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Risk Mitigation in Medical Transport

How Does No-lift NEMT Reduce Risk?

Get a quick overview with our Risk Mitigation flier.

NEMT Risk Timeline

Identifying Recurring Risk in Medical Transport

To identify how risk is introduced into medical transportation, we will do the following:

  • Identify Five Recurring High-risk Events
  • Label Risks with Identifiable Icons
  • Compare 4 Transport Methods:
    • No-lift NEMT
    • Gurney/Stretcher Transport
    • Wheelchair Transport
    • Ambulatory Transport

Medical Transport Risk Timeline

Five High Risk Events

Five high risk events occur in medical transportation:

  1. Transfer – The initial transfer from the bed to or chair to a gurney or wheelchair. (Or vice versa)
  2. Lifting Equipment – Maneuvering, lifting, or lowering a stretcher/gurney with a patient onboard
  3. Transit to Vehicle – Moving a patient, whether ambulatory, via wheelchair, or on a gurney, to the vehicle
  4. Loading in Vehicle – Onboarding, loading, or unloading of the patient in or out of the vehicle
  5. Riding in Vehicle – Transporting a patient in a moving vehicle.

Recognizing these high-risk events, we can attempt to mitigate the risk involved with proper equipment and effective techniques.

How We Keep It Simple

In order to explain the risks factors in medical transport in easily understandable ways, follow the risk as though we are moving from a facility bed (although the patient could be at home on their sofa or finishing up an appointment in a dialysis chair) to a vehicle.

Risk is Round Trip

As you examine these risk factors, remember that transport goes two ways: from a bed to a vehicle and from a vehicle to a bed (or other destination). Risk factors may differ slightly going the other direction, but the underlying processes and risk factors are the same. The transport methods we will explore introduce the same risks regardless if the patient is leaving or arriving.

Our Risk Icons

Below are a list of icons we’ll use to examine risk in various transport methods. Each time an icon appears, it will be accompanied with text describing how the risk has been introduced.

A green shield indicates that a given transport method does not pose significant risk of injury in that transport event or does not involve that event at all.

You’ll also notice “person” icons which indicate how many persons are required to perform a specific action. This is to help demonstrate the complexity or manpower involved in a given action.

Fall Risk

Drop Risk

Lift Risk

Lift Risk

(Two-person Operation)

Crash Risk

Mitigated Risk

Mitigated Risk

(One-person Operation)

Mitigated Risk (Two-person Operation)

Comparing Four Transport Methods

No-lift NEMT | Stretcher/Gurney | Wheelchair | Ambulatory

Five high-risk events occur in the medical transport process. With the right equipment and techniques these risks can be mitigated significantly. The simplest way to demonstrate how No-lift NEMT reduces risk in transport is to compare transport methods. Take a look at the risks involved in ambulatory, wheelchair, and gurney transports and how they compare with a No-lift NEMT transport solution.

Method 1 of 4: No-lift NEMT® with the Broda® Synthesis WC19 Transport Chair

Risk Summary (1/4): No-lift NEMT

No-lift NEMT reduces or eliminates risk at every event.

  1. Transfer – Transferring patients, a lateral transfer eliminates lifting the patient, eliminating the risk of drops and lifting injuries.
  2. Lifting Equipment – No lifting or maneuvering of equipment is required with No-lift NEMT. Positioning of the wheelchair to the upright position is aided by pressurized cylinders.
  3. Transit to Vehicle – No-lift NEMT eliminates risks of falls (ambulatory), drops (gurney), and slipping from wheelchair as patients can be tilted or belted to prevent falling out of the chair.
  4. Loading in Vehicle – No-lift NEMT prevents dangerous drops of gurneys loading into high vehicles. It also eliminated injury risk as transporters are not required to vertically lift a gurney into a van.
  5. Riding in Vehicle – Risk of in-motion or collision injury is greatly mitigated by compliance to WC19, a rigorous, crash-tested, wheelchair safety standard.

Risks to Patient

While there is always risk in medical transport, patient risk is significantly reduced compared with other methods of transport.

Advantages to Patient

Lateral Transfer

Patients are effortlessly glided from bed to chair. When properly performed, there is no risk of falling or being dropped.

Patient Secured While Moving to Vehicle

Patient is secured to the chair preventing them from falling or slipping out of the chair are any point in the transport process.

Patient Secured in Vehicle

Device Crash Tested

Patient is secured in a crash-tested device while vehicle is in motion.

Risks to Transporter

While there is always risk in medical transport, transporter risk is significantly reduced compared with other methods of transport.

Advantages to Transporter

Lateral Transfer

Significantly decreased risk of back or other injury by eliminating lifting patients out of bed.

No Lifting of Equipment

With no equipment involved, staff is at no risk of injury due to lifting and adjusting a gurney.

No Lifting into Vehicle

No vertical lifting is involved when loading the vehicle. The chair is loaded via a ramp or lift.

Method 2 of 4: Stretcher/Gurney Transports

Risk Summary (2/4): Stretcher/ Gurney

Stretcher/gurney transports typically involve durable equipment and have safety in mind. But gurney trips are expensive and pose risks–particularly for those lifting and moving heavy gurneys.

  1. Transfer – Risk can be mitigated with a stretcher/gurney via a lateral transfer. No vertical lifting need be involved. Two persons required for a lateral transfer.
  2. Lifting Equipment – Significant risk of injury to transporters because of the need to raise, lower, and maneuver a gurney with the patient onboard.
  3. Transit to Vehicle – Risk is minimal in gurney transports as patient can be secured to the gurney and two persons accompany the gurney to the vehicle.
  4. Loading in Vehicle – Significant risk is introduced when loading a gurney into a vehicle as the transporters must lift the gurney with the weight of the patient on the stretcher into an elevated vehicle. Significant risk to the patient is also introduced as gurneys can easily slip, tip, and be dropped in the loading process.
  5. Riding in Vehicle – Risk of falling from a gurney is mitigated by securing the patient to the gurney. Gurneys are crash tested and designed to be loaded and secured in an ambulance or van.

Risks to Patient

Drop Risk

Patients must be vertically lifted into the back of an elevated vehicle, presenting the risk of the gurney being dropped.

Gurneys are raised to an elevated position adding the risk of tipping–gurneys should always be operated by two people.

Advantages to Patient

Lateral Transfer (with Transfer Aid)

Patient can be delicately transferred from bed to gurney without risk of falling or being dropped (if performed properly).

Patient Secured While Moving to Vehicle

Patient is secured to the gurney to prevent falling. Raised gurneys present a risk of tipping, but this is mitigated as long as two persons are present at all times while moving the gurney to the vehicle.

Patient Secured

Device Crash Tested

Patient is secured in a crash-tested device while vehicle is in motion.

Risks to Transporter

Lifting

Risk of back injury due to lifting the gurney at two points:

  1. Adjusting the gurney height once the patient is secured to the gurney.
  2. Lifting the gurney (with patient) into the vehicle.

Advantages to Transporter

Method 3 of 4: Wheelchair Transports

According to RESNA’s position paper, those riding in wheelchairs are 45 times more likely to be injured in a crash than a typical passenger. The paper also states that recent studies show that a large percentage of injuries and fatalities to passengers in wheelchairs are caused by non-collision events, like abrupt turns and hard braking. A study from the NHTSA found that over a five-year period, 2,494 wheelchair users were injured or killed due to improper or no securement, and 1,035 were injured or killed while transferring to or from a motor vehicle.

https://nrrts.org/wp-content/uploads/2019/06/RESNAPositiononWheelchairsUsedasSeatsinMotorVehicles.pdf

(See page 4)

Risk Summary (3/4): Standard Wheelchairs

Standard wheelchairs present significant risk when used to transport patients. Standard wheelchairs are not designed to keep a passenger safe in a collision and even fail to protect patients in everyday driving conditions. Standard wheelchairs also do nothing to keep patients from falling out of the chair while rolling outside a vehicle. Serious risk is also introduced in the process of moving patients in and out of a chair, for both the patient and the transporters.

  1. Transfer – Significant risk is presented as two individuals must lift a patient from the bed to the wheelchair. This introduces the possibility of the patient being dropped during the transfer or injuries being aggravated by the cumbersome transfer process. Likewise, those performing the transfer are at risk of back or other injury by virtue of repeated lifting of patients into wheelchairs. Especially with bariatric patients, backs and joints are strained with vertical lifting and body contortions involved in accommodating patients needs.
  2. Lifting Equipment – No particular risk is involved due to equipment. In wheelchair transfers no lifting or adjustments are typically required.
  3. Transit to Vehicle – Significant risk to the patient is presented when moving him/her to the vehicle. Standard wheelchairs offer nothing to ensure the patient remains seated. Significant injuries regularly occur from patients falling out of standard wheelchairs while being moved to the vehicle. Especially for patients who have trouble holding themselves upright, standard wheelchairs are dangerously inadequate.
  4. Loading in Vehicle – With a rear-entry ramp or a vehicle lift, wheelchairs are easily loaded into a vehicle without significant risk of injury when equipment is used properly.
  5. Riding in Vehicle – Standard wheelchairs present two significant dangers to patients when riding in a vehicle. First, patients are not secured to the wheelchair which allows them to fall out of the chair in even subtle braking or turning events. Even when using vehicle safety belts, patients who have trouble holding themselves upright can slip or “submarine” beneath belts during the regular course of driving. Standard wheelchairs do little to nothing to mitigate this risk. Second, wheelchairs are extremely dangerous for patients in collision events. Standard wheelchairs are not designed to maintain their integrity in a vehicle collision resulting in unpredictable injuries as they fall, break, collapse, or lose their passenger. While RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) has established WC18 standards to improve wheelchair safety in vehicles by using approved and tested securement systems, the safety WC18 offers is limited by the design and strength of the wheelchair itself. To this end, RESNA has introduced WC19, a better standard which requires wheelchair manufacturers to build chairs to protect passengers in the event of an impact.

Risks to Patient

Drop Risk

Lifting a patient out of bed to be placed into the chair poses serious risk of dropping the patient.

Fall Risk

Significant risk of the unsecured patient slipping or falling out of the wheelchair is present as the wheelchair is moved from the bedside to the vehicle.

Patients are at risk of falling out of the chair or slipping beneath safety belts during normal driving and especially in rough braking or turning events.

Crash Risk

Patients in standard wheelchairs are at significantly higher risk of injury or death due to a crash.

Advantages to Patient

No Lifting of Equipment

Patient is not at risk of being dropped or tipping while being loaded into the vehicle.

Risks to Transporter

Lifting

Lifting patients from bed to wheelchair poses repeated risk of back and other injuries during transfer.

Advantages to Transporter

Vehicle Lift/Ramp

Wheelchair lifts and ramps on vehicles eliminate the needs for vertical lifting and risk of back injury.

Method 4 of 4: Ambulatory Transports

Risk Summary (4/4): Ambulatory

Strong and healthy passengers can and should travel safely by walking to a vehicle and riding with a seat belt. However, serious risk is introduced when weaker patients are required to get themselves out of bed, walk themselves to a vehicle, and climb inside a vehicle (which in the case of medical transport vehicles, may often be elevated).

  1. Transfer – For ambulatory patients, there is risk of falling when getting in and out of bed, especially when patients have trouble with mobility or clinical needs which interfere with regular movement.
  2. Lifting Equipment – Since no equipment is involved for ambulatory patients, lifting and adjusting equipment is not a risk factor.
  3. Transit to Vehicle – Walking to a vehicle can be a simple process and also a dangerous process when patients have trouble walking. Falling is a regular risk factor for ambulatory patients as they move from a bed to a vehicle.
  4. Loading in Vehicle – Risk of falling is also a persistent risk factor for patients as they enter a vehicle. Patients with limited mobility, wounds, and other needs are at increased risk of falling while entering vehicles.
  5. Riding in Vehicle – Ambulatory patients, when wearing a safety belt, are in the optimal situation as far as vehicle safety is concerned. There is no safer way to travel than while being secured in a vehicle seat with a vehicle safety belt.

Risks to Patient

Fall Risk

Especially for patients with limited mobility:

  • Risk of falling when getting in and out of bed.
  • Risk of falling out of chair while walking to vehicle.
  • Risk of falling while entering vehicle.

Advantages to Patient

Vehicle Seat Belt

Riding with a vehicle seat belt is the safest way to travel in a vehicle.

Risks to Transporter

Minimal Risk Assisting Patient

Staff is at little risk when transporting ambulatory patients who walk without assistance. Risk can be introduced when patients require assistance getting out of bed, walking to the vehicle, and loading into the vehicle–particularly in cases with heavier patients.

Advantages to Transporter

No Lifting of Equipment

With no equipment involved, staff is at no risk of injury due to lifting and adjusting a gurney.

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