# Cot Straps: what do you use and how many?



## DR_KSIDE (Dec 29, 2008)

With our service we use the shoulder straps, chest, waist, and legs/feet. This debate has come up during several meetings and the use of certain straps have led to some pretty heated debate. Needless to say our Executive Board, has made it clear to use them all, but we still have some exceptions. 

What do you use? Kind of curious to get a feel of what everyone else does.

Just to make it clear, the straps I am wondering about are the ones that you attached to the cot and stay with the cot.

Thanks


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## MMiz (Dec 29, 2008)

You really need to ask the cot manufacturer and your insurance provider.  Our service used three straps, and did not use the shoulder ones.  If I were a provider or service I'd require my medics to use three straps, including the shoulder harness.

We've had far too many patients tip over on the cot over the years.  It's always a freak accident, but the patients who were more secured tended to suffer the least amount of injuries.


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## Sapphyre (Dec 29, 2008)

We generally use chest, waist, and legs.  We're supposed to use the shoulder straps, but on most of our cots, the chest strap is not the dual adjustable one that makes them useable....


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## marineman (Dec 29, 2008)

Chest, waist, legs here. We like others have and are supposed to use the shoulder (anyone know if it's a law or not?) but I've never seen them used, they're tucked up out of the way under the head of the cot.


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## KEVD18 (Dec 29, 2008)

in ma, its required that we use all five. nipples, navel, knees and shoulders. we also have to have this strap keeper mounted at the top to keep the shoulder straps from sliding off.


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## JPINFV (Dec 29, 2008)

When I worked in California everyone just used a chest strap and a leg strap. As noted, Massachusetts uses 8 point restraints (5 straps).


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## daedalus (Dec 29, 2008)

JPINFV said:


> When I worked in California everyone just used a chest strap and a leg strap. As noted, Massachusetts uses 8 point restraints (5 straps).



Yup.

Sometimes people only use the chest strap and do not even bother with the leg strap.

Oh southern california..


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## 41 Duck (Dec 29, 2008)

PA: chest, waist, legs.  Never seen a service in this area use shoulder straps.  


Later!

--Coop


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## Sapphyre (Dec 29, 2008)

whoa, I've seen leaving the chest strap undone, but not the leg and waist.  (Well, ok I've seen the leg not used, on really short pts)


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## KEVD18 (Dec 29, 2008)

it doesnt take a significant amount time to do em all up, so why not.


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## JPINFV (Dec 29, 2008)

...because you can't connect something that isn't attached to the gurney.


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## medicdan (Dec 29, 2008)

KEVD18 said:


> we also have to have this strap keeper mounted at the top to keep the shoulder straps from sliding off.



The bane of my existence. Not only did my company need to dig some up (and make some) for the state inspection, now that they are installed, they make the straps a pain to fasten to patients (especially if there is a pillow).

In Israel, no ambulance in the country has more than one stap-- at the patient's waist.


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## lightsandsirens5 (Dec 29, 2008)

We use  the harness type shoulder/chest straps and a waist strap.


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## lightsandsirens5 (Dec 29, 2008)

emt-student said:


> In Israel, no ambulance in the country has more than one stap-- at the patient's waist.



In ISRAEL? How u no dat?


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## mycrofft (Dec 30, 2008)

*If the manufacturer put it on and you bought it, you use it.*

If you neutralize safety features the litter manufacturer is off the hook, and it sounds bad in court. If the law allows and you need to, take it off if it is still safe. Just make sure your undersheet is nonskid.
I think well secured pt's have a harder time tipping the cot over and may be better protected from the impact. We currently have leg-waist-shoulders but since we don't transport they're sort of a nuisance. In fact, I encourage people not to raise the litter.


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## KEVD18 (Dec 30, 2008)

lightsandsirens5 said:


> In ISRAEL? How u no dat?


 

he's psychic.


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## FF894 (Dec 30, 2008)

Its all for looks anyways.  Even with the shoulder straps, very rarely do you see them tight enough.  Even if they are properly tightened, they will not poperly secure a supine patient to the stretcher.  Basically, front end collision (real one) in an ambulance is almost always fatal for rear occupants.  Side-impact occupants are not going to fare well at all either.  The newer safety measures for providers are better, but are still flawed.  I have only seen 2 styles that truely make it safer for providers - first is the side-load ambulances and second is ambulances you tend to see in Ireland and Europe that have bucket style tech seats that allow the provider to sit parallel to the patient (allowing him to face forward) with a 5-point harness restraint.  The second limits capabilites quit a bit as they cannot carry a second patient (the ones I've seen anyways)

To answer the question though, most ambulances in NE have the shoulder straps, and like Kev said at least MA mandates it.  NH & ME uses them as well, not sure if mandated though.


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## medicdan (Dec 30, 2008)

lightsandsirens5 said:


> In ISRAEL? How u no dat?



Do a search of my past posts, from a little more than a year ago. I worked as an EMT in Israel for a few months. I am considering going back now, but have commitments state-side.


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## Laur68EMT (Dec 30, 2008)

DR_KSIDE said:


> With our service we use the shoulder straps, chest, waist, and legs/feet.



Same here.  We are required to use them all.


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## Laur68EMT (Dec 30, 2008)

DR_KSIDE said:


> With our service we use the shoulder straps, chest, waist, and legs/feet.



Same here.  We are required to use them all.


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## BossyCow (Dec 30, 2008)

Often our trip from the patients house to the rig is similar to a four wheeling adventure so we use all the straps.

I would rather take the time to do up the straps than take a day to spend in court explaining to an attorney why I chose not to.


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## frogtat2 (Dec 30, 2008)

*cot straps*

We have a shoulder harness, across the hips and across the feet.  Generally we do not hook the straps that run across the shoulders, just run the others under their arms.  We have so many smaller people that it becomes a saftey hazard to hook the shoulder harness, it ends up looking like we are trying to strangle them.  ( and while we all have those patients we would like to do that to......)

If we have a large patient, or a combative/aggressive patient we will go ahead and use the shoulder harness.  Pretty much boils down to patient size.  If they are/can be safely used, then we use them.


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## mackeydad (Jan 4, 2009)

*cot straps*

since i am very severely claustrophobic, i wonder if you run into any patients that cannot/will not allow the cot straps to be employed? i cannot tolerate restraint of any kind, and the equivalent of world war three would be fought at the scene to avoid this. due to my claustrophobia i cannot be immobilized on the board or even strapped to the cot as long as i am conscious and aware. i am very curious to see if and how a problem such as this can be dealt with.


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## KEVD18 (Jan 4, 2009)

mackeydad said:


> since i am very severely claustrophobic, i wonder if you run into any patients that cannot/will not allow the cot straps to be employed? i cannot tolerate restraint of any kind, and the equivalent of world war three would be fought at the scene to avoid this. due to my claustrophobia i cannot be immobilized on the board or even strapped to the cot as long as i am conscious and aware. i am very curious to see if and how a problem such as this can be dealt with.


 

here how i handle a patient accepting transport but refusing any part of the tx modality:

i write up a short report stating why i think you should do what i tell you to and what might happen if you dont(paralysis or death usually top the list). you sign it, i sign it, a witness signs it and away we go. you end up a quad or dead, its out of my hands.


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## mackeydad (Jan 5, 2009)

*refusing transportation*



KEVD18 said:


> here how i handle a patient accepting transport but refusing any part of the tx modality:
> 
> i write up a short report stating why i think you should do what i tell you to and what might happen if you dont(paralysis or death usually top the list). you sign it, i sign it, a witness signs it and away we go. you end up a quad or dead, its out of my hands.



i want to make it clear that this is a serious post and my claustrophobia is a real problem i have wrestled with all my life. it is not something i want nor is it something i can control. it just IS. my reality is that i CANNOT be restrained, not that i simply do not wish to be. i realize what a huge imposition this would be for EMS providers. i also realize the "lawsuit mentality" of the legal profession and what that could mean. however, i do feel that some compromises need to be made to enable me to get the treatment i both need and want. incidentally, i have suffered through a year of therapy for this that did not work. i close by saying that i don't fault you or anyone else feeling the same way and just thank the good LORD you are not claustrophobic.


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## KEVD18 (Jan 5, 2009)

its not an imposition for me at all. you dont want to be strapped down, im chill with that. you're just going to sign my documentation that says that you fully accept the risks so that if we have an oopsie on the way to the H and you go flying around the box, its on your own hands not mine.

some providers will battle with you over it for hours on scene citing protocols and laws and all sorts of stuff. i dont care. i dont argue and i dont kidnap/assualt.


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## JPINFV (Jan 5, 2009)

mackeydad said:


> i want to make it clear that this is a serious post and my claustrophobia is a real problem i have wrestled with all my life. it is not something i want nor is it something i can control. it just IS. my reality is that i CANNOT be restrained, not that i simply do not wish to be. i realize what a huge imposition this would be for EMS providers. i also realize the "lawsuit mentality" of the legal profession and what that could mean. however, i do feel that some compromises need to be made to enable me to get the treatment i both need and want. incidentally, i have suffered through a year of therapy for this that did not work. i close by saying that i don't fault you or anyone else feeling the same way and just thank the good LORD you are not claustrophobic.




I'm confused because it seems like you're disagreeing with his plan of action which is simply:

1. Confirm that you understand the risks of refusing transport restraints ("you're screwed if we get in an accident").
2. Write up a document stating that you understand the possible consequences of your chocie.
3. Have you sign it.
4. Treat and transport as normal sans transport restraints. 

Note: I'm using the term "transport restraints" to differentate between gurney seatbelts and arm and leg restraints. 

Personally, I'm not concerned about any lawsuit from a patient who refuses seat belts. I'm concerned about the fact that I've got a hundred+ pound unrestrained missile in the back of my ambulance now.

edit:



KEVD18 said:


> some providers will battle with you over it for hours on scene citing protocols and laws and all sorts of stuff. i dont care. i dont argue and i dont kidnap/assualt.



Those are the same guys that can't find their butt with two hands, a map, a protocol, and online medical control. There's too many of them in EMS unfortunately.


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## Sapphyre (Jan 5, 2009)

Curious Mackeydad,
Are you unable to wear the legally mandated seatbelts in your car?  That's what the cot straps are.  on the back board, the straps are there to keep you on the board.  Sorry, there is no alternative.  You will wear my seatbelts, or you will get to the ER some other way.


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## mackeydad (Jan 5, 2009)

*cot straps*



Sapphyre said:


> Curious Mackeydad,
> Are you unable to wear the legally mandated seatbelts in your car?  That's what the cot straps are.  on the back board, the straps are there to keep you on the board.  Sorry, there is no alternative.  You will wear my seatbelts, or you will get to the ER some other way.



i have a legal exemption from the state of kentucky exempting me from the provisions of our seat belt law, signed by my family physician. after discussing this at length with him he provided me a statement recommending i be sedated prior to any restraint being applied to me. he did tell me it is never good to be sedated if not absolutely necessary-----but if i were severely injured and sedation was the only way i could be boarded and transported, that the risks of sedation would be worth the benefit gained. the problem, he stated, would be if the EMS providers and/or medical control might honor this. in answer to a previous post, i did not realize he was saying he would treat/transport without restraints. i apologize for my oversight.


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## KEVD18 (Jan 5, 2009)

mackeydad said:


> i have a legal exemption from the state of kentucky exempting me from the provisions of our seat belt law, signed by my family physician. after discussing this at length with him he provided me a statement recommending i be sedated prior to any restraint being applied to me. he did tell me it is never good to be sedated if not absolutely necessary-----but if i were severely injured and sedation was the only way i could be boarded and transported, that the risks of sedation would be worth the benefit gained. the problem, he stated, would be if the EMS providers and/or medical control might honor this. in answer to a previous post, i did not realize he was saying he would treat/transport without restraints. i apologize for my oversight.


 

yip, lots of basics are running around out there with sedatives. good plan.


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## exodus (Jan 5, 2009)

KEVD18 said:


> yip, lots of basics are running around out there with sedatives. good plan.



Dude, when I'm a -B I will totally risk my certification by pushing a sedative! Wouldn't everyone?!


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## Sapphyre (Jan 5, 2009)

exodus said:


> Dude, when I'm a -B I will totally risk my certification by pushing a sedative! Wouldn't everyone?!



Oh, yeah, nevermind I have no idea how to tell that I'm in the vein or not, or how much to give you, and what if I OD you?  Hmmmmm.  Yup, totally gonna sedate someone that is ok enough to swing at me cause I tried to put his seatbelt on him.


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## exodus (Jan 5, 2009)

Sapphyre said:


> Oh, yeah, nevermind I have no idea how to tell that I'm in the vein or not, or how much to give you, and what if I OD you?  Hmmmmm.  Yup, totally gonna sedate someone that is ok enough to swing at me cause I tried to put his seatbelt on him.



Wait, you mean you have to ACTUALLY get it in the vein? I thought it was like on TV where I just jammed the needle into their butt and squirt!?!


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## MMiz (Jan 5, 2009)

exodus said:


> Wait, you mean you have to ACTUALLY get it in the vein? I thought it was like on TV where I just jammed the needle into their butt and squirt!?!


There are quite a few that work like that too.


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## mackeydad (Jan 5, 2009)

*cot straps*



MMiz said:


> There are quite a few that work like that too.



i attempted to ask a serious question concerning ways in which a severely claustrophobic accident victim might be transported to an ER if he could not be restrained whatsoever. i have asked before just how much weight does the threat of a lawsuit have upon making treatment decisions? i knew as soon as i mentioned sedation i would be caricatured as an addict whose only interest is securing his next high. as difficult as it is to believe, being sedated is my LAST choice, but from the majority of comments here it seems the ONLY way, as i definitely cannot be transported per protocol. surely some of you have had patients in the past with similar concerns as i know i am far from the only claustrophobic person in this country. this is a completely serious question about a serious problem that i feared might be insurmountable. it seems as if my fears were right.


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## exodus (Jan 5, 2009)

mackeydad said:


> i attempted to ask a serious question concerning ways in which a severely claustrophobic accident victim might be transported to an ER if he could not be restrained whatsoever. i have asked before just how much weight does the threat of a lawsuit have upon making treatment decisions? i knew as soon as i mentioned sedation i would be caricatured as an addict whose only interest is securing his next high. as difficult as it is to believe, being sedated is my LAST choice, but from the majority of comments here it seems the ONLY way, as i definitely cannot be transported per protocol. surely some of you have had patients in the past with similar concerns as i know i am far from the only claustrophobic person in this country. this is a completely serious question about a serious problem that i feared might be insurmountable. it seems as if my fears were right.



Like I said, if you're well enough to refuse straps, you're well enough to call a taxi. I am NOT going to put my life, and my partners life in danged by not strapping you down.  And you will NOT be sedated by paramedics ever.


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## BossyCow (Jan 5, 2009)

I have had a pt with similar issues. Not to the severity of mackeydad but close. In that particular instance I had the pt walk with support to the rig. Was that as efficient/safe/effective as a backboard? No.. of course not.. but it passed the alternative in all respects.. since the alternative was having the pt flailing about and fighting us.

Come on people, its not about control. A patient has the right to all their idiosyncracies. Just document the heck out of it. How many times have we put on a report that we weren't able to get a B/P, take a pulse, start an IV because the pt was uncooperative. This is exactly the same thing. To say that because the pt wouldn't let you backboard them that they don't need treatment is putting your need for the pt to submit to your treatment plan higher than the pt's need for care.


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## KEVD18 (Jan 5, 2009)

you've been given my 100% serious answer as to how i would handle the situation. never once did the though evn enter my mind that this was your way of scoring drugs, as its both the most difficult/time consuming and least likely to work way to go about that that i can readily think of.

as i said before, some people will fight you and some will hardline you with rules and laws and what not but im not one of them. id rather see you get to the hospital sans restraints than leave you sitting on your couch/banged up car. to me, even with a proper refusal, thats a higher level of liability. i might be wrong, as i didnt go to law school(but i did play a lawyer on tv). 

of course, the logic does hold that if you're stable and coherent enough to battle with me over straps and boards, then you're ok for private transport.

these are the legit answers from legit providers. you may not like the answers you're getting, but that doesnt make them wrong.


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## mackeydad (Jan 5, 2009)

KEVD18 said:


> you've been given my 100% serious answer as to how i would handle the situation. never once did the though evn enter my mind that this was your way of scoring drugs, as its both the most difficult/time consuming and least likely to work way to go about that that i can readily think of.
> 
> as i said before, some people will fight you and some will hardline you with rules and laws and what not but im not one of them. id rather see you get to the hospital sans restraints than leave you sitting on your couch/banged up car. to me, even with a proper refusal, thats a higher level of liability. i might be wrong, as i didnt go to law school(but i did play a lawyer on tv).
> 
> ...



i never meant to infer your responses were wrong or not legitimate. in fact, i am comforted by the responses from the last two posters. one point i wish to clarify is the interpretation of my refusal of restraint as "not being sick enough". the comment that " if you are stable and coherent enough to battle with me over straps and boards, then you're ok for private transport" is indicative of this. i may or may not even realize i am injured nor have any idea as to the extent of these injuries. it is certainly not the fact you are trying to help me or that you are far more knowledgeable in these affairs than i that is the problem. it is the restraint. it is the fact that am NOT IN CONTROL of whether i am restrained. i fully realize that being boarded and immobilized to prevent further spinal injury is by far the best treatment and this is the way my case should be handled. however, sadly, my claustrophobia will not allow this to happen. i cannot stop it nor control it. it is fact---you attempt to restrain me and i fight you. if i would be assured that i would die if not restrained i would STILL FIGHT RESTRAINT. just wanted to get that point across. i do not wish to control anything or to sue anyone, i am just a patient with a huge problem asking for help in a manner i can tolerate. thank you.


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## exodus (Jan 5, 2009)

mackeydad said:


> i never meant to infer your responses were wrong or not legitimate. in fact, i am comforted by the responses from the last two posters. one point i wish to clarify is the interpretation of my refusal of restraint as "not being sick enough". the comment that " if you are stable and coherent enough to battle with me over straps and boards, then you're ok for private transport" is indicative of this. i may or may not even realize i am injured nor have any idea as to the extent of these injuries. it is certainly not the fact you are trying to help me or that you are far more knowledgeable in these affairs than i that is the problem. it is the restraint. it is the fact that am NOT IN CONTROL of whether i am restrained. i fully realize that being boarded and immobilized to prevent further spinal injury is by far the best treatment and this is the way my case should be handled. however, sadly, my claustrophobia will not allow this to happen. i cannot stop it nor control it. it is fact---you attempt to restrain me and i fight you. if i would be assured that i would die if not restrained i would STILL FIGHT RESTRAINT. just wanted to get that point across. i do not wish to control anything or to sue anyone, i am just a patient with a huge problem asking for help in a manner i can tolerate. thank you.



That is you though, what about any of the other sue-happy patients? We can't just take your word for it, which is why some of the others would transport after you signed a liability release.  But I would not transport you without a seatbelt. If I get into an accident, I don't want you flying into myself or my partner, I could care less if you go flying and hit a wall if you refuse to use the straps. But once you endanger myself and my partner, then I get concerned.


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## KEVD18 (Jan 5, 2009)

i give up.


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## Sapphyre (Jan 5, 2009)

Kev, I gave up a long time ago.


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## mackeydad (Jan 6, 2009)

*explanation of my posts on "cot straps"...*

i wish to apologize to all whom i may have offended with my questions and responses. i gather from the feedback that some would transport me minus restraints as a better alternative than simply refusing and leaving me with no care, while others would enforce the seatbelt requirement. noone seemed to favor boarding me by force. from this it appears that the extent of care i would receive in this instance completely depends upon the responder and their individual outlook and feelings. again i apologize for any trouble i may have caused and thank you for listening to me.


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## JPINFV (Jan 6, 2009)

mackeydad said:


> from this it appears that the extent of care i would receive in this instance completely depends upon the responder and their individual outlook and feelings.


Welcome to EMS. We have people who have the bare minimum of education to people with advanced degrees in the field. Unfortunately the training and protocols have to focus on the lowest common denominator so even good decent providers are left feeling like they have no choice in the matter.


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