Why do we love the stretcher in the United States?

MMiz

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Over the past few weeks I've watched quite a few episodes of the British TV show Ambulance on YouTube.

On the TV show I rarely see patients carried out of their homes on stretchers. Instead, nearly every time the patient is walked to the ambulance or strapped on to a stair chair-like chair with four wheels.

During my active years in EMS we always lugged in the stretcher. Up stairs, through doorways, and into tiny rooms.

I see that Stryker's recent model stair chairs come standard with four wheels and tracks. Is anyone using them? Why don't we use something similar in the United States?
 

DragonClaw

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Over the past few weeks I've watched quite a few episodes of the British TV show Ambulance on YouTube.

On the TV show I rarely see patients carried out of their homes on stretchers. Instead, nearly every time the patient is walked to the ambulance or strapped on to a stair chair-like chair with four wheels.

During my active years in EMS we always lugged in the stretcher. Up stairs, through doorways, and into tiny rooms.

I see that Stryker's recent model stair chairs come standard with four wheels and tracks. Is anyone using them? Why don't we use something similar in the United States?

Everyone (decent) down here has the new Strykers. They're scary to use at first, but the tracks to do all the work really. Just keep the right angle.

My current service has no stair chairs at all. It's a recipe for disasters.
 

DragonClaw

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The powered gurneys cannot go up the steep stairs safely. It's just not going to happen. We had a pt argue this. And there's me and one other guy for a 200+ pt and very very steep stairs.

Backboard and then transfer to strap it to the gurney in most cases.
 

ffemt8978

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Over the past few weeks I've watched quite a few episodes of the British TV show Ambulance on YouTube.

On the TV show I rarely see patients carried out of their homes on stretchers. Instead, nearly every time the patient is walked to the ambulance or strapped on to a stair chair-like chair with four wheels.

During my active years in EMS we always lugged in the stretcher. Up stairs, through doorways, and into tiny rooms.

I see that Stryker's recent model stair chairs come standard with four wheels and tracks. Is anyone using them? Why don't we use something similar in the United States?
Might have something to do with the difference between national healthcare like the UK has and the melee the US has. I'm going to guess that the reason comes down to liability. Someone somewhere probably filed a lawsuit over not getting taken to the ambulance on a stretcher.
 

DragonClaw

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Might have something to do with the difference between national healthcare like the UK has and the melee the US has. I'm going to guess that the reason comes down to liability. Someone somewhere probably filed a lawsuit over not getting taken to the ambulance on a stretcher.

Even when we're going to the ambo, we have the gurney in position and transfer them ASAP. We've never had a stair chair pt walk into the unit.

We've walked a few people that had like a scratch on the arm. The most superficial things.
 

DesertMedic66

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I will gladly use a stair chair going down stairs or even going around tight corners however 90% of calls are gurney only.

In the majority of our units the stair chair is tightly packed into a exterior cabinet. So to pull it out I have to unload everything, pull the chair out, load the cabinet back up, and then wipe the chair down because it is always covered in dust.

Then when I get back to the ambulance it’s the same process to get it back in. I’ve had times when I wasn’t on my Tetris game and couldn’t fit it back in.

It’s usually more of a pain to do all of that when the gurney works perfectly well. I would also hazard a guess that in America the houses, rooms, and hallways tend to be bigger than some other countries.
 

DragonClaw

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I will gladly use a stair chair going down stairs or even going around tight corners however 90% of calls are gurney only.

In the majority of our units the stair chair is tightly packed into a exterior cabinet. So to pull it out I have to unload everything, pull the chair out, load the cabinet back up, and then wipe the chair down because it is always covered in dust.

Then when I get back to the ambulance it’s the same process to get it back in. I’ve had times when I wasn’t on my Tetris game and couldn’t fit it back in.

It’s usually more of a pain to do all of that when the gurney works perfectly well. I would also hazard a guess that in America the houses, rooms, and hallways tend to be bigger than some other countries.
I've only used it when stairs are involved. Otherwise the gurney will fit in the homes with some puzzle solving and collapsing.
 
OP
MMiz

MMiz

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@ffemt8978 I think that’s part of it.

Working for a private service in a vanbulance I hated the stair chair. It was hard to access, every van had a different type unit, and I never quite knew how to use one properly.

I remember my boss one time bragging that our service was the only one in the county that was willing to take a certain dialysis patient on a stretcher with an impossibly difficult front porch. She proudly shared that even though we had several units out on workers comp due to back injuries, we rose to the challenge.

After watching the show, with their stair chairs, ramps, and lifts, I wonder if we could do better.
 

DrParasite

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My current service has no stair chairs at all. It's a recipe for disasters.
So they how do you get Grandpa out of the house when he has an MI on the 2nd floor?
On the TV show I rarely see patients carried out of their homes on stretchers. Instead, nearly every time the patient is walked to the ambulance or strapped on to a stair chair-like chair with four wheels.

I see that Stryker's recent model stair chairs come standard with four wheels and tracks. Is anyone using them? Why don't we use something similar in the United States?
That's how we used to do it back when I worked up north. the stairchair came in on almost every call; the cot was left in the locked ambulance. if you left the cot outside the door, the was a chance that it would not be there when you came out. if the patient was stable enough to walk to the ambulance, they did; if not, they were carried via the stairchair. To be perfectly honest, I have taken more than one person was taken from their second floor bedroom to the back of the ambulance via the stairchair, and then transferred them to the cot.

it was a little different if you were going into an apartment building or commercial facility with an elevator, but you get the idea.

Ferno has had 4 wheel chairs for the better part of 2 decades; the front wheels were crap as anyone who used this model can attest to
but it was doable, and much lighter than the newer models. It was my first-in carrying device every time I worked a shift on a city truck, esp one with narrow hallways and unstable staircases. My back thanked the Stryker designers when they can out with the track system (and we kept it on our truck), but I still make sure to keep this relic on the truck (and once I special called another truck to bring me one to a scene to make it easier to extricate the patient, because we were in a backup truck without one)
During my active years in EMS we always lugged in the stretcher. Up stairs, through doorways, and into tiny rooms.
then you were doing it wrong. Stretchers are not, and were not, designed to go up stairs. you can (and I have) take them up 2 steps, but that's about it. Especially when they were all the way up with a patient on them. If you have a straight shot from the truck to the patient, with no steps, than take the cot in as far as you can. And we did maneuver it into some tight positions; but in general, never take the cot up stairs.

I remember my boss one time bragging that our service was the only one in the county that was willing to take a certain dialysis patient on a stretcher with an impossibly difficult front porch. She proudly shared that even though we had several units out on workers comp due to back injuries, we rose to the challenge.
yeah, we are so afraid of a patient falling and getting sued, that we neglect to consider the workmans comp lawsuits from back injuries, especially when not everyone needs to be carried. Than again, too many providers are working with bad backs, and we wonder why we can't keep quality people who leave for less physically demanding jobs (like the fire service, construction, moving companies,etc)
 

akflightmedic

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I am very happy to share that I do think it is more of a regional culture thing than a standardization across EMS in the USA. Had I not lived and worked here in Maine for the past few years, I would agree with your premise that we tend to lift, carry, coddle, far more than we should. Up here, in my neck of the woods...if you can walk, you walk. End of story.

There are always caveats...no, I will not walk the chest pain patient unless absolutely necessary due to whatever imaginable reason you could think of. And yes, I have encountered those situations, from hoarder homes to refusing to go unless they "can walk themselves" and everything in between.

We have too many old homes here (who would have thought I would ever own an apt bdlg built around 1798, or that a new construction home around here is anything built around 1900??), narrow stairs, creative building designs, weather, and so much more. We do not lift or carry and our service supports that. Even the old granny with a walker or the young disabled guy with crutches. Because you have to ask them, and ask ourselves...what do they do every day normally? What would they do if we were not there? The reality is the majority of these people get around every single day to the best of their ability (their normal) and we should encourage that. It is healthy practice and a healthy mindset.

Let them do everything they can do for themselves. Even if lifting takes 5 minutes and them walking takes 20 minutes, let them freaking walk!!

I type all of this while sitting on light duty for the next 6-8 weeks due to biceps tendon rupture (again) from lifting a 400+ pounder who was full of "I can't", "no", "its too hard", etc...
 

captaindepth

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At my service we walk patients to the ambulance the majority of the time. We usually will bring the stretcher to the front of a home (or the hallway of apartment buildings) and leave just outside the door. Go inside with our kit and monitor, complete the initial assessment and usually we walk the patient to the front of the residence and sit them on the stretcher there. We have easy access to stairchairs but reluctant fireman to go get them, we use them when we have to. When we walk patients to the ambulance we will sit them on the "X" on the bench seat and continue our assessment there. If appropriate we will lap belt them in there and transport with them seated on the bench. If not they can self transfer onto the stretcher in the ambulance and be secured for transport.
 

akflightmedic

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Short answer is it only took one drunk chest pain patient coding for me to learn my lesson.

So I used to say something similar. However, at the end of the day, there is little to no EBM to support carrying versus walking. I do think there is a mountain of evidence showing the increased risk to the provider.

Stuff happens, a patient walks and codes, you can easily document everything and be "protected". Again, are we doing care and treatment based on liability or are we doing EBM and safe practice for providers? What if you want to carry and I as your partner do not? What then?

In the nursing world, the patient has the right to fall. Also, the patient can and should do everything possible within reason for themselves.
 

ffemt8978

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So I used to say something similar. However, at the end of the day, there is little to no EBM to support carrying versus walking. I do think there is a mountain of evidence showing the increased risk to the provider.

Stuff happens, a patient walks and codes, you can easily document everything and be "protected". Again, are we doing care and treatment based on liability or are we doing EBM and safe practice for providers? What if you want to carry and I as your partner do not? What then?

In the nursing world, the patient has the right to fall. Also, the patient can and should do everything possible within reason for themselves.
Does part of the difference between nursing world and EMS world stem from the fact nursing also takes into consideration long term effects and rehabilitation where as EMS is strictly the accute side of medicine?
 

akflightmedic

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Absolutely. However, shouldn't we as the first step in the patient care continuum give some thought and maybe assist in that endeavor? Especially when it reduces risk of injury to ourselves or our partner...?

Does acute mean we do not think long term? And in reality, how many of our patients are "acute"? Many of them are chronic, repeat patients who attempt to do very little for themselves when allowed that option. Even if they are "acute", does that mean they cannot walk?

This is where critical thinking skills come into play, this is where education is vital, this is where ongoing review and possibly changing of our practices is essential. We can do better.
 

DrParasite

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Short answer is it only took one drunk chest pain patient coding for me to learn my lesson.
You did a 12 lead on the patient before you walked the person with chest pain right? and a full assessment, and it all looked good, not vital signs were out of whack? so what lesson did you learn, other than some people will code, regardless of what you do?
At my service we walk patients to the ambulance the majority of the time...When we walk patients to the ambulance we will sit them on the "X" on the bench seat and continue our assessment there. If appropriate we will lap belt them in there and transport with them seated on the bench. If not they can self transfer onto the stretcher in the ambulance and be secured for transport.
sounds like your management and my former agency's management read from the same inner city EMS book
There are always caveats...no, I will not walk the chest pain patient unless absolutely necessary due to whatever imaginable reason you could think of. And yes, I have encountered those situations, from hoarder homes to refusing to go unless they "can walk themselves" and everything in between.
I'll walk chest pain patients all day long; however, I won't walk a cardiac patient (or, after an agreement with my supervisor, anyone over the age of 70). So if my chest pain patient is under 35, and has no other complaints, there is a high probability that they are going to walk to the stretcher. If they are over 35, and 12 lead is clear, vitals are all good, no other warning signs, then I will assist them to the stretcher. While my agency did allow us to walk people, clinical management did not take lightly people who were inappropriately walked to the ambulance. and we required a carrying device to be brought to all patients, even if it wasn't used.
In the nursing world, the patient has the right to fall. Also, the patient can and should do everything possible within reason for themselves.
Few patient's actually want to fall; however if you don't try, you will never be able to do it for yourself. And we can help minimize that risk, but they are going to need to live after we leave.

That being said, if I have a 400lb patient, that's going to be though for me and my partner. even if I pull up on the engine, with 2 FFs (since the driver stays with the truck on our 3 person crew), we and the EMS crew are still going to be sore. now compare that to the patient, whose muscles are used to carrying around that 400 lb weight; that is how he or she gets around every day. Not only that, but it's much safe for everything for the patient to walk down the stairs holding the railing, vs having use try to carry him, because he or she does it every day. if it takes 20 minutes, it takes 20 minutes. If it's clinically indicated, we can always carry them down the stairs (because walking will worsen their acute condition), but there is also a serious risk to the providers' safety if we do (and risk of injury). weigh the risks
 

akflightmedic

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By chest pain, I was implying cardiac patient. Did not think I needed to delve into the weeds much further...
 

Jim37F

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Our EMS uses the Ferno Pro Flexx cots that can fold into a chair, and generally seem to be much lighter than a Stryker, so we can get the gurney into houses and hallways far more often. We won't take them over anything resembling stairs more than a couple steps, and if the patient is capable of walking, our EMS medics are more than happy to have said patient walk into the gurney, whether that's a few feet away, or outside the house.

For second floor stairs and the like. They do have stair chairs, but I've only ever seen them used once here (versus a very regular every shift kinda deal when I was in LA...). If the patient can't walk, well all of a sudden BLS Fire (us) stands for Basic Lifting Services and we will carry the patient out down the stairs to the gurney more often than not.
 

M231163

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Over the past few weeks I've watched quite a few episodes of the British TV show Ambulance on YouTube.

On the TV show I rarely see patients carried out of their homes on stretchers. Instead, nearly every time the patient is walked to the ambulance or strapped on to a stair chair-like chair with four wheels.

During my active years in EMS we always lugged in the stretcher. Up stairs, through doorways, and into tiny rooms.

I see that Stryker's recent model stair chairs come standard with four wheels and tracks. Is anyone using them? Why don't we use something similar in the United States?
I try not to use the stretcher as much as possible. In fact I keep bags on the stretcher to stop people with minor ailments from laying on it after they walk to the truck. Our department wants it used as much as possible for billing purposes. Insurance companies are beginning to not reimburse for medically unnecessary ambulance trips. I don’t understand why a 20 or 30 year old with a headache wants to be carted around on a stretcher. I absolutely use it for elderly patients and sick patients though.
 

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