# Chest And Shoulder Straps on Cot



## Craig Alan Evans (Jul 15, 2012)

What is everyone doing with chest and shoulder straps on the cot.  We use them with the same philosophy as a car seat.  We don't move until the patient is fully secured, but I just talked to a good medic from another jurisdiction and he is not using his.  He quoted some documented incident where during a frontal collision the patient rebounded back down onto the straps impacting the front of his neck causing carotid spasms.  My thought is if the manufacturer of your stretcher recommends using the straps and you are not and the patient is subsequently injured from a collision you and your employer are culpable.  

Thoughts?


----------



## WolfmanHarris (Jul 15, 2012)

All straps at all times. There's a good crash test video on YouTube of a dummy on the stretcher without the shoulder straps. It doesn't go so well for the medic in the jump seat. 

The carotid spasm thing sounds like the whole "seatbelts kill more people than they save" BS.


----------



## Veneficus (Jul 15, 2012)

I agree with your thoughts without condition.

I think that extends to the use of any medical device. The manufacturer recommendation might be BS, completely made up, but I wouldn't want to be the one defending that in court. 

To add to your thoughts though, I have never been in an ambulance collision myself, but from what I have learned about them, it doesn't seem to me like it will make any difference anyway.

The straps will not mitigate a side collision, particularly if the stretcher comes uncarriaged. 

They will not benefit a front hit because the patient is already facing rear, which is the safest position. 

In a "counter coup" force, they do not restrain the head and with the chest and shoulders locked, the neck becomes the lone fulcrum.

In a roll over, the sheetmetal and plywood box is basically destroyed and it is the angle between the frame and the cab that offer the best protection.


----------



## DesertMedic66 (Jul 15, 2012)

All straps at all times before the patient is moved. If they are on a LSB they still get the shoulder straps.


----------



## DrParasite (Jul 15, 2012)

at my former full time employer, there is a written policy that says they are to be used.  the cot manufacturer says they are to be used. the ambulance manufacturer says they should be used.

we never used them, most of the senior emts and paramedics just stuffed them behind the cot mattress, or removed them altogether.

The only time I made sure I used them was when we had a patient who was supine.... ever been on a board and the ambulance stopped short?  you do slide quite a bit.......

but at my side job, we always used them.


----------



## Aidey (Jul 15, 2012)

I have a love hate relationship with them. When attached to the middle/2nd strap I think they are appropriate to use. When attached to the chest/3rd strap I think they are a strangulation device that will do little to help in a collision.


----------



## Epi-do (Jul 15, 2012)

I have never worked anywhere that uses them.  They are always tucked behind the mattress.


----------



## mycrofft (Jul 15, 2012)

Two places I encountered them (out of four) had shoulder straps on their litter wrong. There were people at all four sites who were unaccustomed to using them (not ambulance companies, thank heavens) and had to be coached how to inspect, store, and use them.

I disagree with the design (the straps should not allow the pt to slide up, as these do when there is enough force) but they are an improvement over the two strap system we used before. Two is OK most of the time, three is better. Also, three and shoulders helps keep the patient still before you get into the ambulance.

OP, anytime someone starts telling you they are following an article or study in preference over their protocols, suspect their practice in other areas too.


----------



## bigbaldguy (Jul 15, 2012)

I'd just like to point out that having the shoulder straps on a patient makes it a little tougher for them to lunge for your throat if they have another one of their little "episodes". Happens occasionally.


----------



## dmc2007 (Jul 15, 2012)

State law and company policy here.  Good common sense as well.  The rear facing position is only safe if you're restrained.  Doesn't do you much good if the cot's semi-reclined and the patient slides out the top.


----------



## medicdan (Jul 15, 2012)

Important point: shoulder straps are significantly less beneficial if allowed to drop down to the sides. Ferno and Stryker both sell (and encourage the use of) cloth that keeps the straps at the top (in the center), as it maximizes their restraining power.


----------



## Tigger (Jul 16, 2012)

emt.dan said:


> Important point: shoulder straps are significantly less beneficial if allowed to drop down to the sides. Ferno and Stryker both sell (and encourage the use of) cloth that keeps the straps at the top (in the center), as it maximizes their restraining power.



My truck tonight was missing such connector tonight and it twas quite annoying. 

All belts are to be used, pretty sure its an OEMS directive here to do so, it's definitely company policy. The only exception would be with a traction splint on a taller individual, they have to be feet first into the van to fit. I suppose if I had the extra hands we could switch the straps around. At the very least the "short" leg strap could be lengthened with an extra 9'.


----------



## abckidsmom (Jul 16, 2012)

I totally agree Craig. My department doesn't always provide all three cross straps, much less shoulder straps. It's very frustrating.  

The volunteer departments that do have all the straps usually have them tied behind the head of the stretcher. Some of our medics buckle the chest strap out of the way and don't ever use it except for unconscious patients. 

Like I said, frustrating.


----------

