EMS Corner

The stretcher, or gurney, has come a long way from braided rope strung between two pieces of wood. From removing combatants from battlefields and early sporting events (see the chariot race in Ben Hur if you want to see cinematic reenactments of early EMS stretchers and providers at work) to more modern applications and considerations that are now based on patient needs and EMS safety, the need to transport the sick and injured have endured.  The method of lifting and moving patients has changed drastically just in the last 50 years. Gone are the pole and canvas loop stretchers that served as many a battlefield staple. You may still find large stocks of these on disaster rigs as its pragmatic to plan for needing to manage and transport a large number of individuals, but these are generally not in everyday use.  Aluminum was much, albeit not all, of the saving grace for stretcher innovation.

When I got into the EMS game, the X-frame stretcher (see fig. 1) was already the workhorse of the industry.  While we did not have the rear-load collapsibility popular with coroners and even funeral directors, early X-frame gurneys had to be dead-lifted into the back of the rig. Combine that with obesity and the needs to move very large individuals and what you ended up with was many back injuries and disabled EMS providers (The X-frame was really a step back as slightly earlier versions were designed as “H” frame had collapsible rear loading. Not sure why this happened).  The problem remained as to how to best manage patients with the best possible safety for all parties.  From about 1958 until somewhere in the late 1980’s-early 1990’s, the deadlift, x-frame models continued to thrive until safety considerations and continued disabilities among providers demanded action.

The most current ambulance stretchers come down to all aluminum alloy tubing (still utilizing X-frame design, see fig. 2) to keep the static weight down, and all having rear load, collapsible design.  Still, contemporary models increased the weight carrying capability (from approximately 120-150kg to a whopping 320kg+), and therefore increased the static load.  So the gurney, depending on the model, went from approximately 40 pounds to approximately 65-90 pounds alone without the patient (weights are approximated without mattress and restraints).  As a result, the total load (patient + gurney+ equipment) became almost unmanageable often requiring more trips to complete the transfer.  Solutions were not readily available.

The issue of bigger and bigger patients has been troublesome. We have always had obese patients and, in the past, we have just had to improvise in the management of these large individuals.  My largest patient tipped the scales at 690 pounds (approx. 315 kg.) and was 6’10” in stature. While she could not fit on the gurney, we ended up managing her on doubled tarps with 6 men on each side. She went on the floor of the rig after we removed the stretcher.  This was way less than an optimal solution but we did manage to get her to the hospital.  The problem has not only been how to you handle this size of patient, safely and with the most reasonable comfort that we can offer, but how to protect providers from injury. Remember, you do not have to get hurt just because someone is too big for the crew to manage alone.  Know your limitations and call for help.

In answer to some of these size issues, they have developed bigger gurneys, some even motorized. The concept of a Bariatric Transport system involves bigger, wider gurneys, some with power assist for raising and lowering.  The need for beefier ambulances with increased suspension and width, most equipped with ramps or even hydraulic lifts have come to the forefront. The Ferno POWERflexx+ is one of the power assist models.  While the power-assist is a nice addition it takes the gurney to a whopping 133 pounds of static weight (60kg.) and the max load is no more than other current stretchers (700 lbs/315kg).  (fig. 3) The ramps and lifts available for these large patients store under the floor of most Bariatric rigs and offer reasonable solutions to transport issues. There is even a Bariatric gurney that can carry upwards of 1600 pounds! (725 kg.!)

Stretchers aside, the real issue is safety of the providers.  NO one says you have to get hurt, over extend yourself, or otherwise place your health and well-being in jeopardy.  Movement of patients that are morbidly obese should be a calculated, pragmatic, and well-PRACTICED operation. The criticality of the patient has no bearing on safe operations and the patient’s survival is never assured. You may lose some of these patients due to the added time constraints for proper lifting and moving. Pay attention, know your own limitations, and call for help.