Shoulder Trestraints

The safe handling of patients is an important part of emergency medical service delivery.  Patient handling equipment manufacturers have developed and tested their equipment to reduce the chance of patient injury.  However, these devices require the products to be used in a manner consistent with the manufacturers design and specifications.  

During the recent Risk Control survey of your organization it was noted the manufacturer-supplied shoulder restraint system was not in place on the inspected ambulance cots.  Utilizing all of the patient safety restraints supplied by the manufacturer is an excellent way to reduce the chance for loss associated with patient injury during movement or transportation. 

We recommend your organization ensure all equipment, including ambulance cots, are maintained and used in accordance with manufacturer’s recommendations and/or specifications.  Further enhancements to your patient handling safety procedures could include the following:

• Instituting or updating written policies and procedures for the proper operations, inspection, maintenance and supervision of ambulance cots
• Orientation training and annual refresher training for all EMS care providers incorporating applicable policies and manufacturers’ safety recommendations initially and any time new equipment is introduced
• Specifically highlight refresher training regarding the importance of
• Being alert to pavement and terrain condition hazards at all times when moving a patient;
• Both providers keeping both hands on the cot frame, handles, or straps supplied while moving patients;
• Selecting lower or mid-range cot elevated positions when moving patients. This practice increases stability and provides for a lower center of gravity, decreasing the chance of the cot tipping over.
• Please note all cot manufacturers supply cot handle extensions and straps to enable EMTs to walk upright while pulling or pushing the cot. Higher cot elevated positions and cot loading positions should be restricted to special circumstances and ambulance loading/unloading evolutions;
• Selecting the lowest practical position of cot elevation when they move a heavy patient;
• When it is essential and unavoidable for EMTs to carry equipment on the cot on which they are moving a patient, selecting the lowest practical position of cot elevation;
• Using required cot restraint straps to provide both transverse and longitudinal patient protection (lower leg, mid leg, chest, and over-the-shoulder).  Straps should be utilized at the patient’s knees, hips, chest, and over the shoulders.
• Documenting all training, inspection, maintenance and supervisory activities
• Ensuring preventive maintenance of all ambulance cots, related systems, and accessories in accordance with manufacturers’ recommendations and timeframes
• Instituting a supervisory system designed to assess and monitor cot safety practices

Your organization should consult the specific recommendations provided for the make and model of patient handling equipment currently in use.