|Short boards are designed to assist in extricating patients from vehicles out on to long boards. A wooden and vest type short board are both good options.|
|Backboards are designed to assist in immobilizing possible spine injured patients but are often used to get patients from where they are found to the cot. Wooden and plastic adult boards are shown here with a plastic pediatric long board.|
|The new stair chairs allow for the safe movements of patients in a sitting position. These new designs also feature tracks which take much of the weight off the rescuer.|
|Infant or child seats should be on your ambulance not just for sick or injured infants and children, but children being transported along with an ailing parent. (Fire Apparatus Photo by Will Chapleau)|
|Collapsible stretchers have long provided lightweight, easy-to-store options for getting patients up or down stairs and onto our cots.|
What’s in your ambulance? Getting people out of their homes, vehicles or from wherever they’ve gotten themselves in trouble, has always been a challenge for us in the emergency medical service field.
Often, it’s not practical to bring our stretchers to the patient and we need to find ways to get the patient safely to the security of our ambulance cot.
Some of the devices available to us have been around for years without many changes and others have been significantly reconfigured.
If you started looking at the compartments on your ambulance, you ought to be able to find most, if not all, of these devices on board. Let’s take a look at some of them.
Portable stretchers have been around for years. They’re usually simply constructed of tubular metal with a canvas like material stretched across the tubing to make up the surface upon which the patient is carried.
Some were fixed and had to be stored at full length and others had one or two folding points. These are often referred to as collapsible stretchers. Portable stretchers are lightweight and can make it easier to get patients up or down stairs when it’s not practical to get the ambulance cot to the patient. The disadvantage is that patients in respiratory distress need to be carried in a sitting position and these portable stretchers will not accommodate this configuration.
An option to accommodate these patients is a stair chair.
These have long been an option for getting patients out of the house in sitting positions. Many of us have used chairs from kitchen tables to get patients out of the house and to the ambulance.
Stair chairs, commercially designed for EMS work, provide an option for patients with respiratory problems. Newer versions have tracks that allow the chair to glide down the stairs making it a smoother ride for the patient and taking a lot of the weight off of the rescuers. It goes without saying that patients need to tolerate sitting positions in order for these chairs to be used.
Another viable option is a flexible stretcher and they are available in a variety of versions.
Flexible stretchers have the advantage of being able to be stored in a small amount of space and being able to be squeezed into confined spaces to get under the patient.
Some are made of rigid slats wrapped in vinyl while others are made of plastic that rolls up for storage and for slipping into tight spots.
Then, there are the original basket stretchers to consider.
Called stokes baskets, they were made of a chicken wire-like cage that was supported with metal bands forming a basket that could be used to move patients in confined spaces and in high angle rescue situations.
These baskets provided a secure platform to secure the patient to as well as providing some protection from the environment from which the patient was being extricated.
Newer models are made of lightweight plastics and are more comfortable for the patient than the old wire baskets.
Next are long backboards, or spine boards. Recently, they’ve been come the workhorse for prehospital care providers.
Long boards are designed to provide a base for immobilizing spine injured patients. They have become a tool used to carry patients with all manner of injuries or illnesses, particularly heavier patients that require sturdy portable devices to support them.
Originally made of wood, we have moved away from wood toward stronger plastics that are also safer regarding blood borne pathogens and easier to clean than wood.
Newer versions using strong, lightweight plastics are able to support patients in excess of 400 pounds. This is a valuable improvement to which any of us that have had a backboard break under a patient can attest.
Closely related to the long board is the short board which is just what the name implies, a shorter version of the long board.
They too were once made of wood and over the years improvements have been made to the short board to make it easier to immobilize the head to the board by cutting one end down to closer approximate the size of the head and neck. The sides were also scalloped to provide points for straps or tape to wrap around.
When padding around the head and neck became the standard, some found themselves flipping the board upside down to provide space to secure the padding.
Short boards are designed for use in confined spaces, like cars, where patients are found in a sitting position and need to be secured before bringing them out onto a long board.
The latest versions of short boards are more like vests. The vests consist of stays, or rigid slats, wrapped in vinyl that allows them to be rolled up for storage and slide into confined spaces. They also come with straps built in that allow for securing the device firmly to the patient.
Scoop stretchers have long been in the arsenal of EMS provider and were once the primary tool used to move patients. They made it much easier to get a device under patients that had painful pelvic or hip injuries.
Many providers used them exclusively for patients with fractured hips, as they are difficult to roll onto longboards because of pain. Scoop stretchers are split down the middle and come apart at the foot and head ends. This allows the scoop to be slid in from both sides of the patient, lifting the patient onto itself as the two sides are locked together at the head and foot ends.
When standards for spinal immobilization became more stringent, scoop stretchers were discouraged, as they did not provide adequate support for the head and neck. The latest versions of scoop stretchers, constructed of plastic, seem to remedy that and provide more support for the head and neck.
Recent studies seem to show that the newer versions of the scoop stretcher are effective for immobilizing suspected spinal injuries.
One of the latest additions to our arsenal of devices for moving patients is infant or child seats. These are the same car seats used by parents to safely transport their children in vehicles.
National standards call for ambulances to have these seats on board for whenever children need to be transported. As often as not, we are concerned with infants or children that have to be transported along with a parent that we are treating.
Some manufactures provide devices specifically designed for ambulances but most often we use the same seats found in cars of parents today.
So, considering the myriad of devices available today, what should you be carrying on your ambulances?
Obviously you’ll need the cot, or stretcher and after that, you’ll need to look at the different types of situations in which you find your patients. All of us will find ourselves in places where the cot won’t fit. For these situations, you will need some sort of portable stretcher.
Due to space restrictions on the ambulance, many providers have resorted to using their backboards for this purpose.
On the other hand, a lightweight portable collapsible stretcher can be handy for carrying patients out of their homes if you have the space for one.
So, portable stretchers are great for non-spine injured patients but you can use the backboards for all of your patients if space is an issue. If it ever becomes a decision of more spine boards or a collapsible stretcher, choose the boards.
Flexible stretchers are good to have around for those confined space situations when you can’t get a long board onto the space. Short boards can be useful in these situations too. And as every ambulance should have some type of short boards for vehicle extrication. But, if you ever had to choose just one, again because space restrictions, I’d go with the short board device.
Scoop stretchers are great for geriatric patients and if the studies bear out, may be acceptable for patients with spine injuries. At the very least, you should have one for the hip injuries.
Basket stretchers are special rescue tools and I don’t know many rigs that have space for these on their ambulances.
All EMS providers should have access to one, however, for those rescue situations that call for a protective device for moving the patient. However, some of the flexible stretchers consist of rolled plastic which wraps around the sides of the patient. These take up very little storage space and can be used in situations that would call for the basket stretcher.
Stair chairs should be on every ambulance. The ability to move patients in sitting positions to facilitate breathing and for easing the load on rescuers by not having them lift the patient to move them in and out of the building makes these a necessity.
Further, the weight of our newer ambulance cots makes it impractical to bring them up stairs in many buildings and the stair chair can help us get patients down to our cots.
And, if you don’t have infant or child seats in your rig, get one. It’s a national standard of care and the right thing to do to protect the children that may have to ride in our ambulances.
Check out what you’ve got in your ambulance and if you don’t have some of these that make sense for your operations, consider purchasing them.
Regarding the ones you have, make sure they’re in good condition and all of the straps are in place and ready to work.
Practice using them so you are ready to move your patients safely.
That’s it for this month. Send me your thoughts, questions, and things you’d like me to write about to Fire Apparatus, by emailing firstname.lastname@example.org.
Till next month, be safe.