to illustrate pivoting points, balancing points and mechanical advantage techniques.
Firefighters are creative. Once you start drilling on this evolution, the company will start improving the technique by using webbing, straps, rope, pulleys and tools. There are many ways to accomplish this task, but the basic mechanics are the same. You’re constructing a drawbridge with a backboard to raise a heavy, supine patient from zero degrees to a vertical 90-degree standing position without busting a gut, popping a hernia or blowing a disk in your lumbar spine.
The Seattle Fire Department constructs its own wooden backboards from cabinet-grade plywood (5 to 7 ply) with no blows. They are sanded and heavily varnished for the easy cleanup of bodily fluids, blood-borne pathogens and other contaminates. The edges have oblong holes for hand placement and straps. Most important, there are no metal components so there is no radiopathic interference. This allows for clean X-rays and CAT scans in an emergency room without removing the backboard from the patient.
We also make an extra-wide backboard, 32 inches by 72 inches by one inch for extremely obese patients. If load capacity is an issue, we can duct tape two boards together for extra weight-bearing strength.
There are many commercial backboards available in varying sizes and features. Brand names include Dragone Rescue, EP&R BakPak, Hartwell Combi Carriers, Iron Duck, LSP Spine X, Rapid Deployment Prolite XT and Laerdal BaXstrap. Most backboards weigh about 11 pounds and have load capacities that range from 300 to 500 pounds.
Upper-end commercial backboards are commonly made of tough, medium-density polyethylene, which provides incredible strength with minimal deflection under maximum load. That material also provides for a high degree of X-ray translucency for clear radiological images as well as increased buoyancy for water rescues with flotation capabilities up to 300 pounds, depending on the model. There is a wide variety of strap configurations and cushioned head rolls for patient immobilization. Average prices range from $125 to $250 per board, but can go as high as $1,000 with all the bells and whistles.
The Seattle firefighter in the training photos illustrating the technique is Nathaniel “Nate” Ford Jr., senior crewmember, who died in 2005 after complications arising from cancer. This column is dedicated to his memory.
Editor’s Note: Raul A. Angulo is a 27-year veteran of the Seattle Fire Department and captain of Ladder Company 6. He is on the Board of Directors for the Fellowship of Christian Firefighters. He lectures on fire service leadership, company officer development and fireground strategy and accountability throughout the U.S., Canada and Mexico.