How to Make Up The Stretcher

Okay, new partner, here’s how I like my stretcher made up:

A clean sheet tucked under all sides, but not necessarily tied. A hospital chuck folded across the middle of the stretcher and tucked in. By the foot, I want a wool blanket, a bath blanket, a sheet, and a Johnny top (hospital gown). By the head, a pillow ( with fresh case) and a towel.

I want the bottom sheet tucked in, but not tied because if it is tied, it will be harder for you to take off, and if it is harder for you to take off, then you may be more apt to just leave it on there for the next patient, cleaning the used sheet by brushing off any dirt with your gloved hand, rather than putting down a fresh sheet.

Sure, I have been guilty of using the same bottom sheet from one patient to the next, but I want you to be a good EMT today. And if you are a good EMT, it will reflect well on me.

Once we meet the patient, depending on their condition – if I am going to be doing a 12-lead ECG, listening carefully to their lungs, or putting in an IV, then if convenient, I try to get them to take off whatever they are wearing for a top and clothe them in a fresh hospital gown. If the patient is female, I will try to have a female relative, friend or a medical person help them change. Sometimes I will hold the gown up like a curtain and let them change themselves and then slip their arms into the gown. Sometimes I do the change on scene, sometimes I wait until we are in the ambulance. The reasons for the gown are to enable me to do a better exam, make doing a 12-lead easier, and sometimes just to get them out of their damp or dirty clothes and into something fresh and clean. It also spares them from having to be undressed at the ED and snaking the IV bag through their clothes. The only cases where I remove the bottom portion of their clothes are trauma, childbirth, a definite STEMI (in a STEMI this step speeds time in the ED and enables quicker access to the groin for cath lab cannulation), or if their clothes are so damp or soiled as to be a threat to the patient.

When it is time for the patient to sit or be placed on the stretcher, I will have you take the second sheet and spread it open on top of the first (tucked in) sheet, with the sides dangling down so once the patient is on the sheet, we can each grab a side of the sheet, and adjust the patient to the most comfortable position.

I often fluff the pillow before they lay their head on it. It is a silly gesture, but one appreciated by the patient. Sometimes I apologize for no chocolates. I may finger you as the culprit – a little humor to lighten the mood.

Once on the gurney, the patient is then covered with both the sides of the sheet and a bath blanket. If it is cold enough, the wool blanket goes on top. The patient is then belted to the stretcher. I use three straps. I admit I am not fond of the shoulder straps and make a resolution to use them more often. They are excellent for holding a patient in place, but like the top strap, they are usually always undone by me to allow access to the patient during care. I need to remember to reconnect them once transport starts. Safety first.

The final item – the towel. This — particularly in winter or foul rainy weather—I use to wrap around the patient’s head to keep them warm and dry. If someone says our patient now looks like Mother Theresa, that’s a good thing.

5 Comments

  • McGruber says:

    Sometimes I forget how difficult we paramedics can be to work with. Everyone likes to do things their own way, and most will accept no substitute. I have my own little things that I insist on as well (electrodes pre-attached to the cables?), but I know there are others that absolutely must have it some other way.

    Are there any preferences your EMT partners have with which you must comply?

  • medicscribe says:

    Ah, McGruber, you are so right. I think it is particuarly hard for EMTs who work regularly with different partners. Years ago paramedics got to pick their own partner, which was great. Then, they went to shift bidding and people often got stuck with partners they hated. Where I work now in a contract town, I work with volunteers and it can be difficult for all of us. In one week I can have seven or eight different partners. They all put things away differently. I like to keep a blood pressure cuff on the bench and also I always keep the portable 02 open. Change partners, do a call and I can’t find the blood pressure cuff and I look like an idiot for putting a cannula on setting it at 4 lpm, only to find later the 02 tank has been shut off.

    I am very much a dictator when it comes to how I like things when it comes to patient care and how we work a call. Here is what I do do for my partners. My partner drives and I don’t back seat drive or tell him how to go, unless he doesn’t know where he is going and asks for directions or is driving like a maniac. Also, I rarely, if ever, raise my voice or say anything critical.

    Thanks again for the comments. I may elaborate more into a new post on this. Interesting topic.

  • Cs says:

    I keep it simple. One sheet over the matress, and no more then three sheets or in cold weather 2 sheets and one blanket. I work downtown and taking a ton of sheets off the back only makes a mess. I don’t like putting the sheets on the mattress as many patients walk but then sit on the liter and it only creates more things to move.

  • BadgerMedic says:

    Overheard in the bay: “If they need a pillow, they can take a cab.”

    I hate this kind of thinking. Just put yourself in your patient’s shoes for a second. I was taught that he next patient you run could be someone you know – and I bet you will make darn sure that THEY have all the pillows/blankets/clean sheets that they need. The environmental consideration to me is really important – especially when it’s cold outside. Having enough blankets to keep the patients temperature up (especially the elderly), and keeping things dry when it isn’t outside. If it’s snowing, keep in mind that on first glance you can’t necessarily see the snow that has fallen on a WHITE sheet while you left your stretcher outside the door while you went inside to see your patient… or that the sheets are now soaked from the rain that has been falling and even if you put another sheet down, it’ll soak through it to the patients clothing in no time. It always amazes me the people that don’t carry enough blankets/sheets etc, then have the patient put on a heavy coat before leaving the house to stay warm. (When the patient arrives at the ED still dressed in the same coat they left the house in, it had to have been a pretty thorough exam, huh?)

  • I don’t think that the shoulder straps do a lot to hold patients on the stretcher. I’m not sure that they are even applied properly in most cases. I DO think that they were introduced based on anecdote and not science of any sort.

    The pillows we get are essentially unusable. I’ll roll up a sheet or towel and put it behind the patient because that works much better.

    I think that at about 60 degrees, bath blankets or even those “thermal” cotton blankets are pretty useless. Sick patients, unless they are septic, are almost always somewhat hypothermic. I want to keep them as warm as possible, so I want them in a wool blanket. I’m forever annoying BLS crews about blankets and warmth. Tough, if they don’t do it right, they are going to hear about it.

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