Stopping Injuries Starts in the Bathtub

Rick Binder, Binder Lift

If you’re using sheets to lift patients you lack a true safety system

Anyone who has been in the Fire and EMS industry for more than a couple of years typically knows of a few staggering statistics concerning the high back injury rate of prehospital providers. There have been studies conducted starting in the 90’s through today that all conclude the same thing: Fire/EMS personnel consistently have more reported back injuries than any other industry. According to the NAEMT, EMS practitioners are seven times more likely than the average worker to miss work because of an injury.


Traditionally there is a minimum of five lifts that a prehospital worker will perform on a typical transport:

1) Lifting the patient up from the floor;

2) Lifting the stretcher to waist height;

3) Loading the stretcher into the ambulance;

4) Unloading the stretcher;

5) Transferring the patient from the stretcher to the hospital bed.

Thanks to Stryker® and Ferno®, 3 out of 5 of those lifts can be eliminated using a power stretcher system.

However, we know that most back injuries are caused by manually lifting patients (1). If power stretchers can eliminate 3 of the 5 manual lifts, we can deduce that manually moving the patient onto a stretcher, stair chair, or other location, is the most dangerous task a prehospital provider will perform during an average transport call.

80% of falls happen in the bathroom

From the aforementioned study, they determined what every prehospital provider already knows. Most patient falls happen in the bathroom. The unpredictability of these environments, coupled with awkward and constraining postures, is a major cause of back injuries (2).

“Lift with your legs, and not your back” adage is a great rule to follow, but it’s just not that simple for a prehospital provider. The environment and condition of the patient heavily contribute to:

  • Reaching while lifting
  • Poor posture
  • Bad body mechanics
  • Twisting while lifting
  • Bending while lifting
  • Overextending
  • Single member lifts
  • Poor footing
  • Lifting with sudden forceful movement (shock loading)

This list delineates some of the prime reasons for injury during manual patient handling. To lower the risk of back injuries we need to look at what is causing prehospital providers to practice these detrimental habits.

Case Study

A lift assist call might look like this:

Sue has been struggling for 2 ½ hours trying to get herself out of the bathtub. She fell while trying to pick up the soap. Sue is now losing sensation in her lower extremities, and it is your job to get Sue up and out of that tub.

Prehospital providers tend to utilize improper ergonomics because they have no way to grab hold of the patient during routine procedures like the one described above. If only humans came with handles! Proper lifting ergonomics cannot be properly followed when the providers have nothing to grasp.

In this example, the providers have two options; they can dangerously improvise a way to get Sue out of the tub, or they can use specialized lifting equipment.

Improvised techniques might include;

1) Sending the youngest/strongest provider in to provide lift assistance by getting behind the patient and lifting by the patient’s armpits.

2) Using a sheet in different variations to get the patient up.

3) Using a soft stretcher (tarp with handles) in various ways to provide needed leverage.

Every one of these techniques is widely used, and every single one of them puts either the patient, provider, or both at extreme risk for injury. Unknowingly, we have handed down bad patient handling techniques and improper ergonomics from one generation of providers to the next.

Sheets are for sleeping, tarps are for transferring.

Ambulances typically have many products onboard that are meant for a patient to lie on. Soft stretchers (tarps), sheets, backboards, and reeves are some of the most common. But what does your service have that is specifically designed for lifting and assisting patients? Every ambulance needs to have the proper tools to help lift patients from the floor. Just like you wouldn’t use a backboard for a finger splint, we shouldn’t be using sheets or soft stretchers for lifting. There are a few products on the market that are designed to help with patient lifting but keep these factors in mind when considering purchasing one of these devices. A lift device should score at least 5 out of 9 on the following list.

  1. The device must have a high center of gravity when on the patient.
  2. Provide enough handles for four (4) rescuers to lift with both hands.
  3. Provide full support of the patient’s torso.
  4. It must have leg straps integrated into the device.
  5. It must have the ability to support the full weight of the patient if he or she becomes unconscious.
  6. It must be easily placed on and taken off the patient (Quick release buckles)
  7. It must be less than 5 pounds.
  8. It must be made of a non-porous material.
  9. The device must support weight above 600 lbs.


Any department that seeks to initiate, or is already utilizing, a back-injury reduction program must have protocols that require the providers to use specialized equipment to aid in manual lifting and assisting patients. As soon as we start using the right tool for the job, that allows for proper ergonomics to be followed, back injuries will significantly decrease among prehospital providers.

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