**5. Stretcher operations**

Though rare, patient injuries from stretcher-related incidents do occur and can pose a significant risk to both the patient and the EMS clinician. In a retrospective study reviewing the 671 reported stretcher-related incidents occurring from 1996−2005, 52 patients were injured, resulting in injuries from lacerations and fractures to traumatic brain injury and death [19]. Not surprisingly, injuries to personnel occurred at a higher rate than to patients, with most of those injuries occurring as sprains/strains. This may seem like an insignificant number of injuries given the 10-year span of data; however, this data is only from incidents reported to the FDA and is likely an underrepresentation of risk. Injuries occurred due to numerous reasons and can be classified into four broad categories: equipment malfunction, operator error, surface conditions, and patient-related [20].

#### **5.1 Equipment malfunction**

With the repetitive use of stretchers on patients of varying sizes and over a variety of terrains, it is natural for these to have significant wear and tear over time. Though the breakdown is inevitable, prehospital clinicians should routinely check stretchers to ensure all parts are present and working properly. Any equipment not passing inspection should be immediately taken from the ambulance so that it can be repaired by a qualified professional. It may be inconvenient to take a vehicle out of service over a small missing part or break, but this could potentially lead to a devastating injury from a stretcher failure.

#### **5.2 Operator error**

As with all aspects of the job, knowing how to fully operate a piece of equipment safely is imperative, and a stretcher is no exception. Before a patient is ever placed on the stretcher, an operator should be comfortable demonstrating all the functions required for safe use. Partners should also practice lifting, loading, and unloading a stretcher together to ensure development of a systematic approach to ensure proper timing of releases, therefore optimizing safety. In the study by Wang, the largest portion of injuries occurred while unloading the patient from the ambulance [19]. A twoperson unloading technique should be utilized to ensure the undercarriage deploys correctly and the stretcher does not collapse. Other potential human errors leading to injury include not latching the stretcher properly into the ambulance safety latch upon loading and not utilizing the recommended safety restraints prior to movement.

#### **5.3 Surface conditions**

EMS clinicians work in a variety of environments, regardless of weather conditions. Rain, ice, and snow pose a threat to safety with moving, loading, and unloading stretchers

#### *Patient Safety in Emergency Medical Services DOI: http://dx.doi.org/10.5772/intechopen.108690*

by creating slippery conditions beyond the control of the clinician. These conditions have been shown to precipitate tipping events during movement, as a patient shifting on the mattress in response to slipping or sliding can throw the entire stretcher off balance. In these cases, it may be helpful to have an extra set of hands available to stabilize the side of the stretcher throughout the movement. Additionally, it can be very difficult to safely load and unload a patient when both the stretcher and the floor of the ambulance are covered in precipitation. In these cases, having towels on hand to dry off the floor and the locking mechanism could prove useful in ensuring both patient and crew safety. Though hazards such as cracks in the concrete and uneven gravel surfaces are beyond the control of EMS personnel, keeping a watchful eye for such barriers to safe stretcher use and having a plan for navigating them safely is highly recommended to prevent injury.

#### **5.4 Patient related**

The two patient-related stretcher issues most likely to cause harm to the patient and EMS clinician are combative and morbidly obese patients. Combative patients can easily tip a stretcher during movement, therefore, it is important to ensure that the patient is either calmed or appropriately restrained prior to movement. If possible, have extra personnel to secure the sides during movement to prevent tipping. If feasible, it may also be beneficial to walk the patient to the ambulance, securing the patient to the stretcher just prior to loading. Obese patients lend another challenge, not only due to weight and safety harness size limitations of a stretcher but also for crew safety while lifting. Never place more weight on a stretcher than recommended by the manufacturer, as this could lead to catastrophic injuries from collapse, and use safety belt extensions as needed to properly secure the patient to the stretcher. For stretcher lifts and loading of obese patients, maximizing the number of personnel available to help is important for both patient safety and career longevity. Despite typical EMS job descriptions displaying a lifting requirement in the range of 100−200 pounds, the NIOSH recommended load limit set per healthcare clinician is 51 pounds [3]. Surprisingly, the use of hydraulic stretchers does not completely mitigate the risk of injury when lifting an obese patient, as hydraulic stretchers are significantly heavier than manual stretchers [21]. When faced with lifting any type of stretcher with an obese patient, increasing the starting height of the stretcher and ensuring use of proper body mechanics can be advantageous in preventing injury.
