# Shoulder gurney straps



## Dragon Pie (Jan 9, 2021)

Hello,

I have a question about shoulder gurney straps. 

Our ambulance service used to have shoulder gurney straps that met in the middle and hooked around the seatbelt buckle and went over each shoulder. I found these to be just fine and I really liked them. 

Since then, we replaced them with some that go across the patient's chest in an X and I hate that design so much. I think that if the patient slid down the cut in an accident, they'd find those crossed straps hitting their chin and neck and they seem so much less safe to me. 

I'm just asking if there is any evidence supporting the cross chest version compared to the shoulder harness meeting at the buckle. I could see the forces on the buckle being greater for my preferred design and I was wondering if crash tests gave us any information. 

If not, I'm returning to the original shoulder harness design, but I'd be interested if anybody knows more than I do.


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## PotatoMedic (Jan 9, 2021)

Look up manufacturer recommendations.  If there's ever an accident that's what you and the company will be held to.

And company policy. So hopefully that follows manufacturer recommendations.


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## Dragon Pie (Jan 9, 2021)

PotatoMedic said:


> Look up manufacturer recommendations.  If there's ever an accident that's what you and the company will be held to.
> 
> And company policy. So hopefully that follows manufacturer recommendations.


You mean, the manufacturer of the gurney?


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## PotatoMedic (Jan 9, 2021)

Dragon Pie said:


> You mean, the manufacturer of the gurney?


Correct.


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## Dragon Pie (Jan 9, 2021)

I did a quick search and they show you how to use both styles in their manual, so it doesn't look like they recommend one over the other.


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## PotatoMedic (Jan 9, 2021)

Then it looks like it is an approved way to secure a patient.  May not be your favorite but it is what you have to work with.


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## NomadicMedic (Jan 9, 2021)

The X straps from Stryker replaced the old shoulder harness strap set on the Power Pro XT.  If you have questions about the straps on your cot, you should talk to the manufacturer or their representative.


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## DrParasite (Jan 10, 2021)

Dragon Pie said:


> Since then, we replaced them with some that go across the patient's chest in an X and I hate that design so much. I think that if the patient slid down the cut in an accident, they'd find those crossed straps hitting their chin and neck and they seem so much less safe to me.
> 
> I'm just asking if there is any evidence supporting the cross chest version compared to the shoulder harness meeting at the buckle. I could see the forces on the buckle being greater for my preferred design and I was wondering if crash tests gave us any information.


1) Follow the manufacturer's directions.  read the instruction manual that came with the cot.   that particular model.
2) if you have any questions on how it should be functioning, direct those questions (or your recommendations/requests) to your supervisor.
3) if you are the supervisor, and your management has directed you to find a solution, reach out to the company representative for how they recommend you use their product.  They would also be able to provide you with any crash test information.

that all being said, as long as you have straps over the shoulders, if you are in a crash, the patient will be thrown forward (Newton's law of motion).  if you remember the old school methods, three straps, under arms, hips and legs like here
	

	
	
		
		

		
			





, you know that if you had a supine person and you stopped short, they slid forward.  the shoulder straps were implemented to prevent that.

If your ambulance rolls, or you get T boned, then it's anyone's guess, but the reality is, due to physics, a patient will rarely slide down or backwards from a cot (unless you are rear ended while stopped at a high rate of speed).


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## NomadicMedic (Jan 10, 2021)

I’ll tell you something worth remembering. If you have shoulder straps on the cot and you don’t use them and the vehicle gets in an accident... You. Are. F@&*ed.

Use all 5 straps. Make it a habit. Document it every time. Hell, be known as “the guy that uses all 5 straps”.


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## DrParasite (Jan 11, 2021)

NomadicMedic said:


> Document it every time. Hell, be known as “the guy that uses all 5 straps”.


Please don't... there is 0 need to document something you do regularly so specifically.  I have never, ever, documented how many straps I put on a patient, unless I put on extra ones, or not all of the required ones.  yet, if I get called into the boss's office, or a lawyers office, or into court, I can say, with 100% certainty, that I pul all of the straps on as recommended by the manufacturers and as directed by company policy; if for some reason I didn't, then I would document as such, as well as why it was done.

more documentation is not always better, and too much documentation can sometimes just waste your time, and not provide any real benefit. (despite what many EMS urban legends seem to believe)


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## DesertMedic66 (Jan 11, 2021)

DrParasite said:


> Please don't... there is 0 need to document something you do regularly so specifically.  I have never, ever, documented how many straps I put on a patient, unless I put on extra ones, or not all of the required ones.  yet, if I get called into the boss's office, or a lawyers office, or into court, I can say, with 100% certainty, that I pul all of the straps on as recommended by the manufacturers and as directed by company policy; if for some reason I didn't, then I would document as such, as well as why it was done.
> 
> more documentation is not always better, and too much documentation can sometimes just waste your time, and not provide any real benefit. (despite what many EMS urban legends seem to believe)


Every documentation class and every agency that I have worked for has always specifically state that seatbelts need to be placed into the documentation.

I wouldn’t call it a waste of time when it only takes 5 seconds to type “patient secured to gurney with seatbelts x5”.


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## NomadicMedic (Jan 11, 2021)

DrParasite said:


> Please don't... there is 0 need to document something you do regularly so specifically.  I have never, ever, documented how many straps I put on a patient, unless I put on extra ones, or not all of the required ones.  yet, if I get called into the boss's office, or a lawyers office, or into court, I can say, with 100% certainty, that I pul all of the straps on as recommended by the manufacturers and as directed by company policy; if for some reason I didn't, then I would document as such, as well as why it was done.
> 
> more documentation is not always better, and too much documentation can sometimes just waste your time, and not provide any real benefit. (despite what many EMS urban legends seem to believe)



Once again you are 100% incorrect.  Please reach out to your agency’s quality manager for documentation advice. 

Clearly documenting what you did when on scene is not dangerous nor an urban legend. Unless you have been involved personally in legal action against an agency from a leadership standpoint, where you have gone through discovery and personally been questioned in a deposition, I suggest you defer to attorney on this one.


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## CCCSD (Jan 11, 2021)

I have NEVER been told I “over document”


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## Jim37F (Jan 11, 2021)

I don't think I've ever documented the specific types and number of seatbelts used, and have never once had a problem. No more so than I've ever specified in documentation that we secured the gurney in the antlers and latching mechanism, or that all the ambulance doors were closed prior to transport... I've never had an employer tell us as part of documentation to specify that either (and Supervisors liked to pop into the ERs to spot check if the shoulder straps were in use and would write crews up if they found patients without them, but documenting them in the ePCR was never a thing they worried about)


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## CCCSD (Jan 12, 2021)

Jim37F said:


> I don't think I've ever documented the specific types and number of seatbelts used, and have never once had a problem. No more so than I've ever specified in documentation that we secured the gurney in the antlers and latching mechanism, or that all the ambulance doors were closed prior to transport... I've never had an employer tell us as part of documentation to specify that either (and Supervisors liked to pop into the ERs to spot check if the shoulder straps were in use and would write crews up if they found patients without them, but documenting them in the ePCR was never a thing they worried about)


And that’s why you were banned to HI...wait a minute...


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## NomadicMedic (Jan 12, 2021)

I actually just sent a copy of this question to PWW. I’m curious to their take on “over documentation”.


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## DrParasite (Jan 12, 2021)

NomadicMedic said:


> Once again you are 100% incorrect.  Please reach out to your agency’s quality manager for documentation advice.
> 
> Clearly documenting what you did when on scene is not dangerous nor an urban legend. Unless you have been involved personally in legal action against an agency from a leadership standpoint, where you have gone through discovery and personally been questioned in a deposition, I suggest you defer to attorney on this one.


maybe you should reach out to an attorney who handles this type of things, instead of relying on EMS urban legends.... just because you write it doesn't mean it actually happened, just like just because you didn't write it doesn't mean it didn't happen.  And guess who has was the QA manger for my former agency... so many poorly written charts, gives me nightmares

We have sooooo many urban legends that we have done for years, and documentation varies from agency to agency, and QA/QI person, and much of it is just an opinion with little basis on fact.  Maybe it's from a course they took, or maybe it's just what they like to see.  And I can assure you, those presentations aren't always given by an EMS Attorney (of which I am not one, but I have taken classes taught by EMS attornies at various conferences)

If you want to write "patient was secured with 5 straps to stretcher, +CMS before and after, rolled stretcher down front path of house, raised cot, ensured positive locking mechanism, lifted cot into ambulance, secured with manufacturer-supplied locking system" that's cool, and it is totally accurate. and based on what you are saying above, that is what you expect your personnel to do. It's also grossly unnecessary, and most attornies would agree.

Since you asked PWW the question, did you also ask if a person doesn't put that, does that mean that (legally) the patient wasn't secured to the cot?   Meaning, if you don't put it and you get deposed or called to testify, it will be assumed that that the patient was transported while not properly restrained?  Because they might say to put it just because, but are they going to be able to provide the consequences (with an appropriate case example) where not adding that line resulted in a negative outcome in a court case?


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## DrParasite (Jan 12, 2021)

DesertMedic66 said:


> Every documentation class and every agency that I have worked for has always specifically state that seatbelts need to be placed into the documentation.
> 
> I wouldn’t call it a waste of time when it only takes 5 seconds to type “patient secured to gurney with seatbelts x5”.


What did they say was the downside to not specifically stating that?  and did they provide actual examples of when the agency suffered a negative outcome because it wasn't documented as such?


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## NomadicMedic (Jan 12, 2021)

Oh, I’m in the midst of it. The case is currently in litigation.

it take no time at all to write. Why not just just note what you did? And this comes from documentation classes from PWW and JR Henry. (Look em up)

If you think the attorney that is working to get millions from your insurance and will just roll over when you say ”well, we always do that” you are sorely mistaken. Especially if the second provider on the ambulance  says “he usually uses all the straps”. Usually. That is no good. 

One of the biggest myths in EMS is that too much documentation will get you in trouble. If you’re acting within your scope and in the best interest of the patient, there is no case where documentation of your patient care will come back to bite you. I see this all the time from “seasoned” providers.

As an example, I was part of an investigation of a case of malfeasance that was so poorly documented there was no way the paramedic could defend himself. He left out much of the vital information that could have potentially helped him. He said “I didn’t want to write to much” If he had actually written more, he might have saved himself.


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## DrParasite (Jan 12, 2021)

NomadicMedic said:


> Oh, I’m in the midst of it. The case is currently in litigation.
> 
> it take no time at all to write. Why not just just note what you did? And this comes from documentation classes from PWW and JR Henry. (Look em up)
> 
> ...


interesting... you have a person who answered this?  I have a question I would like to direct to them too, to hear their opinion.  Using your example, where the response is "well, we always do that" is not acceptable, if you don't document that you didn't sexually assault the patient, does that mean you did?  I mean, the response when asked will be "well, we never do that." Esp when the attorney will find articles where EMS providers have sexually assaulted patients, so you can't say it's never done.  Yes, it's an extreme example, but that's the exact logic you used.

I never said more documentation will get you in trouble, I said "more documentation is not always better, and too much documentation can sometimes just waste your time, and not provide any real benefit."  Documentation is good, and we should document what we did.  And I don't expect any attorney to ever roll over, but that doesn't mean if you say it your attorney is going to start adding zeroes to the check; that's the difference, one you seem to be missing.  and if you think the attorney is going to roll over when you write "patient was secured by 5 straps", especially if the second provider on the ambulance says “he usually uses all the straps” well, you are in the same boat.

Document your clinical interventions. what you found, and what you did. applying seatbelts on a cot isn't a clinical intervention, no more than documentation how many blankets you put on a patient because it's 12 degrees outside and snowing. I mean, you don't write on your PCR when you get cut off by another car, resulting in a hard stop, do you? especially if it doesn't affect the patient? Do you understand?


NomadicMedic said:


> As an example, I was part of an investigation of a case of malfeasance that was so poorly documented there was no way the paramedic could defend himself. He left out much of the vital information that could have potentially helped him. He said “I didn’t want to write to much” If he had actually written more, he might have saved himself.


Sounds like your provider wrote a crappy chart.  sorry.  did they neglect to write that the patient was secured with the shoulder straps, and that is why you are going to lose the case?  or did the paramedic neglect vital information about the patient's condition, and that is why he is unable to defend himself?  remember quality vs quantity: there is a difference between a good chart with the correct patient information and a long chart with a lot of irrelevant content, but missing the correct patient information.

let me be clear, since you seem to missing the big picture here: you can write a whole lot of nothing on a chart.  pages and pages.  does it hurt to over document?  no, and I never said it would get you in trouble.  I said it didn't provide the benefit you are claiming, and it just wastes your time.  But it's your time to waste, and if you want to keep pushing the (false) belief that the opposing attorney is going to just roll over because you wrote it on the PCR, then I think you are sorely mistaken.


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## NomadicMedic (Jan 12, 2021)

I believe you like to argue for the sake of arguing. I’m done with this.


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## CCCSD (Jan 12, 2021)

If it’s documented, then it was done and is accepted as such. Prove I didn’t. 
If it’s not, then you can argue it wasn’t done, easier to insert doubt. 
“I always do it”. I can easily tank that in court. All I have to show is ONE TIME it wasn’t done, which isn’t hard.


Others have direct experience in court, you should read and heed.

Why are you arguing about something that should be best practice?


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## DrParasite (Jan 13, 2021)

NomadicMedic said:


> I believe you like to argue for the sake of arguing. I’m done with this.


gotcha, so I gave you a logical argument, which showed exactly where your logic failed, and clarified an incorrect statement you inferred that I said.  If you want to walk away, that's cool.  You're giving bad information, and yes, you got called out on it when you tried to do the same to me.  Please don't give out information that isn't actually supported by facts.


CCCSD said:


> Why are you arguing about something that should be best practice?


Because it's not?  and there is no actual evidence or documented case that has been provided the actually shows otherwise?

If your agency requires you to put that you put 5 straps on the patient, do it.  if your QA person says you need to do something on your chart, then do it, because he or she is speaking for your employer.  You can put a lot of extra stuff in a chart that doesn't really help or hurt you, should you go to court, but if your employer says they want to see it, do what your employer says.

But don't buy into the urban legend that 1) if you don't document you secured the patient with 5 straps that the assumption is that you didn't, and 2) a perfectly written chart will not be picked apart by an attorney, because that attorney will find a way to make you look like an incompetent moron when called into court.


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## CCCSD (Jan 13, 2021)

Ever been in Court? It ain’t “urban legend”. Your style of non documentation WILL make you look like an “incompetent moron”.

In over 30 years, I’ve YET to be made to look bad in court. Proper documentation, proper practice, proper procedures followed wins EVERY time.

I can’t speak for you.


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## DrParasite (Jan 14, 2021)

I've never looked bad in court.  Attornies have looked at my documentation, and have no issues.  In fact, if your documentation is clear enough, you might not even need to go to court.  Because it speaks for itself.

If you do the right thing, if you document what you need to document, and you follow the rules, you will be fine.  stop fear-mongering, and stop saying you need to put in fluff or else you will lose a lawsuit.  unless you can show an actual case where poor documentation resulted in a lawsuit (not poor clinical care, not an inappropriate action, not a crash with injuries), you are just fear-mongering.


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