Stairs

Stairs. I hate them.

We were called to an older lady who'd fallen backwards downstairs, he'd then managed to crawl up her narrow and twisty staircase to bed. It was there she started to feel more pain than was expected and she asked her carer to call for an ambulance.

As an ambulance person one of the first things that you pay attention to once you realise that a patient is upstairs is the state of the staircase. Will it be easy to move a patient down? Will you be able to safely avoid any loose bits of carpet? Is there furniture (or, more commonly in my area, a pile of shoes) at the bottom that is a trip hazard? Then you meet the patient and start mentally totting up their weight and how likely they are to grab out at the bannisters, thus causing the whole lot of you to fall down the stairs and end up in a very litigious heap at the bottom.

Thankfully this patient wasn't heavy, but after examining her I couldn't rule out a broken neck. That and there was some real concern about a broken leg.

I wish she'd stayed put, crawling upstairs was perhaps the worst thing that she could have done.

Thankfully, despite the pain, our patient was in good spirits – so when I told her that we'd be taking full precautions in moving her she understood.

So, with a potentially broken neck, we would have to secure her to a stretcher, then find some way to manoeuvre her down the extremely narrow, steep and twisty stairs. At least the carpet was tacked down securely.

This would need a second crew, in this case many hands would indeed make light work. I made the call while my crewmate gave her some analgesia. Control were a little less impressed, we'd been extremely busy the whole shift and the chances of getting another ambulance any time soon were pretty slim.

Without a second crew I was considering calling out the fire brigade. They have a policy now of only assisting us when the patient has life-threatening injures (which is, needless to say, a policy that we should be copying). I'd have to sell it to them, and perhaps demand that we remove the patient via the first floor window on a cherry-picker.

Except that the window doesn't open and so would need to be smashed.

However a second crew did arrive and we proceeded to strap our poor patient to the stretcher, by now she was nearly pain-free and telling bad jokes, something I normally consider a good sign.

Fully strapped down in a way I described to her as 'as close to bondage that she'd ever likely get' we then started getting her down the stairs.

When you strap a patient down in such a manner it should be possible to stand the stretcher on it's head without the patient slipping. In this case we kept her feet down, but we would have to stand the stretcher vertically in order to get her downstairs. With a broken leg, if any pressure was put on her it would be incredibly painful.

Well either our pain relief, our strapping or our patient's pain tolerance held as we got her down the stairs without any yelping.

From there on out it was a simple matter to get her out to our ambulance and from there to hospital.

It would seem that my decision to strap the patient motionless was a good one, the Doctors were having serious suspicions of a broken neck once the initial x-ray films came back, and the leg was indeed broken.

I don't often strap patients down but in this case I was very glad that I didn't just sit them in my carry chair and have at it down the stairs. Sometimes going slow is in the patient's best interest.

15 thoughts on “Stairs”

  1. I have always learned to rely on my intuition. Mechanism of injury is a driving force, but sometimes you just “have that feeling”.We had a patient that sustained major trauma at a mountain bike race. Despite his combativeness (head injury induced), we managed to c-spine him at least partially (he is an EMT, and was getting out of the straps faster than we could get him into them. Pulled his c-collar off TWICE and pulled his head up after we secure him to the board, pulling the Sta-Bloks up with him. It was a fight keeping him calm and on the board without meds – We are BLS.) until we could transfer care to the local medics and the air evac he required. Turns out he sustained a C1, C2, C3 fracture, along with a basilar skull fx, frontal lobe contusions, and other injuries.

  2. I was wondering the same thing. In France they use a cross between a blow-up mattress and a been bag – which is deflated to immobilize the patient. Having had the misfortune of seeing it in use a couple of times, my only worry is that the ambo be stocked with puncture repair kits.PS Did you get together with NeeNaw at the Bierfest?

  3. 'as close to bondage that she'd ever likely get'There ya go, just seeing the 'sweet little old lady', maybe she could tell you a thing or two about bondage, I doubt she's always been frail and incapacitated. 😉

  4. Only HEMS (our helicopter) has that sort of thing, we have smaller versions for awkward broken limbs but nothing big enough for a whole person.And yes, I did meet NeeNaw – who is great.

  5. Ouch.(and for those who aren't medically knowledgeable – that sort of injury is the sort of thing that'll kill you deader than dead)

  6. Wow! Thats some job! We had a patient recently where a broke neck was entirely possible from mechanism of injury but he was so hypoxic and cerebrally irritated we didn't stand a chance. It took 6 of us to hold him down in resus so he could be RSI'd (knocked out and tubed). Horrible job!I am getting better at sizing up stairs and patients! though don't like the sound of spiral stairs!

  7. The guy we dealt with did fight us. When the local medics arrived at the meet point (we were working an event, this occurred in the back country), the first thing they asked us was, “Why doesn't he have a collar on?” (it was under his neck, but he clearly wasn't tolerating it). I told the guy, “You try… 3 of us couldn't keep it on him, or him on the board 100%”. It took 4 firefighters + sedation to finally get it on him.Tom – Yes, ouch is the word for this one. This is, by far, the worst injury I have treated since I started working in event medicine (Worse happened when I was on standard ambulance duty years ago). Shortly after this gentleman's injury, the bicycling world had a fatality at a large biking event in California. Massive head and neck injuries. He was dead the second he hit the ground. The guy we dealt with was damn lucky. He can still walk. He has some neuro issues, but considering the level of injury, it is amazing he survived, let alone survived relatively intact after all was said and done.

  8. I *believe* that you can be, although I would check with the service you are applying to first – they will have the full details.

  9. I'm a volunteer EMT. We've had to drag patients down many narrow and steep steps, no lights in the stairwell, kicking stacks of magazines out of the way.When my wife and built our house, I made the stairs wide and well-lit, and all the bedroom doors are 36 inches, rather than the normal 32 or 34. The hallway is five feet wide.

    Hope for the best, plan for the worst.

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