By Raul A. Angulo
One of the great inventions in the history of mankind was spurred from the question, “How can we make hard work easier?” So someone (probably an ancient truckie) invented the wheel. My favorite vignette about the invention of the wheel is from Gilligan’s Island, a popular comedy TV series from the 1960s. In a dream scene, the castaways are prehistoric cavemen. The professor is trying to convince them that the wheel will be his greatest invention and is the most important item to take on a trip. In the next scene, the professor is fervently chiseling a wheel from a large stone. Once it’s finished, he demonstrates it to Gilligan. But instead of rolling it, he flips the wheel on its side. Frustrated with failure, he throws the hammer and chisel over his shoulder and says, “Aw! Wheel not work!” Luckily, whoever invented the wheel actually used it the right way, and EMTs nationwide are grateful for that when transporting patients from their point of origin to awaiting rigs.
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| (1) The Stryker Stair-Pro 6252 is built with thick-wall, square- channeled aluminum for strength, yet it is lightweight. It weighs 31.5 pounds and has a 500-pound weight capacity. The oversized caster wheels maximize mobility in tight spaces. The entire unit is power-washable for easy decon. (Photos by author). |
In a previous issue, I reviewed the Stryker Power-Pro™ XT gurney. The Stryker Stair-Pro® Model 6252 stair chair is the companion unit that is a “must have” vital piece of EMS equipment. Firefighters and EMTs perform a wide variety of rescue and extrication techniques that require the use of some sort of equipment. Most take place in potentially dangerous situations or in uncontrolled hazardous environments. But one rescue technique, which contributes to a high number of back injuries, is a common procedure that occurs in a safe, benign environment-manually transporting a patient up or down a flight of stairs.
Scene Size-Up
When my company is dispatched to a medical emergency, we usually know the nature of the call from the run sheet. I have two lead firefighter/EMTs who will head up patient care. As a company officer, part of my job is to size up the nonmedical components of the incident to ensure scene safety. Scene safety is not limited to immediate threats to the patient and the crew like those encountered at a shooting or a motor vehicle accident on a freeway. Scene safety is also accident prevention and predicting actions that may lead to a back injury or a sprained ankle of a crew member during patient packaging and transport to the ambulance.
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| (2) The patient foot rest has hook-and-loop straps to secure the patient’s feet to the chair while descending the stairs. The foot- end extendable handles are molded for better grip and control. The handle’s length and location provide the best position for proper ergonomic lifting. |
Ground-level incidents or those inside multistory buildings with wheelchair access and elevators pose little risk or difficulty during patient transport. The gurney is the preferred tool of choice. The problems occur when responding to single-family residences. Even a one-story house on a hill with a long, steep set of stairs from the street can make a simple transport challenging, especially in inclement weather where rain, snow, and ice can create dangerous slippery conditions. Though concrete steps are strong, the concrete can be cracked or uneven, creating tripping hazards. Moss and wet leaves accumulating on steps during the rainy fall season also create dangerous slippery hazards. Brick steps are extremely slippery when wet.
Another evaluation to be performed by the company officer is on the condition of wooden stairs and porches. Rotten, rickety wooden steps and decking might hold the occasional adult, but what’s going to happen when you have a patient-loaded gurney and four firefighters, each with size 14 boots, performing a four-point carry where there is an attendant at each corner of the gurney? What about hand rails and banisters? Are they flimsy or rusted out? Will they withstand the weight of a firefighter trying to steady himself or leaning against them? What’s going to happen if they suddenly give way?
It’s always smart to check the rear door for another path of egress. Sometimes there is an alley access that’s better suited for patient transport. Often there are only a couple of stairs to deal with from a rear or side doorway. The structural condition of interior wooden stairways needs to be evaluated for the same reasons.
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| (3) The scientifically engineered, ergonomic design reduces physical stress and risk of back injury to the operators. The EMT at the foot is controlling the speed of the descent. The weight of the patient and the chair is riding on the dual track Stair-Tread system. The EMT at the head is merely following the chair down the stairs. |
The width of doorways and hallways is another important consideration, as well as sharp turns into a bedroom. Will a gurney fit without removing interior doors from their hinges? Does the patient have to be moved into the hallway first? Sometimes occupants have furniture, storage, or clutter reducing the width of the main hallway. Can the obstructions be moved in a timely manner and with relative ease to get a gurney to the patient?
So what are the alternatives if a patient needs to be transported in the supine position? That leaves the clam shell or the backboard. Both have their limitations. The problem with each is that they don’t collapse or bend, and it’s hard to four-point carry. That means in tight quarters, you’ll have to tip the patient sideways to some degree-and that’s hard to accomplish without the patient slipping. It also means there may be awkward spinal loading to the two crew members who have to manage all the weight. This realistic scenario has led to many on-duty back injuries. It just takes one missed step or loss of a grip to imagine what’s going to happen.
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(4) The dual-track Stair-Tread system is made of Kevlar to stand |
The Stair Chair
Many first aid books still teach using a chair to carry a patient out. And if you have a sturdy chair available, this will do the trick. But the legs of a chair are designed to accept in-line compression load (like a column). They are not designed to withstand a lateral cantilevered force. In other words, the legs aren’t designed to be used as handles. I have seen firefighters attempt this maneuver with a less that sturdy chair and had the legs snap in half. Fortunately, none of these events led to dropping the patient, but it was sheer luck.
Stair chairs were designed specifically to overcome all these challenges in a safe and efficient way. The 31.5-pound Stair-Pro has rugged, thick walled, square channeled, aluminum frame construction for high strength and light weight. The chair has a 500-pound weight capacity. Anybody weighing more than that probably wouldn’t fit in the chair anyway. It measures 37.5 inches high and 20.5 inches wide. The chair folds down to eight inches for compact storage. The oversized wheels require less force to roll, improving maneuverability over rough terrain, and the front caster wheels maximize mobility in tight spaces. There are dual wheel locks for safety and stability during patient loading. The chair has a contoured ABS seat for patient comfort and easy cleaning. The high-visibility yellow frame has a powder-coated surface to eliminate oxidation and facilitate easy decon. The entire unit is power-washable.
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| (5) The operator positions, adjustability of the handles, in-position chair locks, angle of the tracks, and built-in descent control add to the safety of the Stair-Pro 6252. |
The best features are the scientifically engineered ergonomic designs that reduce the physical stress and risk of back injury to the operators. Independent ergonomic experts confirm the Stryker claims after comparing it to six major competitors. The locking, upper control, rear lift handle extends to be ergonomically positioned for optimal lift and operator-controlled mobility. The length and the location of the extendable foot-end handles (molded for better grip and control) were scientifically proven to provide the best position and support for proper ergo-lifting technique.
Ascending and Descending
The dual-track, Stair-Tread™ System is made of Kevlar® to stand up to tough use during stair ascents and descents. The dual treads allow the EMTs to control movement down the stairs without any lifting, which reduces the risk of lower back injuries. The operator position, adjustability of the handles, angle of the tracks, and built-in descent control add to the safety of the Stair-Pro Model 6252.
No matter how advanced your paramedics or EMTs are or how extensive the patient care delivered is, each EMS incident ends in two ways: with the patient being transported to the emergency room or with the patient remaining at home. That’s it. And, there are three ways to get a patient down to the waiting ambulance. The easiest way is to assist an ambulatory patient into the ambulance. Next, is the gurney, but sometimes that’s not possible. That leaves the stair chair. Even a patient who should be transported to the ambulance in a supine position can tolerate a short ride in a stair chair when there isn’t any other safe option. With a stair chair, the patient is securely strapped in. The airway can be maintained, the IVs can be managed, and the ECG leads can remain connected.
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| (6) Once the crew members reach the ambulance, the patient can be transferred from the stair chair onto the gurney. Then the patient can be loaded into the ambulance for transport to the ER. |
Take note of your district. If your community is similar to mine, you’re seeing a surge of three-story townhouses popping up in the residential areas. Typically, the ground floor will be the garage. The first flight of stairs leads to the second-floor living area. The second set of stairs will lead up to the third-story bedrooms. That’s a lot of stairs. At three o’clock in the morning when you have to transport a 300-pound patient with chest pain down to the ambulance, you’re not going to use a gurney. The stairs are too narrow for a patient-loaded gurney and a four-point lift. You’re going to have to use a stair chair or a tarp. I suggest the stair chair. First, it’s more professional. It’s also safer for the patient and the EMTs. It turns a heavy, awkward maneuver into a relatively simple and fast evolution. Equipping your firefighter/EMTs with this stair chair is protecting your most valuable resource. They’ll thank you for it.
RAUL A. ANGULO, a veteran of the Seattle (WA) Fire Department and captain of Ladder Company 6, has more than 30 years in the fire service. He is a member of the Fire Apparatus & Emergency Equipment editorial advisory board. He lectures on fire service leadership, company officer development, and fireground strategy and accountability throughout the United States, Canada, and Mexico.
