# Proper way to move the gurney with a patient on it.



## Aidey (Jul 28, 2009)

Do you prefer to move the gurney with the patient facing backwards, or facing forward? Why do you prefer that method? Does your company have a policy on it?


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## Hockey (Jul 28, 2009)

Facing forwards

Let them see where they're going so they don't get sick or aggitated


Loading into an elevator I don't know why but I always prefer to just walk in and then push back out instead of taking time to sit there and turn it around.  Thats just me.  I had one partner I absolutely couldn't stand because she made such a huge deal about this and every other thing


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## Sapphyre (Jul 28, 2009)

Generally, we move them facing forward, then turn around at the rig, except for elevators, which, generally are loaded head first.


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## mycrofft (Jul 28, 2009)

*There is actually a difference in the "ride".*

The end which hits an irregularity first hits it with the momentum of the litter pushing it into the barrier. The second pair of wheels has the first pair already across to bear some of the impact and pull it over.
Smoothest ride? At a slight angle, go over a bump one wheel at a time.

Also, consider rain and wind and etc. Use the raised back support as a windbreak.

Finally, coordinate it to avoid unecessary maneuvering around the  unit's back doors.


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## Privet (Jul 28, 2009)

Facing forward.

I would imagine being a patient being transported facing backwards and not knowing where you're going can be a bit frightening.


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## Ridryder911 (Jul 28, 2009)

Patients are placed onto stretchers, beds, gurneys, etc and pushed forward to reduce motion sickness as many can become easily sick by movement. The other point is medics should grasp and have a hold the stretcher at all times. I have too many near turn overs and bumps and scrapes into walls, doors, etc as many are not paying attention of what they are doing. 

As well, placing the stretcher in the most highest level is not even recommended by the manufacture while rolling. Placing mid way will give more stability and safer environment. 

What I personally do not like is the person at the feet not guiding properly or the one at the head not assisting in pushing the stretcher and allowing only one person to perform the role of moving the stretcher. 

R/r 911


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## abckidsmom (Jul 28, 2009)

Generally, facing forward, with the person at the head end PUSHING and the person at the foot end STEERING.  I hate when a partner doesn't push and I'm pulling from the front...bad ergonomics.  Always with hands on the stretcher...never let go of the stretcher.


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## medicdan (Jul 28, 2009)

I just learned something interesting... a second set of reasoning why we go into elevators backwards. 

If the elevator were to malfunction, and we would need rescue from FD via the shaft, there is an access hatch on the far half of the ceiling (away from the entry doors). Its much easier for them to remove a patient by grasping under their shoulders from that hatch, rather then trying to pull up by the legs, or turn the patient around.

I cant seem to find a picture that describes it. Can any FFs here with rescue training explain it better?


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## Sasha (Jul 28, 2009)

The only time they don't face forward is when approaching the ambulance and if we just put them on the stretcher and for some reason don't have room to turn the stretcher and they are already facing backwards. Other than that, it's facing forward. Yes, this is policy. It's sad that it even must be stated as policy! But would you prefer to face forward or face back? Personally I'd prefer to face forward.

I'm usually at the front, and occasionally I've looked back to see a partner not even pushing the stretcher, barely touching it and just walking along. That annoys the heck out of me! I also hate when people try to steer by the siderails and not the foot like they're supposed to.


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## HCEMS (Jul 28, 2009)

We consider it better patient care if we transport them facing forwards.....and then turn them around when we load.


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## vquintessence (Jul 28, 2009)

Random input here... but with gurney instructions figured it's somewhat relevant.  _We're discouraged from "wheeling" in a fully upright position.  In other words, the stretcher shouldn't be raised to maximum height._

Just what we do with our bariatric pts; lower center of gravity is a damn good thing.  I've been issued a written warning before at MGH for wheeling in the fully upright position... blah.


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## mycrofft (Jul 28, 2009)

*My coworkers can't get it straight.*

1. Don't raise or lower the litter more than you need to.
2. Always have the straps on the patient and each day make sure the last users didn't mess with them.
3. Never ever-never-ever always-*never*-EVER leave a patient on a litter without someone (you or your partner) physically in control of the litter. I warned my coworkers, they took control, I walked away, turned around and actually saw the _uncontrolled_ litter tip foot first to the floor and pitch onto its side in one motion when the pt tried to sit up.

I miss the litters with the long D-ring handle on the foot end so you could move the litter almost comfortably with it all the way down. Ferno Washington said they don't sell them anymore, even as retrofits.


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## rescue99 (Jul 28, 2009)

Facing forward in most situations for rolling and backwards through doorways, elevators and the like. Reason being...less nausea and less chance of thudding a head if ya hit a door frame. Then there's the elevator, uneven surfaces and normal cracks found in walks to consider. If the surface is really uneven, turn the cot around and keep even hand distribution on both sides. Keep the cot at a < = 3/4 level (always lower for heavy patients) and both hands on the cot at all times! 

These things are pretty much covered in an MFR or basic EMT course.


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## HotelCo (Jul 28, 2009)

I think of it this way. If I were strapped to the stretcher, I'd like to be able to see where I was going.


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## Aidey (Jul 28, 2009)

Thanks guys. The reason I ask is that I've always been taught to wheel the gurney with the pt facing forward to reduce their anxiety, but my partner insists that the gurney be wheeled with the patient facing backwards so the patient can't reach out and grab anything*. I just wanted to check and see what other people had been taught.

*IMO if you warn the patient not to grab anything, and refuse to listen that is grounds to restrain their hands.


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## Sasha (Jul 28, 2009)

Aidey said:


> Thanks guys. The reason I ask is that I've always been taught to wheel the gurney with the pt facing forward to reduce their anxiety, but my partner insists that the gurney be wheeled with the patient facing backwards so the patient can't reach out and grab anything*. I just wanted to check and see what other people had been taught.
> 
> *IMO if you warn the patient not to grab anything, and refuse to listen that is grounds to restrain their hands.



Yup. I agree with you. I buckle people's hands in if they can't keep them inside the stretcher.


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## WuLabsWuTecH (Jul 28, 2009)

We always wheel forward with the manual cot here except for loading as the L frame allows us to push in backward only (obviously).  Only one level.

With the stryker power cots, we transported in a position of comfort for us (I'm a tall 6'1" guy).  The cot is already very top heavy so we just had to be sure not to wheel it sideways (if we did and then hit a bump it would tip easily).

Guy in the back should do most of the pushing, the guy in the front does a little pulling, but mostly guiding.  Hand on the cot at all times until it's secured to something else.


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## redcrossemt (Jul 28, 2009)

Sasha said:


> Yup. I agree with you. I buckle people's hands in if they can't keep them inside the stretcher.



"Welcome to Mr. Toad's Wild Ambulance Ride. Please keep your arms and legs to yourself and inside the stretcher at all times."


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## mycrofft (Jul 29, 2009)

*No one suggested we push it sideways?*

How very odd......<_<


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## WuLabsWuTecH (Jul 29, 2009)

mycrofft said:


> How very odd......<_<


It flips!  The only time I've pushed it sideways were the stryker power cots and with those I made sure that someone was on the other side ready to catch it and stabilze it should we hit even a small bump!


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## Sasha (Jul 29, 2009)

WuLabsWuTecH said:


> It flips!  The only time I've pushed it sideways were the stryker power cots and with those I made sure that someone was on the other side ready to catch it and stabilze it should we hit even a small bump!



I've pushed a ferno sideways and it didn't tip. Poor communication approaching the ambulance for loading, but still, sideways.

A new tip for you. If you are pushing a fairly large person down hill, place your bigger and/or stronger person in front.

One of our hospitals, you come off the elevator on some floors and you have your choice of going right, which is level, or left, which is down an incline. We had a rather large patient and the momentum was a smidge too much.


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