Moving a sick or injured patient
As a general rule, it is important to avoid moving any sick or injured patient because of the risks of causing complications to the underlying condition. An exception to this rule includes moving a person from life-threatening danger to a safer location.
A first aider should avoid lifting a person off the ground. The safer alternative is to drag the patient in line with the long axis of the body, using either the arms or the legs for traction, keeping the body aligned.
The only safe lift for first aid is the blanket lift (see below), for which a minimum of 6 people and preparation time is needed.
The safest first aid methods of moving a patient are as follows.
Leg drag
This is the preferred method where there are no obvious leg injuries.
Method
Crouching low, the first aider grips the patient’s ankles firmly and, leaning back, uses body weight to drag the patient to safety.
Arm Drag
The first aider should use this method when there are obvious leg injuries.
Method
Crouching low, the first aider should pull the patient’s arms above the head and grip the elbows if possible. The elbows should be held in firmly against the patient’s head to give support and prevent the head from dragging on the ground during the move.
If it is impossible to hold the arms against the head, a wrist grip should be used. The first aider should crouch low and grip both wrists firmly, leaning back to use body weight to drag the patient to safety.
Clothing drag
If the patient has multiple injuries, it may be best to use clothing for the drag to avoid direct traction on the body. However, there are additional risks with this method because clothing may suddenly tear and create a whiplash effect on the patient. Where possible, it is always best to use the arm or leg drag methods outlined above to reduce the risks of moving the patient.
Method
To use the clothing drag the first aider needs to have a firm grip on clothing that is pulled up firmly under the armpits. A coat or jacket will be better than a woollen jersey, which may not take the patient’s body weight. The first aider then crouches down low and leans back while pulling firmly on the clothing.
Blanket lift
This method is safe only when there is a minimum of 6 bystanders available, plus a strong blanket long enough to support the patient’s entire body. It is not a suitable method for an emergency when life-threatening danger is present, but it may be useful in a remote area where there is likely to be a significant delay before the arrival of trained personnel. In this situation it is designed to assist in the transfer of a sick or injured person out of extreme weather conditions.
Method
First the blanket must be rolled up along its length until only half of the blanket is left flat on the ground. The rolled edge is then placed along the patient’s side, making sure that the blanket will support both the feet and head.
Next the three helpers on the opposite side roll the patient onto their knees using a ‘log-roll’ technique in which the patient’s head, neck, spine, hips and legs are kept in a straight line throughout. The rolled edge of the blanket is then placed close to the patient’s spine and the patient gently eased back onto the ground.
The patient is then ‘log-rolled’ flat to allow the blanket roll to be pulled out, leaving the patient lying centrally on the blanket. Three helpers should stand on each side and roll up their side of the blanket into a tight roll held close to the patient’s body.
- The first person on each side should grip the blanket roll with one hand close to the patient’s ears and the other at shoulder level.
- The middle person on each side should grasp the blanket roll at mid-chest level and close to the patient’s hips.
- The third person on each side should grasp the blanket roll with one hand close to the patient’s thighs and the lower hand close to the patient’s feet.
When the most highly trained person present is satisfied that the lift will be safe, the lifters are told to lean outwards slightly to keep the blanket tightly stretched and the order is given to ‘lift slowly’. Lifters should use their legs for lift rather then their back.
The lifters then face forwards and walk slowly to the planned location. It is vital that the lifters are instructed to avoid walking ‘in step’ because this will cause the patient to rock from side to side. Once the new location has been reached, the order is given to lower the patient, slowly and carefully.
Trapped patients
There are situations where a patient may be trapped and require rescue by emergency personnel with special training and equipment.
For example:
- a person trapped in a car
- a person in a workplace who is trapped in a confined space
There are several actions that a first aider can take to maintain life until a full rescue can take place. The first aider should try to carry out the standard assessment and management techniques as best they can. The following are examples of a modified approach.
Unconscious patient
If the patient is unconscious, try to open and clear the patient’s airway in the position found. In a motor vehicle where the patient is held in a vertical position by a seat belt, leave the seat belt in place to stabilise the patient but lay back the seat if possible. Support the head while the airway is opened and cleared using head tilt and chin lift to support the jaw. Either support the head from behind, or through the side window if this is easier.
Bleeding patient
If the patient is bleeding and it is impossible to secure a dressing in place with a bandage, the first aider should hold the pad in place with firm hand pressure until trained assistance arrives.
Care of a patient in a remote area
An emergency in a remote or isolated area presents a special challenge to the first aider, although it is rare for the individuals involved to be without either a mobile phone or access to the closest ambulance service. When people are working in remote areas detailed plans and guidelines should be developed beforehand for managing any emergency. Such plans include:
- communication strategies to notify the nearest assistance;
- provision of an appropriate first aid kit, which contains a wide range of medications and first aid equipment.
Telephone/radio telephone link
If a telephone is used, there will be ongoing advice and feedback and the first aider will not feel so isolated. While there may be a temptation to drive the sick or injured person out of the area, it is rarely wise to undertake such an evacuation because of the real risks of complications during transport.
If there is no telephone contact from the emergency scene, it is best to identify a person who is available to drive to the nearest town or mobile phone coverage area and arrange for a rescue team to arrive. However, each situation must be judged on its merits and it is rarely wise for one of only two people to leave the emergency scene to fetch help unless no other arrangements are possible. The first aider may require help with adjusting the patient’s position, and if resuscitation is suddenly needed, a second person’s assistance can be invaluable.
Longer-term care
The main difficulty faced by a first aider in a remote or isolated area is the likely time delay before the arrival of highly trained help. It often becomes necessary for the first aider to maintain care of the patient.
Shelter the patient
If it is necessary to move the patient into a sheltered area to avoid extremes of heat or cold, do this promptly and carefully, provided that the move will not cause additional pain or injury. The surface on which the patient will rest may need to
be protected by insulated material plus a blanket for extra comfort. It may be necessary to provide an additional blanket on top to maintain body heat, or items of clothing may be used.
Change patient’s position
Consider changing the patient’s position if there is likely to be a delay of 2 or more hours before a retrieval team arrives. Pressure must be taken off the main contact points of the body, which may be achieved by simply allowing the patient to turn from the back to the side or from one side to the other. Much will depend on the underlying illness or injury, and care must be taken to avoid any unnecessary risks caused by moving the patient from one position to another.
Maintaining a safe fluid balance
Maintain an adequate circulation through the provision of fluids if there is to be a significant delay before the arrival of a rescue team. In hot or remote conditions the administration of fluids must be balanced against the risk of dehydration.
The patient should be offered frequent small sips of cool fluids because their condition of shock may make it difficult to absorb any larger volumes. Avoid hot fluids because they will cause a rapid increase in circulation to the stomach, which will divert blood from other areas of the body.
Avoid giving alcohol to a sick or injured patient, which may mask or inhibit their symptoms.
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