Urology – Urinary Tract Injuries: By Lee Zhao M.D. & Darren Bryk M.D.


The urinary tract consists of the kidneys,
ureters, bladder and urethra. The majority of urinary tract injuries are
due to blunt trauma. The kidney is the most commonly injured urinary
tract organ and is particularly vulnerable to deceleration injuries. Evaluation begins by assessing the patient’s
hemodynamic status. Immediate surgical intervention is mandatory
if the patient is unstable. If the patient is stable and either hematuria
is seen or the mechanism of trauma suggests kidney injury, IV contrast-enhanced abdominal/pelvic
CT with immediate and delayed images is necessary. Most kidney injuries are managed conservatively
with observation, bed rest, hydration, hematocrit monitoring and antibiotics. Bladder injuries are often associated with
pelvic trauma. A stable patient with gross hematuria, pelvic
ring fracture or suspicious mechanism of trauma is evaluated via cystography. Extraperitoneal bladder injuries require catheter
drainage and observation, while intraperitoneal injuries require surgical repair to prevent
peritonitis. Posterior urethral injuries are also associated
with pelvic trauma. Prompt urinary drainage should be performed
via suprapubic or urinary catheter. Urethral re-alignment can be attempted endoscopically
in a stable patient but should not be prolonged. Anterior urethral injuries are often caused
by perineal trauma called straddle injuries. Patients may present with blood at the meatus,
perineal hematoma, inability to void, or suspicious mechanism of trauma, associated with bicycle
riding or playing on monkey bars. Males may have penile, scrotal or testicular
pain, ecchymosis or swelling, un-palpable testicle on exam, and unilateral absence of
the cremasteric reflex. Females may have vaginal bleeding; if the
hymen or posterior fourchette is injured, sexual abuse is suspected. With suspicion of child abuse, it is imperative
to examine the entire body to note other abuse-related injuries. For all suspected urethral injuries, retrograde
urethrogram is the standard imaging modality used. With severe scrotal pain or swelling or with
an abnormal testicular examination, ultrasound with Doppler flow to evaluate the scrotum
is necessary. It is important to recognize the signs and
symptoms of urinary tract injuries early. Though most injuries are not life threatening,
a delay in treatment can lead to significant morbidity. With severe injury, definitive management
will require consultation with a surgical specialist.

Vascular Surgery – Vascular Injury: By Adam Power M.D. and Yiting Hao R.N.

Vascular Surgery – Vascular Injury: By Adam Power M.D. and Yiting Hao R.N.


Vascular injury, both as penetrating or blunt
trauma, can be a life-threatening presentation to the emergency room and is often complicated
by non-apparent hemorrhage, for instance into the retro-peritoneal space. Left untreated, vascular injuries can lead
to hemorrhagic shock, thrombosis, and compartment syndrome. Blunt vascular injuries occur frequently during
motor vehicle collisions, and commonly affect the thoracic and abdominal aorta. Blunt aortic injury is thought to occur following
rapid deceleration and tearing of the aorta distal to the origin of the left subclavian
artery. [Parmley, 1958] Penetrating trauma causes
crushing and separation of tissues along the penetrating object and often affects the extremities. This type of injury is mostly associated with
gunshot and knife wounds. On initial presentation be sure to follow
the ATLS guidelines and complete a systematic primary assessment, using the ABDCDE approach. Treatment priority is based on injuries, vitals
and injury mechanism. The primary goals of intervention are to locate
the bleeding, stop it, and restore intravascular volume while maintaining homeostasis through
a functional blood composition. Remember, the clinical features of a patient
with blunt vascular trauma may range from asymptomatic to severe hypotension and shock. It is essential to keep in mind the sources
of severe and life-threatening hemorrhage. ATLS guidelines suggest to look for “blood
on the floor and then four more” (chest, abdomen, pelvis/retroperitoneum, and long
bones). In the extremities, the most common presentation
of arterial injury is acute ischemia. Hard signs of arterial injury are: an audible bruit or palpable thrill
pulsatile hematoma expanding hematoma
active bleeding signs of ischemia The classic 5 P’s of acute limb ischemia
include: Pain
Pallor Paralysis
Paresthesia Pulselessness
We then investigate more thoroughly with a secondary assessment, using FAST scans, as
well as pelvic, chest and abdominal x-rays. Laboratory studies are essential for monitoring
these patients: Blood group and crossmatch is sent quickly
but patients often require O negative blood due to urgency. Complete blood count to monitor hemoglobin
is useful in slow bleeding, and is typical obtained every 6 hours in series. It is of limited used in acute severe hemorrhage. Coagulation parameters must be assessed and
any anti-coagulation medication the patient has been taking must be reversed. Coagulopathy may be observed in a trauma patient
following acidosis, hypothermia, and hemodilution following aggressive intravascular resuscitation. Compartment syndrome is a serious complication
associated with vascular injuries and needs to be monitored after limb ischemia and then
reperfusion. It is the increase in intracompartmental pressure
that impairs tissue perfusion and can lead to tissue death. Although this is a clinical diagnosis, creatinine
kinase and myoglobin in addition to renal function, must also be monitored with increased. Tell-tale clinical signs include: Pain out of proportion to injury not relieved
by analgesicsPain with contraction of compartment Pain with passive stretch
Severe swelling Loss of arterial pulse is a late finding Therapy is often dependent on the hemodynamic
status. While expectant management can be reserved
for intimal tears and some small pseudoaneurysms, definitive therapy in the form of operative
or endovascular repair is reserved for injuries penetrating the outer vessel wall or occluded
arteries.

How to PACK a WOUND | Bitesize First Aid

How to PACK a WOUND | Bitesize First Aid


– Catastrophic bleeding
and how to pack a wound. So many of us have heard of tourniquets and how you can stop bleeding on limbs by actually occluding or
blocking the blood supply below the wound. Or what if it’s more of a blast and you
can’t get to the source of the bleeding? Maybe it’s on the side of you and it’s not suitable for a tourniquet. So another way to stop
bleeding in this sort of wound is to actually pack the wound. Now what you are doing
when you’re doing this is, please wear gloves, so with your gloved hand, you are putting your finger
into the source of the bleeding. So you’re actually stopping
where the blood is coming out. You are then getting something to pack that wound. Now the military and the
NHS use things like Cellux or trauma gauze, which has a clotting agent on it. And that will increase the clotting and allow the wound to clot far quicker than you packing a wound. However, packing a wound
with an improvised dressing is still incredibly powerful. You can save somebody’s life with a sock. How about that? And what you would do is find
the source of the bleeding with your finger, so a gloved finger, gloved hand, and you get something like this, so this is just a triangular
bandage or it could be a sock or it could be a bit of
cotton shirt or whatever, and what you are doing is
literally putting that in and then bit by bit, you are lifting up and pushing down on top of this packing so that you are packing that wound in all the different areas, so that as you are packing it, which you would do relatively quickly, you are then filling the
wound with this material so that when you are now pushing down, you are applying pressure
directly to the source of the wound, because you have filled it. So you would put it in like this. You would apply pressure on top, ideally with a dressing or, if you have access to one of
these great blast dressing type of things, you can do a really good
compression over the top where you will put this
in and you can use this with this natty, little gadget to get it on as tight as you possibly can. ‘Cause you will need the pressure to stop the bleeding coming through. So you would put this on, you twist it, this one, as you go round, but you would put this on tightly and you would get emergency
help as quickly as possible. Look for signs of shock. If they’ve got a catastrophic bleed, they will be showing signs of shock. Keep them warm, keep them dry. Elevate the legs if at all possible. And this is an emergency, get help fast. (gentle music)

The Impact of Vertebral Compression Fractures

The Impact of Vertebral Compression Fractures


The National Osteoporosis
foundation estimates that 10 million
Americans have osteoporosis, with a fracture
occurring every three seconds worldwide. Fractures
in the vertebra of the spine are common
in people with osteoporosis and often go
unnoticed until consequences such as
severe pain or lack of mobility occur. On
today’s show the impacts of osteoporosis:
what you need to know about the often
silent disease. I’m Ereka
Vetrini, Access Health starts now. [Music]
Elderly related osteoporosis is exceedingly high, if you go back
ten years and forward ten years the
osteroporatic patient population is an issue. This is a huge demographic. Osteoporosis
means porous bones and is a disease that
causes bones to become weak and brittle
often leading to fractures of the hips,
spine and wrists. I see a lot of
elderly people and they’re scared and
they hurt because they’ve gone from being
an active person in their community
to now there, they can’t walk they’re
in a wheelchair. My name is Joyce Wagoner and I
am 76 years old I fell in a store and
there was water on the floor and I
slipped and went down on one knee and I coul
feel or hear it pop but I didn’t I
thought it was my knee instead of my
back. I did go in and have the
knee check but I didn’t have the back check
I thought oh I had just pulled my
back and you know it hurt but not severe. I was
riding in the car with my daughter
Janice and when she’d go across a
railroad track or a bump I would just
hurt something terrible and then I
couldn’t sleep at night because I
couldn’t lie flat. My name is
Eddie Lou Halsey and I’m 92 years old and
I live in Guthrie, Oklahoma. I tackle
anything that a woman my age would do and
some things that
probably women my age didn’t do. I drove
myself, I went to all the functions of an
that I need to go to, and whenever anybody needed
anything from, I’d pitch in. I
was in the church and we had had a dinner
and I had a casserole that I was carrying
and going home, and I tripped on a
rubber mat that they had in front of the
door and just went, just fell flat hit my
head and knocked myself out. I knew that there was something
wrong because my back was hurting
terribly and if, I was taken home and it
never did quit hurting, so I knew I had to
do something. I didn’t know that I
had osteoporosis no one had ever
really pinned it down to that. So I
wasn’t thinking about that but I
certainly thought about it after I fell. (music.) Joining me today to discuss what
we need to know about the prevention,
early diagnosis and treatment of
osteoporosis is Dr. Heather Hofflich
professor of medicine at the University of
California, San Diego Health Sciences. Welcome doctor, hi
Ereka, thanks for having me today. I’m so glad you’re here we have
so much to cover in this show so let’s
start from the very beginning what
exactly causes osteoporosis? Osteoporosis is a
silent disease most times until an
actual fracture occurs and actually the
incidence of osteoporosis annually is
even more than the incidence of a stroke,
heart attack, and breast cancer combined. So it’s a very common problem as
we age we lose our bone density, and
thus that can lead to fracture. There are
other non-modifiable causes of
osteoporosis, having a family history is an
extremely common reason, if your mother or
father were to fracture a hip or have
osteoporosis your chances are much
higher of also having osteoporosis, as
women reach menopause we lose our
estrogen and Men as they age also have
declining testosterone levels, and this
too leads to reduce bone density and
osteoporosis the other risk factors
there are many modifiable ones and
that’s what we work hard on in our
clinics to prevent further bone loss
some of them include cigarette smoking,
which is directly toxic to the bone,
alcohol use more than two glasses a day
in woman and three glasses in men is
something that we can change poor diet
lack of exercise so there are many
things that we can change and work on
and help prevent osteoporosis. Doctor how
is osteoporosis diagnosed? The
best test to diagnose osteoporosis is a
bone density scan or DEXA scan that
should be done in all women aged 65 years
or older as per the National Osteoporosis
Foundation guidelines and also men
greater than age 70 and older so that we
can detect the silent disease. It seems
like in the elderly it’s very common to
have fractures of the hip or the wrist
is this osteoporosis? Typically
it is osteoporosis and spine fractures
are definitely the most common
fractures that are seen. How do we know if
we have a spinal fracture what are some
of the signs? Debilitating pain can
often be a signal that someone has a
fracture and so when I see a patient that is
in an awful amount
of pain, I we’ll go ahead and get an
x-ray however two thirds of spine
compression pressures are silent and are
picked up incidentally on x-rays so we
need to have another way to try and find
these it is important that we intervene
at the time of the fracture and that is
where the role of a hospitalist comes
into play, they are seeing the patient
submitted through the emergency room
that have the fractures and it’s important that they identify and
directly provide care for these patients. So it sounds like the hospital
if is a crucial part of the process of
getting to the patient and we’re going
to take a short break but first Access
Health caught up with Dr. Syed for more
on the hospitalist role in
osteoporosis, take a look. Patients come to the ER
because pain,
majority of the time, when pain goes away
people think that we can treat it
everything is fixed and there’s no
further worries and the life goes on
That’s a misperception because if you
don’t plead the underlying process which
is causing the problem you’ll get back
to the years in a matter of time. If you
have a fracture, you have significant
osteoporosis and or the period of time
is going to get worse and you’ll have
more fractures and your quality of life
is going to go down. Coming up
treatment options for the impact of
osteoporosis. (music.) (Music) Welcome back I’m here
with endocrinologist Dr. Heather
Hofflich and before the break we were talking
about the diagnosis and impacts of
fractures related to osteoporosis, doctor
can we now talk a little bit about the
treatment for spinal fractures? There are
both non-surgical and surgical treatments for spinal fractures,
at UCSD where I work we’re very lucky to
have a wonderful orthopedics team,
if a patient fractures whether it be in
the ER, the inpatient team or outpatient,
the patients are referred to orthopedics
and seen within 24 to 48 hours particularly with spine
fractures the patient is seen immediately,
they are put in a brace, given proper
exercises and instructions, and they are given
a complete pain management program
and seemed back with an appropriate
plan. This has been wonderful and a
great resource for our patient there
is a minimally invasive surgeries
that are possible to infer them reduce
their pain. Thank you Heather we’re going to
see you a little later in the show and
let’s go now to Dr. Douglas Beal, Chief
of Radiology Services at clinical
Radiology of Oklahoma to learn more about
this minimally invasive procedure. The issue about
patients with vertebral fractures,
pain is that they lie in bed, that they get
pneumonia, blood clots to the lungs, DVTs
and they typically don’t do better, they
do poorly. End these patients die at a very
high rate so your typical patient is
they’re distraught with pain you can see
a broken arm or broken leg but you
can’t see a broken vertebrae and so
people don’t understand until you truly
have one or experienced a broken
bone. Patients will exhibit specific
symptoms they’re very textbook, it’s a
sharp shooting pain, it’s much pain
with movement it’s pain with any
transition type pain from sitting to
standing or sitting to lying or breathing. So
vertebral plasticies we need to put a
needle into a vertebral body inject
medical cement and that’s a tried and true
methods been present for a long time –
kyphoplasty and balloon kyphoplasty, we put the
needle in and then we balloon the
vertebra try to make it look more normal,
we call these vertebral compression
fractures because they’re compressed top
to bottom, we inflate the balloon it
raises it back up from top to bottom
reestablishes the height of the vertebral body and it also
creates area within the bone and cavity
so whatever we injected revelat
controls, the cement better. Cement goes to
the path with least resistance. The patients that we see are
typically coming to us from their primary
care physician or from a specialist
typically your neurosurgeons or orthopedic surgeons or
endocrinologist even primary care doctors will
put a patient in a brace because they
see the fracture they understand it’s a
broken bone and they are going to the
adage that the bone turnover will then
heal the bone but you’re dealing in an
older population with osteoporosis
where the bone turnover is not fast at all
it’s not like a 16 year old that
breaks an arm in a soccer tournament, this
is a this is a older person that
after menopause or later in life you
don’t turn your bone over, it just
don’t heal fast. Average patient I see
will have a fracture between two and
four months old, used to be worse
used to be six months in a year, and
patients that survived that, survived the
decondition are able to be treated. After
I fell the pain kept getting worse and
worse and I knew there’s something,
that there was something wrong and it
took me about three weeks, two or three
weeks I believe before I went to Dr.
Beal and he immediately knew what it was. The MRI showed 3 fractures and
then he told me I needed to have the
kyphoplasty. He did an MRI and that’s why he
decided I had done had, had and had
broken my vertebras, crushed them. We
diagnosed a fracture with either x-ray CT or
MRI and we treat them based on the
presence of a fracture associated with pain, a
fracture that’s important, one that is is
one that is symptomatic one that hurts so
a fracture combined with pain
combined with patient debilitation equals
need for treatment. So surgical procedure for
someone that comes in with a vertebral
compression fracture include born
kyphoplasty and this is done when the skin is
numbed and we identify the appropriate
starting position from x-ray live x-ray
or fluoroscopy. The kyphoplasty is
accessing the fracture putting the
balloons and trying to make the request
partiro body look more normal, raise it up to
normal height. We insert the balloon
inflate the balloon with contrast something
you can see on x-ray and then once the
balloon is deflated we take it out and
we inject the cement and then after the
fillings complete we wait for the cement
to harden and so it hardens
completely in about 20 to 25 minutes, by the
time we remove the needles the cement is
hard enough to support lots of weight
and the patient is immediately able to
roll back over onto the gurney to go to
the holding area the waiting room
and recovery. There are risk to the
procedure including serious complications
including infection and leakage of bone
cement into the muscle and tissue. Cement
leakage into the blood vessels may
result in damage to the blood vessels
lungs heart and/or brain. Cement
leakage into the area surrounding the
spinal cord may result in nerve injury
that can, in rare instances cause
paralysis. See the
end of this segment for important safety
information. What I see in the
recovery room and recovery period is that
patients are resting and they feel
better and they’re able to sleep and
they’re able to get dressed and they’re
able to to move about. When I
came out I could tell it was fixed. Take it
easier for a couple of days but there
really no restrictions. I walked in
painfully, but after I had the surgery and they
took me to a room I was pain-free, I did
not feel any of the pain anymore and then
when they wanted to wheel me out and
wheelchair I said I will walk so I
walked to the car and didn’t have any
problem at all, I went home that evening. After invertible augmentation
recoveries not much people were a little
sore three or four days
after the surgery, but it’s not without
complications. The largest trial
ever done 354 patients, number of
complications or adverse events, 1.4%. It gets them out of pain, it
gets them back to their daily activities
of living, it helps them be part of the
community again. If you have one fracture
you have about a five times increased
risk of another one, two fractures goes
up to 12 times, so I usually tell people
it’s not if it’s when. I think it was
probably a month later that they found the
other fractures and had to have that
taken care of and then I’ve been free
of pain ever since. Two days later I
believe it was I coughed or something,
anyway I’ve fractured the vertebra right
above the one he fixed and he went back in
and fixed that one and then I was
fine and I have been fine ever since and if
I ever have another fracture, I know it
can be fixed and I will recognize it
immediately. Joining us now is
Michael Switzer an interventional
therapy consultant, welcome Michael. Thank You
Erika. So tell me as an interventional
therapy consultant what does your job
entail. Well we wear many hats, really
our foremost role is to make sure
that patients have access to balloon
kyphoplasy. So we just watch Dr.
Bill perform a balloon kyphoplasty,
tell us about the clinical evidence
behind it. We’ve had many patients that
have been involved in our clinical trials,
most recently a study of 300 patients
where roughly half of them received
conservative non-surgical management and
the other half received balloon kyphoplasty
In that study they found that within the first week the
patients that received kyphoplasty had a three
times greater improvement in their
pain. At one
month those patients reported having a
four times better improvement in their
quality of life and in that first month
they also reported having five fewer
days with limited activity, versus the
non-surgical management patients. Those
are great numbers, it sounds like a
wonderful option for the patients you
support. Thank you Michael for
stopping by, and we’ll be back in just a
moment so stay with us. [Music.] [Music.] We’re back and I’m here
with endocrinologist Dr. Heather
Hofflich, so Heather so far we’ve talked
about the non-surgical and surgical
treatments of spinal fractures, but can we now
talk about the treatment of
osteoporosis as a whole. There are many FDA
approved osteoporosis medications and
they can come in oral, intravenous, or
injectable forms. The goal of therapy is to
actually stop the breakdown a bone and
there is one therapy that actually truly
builds back bone density, these
medications are so important to reduce the risk
of fracture and if somebody has
osteoporosis I highly encourage them to
speak with their physician and to
consider one of these therapies. So
doctor I know there’s no cure for
osteoporosis but what can we do to
prevent it. There are many
things that we can do to prevent osteoporosis
and improve our bone health. Calcium
is one of the building blocks of bone
and it is a very important part in
building bone density. What I do in my office
with my patients I have them look at the
National Osteoporosis foundation calcium calculator and I have
them go home and calculate how much they
really are getting in a normal day. If
someone is not getting enough calcium
their diet then supplementation is okay as
well. Vitamin D is another important
building block for our bones, another
important component of bone health is
exercise and by this we mean weight-bearing
exercise; walking, jogging, elliptical. I
always educate my patients in the exam
room about protecting themselves from
a fall. Seventy-five percent of falls
cause a fracture and that’s what we’re
trying to prevent. There’s a great handout
on the National Osteoporosis foundation
website that teaches people about some
tips to prevent Falls. Doctor thank you
so much for spending time with us today
and giving us so much great
information. Thank you to all of my guests
and especially our patients for
sharing their personal stories. For more
information on all the information we
discussed on the show today you can
visit spine-facts.com or the National Osteoporosis
foundation website at nof.org, and of
course you can log on to our web site access
health dot TV, see you next time. Balloon kyphoplasty is a
minimally invasive procedure for the
treatment of pathological fractures of the
vertebral body. Due to osteoporosis,
cancer or benign lesion,
there are risk to the procedure including, serious complications
including infection and leakage of bone
cement into the muscle and tissue Cement
leakage into the blood vessels may
result in damage to the blood vessels,
lungs, heart, and/or brain. Cemnent leakage
into the area surrounding the spinal
cord may result in nerve injury that can
in rare instances cause paralysis. A
prescription is required. This
therapy is not for everyone, please talk to
your doctor about the risks and
benefits of this procedure and to decide
whether this procedure is right for you. Results
may vary, for more information please
call Medtronic at one seven six three
five oh five five zero zero zero and or
consult Medtronic website at Medtronic
dot com [Music.]

Fractures and Tendon Muscle Joint Injuries

Fractures and Tendon Muscle Joint Injuries


Marine Online this section should give a short introduction to fractures tendon muscle and joint injuries handling and transport you the framework of the body is called the skeleton and consists of approximately 220 bones these bones are connected with joints tendons and muscles injuries to the bones are called fractures fractures are caused by direct force or pressure stretching blowing overloading twisting you definitive fracture is visible pieces of bone open fracture angulation visible shortening of a limb and crepitation indication of a fracture is swelling Payne malfunction and paleness you stabilizing the fractured area is done too locations to relieve pain so the transportation can be carried out fast and gently click on the hot spots to see what a good spin should and should not do professional splints are inflatable splint cardboard splint stretch tension splint Sager splint vacuum splint Cramer splint if you don’t have any of these splints available use your imagination a good splint should not prevent adequate blood Galatian compressed nerves chill or heat the injured area or have sharp pointed edges a good splint must be adequately stiff or rigid be long enough to extend beyond the injured area immobilize the joint over and under the injury and be padded sprained an acute tendon muscle or joint injury is the result of the tissue being for a short moment exposed to a greater force or more pressure than it can endure for example caused by push thrust or blow the extent of the damage depends on the type of tissue its elasticity etc compared to the force it is exposed to the objective of first aid treatment for this type of damage is to reduce pain prevent swelling and reduce the length of the healing process sprain injuries have to a logic same symptoms as a fracture therefore in many cases it may be difficult to tell one from the other if in doubt whether the injury is a sprain or fracture always treat as a fracture the symptoms are Payne decreased mobility swelling and change of color such as blue yellow or purple treatment a sprain injury should be treated according to the RIC II principle rest ice compression elevation this all-round treatment is always for the best of the patient giving pain relief and favorable healing for injuries to larger muscles it is more important to use pressure to the area rather than cooling because the cooling effect will not be absorbed deep enough the letters are I see II mean the following R is the first letter of rest rest means to rest and protect the injured area for the first 24 to 48 hours and to stop activity that causes pain and soreness I is the first letter of ice ice means reduce bleeding reduce swelling and relieve pain see is the first letter of impression this is most important during the first 24 hours compression is done to reduce bleeding and to reduce swelling it is important to observe the blood circulation below the injured area E is the first letter of elevation elevation is done to relieve pain and to improve blood circulation transporting a patient and choice of evacuation or transport method will always depend on the following how much time a disposal available material available personnel type at extent of the injury access to and from place of injury require treatment during the transport there are several methods on how to hand and transport a person we will now take a closer look at the most used methods the injured person is raised to a half sitting position and the rescuer grasps around his wrists the rescuer stands up and can now drag the patient this is no gentle way of transport but it is a fast and effective way of moving an injured person out of a dangerous area the method is relatively easy to practice and an effective way of moving heavy patients it may be difficult to open doors or move objects as the rescuer does not have his hands-free the basis of this lifting method is the drag method number one rescuer stands behind the injured person grasping his wrist number two rescuer takes hold of the injured persons thighs as close to his crotch as possible lifting each leg this is a relatively gentle and safe method of transport where the rescuers at all times can see where they are going this method should not be used if the injured person has fractures and an unconscious patient may easily get his Airways blocked you a well-known lifting method useful when the patient is conscious and able to cooperate this is the fastest method of moving a patient in addition the rescuer has one hand free to open doors move obstacles etc once the patient is up on your shoulders this is an easy way of transport that you must keep in mind that this is not a gentle way of transport this method is safe fast easy and a good way to put a patient onto a stretcher it requires four to five helpers who can lift the patient don’t forget the patient’s head if the patient is unconscious the head will roll sideways unless someone is responsible for securing the head this person should be the one giving the command okay lift so that everyone lifts at the same time one person shall push the stretcher under the patient if the patient has a back injury this is a good way to handle the patient when a scoop stretcher is not available it is very important that everyone lifts at the same time this is the most common used lifting method when placing an injured person on a stretcher the bearers three persons should kneel on the left side of the injured one bearers should be in command and he shall concentrate on the patient’s head neck and shoulders all three bearers shall lift the injured at the same time a fourth helper moving the stretcher under the injured with this lifting method there is very little movement of the patient’s body this method should not be used when moving a patient with counter stretcher you the first aider must at all times consider his own health and safety he can be of no help if he jeopardizes his own safety this means using correct lifting methods whenever possible some lifting operations may have to be carried out within very narrow passages and severe working conditions the following rules must be practiced whenever possible plan the lift and transport try to get help from others before lifting evaluate if the patient can be placed in a better more comfortable position keep your back straight lift your head and look straight ahead lift using your legs