Unneeded stretcher use?

Jkimball · Sep 19, 2017

Kind of long.
For the last couple of days I've had this idea bouncing around in my head. Those that have been in EMS for awhile have seen changes based on research driven practices. (Just a few. Like not using L&S for a PT with a hang nail because there is no life threating medical issues. Because of the higher risk of traffic accidents while running hot. Like no longer keeping pt's on a back board just because of the mechanism of injury and possibly causing other issues done the road.)
With all these changes I haven't seen any research into unneeded stretcher use. We don't use L&S as much do to the higher risk of accidents. So why are we risking a serious back injury while lifting and moving a pt that has no issues walking or was found standing and walking around. Were taught in school to minimize the risk to our selves to avoid injury and were taught how to reduce the risk of injury by safely moving with proper body mechanics. So why are we still puting our selves st risk for a serious back injury when it's not warranted. When I started 10 years ago the medic I worked with had already been in the game for 30 years. I learned a lot from him. One of those things is if a pt doesn't need a stretcher dont put yourself at risk for a back injury or the risk of dropping a pt or tipping the stretcher if it's not needed. Personally I think the issue is the new customer service approach to EMS were every pt gets the red carpet presidential treatment regardless of why they called. I get being nice to pt's but when do you draw the line.

captaindepth · Sep 19, 2017

We have a big white "X" embroidered on the bench seat. If a patient can walk to the ambulance (and it's appropriate) we will tell them to "sit on the X." The patient is then further assessed there and if the patient does not need to be on the stretcher for any reason then a lap belt is put on the patient and an arm rest lowered. The patient is then transported sitting up on the bench seat. Once at the hospital we will either walk the patient inside or grab an ED wheelchair. I'd say I transport approx 20-30% of my patients seated on the X.

My safety is paramount and back safety is just as important as "scene safety." If a stretcher isn't necessary than there is no reason to put yourself at risk, IMO.

DrParasite · Sep 19, 2017

I used to work part time for an agency that has in it's written policy that the patient will be carried to the ambulance, and had check boxes to list how the patient was moved to the ambulance; ambulation wasn't a listed option.....

which is more secure: transporting the patient on the cot with 3 straps and the shoulder straps, or a single lap belt? and by more secure, I mean which will secure them better in the event that you are involved an a crash with the patient on board?

If you walk a patient into the ER, and they pass out at the triage nurse's station, how does that loouk for you? if they pass out while on the cot, how does that look?

Think of your coworkers: are any of them lazy, and can you imagine them inappropriately walking someone to the truck? Can you see why management would want everyone on the cot as a result?

Thankfully, my former full time agency did not have any objections to us walking ambulatory patients into the ER. And if they can walk, or have been walking for the past 3 hours at home, then I see no reason to carry them and risk my back to the ambulance.

VentMonkey · Sep 19, 2017

Jkimball said:
Personally I think the issue is the new customer service approach to EMS were every pt gets the red carpet presidential treatment regardless of why they called.

It isn't all that new, and it isn't going anywhere anytime soon. It's also merely yet another example of a socially accepted adopted change in entitlement. That said, this is another topic for another thread...

I do agree that if you're waiting on an ambulance with your bags packed like you're going on a field trip, well then, the first place you need to start isn't in an emergency room via EMS.

EpiEMS · Sep 19, 2017

At the end of the day, determining whether you need to use a stretcher is a policy decision by a department/service/agency. Obviously, there are patients whose conditions dictate the use of a stretcher, and there are others who are perfectly capable of walking.

The main question that a policy has to answer is this: "How often are the providers subject to the policy going to walk patients who should not be walked?" To me, the answer is "way too often", so it behooves the self-interested (i.e. CYA) administrator to mandate EVERYBODY gets a stretcher (unless they outright refuse).

Tigger · Sep 19, 2017

Lots of my patients walk to the ambulance, are placed on the stretcher, loaded (self loading INx), and then wheeled into the ED (self unloading too). I prefer to sit patients on the cot and load them as it eliminates the hazard of climbing into a big 'ol type 1 ambulance. Even if you don't have self loading cots, the lift into the ambulance is probably the safest one we do.

Mitigate risk for you and the patient.

akflightmedic · Sep 19, 2017

VentMonkey said:
I do agree that if you're waiting on an ambulance with your bags packed like you're going on a field trip....

When I used to teach, I always taught this as one of "the signs" to recognize in EMS.

It is called a "Positive Samsonite" sign. Basically when they greet you on the porch with 2 pieces of luggage....

StCEMT · Sep 19, 2017

If anyone sits on the bench, they walk in with me. The 18 year old with a 1/2" cut? You're walking dude. Most people don't walk in, it's obviously a use good judgment thing, but I have no issues walking the bullshitters in or maybe grabbing a wheelchair. Unfortunately there is no shortage of those folks either.

hometownmedic5 · Sep 19, 2017

In Massachusetts, there is a general "preference" against allowing patients to walk. Basically, regardless of their complaint or presentation, if they become injured or exacerbate their condition while walking, I'm going to lose my license. It could be simply that they tripped over a crack in the sidewalk, it wouldn't matter.

I almost never walk a patient into the hospital. As in I might have done it 5 times in 13 years. I will allow patients to walk to the ambulance occasionally, but I have to feel really good about their condition...

cprted · Sep 19, 2017

My agency has a "Guideline for Ambulating Patients" right in our Treatment Guidelines. In a nutshell, if the patient appears well, doesn't have a high risk complaint (chest pain, sob, etc), vital signs are NWL, and can physically ambulate, they can walk to the car.

hometownmedic5 · Sep 19, 2017

I would love to live and practice in a world where people capable of walking were allowed to do so. Sadly, an untied shoelace could cost me my livelihood in this state. For sure, there are agencies and providers who dont exactly take this regulation seriously; so perhaps I'm too stringent in my application on this theme, but where I'm coming from is pretty simple. I'm 32 and grossly unqualified to do anything else with my life. If I lose my license, Ill be bankrupt in 30 days and be completely and totally screwed. So I roll the overwhelming majority of patients in on the rack and probably carried them out of the house in the chair.

DesertMedic66 · Sep 19, 2017

We are actually able to walk patients to the ambulance and walk them into the hospital. I do it occasionally without any issue so far.

AtlasFlyer · Sep 19, 2017

A good percentage of our patients are 'self loading'. Obviously it's on a case-by-case basis, determined by individual situation, but I'd say a good 25-ish% of our patients walk both onto and off of our ambulances. Probably another 25% walk onto the ambulance, but are better served in one way or another by riding on the cot during transport and if they're already on the cot we'll take 'em in on the cot. No one cares if the patient can walk, and we have them walk. Often we'll get them a wheelchair to go from the ambulance bay into triage.

hometownmedic5 · Sep 19, 2017

That's our protocol, the patient approach section. As you can see, it isnt black and white, but the language is pretty strongly against it. More importantly, I personally know providers who have suffered grievously by allowing a patient to walk.

I dont agree with it, but this is the world I live in, so my patients get carried.

Jkimball · Sep 19, 2017

Thank you everyone for there feed back and comments. I just wanted to get some outside opinions and see what others thought. I would like to see a study done on back injuries related to inappropriate, unneeded or unwarranted stretcher use done in the feature.

E tank · Sep 19, 2017

No better way to assess cardio-pulmonary fitness than exercise tolerance. No better way to assess exercise tolerance than walking. Like a mini tread mill test to the ambulance.

Never2Old · Sep 20, 2017

Curious. Is this perhaps a billing issue? I had been told in the past that patients are required to be brought into the ER on a wheeled stretcher in order to bill as an emergency service. Granted, I have wheeled many a patient right through the ER and into Triage and transferred to a wheel chair, but that was at the request of the Charge Nurse in the ER after transport was complete.

Jkimball · Sep 20, 2017

Not a billing issue from the stance of the original post. Most polices for billing are like that though. Atleast my company views it that way.

Bullets · Sep 20, 2017

I can and do regularly walk patients to and from the Ambulance. We walk patients through triage into the waiting room often. We have a lot of patients who meet us at the curb. If they do i will secure them on the airway chair with the three point belt.

Also our ER leaves a bunch of wheelchairs inside the ambulance bay doors, so even if they walk in, we will use the wheelchairs to get them into a recliner.

Tigger · Sep 21, 2017

hometownmedic5 said:
View attachment 3994
I dont agree with it, but this is the world I live in, so my patients get carried.

Once this happened in Massachusetts, it was all over for OEMS. I started working at Brewster not long after the state included phrasing to pretty much insist patients be carried in the state protocols, we had supervisors coming to do spot checks. Woof.

Unneeded stretcher use?

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