Introduction
A significant amount of an emergency department (ED) technician’s (EDT’s) shift will be spent moving patients throughout the department and assisting them with various tasks outside the stretcher. Some patients in the department will be independent; some will be at risk to fall and hurt themselves; and some may be completely reliant on the tech’s assistance to move or even go to the bathroom. It is a vital part of the EDT’s job to know how to assess and assist patients in ways that are not only safe for the patient but also for the technician.
Initial Assessment
The EDT is often the first member of the ED team to assess a patient as they are transported throughout the department. Before transporting, moving, or allowing a patient to move throughout the hospital, it is important to perform an initial assessment. This assessment will include, but is not limited to, evaluating them as a fall risk, assessing any handicaps that require the tech’s assistance, and knowing why they are in the ED in the first place, as this will affect their transport.
Clinical Condition
Before transporting a patient, the EDT must know why the patient is in the ED and how that might affect their transportation. If a patient is in critical condition, they should always be moved on a stretcher. The patient who presents to the ED for a twisted ankle will likely need a stretcher or wheelchair in order to be brought to their bed. Patients in critical condition often have multiple medications running through IVs as well as monitors that need to be transfered with them. Intubated patients must be transfered with their attached ventilator and may also have a respiratory therapist with them. Because each patient is unique, and before transporting them to a different location, assisting them in walking around the department, or even helping them use the restroom, it is the EDT’s job to accomodate their specific needs. However, there will always be somebody the EDT can ask to help clarify the the patient’s condition and needs. It is good practice for the EDT to review the patient’s chart before transporting them.
Fall Risk
Falls in the hospital can cause anything from minor scrapes and bruises to severe disability and even death. It is important to assess a patient for how at-risk they are for a fall prior to leaving them alone, as patients can fall when standing on their own, when out of bed, or even when hospital staff are carrying them. It is often the EDT’s job to identify patients who are at high risk for falls and to make sure they are given proper assistance to ensure a fall does not happen. Sometimes it is easy to identify people who are a low fall risk simply by clinical judgment (e.g., a 24-year-old male who walks into the ED for a finger laceration and does not seem to have any trouble walking). Sometimes it is easy to identify people who are a high fall risk just by judgment (e.g., the intoxicated patient who cannot stand up without swaying). Any patient in critical condition should be considered a high fall risk. However, for those more subtle but clinically relevant fall risk patients, there are decision tools that help, such as the Johns Hopkins Fall Risk Assessment Tool. Do not hesitate to ask a nurse, or other members of the care team for clarification of the patient’s fall risk.
Once a patient at high fall risk is identified, it is important to provide a visual indicator on the patient so that all staff who interact with them know they are at risk for a fall. Different hospitals use different fall risk indicators. Some facilities will use a colorful wrist band while others may use color-coded gowns or socks ( Fig. 23.1 ). Whatever the method, it is important to easily identify patients at high fall risk in order to prevent falls in the ED.
Special Populations
In addition to recognizing the specific needs of the critical patient, there are other special populations in the ED who require specific accomodations.
Different Languages
The ED staff may need translation assistance for patients who speak a diffrent language. It is a patient’s legal right to receive care in the language they prefer. Hospitals will either have in-person interpreters for more common languages, or they will provide a phone or video conference for other languages. The EDT should never use a family member to translate, as this violates the patient’s privacy, and they may not be willing to be forthcoming with you, except in emergent (life-threatening) situation. However, they are not to be relied upon for translation once a translator is obtained.
Obese Patients
Patients who are extremely obese and immobile may require extra assistance with transportation. One can simply ask the person if they need help getting up to walk or to use the bathroom in order to gauge what extra assistance is needed. Some may need special devices to move them from a chair to bed or from one bed to another, and some may need differently sized wheelchairs or hospital beds in order to accommodate their body habitus. Keep in mind that the patient may feel uncomfotable about the extra staff, equipment, or special needs that go into transporting them and it is the responsibility of the ED staff to ease that discomfort through compassion and respect.
Physical Disabilities
Patients with various physical differences and disabilities will present to the ED. It is important to know that many patients live independently and may not require any assistance. Although patient safety is our top priority, patient autonomy is also important. One can simply ask a person with a physical disability what assistance they need, if any. Attempting to help patients with various tasks, without their permission or guidance may be percieved as disrespectful and may interfere with the patient’s own abilities.
Preventing Provider Injury
In all aspects of patient care in the ED, the EDT must remain safe. This includes the EDT’s physical safety during patient handling. To prevent musculoskeletal injury and to ensure patient safety, manual lifting of a patient should be avoided. Assistive devices should be used to replace manual lifting when possible. Some hospitals and institutions have “no lift” policies in which that require staff to use an assist device during patient movement. Be sure to talk to your supervisor and nursing staff for further clarification on when manually lifting a patient is permitted.
When handling patients, an EDT must consider the patient’s size, strength, ability to follow and cooperate with instructions, physical abilities, and medical conditions. Determine the patient handling equipment that will be needed for the movement, such as a slide board, low friction draw sheet, or sling device. If you have any questions or concerns, follow your hospital’s guidelines or ask someone around you for help and assistance.
Determine the support that you will need from other staff members. A patient should never be lifted by one individual. Prior to moving a patient, ensure that the bed is in locked position, all clutter is removed from the area, and that the bed is at hip level. Ensure that the bed is in an appropriate position, such as keeping the head of the bed flat or tilted downward when pulling a patient up in bed. Keep the patient close to you and directly in front of you when moving to eliminate awkward twisting motions. Legs should be kept at a wide stance to remain stable during the movement. Maintain a bend in the knees and use them to lift the patient. Avoid using the back to lift. Encourage patient participation when possible.
It is important to use assistive devices whenever possible to prevent staff member injury. Follow hospital and manufacturer guidelines on use for assistive devices. Eliminate lifting whenever possible.
Patient Positioning
A patient’s position is not only important for their comfort but is also helpful for certain medical needs. Table 23.1 lists common names for patient positions.
| Name | Description |
|---|---|
| Supine | Lying flat on the back |
| Prone | Lying flat, face down |
| Lateral recumbent | Lying on either side, often curled up |
| Fowler | Sitting, head of bed at 45 degrees, knees can be raised |
| Semi-Fowler | Sitting, head of bed at 30 degrees |
| Trendelenburg | Lying flat with entire bed angling the head down and feet up |
| Reverse Trendelenburg | Lying flat with entire bed angling head up and feet down |
Special Considerations
Intubated Patient
Always make sure there is either a registered nurse (RN) or a respiratory therapist present before moving an intubated patient. This is critical because it is important to maintain their airway. A patient who is intubated should be positioned and transported with the head of the bed raised to approximately 30 degrees. This has been shown to decrease rates of pneumonia that are associated with the ventilator.
Spinal Precautions
In some situations, moving a patient’s spine can cause or worsen an existing injury. Improperly moving a patient with a spinal fracture, or potential spinal fracture, can result in permanent paralysis. Patients with possible spinal fractures should have a cervical collar applied and be in the supine or semi-Fowlers position, depending on concern for thoracic or lumbar spinal injury. Ask the patient’s nurse or medical provider if they should be on spinal precautions.
When a patient cannot move any part of the spine at all and it is necessary to turn the patient to look at their back, they must be “log-rolled.” In this procedure, one person is at the head of the bed stabilizing the C-spine, and two people stand next to each other on one of the patient’s sides. The two people cross their arms so one hand is on the patient’s shoulder, above the hip, below the hip, and legs. Whoever is controlling the head needs to count, and then in one motion, the patient is turned to their side, so as not to twist the spine ( Fig. 23.2A,B ).
