1. Nursing Skills
Lifting and Moving
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 1
Foundations of Nursing Abejo
Lifting and Moving
NURSING SKILLS
Lifting and Moving
Lecturer: Mark Fredderick R. Abejo R.N, M.A.N
LIFTING and MOVING
PURPOSES OF LIFTING AND MOVING POSITION
• To encourage patient’s mobility
• To promote patient’s comfort
• To promote blood circulation
• To maintain skin integrity
• To transfer patient safely
• To avoid injury whenever a patient is moved.
• To practice using equipment.
• To know that certain patient conditions call for special
techniques.
BASIC PRINCIPLES OF LIFTING AND MOVING
PATIENTS
1) Keep the weight of the object as close to the body as
possible.
2) To move a heavy object, contract your abdominal
muscles and lift with the leg, hips, and gluteal
muscles.
3) When lifting, align your shoulders, hips and feet in a
vertical line.
4) Reduce the height or distance through which the
object must be moved.
TYPE OF MOVES
.
Emergency moves
This used when there is immediate danger to the
patient or to threscuer
1. Top priority in emergency care is to maintain the
patient’s ABCs. Generally, you will control any life-
threatening problems and stabilize the patient before
moving
2. If scene is unstable or unsafe and there is threat to the
life or well-being of the patient or of you, the above
priority changes.
3. Emergency moves are a last resort. Do only when you
run out of options.
4. Three reasons to use an emergency move:
 There is an immediate environmental danger to
the patient or rescuer such as fire, exposure to
explosives, toxic fumes, etc.
 You cannot gain access to other patients who
need life-saving care.
 You cannot render life-saving care due to the
patient’s location or position.
5. Three types of emergency moves:
i. Bent Arm Drag
ii. Clothing Drag.
iii. Blanket Drag.
An Urgent Move
This used when the patient is suffering from an
immediate threat to life.
1) A patient in an MVA must be quickly
moved from the vehicle for emergency care
and immediate transport
2) In this case, fully immobilizing the spine
would take too much time.
A non-urgent Move
1) When there is no immediate threat to life, take
the time to choose the best equipment and
positioning for moving the patient safely
2) The best way to move a patient is the easiest
way that will not cause injury or pain
3) There are many ways to move patient’s, you
are only limited by your imagination and the
safety and comfort of the patient.
Example: Crutch Method-patient leaning on
you while walking
4) Extremity lift is the most popular non-urgent
move
PRINCIPLES FOR MOVING PATIENTS
Emergency Moves
A patient should be moved immediately by an emergency
move only when there is an immediate danger to the patient or
the EMTs including:
Fire or danger of fire.
Danger of explosives or other hazardous materials.
Inability to protect patient from other hazards at the
scene.
Inability to gain access to other patients who need
lifesaving care.
Inability to provide care due to location or position.
Clothing Drag
1. Tie the patient's wrists together if you have something
quickly available. If nothing is available, tuck the
hands into the waist band to prevent them from being
pulled upwards.
2. Clutch the patient's clothing on both sides of the neck
to provide a support for the head.
3. Pull the patient towards you as you back up, watching
the patient at all times. The pulling force should be
concentrated under the armpits and NOT the neck.
Blanket Drag
1. Lay a blanket lengthwise beside the patient.
2. Kneel on the opposite side of the patient and roll the
patient toward you.
3. As the patient lies on their side while resting against
you, reach across and grab the blanket.
4. Tightly tuck half of the blanket lengthwise under the
patient and leave the other half lying flat than gently
roll the patient onto their back.
5. Pull the tucked portion of the blanket out from under
the patient and wrap it around the body.
6. Grasp the blanket under the patient's head to form a
support and means for pulling.
7. Pull while backing up and while observing the patient
at all times.
Bent Arm Drag
1. Reach under the patient's armpits from behind and
grasp the forearms or wrists.
2. Use your arms as a cradle for the patient's head and
keep the arms locked in a bent position by your grasp.
3. Drag the patient towards you as you walks backwards,
observing the patient at all times.

2. Nursing Skills
Lifting and Moving
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 2
Foundations of Nursing Abejo
Lifting and Moving
Urgent Moves
Sometimes a patient must be moved more quickly than usual
due to reasons of an urgent nature. Weather conditions, hostile
bystanders, uncontrolled traffic, and rapidly rising flood waters
are some examples of situations requiring an urgent move.
Procedure for Rapid Extrication
One EMT should be stationed behind the patient.
Place one hand on each side of the patient's head to
stabilize the neck in a neutral position. It is done as
you begin evaluation of the airway.
The second EMT quickly applies a cervical spine
immobilization device while doing a rapid primary
survey.
A third EMT simultaneously places the long
backboard onto the seat and, if possible, slightly under
the patient's buttocks.
The second EMT supports the chest and back as the
third EMT frees the patient's legs from the pedals and
floor panel.
The patient is rotated in several short coordinated
moves until the patient's back is in the open doorway
and feet are on the backboard.
Another EMT supports the patient's head until the first
EMT gets out and takes control of the cervical spine
immobilization device from outside the vehicle.
The EMT team lowers the patient and slides the
patient onto the board in short coordinated
movements. Straighten the patient's legs and make
sure the neck and back do not bend. Secure patient to
backboard after the patient is brought back to the
ambulance.
Non-urgent Moves
This is the most frequent type of move and the best way to
make the move depends on the illness or injury, factors at the
scene, and equipment and personnel resources available.
Direct Ground Lift
1. 2-3 EMTs line up on the same side of a supine patient.
2. The EMTs all kneel on one knee.
3. Cross the patient's arms on the chest if injuries don't
prevent it.
4. The EMT at the head places one arm under the
patient's head and shoulders, cradling the head. The
other arm is placed under the patient's lower back.
5. The second EMT places one arm directly below the
first EMT's arm in the small of the patient's back. The
second arm is placed under the patient's knees.
6. The third EMT (if available) slides both arms under
the patient's waist. The other EMTs adjust their arms
accordingly.
7. On signal, the EMTs lift the patient to their knees and
roll the patient in toward their chests.
8. On signal, the EMTs stand and move the patient to the
stretcher.
9. On signal, the patient is lowered onto the stretcher,
which has been positioned at waist level.
Extremity Lift
This is only used when a spinal injury is not suspected. It is
best used for short distances.
1. One EMT kneels at the patient's head and the other
EMT kneels at the patient's side by the knees.
2. The EMT at the head reaches under the patient arms at
the shoulders and grasps the patient's wrists. If the
patient is unresponsive or uncooperative, the other
EMT may assist by lifting the patient's wrists to within
the reach of the partner. To improve stability, the
patient's left wrist may be grasped by your right hand
and their right wrist by your left hand. This crosses the
patient's arms over their chest creating a more secure
hold with less give.
3. The second EMT reaches under both knees with one
arm and under the buttocks with the other arm.
4. The EMT's raises to a crouching position, then
simultaneously stand and move with the patient to the
stretcher.
EQUIPMENT FOR MOVING PATIENTS
Wheeled Stretcher
Two basic types of stretchers are used: the two-person
and the one-person. The two-person requires two EMTs to lift
and load in the ambulance, whereas, the one-person stretcher has
special loading wheels at the head that allows one EMT to load
it into the ambulance. Stretchers are usually adjustable to
different heights and different angles. Some can be adjusted to
elevate the legs (Trendelenberg position). Additional equipment
may be attached to the stretchers including oxygen, IV lines, and
cardiac monitors or defibrillators.
Stair Chair
These are designed for patients that can sit up while
being carried. They are useful for taking patients up or down
stairs, or through narrow passageways. The patient must be
transferred to the stretcher once back at the ambulance.
The extremity lift is used to place the patient in the stair chair.
All belts and straps must be secured before moving patient. The
patients wrists may be loosely tied to prevent grabbing onto
fixtures and causing loss of balance when moving them. The
chair is tilted slightly backwards to allow movement with the
wheels on the chair.
Short Backboard
This is used when a spinal injury is suspected and the
patient is in a seated position. They made be made from wood,
aluminum, or plastic. A vest type is also used when a patient is
found inside a small car or place. It wraps around the patient and
has all the straps attached or enclosed.
Scoop (Orthopedic) Stretcher
This is designed to easily lift supine patients. The
stretcher is made of a rectangular aluminum tube with V-shaped
lifts to "scoop" patients from the floor or ground without
changing their position. Its greatest advantage is that it can be
used in confined spaces where other stretchers cannot fit.
Flexible Stretcher
Do not use the flexible, or "pole" stretcher if spine injury is
suspected. It is designed for limited access space, on stairs or
around cramped corners, or when other equipment is not
available

3. Nursing Skills
Lifting and Moving
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 3
Foundations of Nursing Abejo
Lifting and Moving
GUIDELINES FOR LIFTING AND MOVING
Guidelines for Safe Lifting
Consider the weight of the patient together with the
weight of the stretcher or other equipment being
carried and determine if additional help is needed.
Know your physical ability and limitations. Know
your combined ability with your partner. If absolutely
necessary, you can ask bystanders to help. You or
your partner must be in charge and give the orders, not
the bystander.
Lift without twisting. Avoid any kind of swinging
motion when lifting as well.
Position your feet shoulder width apart with one foot
slightly in front of the other. Wear proper boots that
go above the ankle to protect your feet and help keep a
firm footing. Boots should have nonskid soles.
Communicate clearly and frequently with your
partner. Decide ahead of time how you will move the
patient and what verbal commands will be used. Also,
tell the patient what you will be doing ahead of time.
A startled patient may reach out or grab something
and cause a loss of balance.
Guidelines for Lifting Cots and Stretchers
Most back injuries to EMTs can be avoided by following the
following guidelines:
Know or find out the weight to be lifted.
Use a minimum of two people to lift, even if a one-
person stretcher is being used.
Use an even number of people to maintain balance
during the lift.
Know the weight limitations of the equipment you
use. Know what to do if the patient exceeds the weight
limitations of the equipment.
Use the power lift or squat lift position. Feet are
shoulder width apart. Back is tight and the abdominal
muscles lock the lower back in a slight inward curve.
Distribute weight to the balls of the feet. Keep both
feet in full contact with floor or ground. While
standing, keep the back locked in, as the upper body
comes up before the hips.
Use a power grip to get maximum force from the
hands. Hands should be at least 10 inches apart. Palms
face up and fingers in complete contact with the
stretcher bar.
Lift while keeping your back in the locked-in position.
When lowering the cot or stretcher, reverse the steps.
Avoid bending at the waist.
Avoid twisting. "Feed" the stretcher into the
ambulance while face across the patient.
Guidelines for Moving Stretchers
Stretchers should be handled by two EMTs with both
hands on the stretcher. Other personnel or bystanders
may be asked to help carry additional equipment if
necessary.
Never leave the patient alone on the stretcher.
Load the stretcher with the foot end first or going
upstairs.
Position one EMT at the foot and one EMT at the head
of the stretcher when rolling it. The EMT at the foot
should pull while the EMT at the head should push.
Always maintain a firm grip on the stretcher when
rolling to prevent a tipover.
Lower the stretcher and carry end to end if the ground
is to rough to roll the stretcher safely.
Use four EMTs, one at each corner, when moving a
stretcher across extremely rough terrain.
Turn corners slowly and squarely, avoiding sideways
movements that might make the patient dizzy.
Lift the stretcher over rugs, grates, door jams, and
other such obstacles on the ground or floor.
Keep the patient secured with belts at all times while
on stretcher even if the stretcher is not being moved
COMPONENT SKILL FOR MOVING AND LIFTING
A. MOVING TO THE SIDE OF THE BED
1. Stand facing patient at the side of the bed.
2. Assume a broad stance, one leg forward of the other
with knees and hips flexed, bring arms to the level of
the bed.
3. Place one arm under shoulders and neck of patient and
another arm under small of patient’s back.
4. Shift body weight from front to back foot, rock
backward to a crouch position, bringing patients
towards his side. Nurse’s hips come downwards as he
rocks backwards. Patient should be pulled.
B. HELPING THE PATIENT TURN ON HIS SIDE
1. Stand at the side of the bed towards which patient is to
be turned. Place patient’s far arm across his chest and
far leg over near leg, near arm is lateral to and away
from his body.
2. Stand opposite to the patient’s waist and face side of
the bed with one foot a step in front of the other.
3. Place one hand on patient’s far shoulder and one hand
on his far hip.
4. Shift weight from forwarded leg to rear leg, patient is
turned towards the nurse hips come downward.
5. Patient is stopped by nurse’s elbows, which come to
rest on mattress at the edge of the bed.
C. RAISING SHOULDERS OF THE HELPLESS
PATIENT
1. Stand at side of the side of the bed and face patient
head.
2. Assume a wide stance with foot next to bed behind the
other foot.
3. Pass arm over the patient’s near shoulders and rest
hand between patient’s shoulder blades.
4. Rock backward, shift weight from forwarded foot to
rear foot, hips coming straight down.
D. RAISING THE SHOULDERS OF TH SEMI
HELPLESS PATIENT
1. Stand at one side of the bed facing the head of the
patient. Foot next to bed is to rear and the other foot
forward. Provide wide base of support.
2. Bend knees to bring arm next to bed down to a level
with a surface of the bed.
3. With elbow on the patient‘s bed grasps the nurse’s
arm in the same manner.
4. Rock forward, shift weight from forwarded foot to
rear foot to bring hips downward. Elbow remains on
bed, which serves as fulcrum.
E. MOVING THE HELPLESS PATIENT UP IN BED
1. Stand at the side of the bed and face the far corner of
the foot of the bed.
2. Flex knees so that arms are leveled with the bed. Put
arm under patient, one arm under patient’s head and
shoulders, one hand under small of his back.
3. Rock forward. Shift weight from forwarded foot to
rear foot, hips coming downward. Patient will slide
diagonally across the bed towards the head and side of
the bed.
4. Repeat from tuck and legs of patient.

4. Nursing Skills
Lifting and Moving
Prepared by: Mark Fredderick R. Abejo R.N, M.A.N 4
Foundations of Nursing Abejo
Lifting and Moving
5. Go to the other side of the bed and repeat number 1 –
3. Continue this process until patient is satisfactorily
positioned.
F. MOVING THE SEMI HELPLESS PATIENT UP IN BED
1. Patient flexes knees, bringing heels up to his buttocks.
2. Stand at the side of the bed, turn slightly towards
patient’s head. One foot is stepped in front of the other
foot closer to bed. Feet are directed towards the head
of the bed.
3. Place one arm under patient’s shoulders, one arm
under thighs. Flex knees to bring arms to the level of
the surface of the bed.
4. Patient places chin on his chest and pushes with his
feet. Nurse shifts weight from rear foot to forwarded
foot. Patient grasps the head of the bed with his hands
to pull on his own weight.
G. HELPING THE SEMI HELPLESS: PATIENT RAISE
HIS BUTTOCKS
1. Patient flexes knees and brings heels towards the
buttocks.
2. Nurse faces the side of the bed and stands opposite to
the patient’s buttocks. Assume a board stance.
3. Flex knees to bring arms to the level of the bed, place
one hand under sacral area of the patient. The elbow is
resting firmly on the 3 bed.
4. As the patient raises his hips, the nurse comes to a
crouching position by bending his knees while his
arms act as a lever to help support the patient’s
buttocks. Nurse’s hips come straight down. While
supporting patient in this position, free hand can place
bedpan under the patient’s sacral area.
H. ASSISTING THE PATIENT TO A SITING POSITION
ON THE SIDE OF THE BED
1. Patient is turned to the side towards the edge of the
bed.
2. The nurse ensures that the patient does not fall out of
the bed by raising the head of the bed.
3. Face the far bottom corner of the bed, support the
shoulders of the patient with one arm and the other
arm helps patient extend lower legs over the side of
the bed top the rear of the other foot.
4. Bring patient to a natural sitting position on the bed;
support the patient’s shoulders and legs over the side
of the bed. Pivot body to lower legs of the patient.
Patient’s legs are swung downward. Nurse’s weight is
shifted form front to rear leg.
I. ASSISTING THE PATIENT TO GET OF BED AND
INTO A CHAIR
1. The patient assumes a suiting position on the edge of
the bed, put on shoes/slipper and gown.
2. Place the chair at the side of the bed with back
towards foot of the bed.
3. Stand facing patient with foot closer to the chair and a
step in front of the other to give the nurse a wide base
of support.
4. Place patient’s hands on the nurses shoulders and the
nurse grasps patient’s waist.
5. Patient steps on the floor and the nurse flexes her
knees, forwarded knee is against the patient knee. This
provides patient’s knees bending involuntarily.
6. Turn with the patient while maintaining a wide base of
support. Bend knees as the patient sits on chair.
J. TRANSFERRING PATIENT FROM BED TO
STRETCHER
1. In preparation of the transfer, lower the head of the
bed until it is flat or as low as the patient can tolerate
2. Raise the bed so that it is slightly higher than the
stretcher.
3. To transfer with client assistant: Ask the client o
move feet, legs, buttocks and upper body to the
stretcher, make sure that the client is in the center of
the stretcher.
4. To transfer without client assistant: Make sure there
are two to three caregivers for this procedure, if there
are two, one should stand on the side of the bed and
the other is on the side of the stretcher. If 3, two
should stay at the side of the stretcher.
5. Grasp pull sheet that support client’s head to mid-
thigh.
6. Roll pull sheet close to the body
7. Assist client to cross arms over the chest.
8. On the count of 3, slide the client towards the edge of
the bed.
9. Repeat and slide the patient towards the center of the
stretcher.
10. Raise the side rails and head of the bed if not
contraindicated
K. LOGROLLING PATIENT
Logrolling is a technique used to turn a patient whose body
must at all times be kept in a straight alignment (like a log).
This technique is used for the patient who has a spinal
injury for the patient who must be turned in one movement,
without twisting. Logrolling requires two people, or if the
patient is large, three people. The techniques involved are:
1. Wash your hands and approach and identify the
patient (by checking the identification band) and
explain the procedure (using simple terms and
pointing out the benefits).
2. Provide privacy. Position the bed should be in the flat
position at a comfortable working height. Lower the
side rail on the side of the body at which you are
working.
3. Position yourself with your feet apart and your knees
flexed close to the side of the bed.
4. Fold the patient's arms across his chest. Place your
arms under the patient so that a major portion of the
patient's weight is centered between your arms. The
arm of one nurse should support the patient's head and
neck.
5. On the count of three, move the patient to the side of
the bed, rocking backward on your heels and keeping
the patient's body in correct alignment.
6. Raise the side rail on that side of the bed and move to
the other side of the bed.
7. Place a pillow under the patient's head and another
between his legs.
8. Position the patient's near arm toward you. Grasp the
far side of the patient's body with your hands evenly
distributed from the shoulder to the thigh.
9. On the count of three, roll the patient to a lateral
position, rocking backward onto your heels.
10. Place pillows in front of and behind the patient's trunk
to support his alignment in the lateral position.
11. Provide for the patient's comfort and safety which is
position the call bell and place personal items within
reach. Also be sure the side rails are up and secure.
12. Report and record as appropriate.