How Much Is TOO Much?
One of my part time part-time jobs is helping defend EMS providers when they find themselves involved in some sort of litigation. I recently found myself as part of a legal team helping defend two EMSers and their respective agency in an alleged "patient drop" case. A close look at the case revealed that the EMS team did not actually "drop" the patient, per se. The patient was returning home from an MRI, so a non-emergency unit was scheduled to handle the call. When the patient came out of the facility, both medics knew they had their work cut out for them, as the patient looked to be close to 400 pounds. With the dual purpose of patient comfort and improving the mechanics of the lift, the medics positioned the gurney up a couple of notches—roughly 9 inches off the lowest position. They positioned themselves for the lift, coordinated the move with the customary "on the count of three," and, as the medic pulled the release, absorbed the entire weight of the patient, and the gurney went straight down onto the pegs.
The medics wrote an addendum and documented that while preparing to load the patient there was a "controlled drop." Actually, there never was a drop and the patient never left the gurney, but "pain was the claim." When the dust settled, the patient had a $580,000 check in his hand because the insurance carrier decided that going with a jury was just too risky, given what was documented on the addendum. In the interest of helping you avoid being a participant in a drop case, let's look at this vexing matter.
All Patients Weigh More Than They Say
When errant patient weight information is provided to you, be it intentionally or innocently, and you base your mental calculations on bogus numbers, it can increase the likelihood of some sort of failure during the move. In those cases where the patient's stated weight is clearly nowhere in the ballpark, it's worth revisiting the weight estimate by directly asking the patient when he or she was last weighed (probably in a physician's office) and how much that weight was. When in doubt, I've found that taking the stated weight and adding 20% seems helpful.
Know Your Limits
EMS providers are increasingly interested in their well-being, especially regarding professional longevity, and many belong to a health club or workout facility. Talk with a trainer or staff member and, if possible, have them watch and assess your ability to do curls, squats, bench press and leg presses. The goal is to get a reasonable handle on how strong you are and how much weight you can safely lift and maneuver. Knowing how much weight you can handle reduces the likelihood of overestimating your lifting and moving potential.
Know When To Call the Cavalry
When stairs are involved and when no specialty patient movement devices are available, never hesitate to call for back-up for that patient who looks like he is more than you can handle safely. Tight stairwells, multiple turns and small landings all contribute to increased difficulties with patient lifts and moves. Having to pirouette a gurney to turn on a 4x4 landing is no small trick. This scenario becomes even more complicated with a sicker patient. With increasing severity of the patient's condition comes a parallel rise in the likelihood the providers will try to make the lift alone to get the patient moving toward the hospital. It is not an unreasonable thought process, but it's one that must be closely assessed. Any failure during a patient care lift/move can result in injury or disability for everyone involved. Obviously with a catastrophe, even death is a possibility. If more help is needed, take time to bring in the right resources so you can safely handle the patient.
Follow the rules of lifting with religious fervor. Somewhere permanently stashed on your mental hard drive must be the template for the rules of making a safe lift:
- Feet flat, on a dry surface, shoulder width apart
- Back straight, eyes forward, butt down
- Keep the weight as close to your body as possible
- Use your legs as your primary lifting muscles
- Communicate clearly when initiating, making or terminating a patient move.
Improving your ability to quickly and accurately assess a patient's weight is clearly an important skill to develop. Then, taking time to learn your lifting and moving limits gives you a handle on the two key variables involved in any patient lift. Together they can help avoid a failed lift and all the physical pain, emotional impact and legal baggage that will most certainly come with it, especially if the patient is injured or killed. It is both literally and figuratively an ounce of prevention or a pound of cure, so take time to figure out HOW much is TOO much.
Until next month…
EMS EXPO™
Mike Smith is a featured speaker at EMS EXPO, October 15–17, in Las Vegas, NV. For more information, visit www.emsexpo2008.com.
Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of EMS Magazine's editorial advisory board.
