All firefighter and emergency medical technician courses discuss lifting and moving patients with various methods and devices. Most of these methods are taught based on a patient location close to the ground with plenty of access for multiple responders to position accordingly. However, as access is restricted or the patient is in an elevated position, relatively simple methods can become extremely difficult. Even small and lightweight patients can present challenges.
As responders, we are responsible for properly and safely moving patients while maintaining cervical spine immobilization. This is one reason I prefer side removals vs. roof removals in most cases. Completing a side removal and lowering the seatback allow responders to keep the patient close to the ground and avoid the need to lift dead weight into an elevated position. In addition to protecting the patient from further injury, responders should maintain proper body mechanics and use lifting and moving devices to avoid common sprains and strains.
One tool that may assist responders in removing patients from vehicles is a ladder. Various fire service ladders are readily available and are tested to stringent standards. They have been used in other situations to assist with the removal of patients, including low-grade rescue, firefighter removal from elevated positions, and movement over rough or uneven terrain.
Movement using a ladder should be similar to any other type of patient movement. It should be completed in a planned and orderly manner. Although the disentanglement supervisor may be in control of the overall tactics, the responder providing medical care should control the patient movement, as he has established a relationship with the patient, assessed and identified potential injuries, and formulated a plan to limit further injury.
In addition, he is probably positioned at the head of the patient, which is the common position to control movement. Prior to any movement, the medic should indicate where each responder should be located and briefly describe the steps that will be performed to ensure each responder knows what is expected once the movement begins. The responders moving the patient should anticipate and understand the method in which the patient will be moved and each individual's responsibility. The medic should also communicate with the patient so the patient understands the actions that will take place.
The ladder may be incorporated into the initial spinal immobilization of the patient or used as a supplementary device after the patient has been immobilized onto a long spinal board. For example, during school bus operations, the patients will be immobilized inside the bus and then the ladder can be used for transfer through egress points to awaiting responders on the exterior. In other situations where a vehicle is in a more vertical position, the long spine board can be rested on a ladder behind the seat and the patient moved to the spine board.
The ladder should be held in position to limit any movement while responders are working with victims. Securing the ladder can be accomplished by heeling the ladder or by tying it in at the butt or tip. If it can be accomplished quickly and easily, tying the ladder would be preferred to free responders who would otherwise be required to hold the ladder in place. Attachment points for webbing or straps should be readily available on vehicles. If the ladder is equipped, roof hooks can be used as well.
For most situations, the ladder can be carried with the tip leading and inserted in the same manner, much like laddering an attic space or outside area with overhanging obstructions. This will also eliminate having to rotate the ladder in the hot zone.
Typically, the height and angle of the ladder do not require the use of a technical lowering system with ropes and descent devices. A simple girth hitch around the patient with a long piece of webbing may make lowering to the board and down the ladder easier. The running end of the webbing can be wrapped over or around part of the vehicle and used as a friction device. Ensure the attachment point is in-line with the patient as much as possible.
With the height of larger vehicles and the potential for smaller vehicles coming to rest in elevated positions, having the ability to safely and proficiently move victims to the ground is an important aspect of extrication incidents. A well-placed ground ladder can assist responders in moving the patient and prevent common lifting and moving injuries.