TRANSFER AND AMBULATION

Objectives:

After 1 hour of teaching-learning activities, the level 3 students will be able to:

1. define the following:

1.1 ambulation
1.2 rescue
1.3 transfer

2. identify the factors that affect transfer and ambulation.

3. cite the pointers to observe during transfer and ambulation.

4. enumerate the methods of transfer and ambulation.

4.1 one-man carry

4.1.1 assist to walk 4.1.6 arm drag
4.1.2 carry in arms 4.1.7 cloth drag
4.1.3 piggyback carry 4.1.8 feet drag
4.1.4 fireman’s carry 4.1.9 inclined drag
4.1.5 blanket drag 4.1.10 pack-strap carry

4.2 two- man carry

4.2.1 assist to walk
4.2.2 four-handed seat
4.2.3 hands as a litter
4.2.4 carry by extremities
4.2.5 firemen’s carry with assistance

4.3 three-man carry

4.3.1 bearers along side
4.3.2 hammock carry

4.4 four/ six/ eight – man carry

4.5 blanket carry
4.6 improvised stretcher
4.7 commercial stretchers
4.8 ambulance or rescue van

5. specify the commands during transfer and ambulation.

6. cite the reminders during transfer and ambulation.

1. Definition of Terms

Ambulation – ability to walk from place to place.

Rescue - to save somebody or something from a dangerous or harmful situation.

Transfer – to move a person from one place to another.

2. Factors that Affect Transfer and Ambulation:

Age - greatly affects activity, during the infants and toddler period, mobility develops
rapidly and is refined and expanded throughout childhood and adolescence and into
young adulthood with effects to maximize the attributes.

Lifestyle - people learn early in life often from the families, the value of activity in
relation to health.

Neuromuscular and skeletal impediments - disease and injuries that affect the
neuromuscular or skeletal systems can hinder movement.

Nutrition - adequate nutrition supplies vitamins and minerals essential for bone
function.

General Health - the client’s general health status is reflected on how the individual
moves. Illness, disability, inactivity and chronic fatigue have unfavorable effects on
musculoskeletal function.

Emotions - the client’s emotional state may influence posture and ways of moving
about.

Attitudes and Values - people who are conscious with body mechanics and gait
would protect their body structures and posture from injury.

Level of Understanding - understanding the elements of body mechanics would

encourage its use.
3. Pointers to Observe during Transfer and Ambulation

 Position your feet properly, they should be on a firm, level surface and positioned
shoulder-width apart.
 When lifting, use legs; not your back to do the lifting.
 When lifting, never twist or attempt to make any moves other than the lift.
 When lifting with one hand, do not compensate. Avoid leaning to either sides. Keep
your back straight and locked.
 Keep your weight as close to your body as possible.
 When reaching:
 keep your back in a locked-in position.
 avoid twisting while reaching.
 avoid reaching more than 15-20 inches in front of your body.
 avoid prolonged reaching when strenuous effort is required.
 When pushing or pulling:
 push rather than pull whenever possible.
 keep your body locked-in.
 keep the line of pull through the center of your body by bending your
knees.
 if the weight is below the waist level, push or pull from a kneeling position.
 avoid pushing or pulling overhead.
 keep your elbows bent with arms close to your sides.

4. Methods of Transfer and Ambulation

One - man carry

Assist to walk

The most elementary form of transport is the walking assist.

 Procedure: Patient’s weight burden is assumed by the first aider. The
patient’s arm is placed across the back or waist, depending on what is
most advantageous at the time. The key to effectiveness of this procedure
is not to impose any added force or strains on the injured part but rather to
give the injured person a sort of walking crutch. Do not pull or tug at the
patient’s arm across your shoulders, since this may be a source of
discomfort o patient.

Carry in Arms

The arms carry can be used to move a conscious or unconscious

casualty. It is generally used with an unconscious casualty or a conscious
casualty who cannot walk. The arms carry is very tiring and is only used
for short distances.
Piggyback Carry

Assist the patient to stand. Place her arms over your shoulder so they
cross your chest. Bend over and lift patient. While she holds on with her
arms, crouch and grasp each thigh. Use a lifting motion to move her unto
your back. Pass your forearms under her knees and grasps her wrists.

Fireman’s carry

Used to be a common way for firefighters to carry injured or unconscious

people away from danger.

To perform the fireman's carry, the carrier would grasp the subject's wrist
and put the subject's arm across one of his shoulders. Then, the carrier
would reach between the subject's legs, passing his arm between the
subject's legs and then grasping behind the subject's thigh. To avoid back
injuries, it is important for the carrier to lift the subject using the strength of
his or her legs. The carrier would have hold of the wrist of the subject and
his other arm would be holding onto one of the legs of the subject. The
subject would have one arm and one leg hanging freely behind the
carrier's back.

Carrying someone in this manner has several advantages. The subject's

torso is fairly level, which helps prevent further injuries. When the subject's
weight is evenly distributed over both shoulders, it is easier to carry them
for a longer distance (50 feet or more).
Blanket Drag

An alternate method to the drag carry where the rescuer can use a blanket
to support and pull the casualty.

Arm Drag
Grasp the arms of the victim and drag him to a safe place.
Cloth Drag
Uses the victims upper clothing for dragging

1. Before using clothing to drag the victim, make sure that the clothing is
sturdy enough and that the victim will not be chocked in the process
2. Kneel next to the victim at the head
3. Grasp the clothing at the collar under the victim's head
4. Drag the victim to safety

Feet Drag
By using a cloth or bandage, tie both feet of the victim and make sure that
the extra bandage is placed at the center of both feet, then drag the victim.
Make sure that there are no bumps to prevent injury to the victim.

Inclined Drag
used to move a victim down a stairway or incline

1. Turn the victim so that the victim is supine

2. Kneel at the victim's head
3. Support the victim's head and neck
4. Lift the victim's upper body into a sitting position
5. Reach under the victim's arms and grasp the victim's wrists
6. Stand using legs rather than back to move the victim while easing
the victim down a stairway or ramp to safety
 Pack- Strap Carry

The pack-strap carry is generally used to carry a conscious or

unconscious casualty for a moderate distance. The carry is not used if the
casualty has a fractured arm.

 Two- man Carry

Assist to walk

Both rescuers position the patient’s arms over their shoulders.

Each rescuer grasps the patient’s wrist, with the other arm around the
patient’s waist.
Two-hand seat carry

This is another way to carry a conscious casualty who can neither walk
nor support the upper body. Make a hook with your fingers by folding them
towards your palm and grab onto your partner's "hook". If you don't have
any gloves, use a piece of cloth to protect your hand from the other
person's nails. This is yet another good reason to wear gloves.

Four handed seat

This is also a good carry for a conscious casualty who can use hands and
arms for support.
Carry by extremities

An injured person can be carried by his extremities as shown here.

However, this carry should not be used to carry a person who has serious
wounds or broken bones.

Fireman’s carry with assistance

Have someone help lift patient. The second rescuer helps to position
patient.

Three – man carry (Note: No illustration and description)

Bearers along side (Note: No illustration and description)

 Hammock carry (Note: No illustration)

The three-person hammock carry is very similar to the two-person carry,

except that three people are involved: One positioned at the victim's
calves, one at the hips, and the third person at the shoulders. The carriers
kneel on their knee nearest the victim's feet. The person at the victim's
head gives the command, and all three lift the victim to their knees
simultaneously. The victim is then turned so that he faces the rescuers.
The person at the head then gives the command and the three rescuers
stand.

 Four/ Six/ Eight man carry

Four-man Carry

The four-man carry is t h e carry normally used to transport a litter

casualty when t h e terrain is generally smooth a n d level.

1. The bearers position themselves as described below prior to performing t h e

carry. The leader of t h e litter squad (bearer one) positions himself at t h e litter
handle nearest t h e casualty's right shoulder, normally at t h e back of t h e litter.
This position allows h i m to observe t h e casualty a n d to direct t h e three other
members of t h e squad. In figure 3-28, bearer o n e is t h e leader of t h e litter
squad.

2 . The other three-squad members position themselves at t h e remaining

litter handles.

3. All bearers face t h e direction of travel a n d kneel on o n e knee (the knee near
t h e litter). On t h e preparatory command "Prepare to Lift," each bearer grasps
his litter handle with t h e h a n d closest to t h e litter a n d places his other h a n d
on his raised knee. On t h e command of execution "LIFT," all bearers rise
together, lifting t h e litter a n d keeping it level.

4. Each bearer uses t h e h a n d on his knee to help support a n d balance

himself as he rises. Leg muscles, n o t back muscles, are used when lifting a
litter. This helps to prevent back injury.

5. After t h e bearers are standing, t h e y are in position for t h e four-man carry.

The command to proceed is "Four-Man Carry, MOVE." This command is also
used to change to t h e four-man carry from another carry without lowering t h e
litter.
 Six man Carry

 Blanket Carry

A variety of materials, such as blankets, can be used as improvised stretchers.

The blanket carry can be used to remove victims who cannot be removed by
other means. Six rescuers are recommended for this carry to ensure the victim's
stability during the move. One rescuer must be designated the lead person to
ensure teamwork when performing the lift.
Improvised Stretcher

If a commercially prepared stretcher is not available, you can improvise one by

using a tabletop, door, two rigid poles and a blanket or clothing. Don't use non-rigid
stretchers for casualties with suspected head or spinal injuries.

Blanket and poles stretcher

1. Place the blanket flat on the ground and place a pole one-third of the way from
the end. Fold the one-third length of the blanket over the pole.
2. Place the second pole parallel to the first so that it is on the doubled part of the
blanket, about 15 cm (6 in) from the doubled edge.
3. Fold the remaining blanket over the two poles. The casualty's weight on the
blanket holds the folds in place.

Stretchers from found materials

Doors, short ladders, sheets of galvanized metal, etc can all be used to improvise
stretchers. Keep an eye out for suitable materials.

Make sure the stretcher and casualty will clear passageways and that the
stretcher is strong enough to hold the casualty.

Commercial Stretchers

A kind of bed with rollers used for transporting the victim from one room to
another. Commonly found in hospitals and ambulance.

Ambulance or Rescue Van

A vehicle used by health care practitioners/ rescuers in transiting patients to a

near hospital.
5. Commands during Transfer and Ambulation

COMMANDS:

“Ready to kneel.”

-to position the rescuers beside the victim

“Hands over the victim.”

- to position the hands over insertion point of the victim

“Ready to insert.”

- to get ready to insert hands below the victim to create a litter

“Ready on the knees.”

-to make sure the rescuers are ready to lift the patient from the ground

“Clip.”

- to lock the victim in the arms of the rescuers, to prevent any accidents

“Interlock.”

- (for hammock carry) to lock each other’s arms for a much durable and
solid litter

“Ready to stand.”

- to ensure a simultaneous manner of lifting the victim as to prevent further

more injuries

“Stand.”

- signals the rescuers to stand

“Ready to walk.”

- to get ready for walking

“Head/Foot center pace.”

- to direct rescuers which way to go, either towards the direction of the
head or feet of the victim
 “Abort.”

- abort any action done to prevent further injuries

(e.g. when lifting victim on the knee and one rescuer loses grip, the leader will
command them to abort lifting)

6. Reminders during transfer and Ambulation

 Know your own physical abilities and limitations.
 Do not overestimate yourself or the other rescuers.
 Before lifting, know or find out the weight of the patient as well as the weight
limitations of the equipment being used.
 Call for additional help whenever necessary.
 Even thought your first impulse may be to jump in to help the patient, you must not
proceed until you know you can do so safely.
 Always try to use an even number of rescuers to maintain balance. Two rescuer
teams should carry heavy loads for one minute or less.
 More time can generate a high level of muscle fatigue, which can significantly
increase the potential for injury.
 Whenever possible, transport patients and equipment on wheeled stretchers or other
rolling devices.
 When you must carry, keep the weight as close to your body as possible.
 Keep your back in a locked-in position.
 Do not hyperextend your back, or lean from the waist.
 Refrain from twisting, and never lift and twist simultaneously.