Moving an ill or injured patient

In basic first aid classes, there is great emphasis on not moving a patient under any circumstances. But is this always right? Our Paramedic friends tell us about times they have arrived on scene to find an elderly faller virtually held down onto the icy ground they slipped on because they think it’s best. Or a care home resident who is unharmed, wriggling around but just unable to get themselves off the floor.

Of course, if the person is ill or injured, care must be taken to prevent the condition from worsening, but certainly in our maritime environment there may be times when we MUST move a patient for both their and our safety and wellbeing. We may even need to move them into a safe space (such as lowering from height) before we can assess them and work out the potential injuries and associated risks.

But how do you know when to move them? Or how to move them safely?

Here are some situations where moving the patient might be essential:

Immediate danger – if the patient is in immediate danger, and if it’s safe for you to help, they should be moved away in some manner. This could be due to fire, an unstable structure, in the water, an otherwise unsafe location.

Cardiac Arrest – the patient must be on or moved to a hard, flat surface in order for compressions to be effective. Ideally with a bit of space for a team to work around them. 

To prevent further harm – if the patient is in a position where they could worsen, or something life threatening could develop, you may need to move, or at least reposition them. This could be due to vomiting, choking on blood, unable to maintain their own airway and could be as simple as sitting them up or rolling them over. 

Self-extricate – if the patient is able to self-extricate, they should do so. There has been a lot of recent research into this area and old techniques challenged and changed. For instance, in a road traffic collision, if the patient can get out of the car themselves, they should. You can find out more here: https://phemcast.co.uk/2022/09/15/extrication/

Worsening conditions – if the weather and environment change, then you may need to move your patient. For illness or injury, keeping someone warm is important, if not vital. Even in a tropical climate, a trauma patient can cool more rapidly than you think and those rain squalls may pass quickly but do a lot of soggy damage in a short time.

To reach someone with more serious injuries: there may be occasions where you need to move a patient with minor injuries in order to reach someone more serious. If the less injured person can self-extricate, all the better.

Unresponsive but breathing normally – if it’s safe and there are no other injuries that may worsen, you can move this patient into the recovery position to monitor them and help to protect their airway. Please see this blog for details of how to move someone into the recovery position, including an option for a suspected spinal injury.

We need to take care when moving any patient, and in certain circumstances, such as a suspected spinal injury, it may be best to keep them still and warm unless they are in immediate danger and the risk of the danger outweighs the risk of moving them. Remember to insulate too – with blankets under and over the patient if possible. 

If you have to move someone with a suspected spinal injury, especially if they have neck or spine pain, try to keep their neck and spine as straight and stable as possible and avoid bending or twisting them.

As a general rule, we should avoid moving a casualty unnecessarily and minimise . So it’s a good idea to plan any movements needed to see what else you can include at the same time. One example would be checking the back for injuries during a log roll to put a stretcher underneath the patient. Or placing a vacuum splint on the stretcher or bed so it’s in place and the injured limb can be positioned in it as the patient sits or lies down. If you do log roll someone, make sure you have enough people available, coordinate commands and remember  that the person at the head is in control.

Finally, make sure you drill with the crew. When someone is feeling unwell, they normally go to their cabin, or to the toilet. What are two of the smallest spaces you can find on a vessel of any kind?

You can work out what you might need to do to move a patient from their bunk to the dock or to the location where a Medevac helicopter will winch down to. Talk it through, make a plan then trial it. You can try a few options:

• The patient is walking but needs assistance

• They are conscious but not able to walk

• They are unconscious and require continual monitoring

Think about who you need, what communications will be required? 

What equipment do you have to move someone, where is it, and do you know how to use it? 

What kit will need to stay attached and move with the patient? 

How will you get to the patient to assess them properly in a tight space, before making the decision to move them?

Work out the tricky areas if you need to keep the patient horizontal, such as tight corners, narrow corridors and stairwells. 

Finally, get the team together, find a volunteer patient and give it a go. If you need any help putting a drill together, please get in touch and we’d be happy to help.