Public Safety

Section 2 - EMERGENCY OPERATIONS

PURPOSE:

This guideline establishes specific operational requirements, safety rules and service procedures for the operation of EMS patient transport stretchers.

PROCEDURE:

General Stretcher Handling and Movement:

• Read all manual labels and instructions on the stretcher devices before using them.
• Operator requirements:

1. The stretcher must be attended by a minimum of one person at all times while loaded with a patient on the stretcher and not in motion.
2. A minimum of two (2) operators are required to manipulate the stretcher while a patient is loaded. Two operators can safely move or operate the stretcher in flat, even and stable surfaces.
3. When rolling the stretcher with a patient on it, position one operator at the foot end and one at the head end of the stretcher at all times.
4. In unstable soil, sand or rocky terrain a minimum of 4 personnel (four-point) handling is recommended whenever possible.
5. At any time that the conditions, activity, weight or movement of the patient can potentiate the overturning of the stretcher the unit may be lowered to the safest handling height. In addition, number of personnel must be increased proportionally to insure safety of the patient and those handling the stretcher. Additional resources may be requested to insure the patient's and personnel safety.

• Do not adjust, roll or load the stretcher into a vehicle without advising the patient. Stay with the patient while maintaining control of the stretcher at all times.
• The ambulance stretcher can be moved in any height position. Stryker recommends transporting the patient in the lowest position that is comfortable for the operators to maneuver the stretcher.
• During transport, approach door sills and/or other low obstacles squarely and lift each set of wheels over the obstacle separately.
• Wheel lock(s) are only intended to help prevent the stretcher from rolling while unattended. A wheel lock may not provide sufficient resistance on all surfaces or under loads.
• The restraint straps must be used at all times (when safely able to without impairing patient transport). This includes the shoulder, waist, knee and leg straps.
• Only Fire Department personnel trained in the use of the stretcher are authorized to operate or handle the stretcher. Other personnel may be used in stabilizing the stretcher under the direct supervision of a MFRD member.

Safety and Security:

• Personnel must adhere to all manufacturer safety warning and precautions at all times when handling any stretcher device.
• Straps

1. All safety straps must be securely fastened at all times around the patient. This includes the lower extremity, waist and shoulder straps.
2. Exception to this rule: In the event that the straps are impeding a procedure (for example -CPR) the necessary strap may be removed providing that all remaining straps are securely fastened and measures taken to insure patient safety.

• Side Rails

1. Side rails must be in the up position at all times when the patient is loaded on the stretcher.
2. Side rails do not eliminate the need for proper fastening of ~ straps.
3. Side rails are not intended to serve as a patient restraint device.

• Operators must strictly adhere to proper lifting and pushing/pulling techniques when lifting, loading and operating the stretchers.
• Do not "jog" the stretcher past the load height while the safety bar is engaged.

Loading Procedures:

• Loading an occupied stretcher into the vehicle requires a minimum of two (2) trained operators.
• When loading the stretcher into a vehicle, an operator should remember the following important issues:

1. There must be a safety hook properly installed in the vehicle so that the bumper does not interfere with the front legs of the base frame.
2. Stretcher operators must be able to lift the total weight of the patient, stretcher and any items on the stretcher. The higher an operator must lift the stretcher, the more difficult it becomes to hold the weight. An operator may need help loading the stretcher if he/she is small or if the patient is too large to lift safely.

• Place the stretcher in a loading position. Roll the stretcher into the open patient compartment. Lift the vehicle bumper to the raised position (if option is available).
• Push the stretcher forward until the load wheels are on the patient compartment floor and the safety bar passes the safety hook.
• For maximum clearance to lift the base, pull the stretcher back until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.
• Operator procedures for loading:

1. Operator 1 -Grasp the stretcher frame at the foot end and push the retract (-) button until the undercarriage of the stretcher retracts fully (power pro models).
2. Operator 2 -Securely grasp the stretcher's outer rail to stabilize it during retraction (power pro models).

• Both Operators -Push the stretcher into the patient compartment until the stretcher engages the floor bracket.

Unloading Procedures:

• Unloading the stretcher from the vehicle while a patient is on the stretcher requires a minimum of two (2) operators, positioned at each end of the ambulance stretcher. Each operator must grasp the ambulance stretcher frame securely.
• Disengage the stretcher from the stretcher floor bracket.
• Lift the vehicle bumper to the raised position (if option available).
• Operator 1 -Grasp the ambulance stretcher frame at the foot end. Pull the stretcher out of the patient compartment until the safety bar engages the safety hook. Operator two should verify that the bar engages the safety hook.
• Do not press the extend (+) button until the safety bar engages the safety hook (power pro models).
• Once the undercarriage is locked and weight of the stretcher is securely resting on the wheels the safety bar release lever is pushed forward to disengage the safety bar from the safety hook in the patient compartment. Never pull or lift on the safety bar when unloading the stretcher. Damage to the safety bar could result and injury to the patient or operator could occur.
• Remove the load wheels from the patient compartment of the vehicle.

Emergency Manual Operation Procedures on Power-Pro Units:

• In the event of loss of electrical function on power pro models, the ambulance stretcher is equipped with a manual override to allow manual operation of the product until electrical functionality is restored.

1. The red manual release lever is located along the patient left side of the lower lift bar at the foot end of the stretcher.

• To raise or lower the stretcher with the manual release:

1. Both Operators -lift the stretcher during the raise/lower operation to support the weight of the stretcher.
2. With the ambulance stretcher supported by an operator at each end, the operator at the foot-end must pull the release handle towards the lift bar. While the release handle is pulled, raise or lower the ambulance stretcher to the desired position and then release the handle to lock ambulance stretcher into position.
3. The operators must lift the stretcher weight slightly oft the wheels to use the manual extend or retract while a patient is on the stretcher.

Stair Chair Operating Procedures:

• The Stair-PROe Stair Chair is to be operated only as described in the owner's manual.
• Stair chairs are intended for the use of conscious patients through confined hallways or stairs. Patients who are unresponsive should not be transported using this device.
• When a patient is on the chair, use a minimum of two operators to manipulate the chair on stairs. If more people are required to safely control the chair, position the additional personnel in a way that the loaded stair chair is balanced.
• Do not roll the chair, ascend, or descend stairs without advising the patient. Explain to the patient not to use their hands to grasp rails or attempt to balance themselves while the stair chair is being moved.
• Stay with the patient and control the chair at all times.
• Only use the wheel locks during patient transfer or without a patient on the chair.
• Always use the restraint straps when a patient is on the chair. These include the waist and shoulder straps at all times.
• The Stair- TREAD@ system must be used when descending stairs. These are designed to roll slower as the weight placed in the chair is increased. Do not force the Stair- TREAD@ system to roll faster. Forcing the Stair- TREAD@ system will cause damage to the unit and possible injury to the patient or operators.
• Use properly trained helpers when necessary to control the chair and patient.

Daily Inspections:

• All stretchers and stair chairs must be inspected during the daily truck and equipment check.

1. A visual inspection is required to ensure that there is no damage or loose parts.
2. The operator must also complete a hands-on operation of all mechanical parts to ensure they are operating properly.

• Daily stretcher inspections must be documented on the daily truck check form. The completed stretcher inspection must be documented as "ok" or identify deficiencies specifically.
• Any deficiencies must be immediately reported, an incident report completed and replacement stretcher obtained.

Weekly Inspections:

• All stretchers must be inspected during the unit's weekly cleaning and inspection day (usually Saturday of each week) and a checklist completed.
• When completed attach the weekly checklist form to the apparatus check form in the truck check off book.
• Inspection Checklist:

1. General appearance is clean with no visible signs of contamination.
2. All fasteners secure (Use assembly drawings as reference).
3. All welds appear intact, not cracked or broken.
4. No bent or broken tubing or sheet metal.
5. No debris, oil or other contaminants on wheels.
6. All wheels secure, rolling and swivel properly
7. Wheel lock holds wheel securely when on and clears wheel when off.
8. Side rails move and latch properly.
9. Backrest operating properly.
10. Optional accessories intact and operating properly.
11. Height positioning latch functioning properly.
12. Stretcher secure in each height position.
13. Undercarriage folds properly.
14. Breakaway head section operating properly.
15. Safety bar operating properly.
16. Foot rest operating properly.
17. Mattress is clean, no rips or cracks in mattress cover or contaminated
18. Body safety restraints intact and working.

• Power-Pro Models:

1. Battery with adequate charge on unit. Check battery indicator, charged.
2. Charge spare battery (as necessary) according to Dewalt instructions.
3. Install battery into foot-end enclosure, battery indicator operates.
4. Ensure the battery remains firmly secured. Release and remove battery from foot-end enclosure.
5. Ensure operating switches are operating properly.
6. Inspect motor mount, all fasteners secure.
7. Check cylinder attachments at both ends, all fasteners secure. Inspect hoses and cylinder seal for leaks.
8. Inspect main cable, all connections secure.
9. Verify the manual release lever functions properly, adjust accordingly.
10. With the stretcher empty, check the raise/lower function.
11. With the stretcher loaded with a minimum of 45 kg, check the raise/lower function.

Yearly Maintenance and Inspection Procedures:

• EMS equipment personnel will organize yearly maintenance and inspection schedule with Stryker.
• EMS equipment personnel will provide a schedule to the on duty BC's for unit rotation on the scheduled dates.
• Units are to be placed out of service during maintenance and inspection.

Stretcher Exchange Procedures:

• Should a significant deficiency be discovered requiring the stretcher to be placed out of service, personnel must notify their supervisor and the chain of command.
• Place the stretcher out of service, tag the stretcher identifying the problem and notify the EMS equipment personnel via phone or e-mail.
• Bring the out of service stretcher to the available station and pick up a spare stretcher.
• EMS equipment personnel will facilitate the repair process with the selected vendor.

Cleaning and Disinfecting Procedures:

• Follow the cleaning solution manufacturer’s dilution recommendations exactly as directed on the label. Suggested cleaners include:

1. Quaternary Cleaners (active ingredient -ammonium chloride)
2. Phenolic Cleaners (active ingredient -O-phenyl phenyl)
3. Chlorinated Bleach Solution (5.25% -less than 1 part bleach to 100 parts water)

• Spray and wipe all surface areas of the stretcher. Pay particular attention to the underside surfaces as they are not readily visible and may hold contaminated products or fluids.
• Clean Velcro AFTER EACH USE. Saturate Velcro with disinfectant and allow disinfectant to evaporate.
• Wipe all safety straps after each use. If visibly soiled, remove the straps for cleaning and place a spare set of straps in its place (Replacement sets of straps are available in supply). The stretcher must NEVER be operated for patient transport without a complete set of straps.
• Stryker stretchers are designed to be washable.

1. Frequent washing may show some signs of oxidation or discoloration from continuous washing, however, no degradation of the stretcher's performance characteristics or functionality will occur due to power washing as long as the proper procedures are followed.
2. Stryker stretchers are not designed to be steam cleaned.
3. Maximum water temperature when washing should not exceed 1800 F.
4. Towel dry all casters and interface points between the stretcher and the breakaway head section.
5. When using chemical products Avoid over-saturation and ensure the product does not stay wet longer than the chemical manufacturer's guidelines state for proper disinfecting.

• Failure to properly clean or dispose of contaminated mattress or stretcher components will increase the risk of exposure to blood borne pathogens and may cause injury to the patient or the operator.
• All personnel shall follow the AeroClave decontamination procedures outlined in SOG 250.07 for any stretcher that has been contaminated.