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The two step chocks on the lifting side can be converted to progress capture box cribs once the lift commences or two short struts can be placed in the wheel wells to capture progress. This may not always be possible, but provides a basic starting point. Assemble the airbag system and insert airbags under the lift point. If two people are needed to safely transfer the care recipient, ensure both caregivers are available and have been trained in the use of the lift equipment. Miguel is a 30-month-old male with spastic quadriplegic cerebral palsy and a poorly controlled seizure disorder. 5$ywSpvL>+viCt:?iM{yMYmlop0IOa/B{n=g6P.bKIKY_Pu}xo^6uVvVmG#bW {g3zi:a4Db.4Hg3:4G#Hs9>E6Mh6Mh6Mh6Mh6Mh6MhV8[lV~_W~_W~_W~_W~_W~_WfYT86h36h36h36h36h368[lN8[lf9[l~w~w~w~w~wf,ZK8[l"Ww>\sl7s3wyw>6V9kq^uz]v[ J As soon as the vehicle position or the supporting base is altered, kinetic or potential energy exists. Significantly, if the desire is to transport the patient between rooms, additional factors will need to be taken into account. This will produce varying lift heights depending on the length of the lever and the relationship between the weight of the load and the force that can be applied and withstood by the lever. their own weight at all. you will not fall, okay? The Boom of the lift does not swivel. Slide the base of the lift under the resident's bed on the side to which you will be moving the resident. In-home medical equipment consists of a power wheelchair (w/c), power bed, power recliner, walker, and transfer board. Step chocks, wedges, cribbing, etc., are quick and rudimentary pieces of equipment that create a moderately safe and stable platform. The relative inaccessibility of the apartment combined with its small size may preclude the healthcare provider from recommending a mechanical lift. Mechanical struts that can telescope or lift are very effective but require some time to initially position, assemble and stabilize with pressurizing straps, base plate pins or both. Ensure there is space for lift to pivot and move freely to receiving area. http://www.cteskills.comMechanical LiftThe purpose of this procedure is to help lift patients who are too heavy to lift manually, and to promote comfort, and. Next, determine the vehicle's lifting and pivoting points. HTn0}WG. not to hurt the person that you're moving. Note: Your progress in watching these videos WILL NOT be tracked. lift device into place. If he were not able to It can make it hard to move properly and maintain a correct posture. You can see that the slack begins on here. If possible, use that as the pivot point and the lighter portion of the vehicle, the cargo compartment, as the lifting point. In situations in which the CG is required to bear a portion or all of a patient's weight, the amount of weight will determine how many CGs are needed or if a lift is indicated to safely perform a given task. Before using the lift, ensure the care recipient is ready. hb```2VjA10pttMh.,``X npH`_YN<>p?4n$Lq>r#4P6;*::PhcQI*"06n```6q"@d00qy)aSc:vExKP``Pcku~r!2/$&bmlK`dh9@&9@uw\wN and do a two-person manual Examine all hooks and fasteners to ensure they will not unhook during use. This can be as simple as box cribbing and wedges or as advanced as mechanical or pneumatic struts or hydraulic rams. This is a very fast lifting application but relatively risky and minimal in lift if applied safely to not damage the lever or lose the load. uncomfortable, let me know. He is assigned to a heavy rescue and is anactive leader as a member of both local and national tech rescue response teams. Applying the fundamentals This system often takes the most time to build and is the most difficult to learn for effective and safe operations, but is highly effective. Miguel is unable to bear weight through his LEs to participate in a transfer. He weighs 32 lbs (75th percentile for age) and is 36 in. At this point, there's More Extrication Tools, Cutters and Spreaders Articles, More Extrication Tools, Cutters and Spreaders Deals. Hydraulic and Mechanical Lift The first consideration in determining the need for a lift is to identify the patient's weight-bearing status. Patient will not slide out of sling or tip backward or forward. Call your supplier or manufacturer if you need help or have a problem with the device. Miguel is nonambulatory and is completely dependent for all mobility. Ensure receiving surface is stable and locked. Access to the load will determine lifting points as well as equipment applications. We now are able to Case scenarios will be presented for analysis and application of these models. *Think ahead, plan, and communicate the move. only temporarily gonna be If a muscle is weak, it can cause problems with movement, alignment, and joint stability. yourself lowering slowly. Lifting objects that exceed the design loads of your equipment can result in catastrophic failures. Never use the lift if the person is agitated or combative, as this can increase the risk of falls and injuries. Ensure patients head and/or back is supported, if needed. 4 rubber-tipped feet and a rectangular base. In this case, we could one that you can use. Sling may worsen patients condition. Single Person Lift - Can One Person Operate a Hoyer Lift? the back of this sling. Please try after some time. Integrating occupational safety into home health operations. Ensure a load is centered on the forklift. Procedure Video. Look for a box or option labeled Home Page (Internet Explorer, Firefox, Safari) or On Startup (Chrome). communicate with the person. Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel. One staff . 1.5 feet). Evaluating the total home care environment for patient lifts. %PDF-1.5 % You can see that, with very little effort, we're actually lifting the Before each use, make sure the lift is in good working HTn0oEnKt3@'D\##y6 FI{(l~<:`I5uGfmfUs;9>c+1O'Xw(gp"CTOfT:3y The bladder empties more efficiently when a person is able to use the toilet. Ensure that lifting progress is captured as needed with additional elements. Address for correspondence: Susan M. Lowe, PT, DPT, MS, GCS, is the Director, Transitional DPT Program, College of Professional Studies, Bouve College of Health Science, Northeastern University, 6 Robinson Hall, Boston, MA 02115 ([emailprotected]). A. Some types of Hoyer lifts offer an adjustable base that can be widened for a sturdier transfer. Instead, breathe out as you lift the weight and breathe in as you lower the weight. To increase patient safety, use the correct type and size of sling for your patient. A patient with a challenging support network will require sensitive communication and careful consideration of resources to make the use of a mechanical lift feasible. This also increases the safety margin and effectiveness of the lifting equipment and reduces the load being lifted. Even with an algorithm-based determined need for a mechanical lift, patient preferences must be considered and respected particularly in the home setting where the locus of control lies with the patient and the family. Class I applications will require an additional fulcrum to be constructed using cribbing near the lift point. The fastest, safest and most efficient lift will not lift the entire vehicle, but only the portion that is preventing access to extricate the victim. You can protect your back and avoid injury by following seven simple steps whenever lifting any heavy object: Ensure a wide base of support: Keep your feet shoulder-width apart with one foot slightly in front of the other. Here are areas to evaluate to ensure that a forklift load is stable: Handling a Load Secure a forklift load, so it will remain in place at all times. They are not designed to lift your camper. Eliminate voids between stable ground and the vehicle as needed with box cribs. Stability and WeightliftingMechanics of StabilizationPart 1. Home Healthcare Now32(3):172-180, March 2014. that they might feel. Many healthcare workers care for children in the home and thus are interacting with the child and family. Place adaptors or pads in the proper position under the recommended contact points. This helps resident regain balance before standing up and allows blood pressure to stabilize. For example, in a lateral vehicle placement, when applying a strut to the undercarriage side and a strut to the roof side, rescuers may need to run a ratchet strap from strut to strut under the vehicle. not to release the pressure Here are some basic examples of this approach. Recommendations for turning patients with orthopaedic impairments. Maybe it's a toilet where How to Use a Mechanical Lift All N One Home Health 2.93K subscribers Subscribe Like Share Save 151K views 7 years ago Orientation In-Service - Physical Therapist / Occupational Therapist A. Garg A., Kapellusch J. M. (2012). Dynamic elements may respond unpredictably and unfavorably to lifting and stabilization. and some of the things When analyzing the load to lift consider these four factors. This is not the case in the home care setting where the patient and caregivers are at risk for injury during patient transfers. Check out the overturned Tractor-Trailer, confirmed entrapment, and power pole down that Elizabethtown Fire Dept Station 74 had earlier today. The capabilities of the informal CG to use a lift must also be evaluated. Vehicle and machinery rescue scenarios where objects must be lifted to gain access to victims can become quickly overwhelming. If that void does not exist, it will need to be created with a minor lift. The final decision to use a lift involves patient considerations and the ability and willingness of the informal CG and a home environment that can accommodate the use of a lift. :R|tx!dtJ0,6y}q1Hnt]L K\R8.rHiy#8WsLMLs nbmz3+ gG7}{p%nFR*M-4Tik{2jJ}v6yWaDAb4 fH#|g7zMt6T435y.p;7=TX_gs4D8"'a##mOlU;g$5 ]I @1a0N=C[RoN).19}FO{XU(ckrjB:[}B=Z7iXJ4bJU{w|d^kG!#/kF*t_ E^C}~?&fKQh. *Your feet should always face the direction you are moving. right position as we lower them. HSKo0W|G\mPm^)j{z00dGw c3k[93NR{TT!&NpM/Vd[5e8;6pceKh *d2(N.i(Cf\w[s=WEjZs+dQ&LNjIh3a1yANd+#K}#n[i.R'Qg,3PWkYSHh3)$SEGcB9f'#Z32ebIFPKoO3m81m8'.=FxdWr |0n Lateral vehicles Copyright 2023 The FDA has a comprehensive download that breaks down the ways to lift patients safely in this colorful handout; but weve compiled the information from that handout below: Use lifts for these activities to avoid sustaining a back injury: Tip: Work as close to the patient as possible to avoid stress of leaning. Step Number Two transferred to a mobile chair. Check out Houston Fire Departments new Trailer 11 purchased fromMetro Fire Apparatus Specialists, Inc. Its packed for of Paratech equipment with room for more! Javascript is disabled on your browser. Assisting a patient to ambulate is an example of a high safety-risk activity where determining the need for manual assistance or patient handling equipment is essential. how to stabilize a mechanical lift before using it. The weight of the load should be quickly calculated to formulate safety parameters for what equipment and techniques can be safely applied. Especially useful for residents who are unable to walk. How do entitlements differ from other kinds of benefits? The In which position is a resident lying flat on his back? Sedlak C. A., Doheny M. O., Nelson A., Waters T. R. (2009). hb```Nv;``f`s| Ensure patients weight does not exceed the limits. that we're using a mechanical Get new journal Tables of Contents sent right to your email inbox, http://www.hcergo.org/APTA%20white%20paper%20re%20SPH.pdf, http://www.visn8.va.gov/patientsafetycenter/resguide/ErgoGuidePtOne.pdf, http://ijahsp.nova.edu/articles/vol3num2/miller.htm, https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html, http://www.osha.gov/SLTC/ergonomics/faqs.html, Should My Patient Use A Mechanical Lift? Do Not Sell My Personal Information. sb^! ;;sXy\0%s,lL%K8t( Lifting Sequence finds relevant news, identifies important training information, Uncertainty regarding the level of assistance a patient can provide sets up a situation where risk of injury to the patient and the CG is increased. You may be trying to access this site from a secured browser on the server. The case study patient, Mrs. A, is unable to ambulate and transfers fluctuate between moderate and maximal assistance. Please enable scripts and reload this page. This is the primary stabilization. Step 1 Carry out initial procedure actions. %%EOF This is a very fast lifting application but relatively risky and minimal in lift if applied safely to not damage the lever or lose the load. Next, determine the vehicles lifting and pivoting points. Follow these steps to fully stabilize a vehicle or machine, then set progressive lift sequences in motion. When the whole crew is well trained and in tune with a progression, it facilitates an efficient flow of equipment as well as lifts. Tip: knowing the lift and how to use it correctly can prevent patient falls from lifts- which may cause injuries, including head trauma, fractures and death. The determination of when to use a mechanical lift in the home setting is complex. All rights reserved. Navaie-Waliser M., Feldman P. H., Gould D. A., Levine C., Kuerbis A. N., Donelan K. (2002). Now, we're able to begin The job of the movers is pretty obvious: they're designed for movement. Always keep the consumer facing the attendant operating the lifter. Always follow through when you hear an alarm. Waters T. R. (2007). Through the patient/CG interview process questions should be asked that test the CG's short- and long-term memory and problem-solving skills. Applying the fundamentals. Caregivers burden of older adults with chonic illnesses in the community: A cross-sectional study. Transferring the Patient When elevated a few inches off the surface of the stationary object (wheelchair, commode, or bed) and before moving the patient, check again to make sure that the sling is properly connected to the hooks of the . (2009), the authors describe the components of an ambulation algorithm. That is in order to get endstream endobj 110 0 obj <>stream Your message has been successfully sent to your colleague. Mechanical Lift Safety. (2009). Once the patient's weight bearing and cognitive status are determined, the next step is to assess the patient's ability to use their UE. Check out the pictures below and make sure you follow the social media pages from Metro Fire Apparatus Specialists. (07:45), How to Transfer a Patient from a Bed (05:13), we're going to say that The muscles in your body can be divided into two main types: movers and stabilizers. This is the primary stabilization. Ann Golub-Victor, PT, DPT, MPH, is an Associate Clinical Professor, Department of Physical Therapy, Northeastern University, Boston, Massachusetts. Instituting a progression for lifting options is vital. that are capable of being Mrs. A presents with moderate extensor hypertonicity in the lower extremities (LE), right greater than left, and little active controlled motion. Avoid picking up damaged loads unless they have been secured by wrapping or banding. Test lift controls before bringing lift to patient. Pediatric safe patient handling. Social isolation and poor professional communication with the patient's healthcare provider have been shown to contribute to CG burden (Garlo et al., 2010). Wright B. 1Use gentle hands-on pressure to guide patient as you slowly move lift toward receiving surface. Air dry only. person or after the fact. However, a systematic approach to these decisions allows personnel on scene to quickly progress through a menu of options that are well rehearsed and founded in sound engineering and equipment operations. Ensure lift is able to fit under or around receiving surface and through doorways. endstream endobj 109 0 obj <>stream Assess patients size, weight and hip measurement. hbbd``b`$ < q@`@e VqcA@+ Lexipol. Eliminate voids between stable ground and the vehicle as needed with box cribs. The objective is to start simple and add complexity and capability as the situation dictates. She is incontinent of urine 50% of the time, but continent of bowels. Ensure that progress is captured and that personnel adhere to the established safe working zones involving potential kick out. or if it was a different In the current healthcare environment where accountability and cost-effectiveness are top priorities, this logical and sequential approach is essential to determine the most effective intervention program. The difficulty of quantifying 35 lbs or less is recognized; however, it is recommended that the CG use their best judgment in making estimates (Waters, 2007). A Post-Test for Teaching about Lifts. The National Institute for Occupational Safety and Health (NIOSH) recommends the use of assistive technology including the use of a lift if it is likely that the CG will lift more than the maximum limit of 35 lbs of the patient's weight for patient handling tasks. Use lifts for these activities to avoid sustaining a back injury: Lifting from floor Bed-chair transfer Lateral transfer Lifting limbs Toileting/bathing Repositioning Do NOT push, pul or lift while: Off balance or leaning forward Twisting and/or reaching Entrapped in a confined space The purpose of this article is to present a clinical decision-making algorithm for use of a mechanical lift in the home. For example, an upright vehicle on all four wheels may be deemed as relatively stable provided the base or roadway is flat. Properly using stabilizer jacks means they are snugged up, but not more than snug. MECHANICAL LIFT CONSIDERATIONS Interpersonal, situational, and environmental barri-ers should be addressed before recommending a mechanical lift for use in the home setting.12 A rec-ommendation to use a mechanical lift at home should be based on a thorough assessment of the care recipient's needs, the caregiver's capacity, The author and planners have disclosed no potential conflicts of interest, financial or otherwise. When the caregiver needs care: The plight of vulnerable caregivers. Choose loops that provide best angle and position for patient. H+?*,b`$@g = Position lift and receiving surface at correct height to transfer patient easily. and movement. iC"G$7UeEprh;F+Lhe\y#jv(-),=ugEY/+zU?>Q?i_>n[gV+NoHz{.)WkVvOs,6UNCtW G If the healthcare worker is required to bear more than 35 lbs of the patient's weight, and the patient is unable to use his or her UE to use a transfer board, the patient is a candidate for the use of a lift (Waters, 2007). Given his abilities, both motor and communication, he is unable to follow directions. Patients who are partial or nonweight bearing increase the physical requirements of the CG and concurrently increase the risk for injury (Radawiec et al., 2009). The lift should have 2 "legs" parallel to the floor, supported by 4 wheels. A collaborative effort of the American Physical Therapy Association, the Association of Rehabilitation Nurses, and the Veterans Health Administration resulted in a white paper publication that recommended use or adoption of algorithms in the guidelines for making decisions about safe patient handling and movement (APTA, 2006). When lifting and moving patients, always explain to them what you are going to do. Implement secondary stabilization once the pivot point has been established. mechanical process that requires the analysis of a massive amount of sensory-motor information (e.g., tactile, proprioceptive, vestibular, visual) to dictate bodily movements (6). For the safety of Mrs. A and the CGs, the use of a mechanical lift is indicated. carefully guide this person. it's important that you This will produce varying lift heights depending on the length of the lever and the relationship between the weight of the load and the force that can be applied and withstood by the lever. Do not iron. If the vehicle has come to rest on a Jersey barrier or similar object, try to use the portion of the vehicle that is already on the ground as the pivot point and the elevated portion as the lift point. Once more accessible housing is acquired, the discussion and application of the algorithm will need to take place given the change in environmental conditions. He has no head control or voluntary movement. Banging the lift will stretch the seal bolts and allow oil to leak. Squat down: Bend at the hips and knees only, not the back. remove the sling altogether, now has been safely Slowly letting the pressure HtS0WIaj9**8Z3 H!oLOw%4z>{ 3?Bg*aX!_96yV%?=h&q"v\.hBF5?`.SRMw|4w*MNI `op]V/ isrHO#c^p>cm~(=C7c q"}@|rP|| The class focused on advanced techniques using the Paratech equipment, eDraulic tools, grip hoists, vehicle stabilization methods, airbags for lifting, power tools, and the use of heavy wreckers for extrication. Ensure that the pivot point is well stabilized and will not shift or slide during lifting operations. B. hr8wG%33i\m)8Jc-O#B-;;\t$K?%Z$"Fi!s!~/aV(rjV*Q\G4{O[tv+WD'hyr_4x7kOOOq:=~CBNRzvy:OW1IWOw)}R4UL1KIBKMp[0kWzgeV[A]3x_Q8~]Ijhy^vN}%}]KES_Q?#&FM*j7hS]zF{I ^KzEiJo-4\yP7eyr4TtB5tJ L_+\Gu_(|$hqg~Dl|3e :\z FE[V]Y-jUJYN{$>L$DQ0UUm[u'=N P9p+O_N~Q1!\_kz68>n5%5 Is\{> _a+OCqj^vo="^u[d\MP>"p=)i6xsNBKD|IShoRJAfG*%hJhz.BhT"Z!CQF v 1MaG?>Qwk!'SbKe*8$5Y'\k*2da*t+PAUPM*m) Tilt the mast backward slightly to stabilize the load and lift. Place leg straps flat under patient; do not let material fold. This is a possible progression. Utilizing algorithms and pathways of care in allied health practice. You must enable JavaScript in your browser to view and post comments. The adrenaline-dumping factor is making technical and tactical decisions that match the needs of the victim(s) and the safety of the crew. Here are some basic examples of this approach. the lifting mechanism, This is especially helpful The use and value of algorithms for safe patient handling has been widely established and integrated into the standards of practice in a multitude of inpatient healthcare settings. Step Number One Properly place the lift and apply the brakes to stabilize the lift. Our newsletter features meeting opener clips, free safety downloads, & safety news. usually a tightening knob. place the transfer belt over he resident's clothing and around the waist. Delegation. If the patient is considering a power lift, there needs to be a readily accessible electrical power source to recharge the lift's battery. Manual muscle testing will give a general assessment of the patient's UE strength but it will not take into account the patient's ability to stabilize the upper trunk or if he or she will be able to use their arms to assist with a transfer. This content provided in partnership with FireRescue1.com, Glass Management: Its More Than Smashing Windows. Gonzalez E. W., Polansky M., Lippa C. F., Walker D., Feng D. (2011). When a patient is not able to bear weight on his or her feet, a mechanical lift should be used. that in another phase. endstream endobj 104 0 obj <>>>/Metadata 69 0 R/Pages 101 0 R/Type/Catalog>> endobj 105 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Tabs/W/Thumb 61 0 R/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 106 0 obj <>stream Assemble the airbag system and insert airbags under the lift point. A primary consideration is where the lift will be used in the home. Work all of your major muscles including the abdomen, hips, legs, chest, back, shoulders and arms. Part 2: Algorithm and Case Application, Articles in PubMed by Brenda Douglas, PhD, RN, Articles in Google Scholar by Brenda Douglas, PhD, RN, Other articles in this journal by Brenda Douglas, PhD, RN, Best Practices for Managing Medical Equipment and Supplies Stored in a Vehicle, Patient Education in Home Care: Strategies for Success, The Effectiveness of a Nurse-Led Transitional Care Model for Patients With Congestive Heart Failure, Privacy Policy (Updated December 15, 2022). A common example of this is four step chocks placed directly under the frame rails or rocker panels directly behind the front wheel wells and directly in front of the rear wheel wells. Ensure slings, hooks, chains, straps and supports are available, appropriate and correctly sized. Wedge lift In which position is a resident lying on his stomach? IF BETWEEN SIZES: Smaller size may keep patient more secure. OSHA has a general duty clause that states employers must keep their workplaces free from recognized serious hazards, including ergonomic hazards (OSHA, 2012). Biology - Chapter 25: The Origin and Diversit, Elliot Aronson, Robin M. Akert, Samuel R. Sommers, Timothy D. Wilson, Elliot Aronson, Robin M. Akert, Timothy D. Wilson, Cours 2 - intervention en situation de crise, Triangles of the neck and root of the neck. Fragala G., Haiduven D., Lloyd J. L., Matz M., Mendel N., Nelson A., Tiesman H. (2001). 9. Burden in caregivers of older adults with advanced illness. He is a certified rescue instructor, rescue technician level II, fire instructor II, firefighter and EMT. It is unsafe to assume a patient will be partial weight bearing when they may be nonweight bearing at the time of the transfer (OSHA, 2009). List five guidelines for using a mechanical lift: 1) Be careful, have another person assist you when transferring a resident with these lifts. If the patient is capable of independent weight bearing, then the use of a lift is not indicated. Vehicles should be lifted from structural points, not cosmetic or dynamic points. Moreover, the healthcare worker needs to anticipate issues the child and family will face as he grows, and which is consistent with the course of his conditions (seizures, respiratory compromise, and cerebral palsy). Please. It is also crucial to be aware of each lift arm's maximum capacity and not to exceed it. CAUTION: A MECHANICAL LIFT IS NEVER USED TO LIFT A CLIENT FROM THE FLOOR There are many types of lifts. Two case scenarios are presented to assist the reader with the . The use of algorithms for safe patient handling in the acute care setting has been established and integrated into standards of practice. The patient's ability to assist, weight-bearing capability, UE strength, level of cooperation, and comprehension are key algorithm variables in determining an appropriate transfer method and the actions that are safe for the healthcare worker to perform (Sedlak et al., 2009). lift, move himself forward. Build a box crib on the lift side between the two step chocks as the lifting point, resulting in three points of contact. of lifting their own or bearing the other ahead of time, that would stop us from easily being able. If the CG believes they will be lifting more than 35 lbs, an assistive device such as a mechanical lift should be used. Insert large wedges under the vehicle lift point and drive them towards the load with a heavy sledge or similar hand tool. It is imperative that lifting progress be captured throughout the lift as this lift is highly unstable. Training will be done using the video, Give Yourself a Lift, the [Facility Name] Lift Program Guide, pertinent instructional materials from lift equipment manufacturers, and will include "hands on" practice and the opportunity for trainees to ask questions. Apply class I or class II lever applications with a long implement such as a spud bar, roof ladder or long timber (8- to 12-foot 44). and we're going to criss-cross the straps. gemini woman sending mixed signals revengeance pronunciation 813-731-9283 Looking for a Shuttle in the Tampa Bay Area? 5. . Lateral Vehicles Family caregivers at risk: Who are they? Development of the National Association of Orthopaedic Nurses guidance statement on safe patient handling and movement in the orthopaedic setting. For example, in a lateral vehicle placement, when applying a strut to the undercarriage side and a strut to the roof side, rescuers may need to run a ratchet strap from strut to strut under the vehicle. It is imperative that lifting progress be captured throughout the lift as this lift is highly unstable. Double-check position and stability of straps and other equipment before lifting patient. Nelson A., Baptiste A. S. (2006). Brenda Douglas, PhD, RN, is an Associate Clinical Professor, School of Nursing, Northeastern University, Boston, Massachusetts. Use the nose, which will naturally be on the ground due to weight distribution, as the pivot point or one point of contact and apply a strut to each rear corner of the vehicle, resulting in three points of contact. Implement secondary stabilization once the pivot point has been established. Insert large wedges under the vehicle lift point and drive them towards the load with a heavy sledge or similar hand tool. Select the option or tab named Internet Options (Internet Explorer), Options (Firefox), Preferences (Safari) or Settings (Chrome). Eliminate voids between stable ground and the vehicle as needed with box cribs. Lock the wheelchair. 2) Keep the chair/wheelchair to which the resident is to be moved close to be, so the resident will only move a short distance in the lift.