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Stretchering Your Imagination

This animation shows different solutions from various services like a classic ambulance, ECMO services and aviation-based transfers.

Stretchers are the centre-piece of every transfer and one that you’ll become very familiar with, as you will use it for every patient.

A transfer stretcher has to provide:

  • safety
  • comfort for the patient
  • pressure sore prevention
  • space to secure all equipment
  • injury prevention for the staff operating it

Grahpic shows a person lifting, a waving hand, an injured person and the text reading 6000injuries/year

A well designed stretcher prevents work related injuries for staff. The CDC (Centre Of Disease Control) has published some very good infographics and data on how to prevent injuries which are available below, in the “Downloads” section.

Loading A Stretcher

There are several systems for loading a stretcher; the Easi-Loader, the ramp and the tail-lift systems are most commonly used.

EasiLoader stretcher elevating patient unit to the height of the ambulance for safe loading

© Getty, Example of an Easi-Loader in action as team quickly offload the patient.

Picture shows a stretcher on a ramp to be hoisted into the ambulance

Example of a tail ramp with winch to load stretcher onto a mobile ICU type ambulance

Picture shows the tail lift at the back of an ambulance which is used to lift the entire stretcher onto the level of the ambulance box

An ambulance tail lift in action
There is evidence that electrically powered stretchers can decrease the number of stretcher-related work injuries by approximately 70%
The graph below shows the rate of lost-work-day injuries. There is significant reduction in the relative incidence of occupational injury when using mechanical patient lifting systems.
Graph shows days away from work /100 people. The graph demonstrates that most injuries are back injuries followed by back, neck und knees. The sole back anomalies are the least happening
© Studnek et al, 2012
A study on the physical forces on handling the stretcher by Cooper and Ghassemieh in 2006 concluded with the following recommendations:
The Easi-Loader stretcher should not be used since it requires applied loads which exceed safe loading levels.
The ramp system appears to be safe, but the winch system should be used for all patients > 75 kg. Training on how to share the load when using the winch is recommended.
Changes in the design of stretchers like reducing stretcher mass, restricting maximum force application angle to 25° and reducing wheel friction can mitigate the risk of injuries for staff.

Securing The Patient & Equipment

When transferring critically ill patients there is naturally a lot of equipment involved and so the secure mounting of every single item is crucial, using mounts, rails and brackets. These all have to be crash tested and secure to ensure you and the patient are safe.
A study published during the development of the US American SAE (Society of Automotive Engineers) standards showed that during a front impact collision at just 30mph the force was significant enough to cause the stretcher to break free of the antlers, sending even a properly restrained patient forward into the space often occupied by the jump seat in the patient compartment.
Picture shows ambulance in a crash test and seriously damaged front cabin
© https://www.cdc.gov/niosh/docs/2010-164/images/CrashTest.jpg
This photo shows the inside of an ambulance after a crash, demonstrating the impressive forces acting even at low speeds. It’s obvious from this that securing the entirety of the equipment is as important as securing the patient and yourself.
It is our responsibility to reduce the risks to patient, personnel and equipment.

Picture shows the insie of an ambulance after a crash. All equipment had been thrown around and covers the floor of the cabin chaotically

© https://www.cdc.gov/niosh

Practical Stretcher Rules

  • Check wheels, brakes, legs, bolts and screws daily.
  • Check the battery and lifting system daily.
  • Keep backup batteries in the ambulance.
  • Check the patient’s weight plus the equipment against the maximum loading capacity.
  • Check the stretcher is securely locked into the ambulance.
  • Use restraints or secure straps.
  • Lock all wheels when the ambulance is in motion.

In the next step we continue to look at transfer equipment. Discuss what to pack, how to organise equipment and how to transport it. There are some really good solutions available; share your own experience with us.

References

This article is from the free online

A Journey Through Transfer Medicine

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