Stretcher Question

[medichopeful]

(Not sure if this is the right section. Please feel free to move it)

Quick question. I did a quick Google search, and didn't see the answer.

Why are some stretchers tilted so that the head end is higher than the feet? Is there any medical reason? Is it so the patient can see and feel more comfortable? Or is it so it's easier to load into the ambulance? I don't have any training, so I am curious.

I have included a picture to help clarify, as I don't really know if I explained it very well :sad::

(Sorry for the size of the picture. I don't know how to thumbnail it.)
Thanks!
Eric

 

[WuLabsWuTecH]

I think that's just the default position.

The one you show is a stryker and they are made that way so that the powered versions of them can load into the ambulance easier (since you don't lift to get them into the back). Any cot should be able to elevate the head and feet to desired angles (shock position, trendelenberg position, fowler's position) to be able to transport any sort of patient.

 

[MSDeltaFlt]

(Not sure if this is the right section. Please feel free to move it)

Quick question. I did a quick Google search, and didn't see the answer.

Why are some stretchers tilted so that the head end is higher than the feet? Is there any medical reason? Is it so the patient can see and feel more comfortable? Or is it so it's easier to load into the ambulance? I don't have any training, so I am curious.

I have included a picture to help clarify, as I don't really know if I explained it very well :sad::

(Sorry for the size of the picture. I don't know how to thumbnail it.)
Thanks!
Eric

They call it the "load position" for that exact reason.

 

[medichopeful]

I think that's just the default position.

The one you show is a stryker and they are made that way so that the powered versions of them can load into the ambulance easier (since you don't lift to get them into the back). Any cot should be able to elevate the head and feet to desired angles (shock position, trendelenberg position, fowler's position) to be able to transport any sort of patient.

I wasn't sure if they could be adjusted, as I have never used one. I thought it would be a little strange to keep it like that, as I know that for shock you want blood going to the head. You have solved my curiosity and confusion. Thanks!

 

[medicdan]

The "head up position" becomes more pronounced as the cot is raised (low "clicks" are flat, and gradualy move into that position).

I always thought another reason was patient orientation-- when lying supine, such as when on a backboard. That slight tilt gives them some view of what is ahead-- and minimizes disorientation and/or vertigo.

 

[Sapphyre]

Like dan said, I really only noticed the "head up" position when we're in the load position, aka, the highest you can take it. It does seem to be a bit more comfortable and less disorienting to a boarded pt. Additionally, the back does raise for fowlers, and as do the feet

 

[Sasha]

To clarify since I know you're not an EMT student yet. Fowlers is when the head of the stretcher is straight up, like the patient is sitting in a dining chair with their feet up on the dog or something. Semi fowlers is a more reclined position like someone lounging around on a lounge chair. This is perhaps the most common, I've only had patients with difficulty breathing request to be straight up. Trendelenburg has proven to be useless, but it's when you elevate the feet above heart level for shock and hypotension etc. The slight dip in the stretcher is for easier loading, the adjustable head portion is for patient comfort, most of the time. Supine is when they are laying flat on their back.

Also if you are pushing a patient around in fowlers and you are short, try not to be at the back or you will be blind!

Side note.. I am a little alarmed by the backboard strap over the patient's neck in the picture.

 

[Onceamedic]

I have to disagree about the trendelenburg being useless. I have transported many hypotensive patients where all that was required was a trendelenburg to restore BP.

 

[WuLabsWuTecH]

I think that's a piece of tape Sasha! It doesn't seem to have a buckle and it's also ofer a rigid C-collar!

And yes that position is more comfortable for some patients. Sometimes we'd push the cot in the full up position for that reason.

 

[Shishkabob]

sitting in a dining chair with their feet up on the dog

You dog hater!



As for Trendelenburg, could have sworn I read somewhere that it only moves ~100-200ml of blood, and that's until peripheral vessel constrict to even it out again.

 

[WuLabsWuTecH]

You dog hater!



As for Trendelenburg, could have sworn I read somewhere that it only moves ~100-200ml of blood, and that's until peripheral vessel constrict to even it out again.

Yes, but when you're patient is bleeding at 100-150 mL's a minute, you need every mL you can get!

 

[Shishkabob]

That's 2 heartbeats in the "average" adult... won't help much for long

 

[Markhk]

The reason for the "tilt" on some cots and not others is actually fairly straightforward: there are two cot designs out on the market.

The cot you see the the picture - the Stryker R3 - is a "X-Frame" Style cot. The design allows for the user to adjust the position to any height, the trade off being that as the cot is put into the higher position, there is a gentle incline.Technically, the X-Frame does not have a "load" position - the wheels can be lifted up regardless of ambulance floor height.

You can see the X-Frame design in these company's designs:
http://www.ems.stryker.com/detail.jsp?id=1
http://www.ferno.com/proflexx/

The contrasting product is the "H-Frame" style cot. This cot has a definite "load" position which is the highest level. You must put it into a "load" mode in order to get it into the ambulance. (It allows the front wheels to collapse into itself as you push the cot in). The trade-off to somewhat easier loading is that there are much more limited cot heights -- usually only a total of 5 compared to "infinite" on the X-Frame. However, once it is out of the load position, the cot is really flat - you don't have that weird tilt that you see on the X-Frame. The load process is actually kind of complicated because this design requires an additional safety feature: an auxiliary lock on the side to prevent the front wheels from collapsing prematurely. Most agencies recommend never transporting at the load position on an H-Frame because of the center of gravity is very high in this position and increases the risk of tipping over.

You can see the H-Frame design here:
http://www.ferno.com/promoLinks/pt9340.htm
http://www.ems.stryker.com/media/pdf/ezpro.pdf

Honestly though...no patient I've known really notices the cot tilt on the X-frame. I've used Strykers, Fernos, X-Frames and H-Frames...they all get the job done. I do love the Power Cot though, man those are sweet.

To be clear though: the tilt in the picture has nothing to do with clinical reasons...it is merely the design of the cot as it is pulled out.

 

[medichopeful]

To be clear though: the tilt in the picture has nothing to do with clinical reasons...it is merely the design of the cot as it is pulled out.

^This was what I was really curious about.

Thanks for all the other info, though.

 

[medichopeful]

To clarify since I know you're not an EMT student yet. Fowlers is when the head of the stretcher is straight up, like the patient is sitting in a dining chair with their feet up on the dog or something. Semi fowlers is a more reclined position like someone lounging around on a lounge chair. This is perhaps the most common, I've only had patients with difficulty breathing request to be straight up. Trendelenburg has proven to be useless, but it's when you elevate the feet above heart level for shock and hypotension etc. The slight dip in the stretcher is for easier loading, the adjustable head portion is for patient comfort, most of the time. Supine is when they are laying flat on their back.

Also if you are pushing a patient around in fowlers and you are short, try not to be at the back or you will be blind!

Side note.. I am a little alarmed by the backboard strap over the patient's neck in the picture.

Thanks. That helps me begin to learn about the different positions.

Also, the "dog" thing made me laugh

 

[WolfmanHarris]

Even the x-frames are not supposed to be transported at full height. They usually are, but by the letter of the equipment manual a few notches down is the more stable and thus transport height. Moving the patient at loading height into the facility is certainly better for my back, but be aware that you run the risk of wearing it if there's a fall due to your improper use of the device. That's why if I'm ever leaving the stretcher without crew hands on it (thank-you offload delay) I lower into down to a more stable height.

Now this is based off of my schooling and the provincial equipment manual. I will have to go digging when I'm not in bed if anyone wants confirmation from the manufacturers guidelines for the Ferno 35 series.

 

[JPINFV]

I have to disagree about the trendelenburg being useless. I have transported many hypotensive patients where all that was required was a trendelenburg to restore BP.

Was it trendelenburg or the handful of strangers saying weird things with beeps and buzzers and sirens going on in the background while being stuck with sharp needles, all together causing a stress response that increases the BP? That's the big difference between the studies done in the lab versus what is observed in the field. I'd imagine that most of our critical patient's BPs go up once we arrive.

 

[Ridryder911]

I have to disagree about the trendelenburg being useless. I have transported many hypotensive patients where all that was required was a trendelenburg to restore BP.

Blood can't run up hill through channels and locks... Ever noticed varicose veins? Remember you have three muscles in the venous system (tunica intima, media, adventitia) that prevents back flow as well as valves (ever hit those pisky things, when starting an IV?).
Nice theory that trendelenburg works but a myth.

Laying a patient in supine position has the same effect, preventing increasing circulation and promoting homeostasis, but to actually consider blood returning back into the system as per gravity is not effective. One of the myths that we learned about PASG even was that with compression and squeezing we did not increase or improve the blood flow back to the central circulation.

Just a hard myth to bust since so many have been taught it and it has been taught for so long.

R/r 911

 

[Sasha]

I think that's a piece of tape Sasha! It doesn't seem to have a buckle and it's also ofer a rigid C-collar!

And yes that position is more comfortable for some patients. Sometimes we'd push the cot in the full up position for that reason.

Yeah, but the tape is what's holding the guy to the backboard. I don't see any other straps beside stretcher straps. It may be over a C-Collar but it is still over his neck. Should complications arise you still have to locate your shears and cut the tape, freeing the head and making the backboarding useless. It also would prevent assesment of the trachea for deviation (although I'm told this is a late sign, not something you are likely to see in the field.). There is a reason you have that cu out in the neck of the c-collar.

Generally I don't think things that go over the neck are a good idea.

 

[NomadicMedic]

Yeah, but the tape is what's holding the guy to the backboard. I don't see any other straps beside stretcher straps. ... (snipped for brevity)

This is simply a PR shot for Stryker. The methods used to secure the PT to the board are secondary to how shiny and nice the stretcher looks in the shot.

Medical equipment suppliers and manufacturers often take liberties with how their products are displayed in "action shots" as to provide the most "photogenic" angle and presentation.

Need another example? Look at any print ad for a monitor.

Welcome to the world of advertising, where things are never as they seem.