Do you properly secure patients to the cot?

[katbemeEMT-B]

Our cots have a leg, torso, and chest with shoulder straps secured at all times with side rails up.

We also take our cot into the home. We will carry it up the steps if there are only a few. Our other options are the stair chair or a LBB.

[scope2776]

Do you guys always secure with the over-the-shoulder straps?

I know some people are really big on always using the shoulder straps, but it is rarely done around here.

How about restraints for the attending in the back of the ambulance? How often do you buckle up in the back? I know our ambulances only have a lap belt for the capitan's chair.

[katbemeEMT-B]

Do you guys always secure with the over-the-shoulder straps?

I know some people are really big on always using the shoulder straps, but it is rarely done around here.

How about restraints for the attending in the back of the ambulance? How often do you buckle up in the back? I know our ambulances only have a lap belt for the capitan's chair.

We are required to use the shoulder straps. This is what keeps your patient from sliding off the cot should the driver have to hit the breaks or God forbid hits something head on. Any crew caught not using them gets written up. Three in your folder and your gone.

We also have lap belts on the airway seat, side seat, and three on the bench. If we are able to sit while enroute we use them. An example would be an interfacility transfer for a stable patient who needs observation only. More often than not we are moving about the rig performing patient care. I have become very well balanced and use the hand rail quite a bit.

[pacman]

I use all three straps for the legs, torso, and chest. If there is difficulty breathing, I put the chest strap somewhat loose when the patient is not being moved, otherwise its tighten to comfort. For obese patients, we have a strap extender, those things are great. The last thing I need is a 400 pound man falling sideways bringing the stretcher and myself with him.

I know some patients complain about the straps, but I remind them that it is for their safety and that I don't want them to fall over. Sometimes I ask them to look over the side and ask them if they want to take the risk of making that kind of fall. I usually loosen the chest strap once on the ambulance since its more comfortable for the patient and it makes it easier for me to do ongoing treatment and vitals enroute.

When backboarded, legs straps, two straps on top crossed and the head blocks or towels onto the backboard. Then they get the three additional straps on the stretcher. If possible, I go for the shoulder straps here as well so that the patient doesn't slide on the stretcher. Immobilized does mean immobilized right?

I should use the shoulder straps more often, but I have colleagues that don't use that at all. I know many places don't use them, or even have them!

As much as I care for my patients safety, I have to admit that I don't do much care for myself. I'm usually in the back unrestrained doing treatment with one foot on the back of the stretcher and one foot on the floor for support. When I need to move around, I feel like I'm on the monkey bars transferring from pole to pole. I understand this is dangerous, but it seems like the norm. What is everyone's take on this?

EDIT: Of course, the side rails are always up while moving.

[CBEMT]

All our gurneys have two straps. Patients are strapped in 100% of the time with both straps and guardrails up unless there's special circumstances.

Now some questions for you guys:

Do you take you gurneys into people's homes or always leave it at the door?

Do you carry the gurney over steps (say 3 or 4 steps) where you have to lift gurney from both sides or do you always keep 2 wheels on the ground?

Since stretchers aren't sold without 3 straps plus the shoulders, I find this interesting. Also, since all stretcher manufacturers operating guidelines require all straps to be used, I don't see what your defense is going to be.

Don't believe me? Alert Ambulance in Bristol, RI lost themselves a whole heapload of money because the crew failed to "secure the patient against both lateral and longitudinal movement," if I remember the ruling correctly. The court found that the patient was owed a certain level of protection (3 straps plus the harness), and anyone failing to do so was liable for whatever happens to the patient in an accident.

Whether we leave the stretcher at the door depends on how many stairs and the weight of the patient.

I use my seatbelt at all times in the back unless I absolutely have to do something enroute that can't be done from my seat.

[akroeze]

As far as I have seen everywhere in Ontario we always use atleast two (chest with shoulder and legs) or three (additional across abdomen) sets of straps.

[JPINFV]

I'm in the same boat as Anthony, none of my company's gurneys have 3 straps, only one across the legs and one across the chest. I remember seeing shoulder belts a few times in my two years with the company, but they were rare (grant it, so are jump bags [these only see light for event standbys] and short spine boards [1 ambulance that I know of, no KEDs at all]). Most EMTs at my company are either too dumb, stupid, or lazy to care, the crew chiefs will just shrug (I love the, "No, you can't replace ___ piece of equipment from another unit because I'll just have to deal with it again tomorrow" line), and management only cares about the bottom line.

Outside of any special cases (using the large body surface flaps, for example). the side rails are always up. We have 3 sets of seat belts on the bench seat and a seat belt on the captains chair with our newer ambulances have a shoulder strap on the captains chain. I always use a seat belt in the back, but again, most don't for the same reasons outlined above.

[spenac]

Thanks for all the comments, keep them coming.

As far as the straps on the cot, we recently got a new cot. The straps came in a bag for us to attach. Maybe some services have been to lazy to attach them all and thats why they only have 2 sets? We take the cot in the house if the patient cannot walk to the ambulance. We get as close as possible to the patient to limit the amount of lifting and carrying we do. Some houses here have front doors that are to narrow for the cot to go in the house. If to many stairs or can't get cot to them will use chair, scoop, or sometimes just carry patient.

I try to use seat belt when possible. I have dislocated a shoulder when thrown around in the back, 2 years before he ever drove again.

Have any of you used the harness with bungy cord looking restraint systems? What about the nets?

Remember the EMS rule the fatter they are the further from the door they are, the tighter the work space, the more distance you'll have to carry them, the more corners you'll have to try and go around with them, and the more stairs you'll have to climb. O by the way I live at the back of the house up a narrow flight of stairs with a hard right, right at the to of them, down a narrow hall, then a hard left.......... OK not that fat but with my EMS diet maybe soon.

[AnthonyM83]

Yup, we have one across the chest/waist area and one across the legs. Yellow Styker Gurneys.

I personally hate carrying it over steps, b/c if the patient freaks out and displaces his weight to the side, we can't stop it from tipping. So, I don't really like more than one step.

[spenac]

Yup, we have one across the chest/waist area and one across the legs. Yellow Styker Gurneys.

I personally hate carrying it over steps, b/c if the patient freaks out and displaces his wait to the side, we can't stop it from tipping. So, I don't really like more than one step.

Sounds like somebody just didn't attach them all. Stryker sends 3 + 2 shoulder straps with cots, at least all I've seen but you have attach them.