Resuscitation Council (UK)

Guidance for
safer handling
during
resuscitation
in healthcare
settings

Working Group of the

Resuscitation Council (UK)

November
2009

Resuscitation Council (UK)

Guidance for safer handling

during resuscitation
in healthcare settings

Working Group of the Resuscitation Council (UK)

November 2009
Review date: 2014 (or earlier if necessary)

Published by the Resuscitation Council (UK)

5th Floor, Tavistock House North
Tavistock Square
London WC1H 9HR
Tel: 020 7388 4678

Fax: 020 7383 0773

Registered charity no. 286360

E-mail: [email protected]
Website: www.resus.org.uk

Copyright Resuscitation Council (UK)

No part of this publication may be reproduced without the written permission
of the Resuscitation Council (UK).

Resuscitation Council (UK)

Members of the Working Group

Sara Wright (Chair)

Manual Handling Trainer/Advisor *

Sally Cassar

Manual Handling Trainer/Advisor *

Zo Hayman

Resuscitation Officer

Sarah Iceton

Manual Handling Trainer/Advisor *

Ben King

Resuscitation Officer

Melissa Lovell

Manual Handling Trainer/Advisor *

Sarah Mitchell

Director, Resuscitation Council (UK)

James Pearson-Jenkins

Senior Lecturer in Adult Acute Nursing;

Manual Handling Trainer/Advisor *

* Members of the National Back Exchange

Acknowledgements

The Resuscitation Council (UK) acknowledges the invaluable contributions made by

several people in the preparation of this advisory document. Many individuals have
given their time to review the contents and make suggestions to the Working Group.
Particular thanks go to:
Steve Brindley and Rich Taylor for the illustrations
Mike Betts
Gavin Chambers
Kay James
Mary Muir
Anita Rush
Sara Thomas
Clive Tracey
Executive Committee, Resuscitation Council (UK)

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Contents

Introduction

Background

Glossary of terms

Cardiopulmonary resuscitation on the floor

10

Cardiopulmonary resuscitation on a bed or trolley

16

Dealing with a cardiac arrest in a sitting position

21

Dealing with a cardiac arrest in a bath

25

Dealing with a cardiac arrest in a hydrotherapy pool

26

Cardiopulmonary resuscitation and the bariatric patient

28

References

30

Conflict of interest declaration

31

Useful websites

32

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Introduction

This advisory document is a revision of previous guidance from the Resuscitation

Council (UK) published in Guidance for safer handling during resuscitation in
hospitals (2001). It is aimed at healthcare providers, resuscitation officers and
manual handling advisors involved in resuscitation. It is primarily for adult patients
but may be appropriate for children over 8 years. It cannot provide all the answers
and is unable to cover all possible situations, nor is it intended to replace existing
manual handling procedures written by hospitals, or other establishments, following
full risk assessments; rather it is hoped these principles can be adapted as a
resource to assist in the making of local decisions and guidelines.
The aims of the working group were to:

Identify areas of concern

Provide realistic principles for dealing with manual handling situations which
have been scored using Rapid Entire Body Assessment (REBA)1 and taking
into account the urgency of the cardiac arrest situation (see glossary of terms)

Consider that each healthcare setting will have different facilities and will face
different situations

Minimise the risk to the rescuer as far as is reasonably practicable

Base the recommendations on current safer practice.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Background

Manual handling operations have been defined by the Health and Safety Executive
as any transporting or supporting of a load (including the lifting, putting down,
pushing, pulling, carrying or moving thereof) by hand or by bodily force.2
In 2003/04 an estimated 4.9 million working days (full day equivalent) were lost in
the UK because of back pain caused or made worse by work. It has been identified
that one in four nurses has taken time off as a result of back injury sustained at
work.3
It is estimated that four out of five adults will experience back pain at some stage in
their life.4 Poor manual handling accounts for more than 52% of reported incidents
in the health service.2 Although many injuries to the back are the result of
cumulative stress rather than from an isolated incident, careful and safe manual
handling during resuscitation must be considered at all times.
Cardiorespiratory arrest is seen as the most acute medical emergency faced by
healthcare providers and the speed of response is essential because delays in
providing cardiopulmonary resuscitation (CPR) reduce the chance of survival. In
approximately 80% of adult cases there are clinical signs of deterioration, therefore
cardiorespiratory arrest is a foreseeable event.5 As such, this situation should be
assessed for risk and the outcome of this should lead to plans and provisions being
implemented locally to handle the emergency situation safely as far as is reasonably
practicable. For example, patients who are at risk of cardiac arrest should be on an
appropriate bed type.
In response to the requirements laid down by the Manual Handling Operations
Regulations 1992, manual handling advisors are now employed by most hospitals
and healthcare settings and risk assessments are performed for most situations.2
Moving and handling training is a statutory requirement under the Health and Safety
at Work etc Act 1974 and expanded on in the Management of Health and Safety at
Work Regulations 1992.6, 7 Managers and staff have to consider the working
environment and plans should be in place for dealing with identified medical
emergencies. The principles for moving bariatric patients are the same, however
healthcare settings should have a policy which takes into account the increased risk
and provision of suitable equipment. The term bariatric patient has been used in
this document to describe a patient who is overweight or obese. Resuscitation
guidelines for basic and advanced life support still apply with bariatric patients.
Their weight, body shape and increased tissue mass can make airway
management, CPR and defibrillation technically more difficult.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

A common dilemma is how to manage the patient as they collapse to the floor.
When a patient collapses, the urgency of the situation may distract rescuers from
using safe handling techniques. If the patient is out of reach it is unrealistic to be
able to lower them in a safe manner. Most healthcare settings have developed local
guidance on the management of the falling person.
Whilst this document does not address specific issues (e.g., protection of the
cervical spine), before starting the resuscitation attempt the rescuer must rapidly
and correctly assess the risks to both the patient and the rescuer. This is the first
action in the sequence of events for basic life support (BLS).8 The rescuer must
take into account their own individual capability and experience, and the weight and
build of the patient before handling them. Environmental factors such as space
must also be rapidly assessed. Care must be taken to avoid any injury to the
rescuer during the resuscitation procedure as this may prevent them performing
effective CPR. Within the clinical setting it is likely that additional rescuers will arrive
at the scene rapidly and it may be more appropriate to wait for such help rather than
risk personal injury. In the community, lone workers should refer to their local
policies/guidelines.
Low-friction material devices, e.g., sliding sheets are now widely available and used
commonly. They are especially useful for turning or moving a patient. These should
be readily available and it is recommended that they be kept in strategic areas within
the hospital and other healthcare settings. If space permits they should be kept on,
or next to, the emergency resuscitation trolley, or at the nearest location to this
which is easily identifiable.
Performing chest compressions is physically demanding and may exhaust or strain
the rescuer. Another rescuer should take over CPR about every two minutes to
prevent fatigue.8
This document does not address mechanical hoists because there is a plethora of
appliances being used in practice. There is a statutory duty under the Provision and
Use of Work Equipment Regulations 1998 (PUWER), to train employees in the use
of work equipment and more specifically the Lifting Operations and Lifting
Equipment Regulations 1998 (LOLER) place a duty on employers to ensure that
every lifting operation is planned and prepared properly and carried out by
competent persons.9, 10 The moving and handling of resuscitation training
equipment has also not been addressed. This is beyond the scope of the working
group and is an issue that should be dealt with locally following full risk assessment.
Similarly, local policies should be established for the unique situation of the MRI
scanner. Generic handling procedures, such as how to log-roll a patient and
insertion of sliding sheets should be addressed in staff training sessions. If you are
unfamiliar with these procedures, seek appropriate training and advice. This
document only pertains to safer handling techniques and methods that are specific
to CPR.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Glossary of terms

Kneeling positions:

Neutral position of the wrist:

High Kneeling
[REBA score 2]

No flexion, extension or twisting

Half Kneeling
[REBA score 2]

Innermost: Nearest to the patient

Outermost: Furthest from the patient

Walk stance:
[REBA score 1]
Low Kneeling
[REBA score 2]

An example of
a dynamic stable
base

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Rapid entire body assessment (REBA):

A tool designed to assess postures for risk of work related musculoskeletal
disorders.
REBA score

Risk

Negligible risk

2-3

Low risk

4-7

Medium risk

8 - 10

High risk

11 - 15

Very high risk

Reasonably practicable duties:

It is a statutory duty that the employer must take safety precautions 'so far as is
reasonably practicable'. 6 In this instance, the employer has to weigh up the risks
involved in a particular situation against the costs of removing or reducing the risk.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Aide memoire to safer handling

ASSESS THE SITUATION
Communication
One person co-ordinates the commands.
The commands must be clear, ensuring that people
know who is doing what, when and where.

A commonly accepted command is

Ready? Steady? Move

Stay close to the patient
Ensure you have a stable dynamic base of support.

Avoid twisting
Keep your spine in the neutral position.
Alter your base of support rather than twist your body
to ensure that you face the patient/object straight on.

Maintain your balance

good posture

bad posture

straight spine

C-shaped spine

stable dynamic base

unstable base

close to load

reaching and twisting

[REBA score 4]

[REBA score 9]

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Cardiopulmonary resuscitation on the floor

If a patient is found collapsed on the floor, CPR should be carried out on the floor.
Start CPR as quickly as possible and try to provide the best quality CPR, particularly
chest compressions, that is possible in the circumstances. Do not move the patient
unless there is inherent danger to the patient or rescuers in that location.
If the patient has collapsed in a public area (such as a waiting room) consider the
use of screens to provide some privacy. Alternatively, ask the other patients and
members of the public to leave the area.
If access to the patient is restricted, where possible, move the furniture. If it cannot
be moved quickly and safely it may be necessary to slide the patient horizontally
across the floor to an area that is less restricted. Use sliding sheets to achieve this
to reduce the risk to the rescuers. Poor access to the patient may result in the
rescuers having to twist and bend awkwardly and this may impair the quality of CPR
or risk potential injury to the rescuer.

[REBA score 4]

10

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Chest compressions
It is important that the rescuer minimises twisting their spine and applies force
vertically down from their shoulders. This reduces the risk of injury and makes
compressions more effective.

Kneel in the high kneeling position with your knees shoulder-width apart at the
side of the patients chest

Position your shoulders directly above the patients chest and keep your arms
straight

The force of compressions should come from flexing your hips not from
bending the arms

With hands kept in position, allow the chest to recoil to its fullest extent before
starting the next compression.

Airway management and ventilation

It is important there is sufficient space around the patient to enable rescuers to
manage the airway effectively. Access from behind the head of the patient, as well
as from the side, is required.
Bag-mask ventilation
The two-person technique for bag-mask ventilation is preferable.5

Kneel behind the patients head with your knees shoulder-width apart

Rest back to sit on your heels in the low kneeling position

Keep your back as upright as possible and keep your arms straight while
holding the mask on the patients face.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 11

Resuscitation Council (UK)

Bag-mask ventilation (continued)

Mouth-to-mask

Kneel behind the patients head with your knees shoulder-width apart

Rest back to sit on your heels in the low kneeling position

Bend forwards from your hips and lean down to blow into the mask

Resting your elbows on your legs may offer some support

Using a pocket mask may be less comfortable for the rescuer compared
with bag-mask ventilation.

12

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Airway devices
Supraglottic airway devices (e.g., laryngeal mask airway)

Kneel behind the patients head with your knees shoulder-width apart

Rest back to sit on your heels in the low kneeling position

Place one hand behind the patients head to keep it tilted back

During airway insertion lean forward slightly from your hips.

Tracheal intubation

Kneel behind the patients head with your knees shoulder-width apart

It will be necessary to bend forward considerably, from the hips, in order to see
the vocal cords

Resting your elbows on the floor or widening your knees may provide more
stability

Intubation will require considerably more bending forward than using any of the
supraglottic airway devices

No intubation attempt should take longer than 30 seconds.5

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 13

Resuscitation Council (UK)

Following resuscitation
The safest method of transfer is to use a hoist with a stretcher attachment that
enables direct lifting from the floor because it keeps the patient horizontal. If this is
not available, a hoist and sling may be used as long as this enables direct lifting
from the floor and the following criteria are met:

The hoist sling must provide adequate support to the patients head and trunk

The hoist sling is inserted underneath the patient using either a log-roll
technique or by using sliding sheets if the patient is too unstable to be rolled

During hoisting care is taken to ensure the patients trunk and head remain as
horizontal as possible. A good team approach is vital when managing this
transfer to ensure the safety and comfort of the patient

If the patient re-arrests whilst in the hoist, either continue the transfer onto the
bed or trolley or lower them back to the floor depending on which is the
quickest or easiest

Always use mechanical lifting devices when lifting bariatric patients.

Try to keep the patient horizontal. A head down position increases the risk of
regurgitation and makes ventilation more difficult.
Extra Caution!
The use of the stretcher attachment on a hoist may lower the hoists overall safe
working load. Always check the safe working load of any attachments and never
exceed it.
Alternative mechanical floor lifting devices
If a hoist is not available then the patient can be log rolled onto a solid flat surface
(e.g., a scoop stretcher) and raised with a mechanical lifting cushion. The patient
must be kept in a horizontal position; therefore sufficient staff must be available to
ensure the surface is well balanced on the cushion. Once raised transfer the patient
laterally across onto the receiving bed or trolley using a minimum of four handlers.
Manual lift from floor
Manual lifts from the floor (especially those within confined areas) are high risk.11 A
mechanical lift using a hoist is undoubtedly the safest method of lifting a patient from
the floor. However, if a hoist transfer cannot be achieved, for example if the patient
has collapsed in an area that is inaccessible to a hoist, a manual lifting transfer may
be the only alternative.
Determine the safest method: this should take into consideration the varying heights
of the rescuers, the environment and the optimal positioning of the trolley. The risks
are significantly increased if transferring directly to a bed because a bed is wider
than a trolley. This causes the rescuers to hold the patient further away from their
trunk, which increases the load on their spine.

14

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

This type of transfer is high risk consider it only as a last resort. Make all
individuals involved aware of the risks associated with this transfer and the
physical abilities that will be required of them.
The following is advised:

The transfer must be well planned and all rescuers briefed in total 8 people
will be required to assist

One person co-ordinates the commands and lifting activity; this person is
required to support the head

Ensure that a designated lifting sheet (i.e., a sheet that has been designed for
lifting) is available. A scoop stretcher may be used

Log roll the patient onto the lifting sheet

A minimum of three people are positioned on each side of the patient

[REBA score 11]

An additional person will need to position the trolley under the patient

Each rescuer faces the patient and drops down into the half-kneeling position
(or into a position they feel comfortable in and are able to rise from)

Each rescuer grasps the lifting sheet (or handles if present) with their wrists in
a neutral position

On the command the rescuers stand lifting the patient to approximately waistheight

The patient is transferred onto an appropriately positioned height-adjustable

trolley.

If the resuscitation is unsuccessful, and hoist access is available, hoist the patient
and transfer onto a trolley, bed or directly onto the mortuary trolley.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 15

Resuscitation Council (UK)

Cardiopulmonary resuscitation on a bed or trolley

This is the most likely scenario faced by healthcare providers within the hospital
setting. There are numerous types of beds and trolleys available; therefore, it is
more useful for rapid assessment and intervention, that two categories are
considered. This document addresses the general issues faced in relation to
electrically powered and manually operated beds or trolleys. The use of heightadjustable beds and trolleys with electric profiling frames will eliminate many of the
handling risks faced in the following situations by avoiding poor posture and actual
moving and handling. It is the responsibility of the healthcare provider to ensure that
they are fully familiar with any moving and handling equipment, including beds and
trolleys. Significant injury can occur if individuals who have not received the
relevant training attempt to use these devices.
To enable effective CPR, ensure the patient is supine. Keep a pillow because it
may be needed to optimise the patients position during laryngoscopy and tracheal
intubation.
The following describes the general principles of how to get a patient on an
electrically powered height-adjustable / profiling bed from a semi-reclined position
into a supine position for performing CPR:

Clear the environment of any hazards

Ensure that the brakes are on and, if applicable, bedrails are lowered

Depending on Make / Model / Specifications*, one or two rescuers should use a

dynamic stable based position

With one hand to steady the raised part of the bed and the other to release the
marked CPR handle, the rescuers lower the bed slowly to a horizontal
position. If available, the powered CPR button should be used.

* Some electrically powered beds have controlled release mechanisms; others may
require the rescuer to release the bed while manually supporting the load. In these
cases, be very careful to avoid bad postures, traumatic loadings and trapping
hazards.

16

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

The following describes the general principles of how to get a patient on a manually
operated height-adjustable bed from semi-reclined to supine to enable CPR to be
performed:

Clear the environment of any hazards

Ensure that the brakes are on and, if applicable, bedrails are lowered

If a sliding sheet(s) is in position (i.e. ICU / HDU patient)

-

If a sliding sheet(s) is readily available

-

With the bed at approximately hip-height, grasp the top layer of the sliding
sheet and slide the patient down the bed away from the backrest until
supine
It may be possible to insert this quickly underneath the patients
hips/buttocks by rolling the patient to one side. Use the technique outlined
above to move the patient down the bed away from the backrest

If no sliding sheet is available do NOT use the bed sheet as a sliding aid:
-

Lower the bed to the lowest height

Each rescuer faces the patient and positions themselves on either side of
the bed

The innermost knee of each rescuer rests on the bed whilst their outermost
leg remains on the floor

[REBA score 9]
-

The patients legs are flexed at both knees and hips

Each rescuer grasps behind the back of the knee closest to them. One
hand is placed in the crease of the knee and the other behind the calf

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 17

Resuscitation Council (UK)

On command, the rescuers transfer their body weight backwards towards

their heels pulling the patient with them

Re-position and repeat as necessary

Readjust the height of the bed. The optimal height positions the patient
between the knee and mid-thigh of the person performing chest
compressions

Consider the combined weight of the rescuers and the patient when using
this approach; the total weight must not exceed the manufacturers
guidance or specified safe working load of the bed.

If the patient has had a lower limb amputation, the rescuers handgrips are modified
according to the level of the amputation.
In the event that the resuscitation takes
place on a trolley where there is a
manual pull up backrest, two rescuers
are required to lower the backrest using
safer handling principles.

[REBA score 5]
When resuscitating a patient on a pressure relieving bed or mattress, refer to the
manufacturers instructions. For resuscitation to be effective, a firm surface is
required underneath the patient.

18

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Chest compressions
The optimal height of the bed places the patients chest level between the knee and
mid-thigh of the person performing chest compressions. Teamwork is essential and
the bed may need to be adjusted according to the different heights of the rescuers.

Stand at the side of the bed

Place your feet shoulder-width apart

Flex forward from your hips

Ensure that the compression force comes from flexion of your hips and that
your shoulders are positioned directly over the patients sternum

If necessary, kneel with both knees on the bed. The bed must be clear of any
hazards e.g., needles, blood. Ensure that your weight combined with the
patients does not exceed the safe working load of the bed

Do not remain on the bed if the patient is being defibrillated.

If a patient has arrested on a fixed-height bed or trolley, a firm stool or steps must be
provided. These must be of a suitable height to ensure that the rescuer performing
chest compressions is able to stand with the patient level between their knee and
mid-thigh region. The stool or steps must have a non-slip surface area, which is
large enough to accommodate the rescuer standing with their feet shoulder-width
apart. Kick stools are not suitable for this procedure. No attempt should be made to
kneel on a trolley.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 19

Resuscitation Council (UK)

Airway management and ventilation

For mouth-to-mouth, or mouth-to-mask ventilation (one rescuer):

Stand at the side of the bed facing the patient, level with their nose and mouth

Bend forwards from your hips to minimise flexion of the spine

Support your weight by leaning your legs against the side of the bed frame.

To intubate the patients trachea or to provide mouth-to-mask or bag-mask

ventilation (with two rescuers present), enable access by moving the bed away from
the wall and removing the backrest.

Position yourself at the top of the bed facing the patient

Place your feet in the walk-stance position

Once the tracheal tube has been inserted adopt a comfortable position and
avoid prolonged static postures.

20

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Dealing with a cardiac arrest in a sitting position

To provide effective chest compressions the patient must be lowered to the floor.
This manoeuvre should be carried out in a safe and controlled manner. Transferring
a patient from a seated position onto the floor is high risk. Do not move the patient
directly from the chair to the bed/trolley. An exception to this may be if the patient is
already sitting on a sling and a hoist is readily available.
The optimal number of people required to perform this transfer is three. If fewer
than three people are available, a less than optimal transfer may have to be
attempted. Wherever possible wait for additional people to provide assistance.

Three-person transfer

The chair must be secure, with any brakes in the ON position

If a sliding sheet is readily available, place it under the patients feet and
extend their legs to enable the feet and legs to slide away from the chair as the
patient is lowered onto the floor

One rescuer supports the head by standing at the side of the chair, level with
the patients head

The other two rescuers face the patient in the chair, and position themselves
slightly in front and to the side of the chair

These rescuers get into a half-kneeling position with their innermost knee on
the floor and grasp hold of the patient at the back of the pelvis/hip region with
their outermost hand and behind the patients knee with their innermost hand.
An alternative is to use the high-kneeling position which some rescuers may
find more comfortable

[REBA score 9
of kneeling rescuers]

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 21

Resuscitation Council (UK)

If the patient is dressed it may be helpful to grab hold of their clothing or belt

On the command from one rescuer, each kneeling rescuer transfers their body
weight back towards their heels. This pulls the patient forwards out of the
chair into a sitting position on the floor with their back resting against the chair

NOTE: A pillow placed on the floor to cushion the fall acts as a hindrance
rather than a help.

Once in this position, either move the chair and lower the patients head and
chest carefully to the floor, OR pull the patients legs forwards away from the
chair until the patient is supine.

Two-person transfer

Both rescuers face the patient in the chair, and position themselves slightly in
front and to the side of the chair

If readily available place a sliding sheet under the patients feet

Both rescuers get into a half-kneeling position with their innermost knee on the
floor and grasp hold of the patient at the back of the pelvis/hip region with their
outermost hand and behind the patients knee with their innermost hand. An
alternative is to use the high-kneeling position which some rescuers may find
more comfortable

22

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

If the patient is dressed it may be helpful to grab hold of their clothing or belt

On the command from one rescuer, each kneeling rescuer transfers their body
weight back towards their heels. This pulls the patient forwards out of the
chair into a sitting position on the floor with their back resting against the chair.

[REBA score 11]

NOTE: A pillow placed on the floor to cushion the fall acts as a hindrance
rather than a help.
Once the patient is in the sitting position on the floor, one rescuer takes
responsibility for supporting their head, whilst the other pulls the patients legs
forwards and away from the chair, or if there is enough room, moves the chair.
Alternatively, one rescuer gently pushes the patient sideways towards the other
rescuer who lowers them to the floor.

One-person transfer
Wherever possible one rescuer should not undertake this task and they should wait
for assistance to arrive. However, it is recognised that in some situations a rescuer
may decide to begin resuscitation and will need to transfer the patient to the floor.
This is a high risk activity it should only be undertaken in life-threatening or
exceptional circumstances.12

Kneel on the floor to one side of

the patient

Position the patients arm that is

closest to you across their chest

Push against the patients thigh

which is nearest to you with
both your hands to position
the patients hips at the front
of the chair

Place your hand around

the patients furthest hip.
Place your other hand
on the patients thigh which
is closest to you

[REBA score 12]

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 23

Resuscitation Council (UK)

Push / pull the patient down to the floor.

[REBA score 12]

Cardiac arrest on the toilet

If a patient has a cardiac arrest on the toilet it is likely the patient will fall either
sideways or forwards. Before transferring the patient onto the floor it is important
that the door is kept open. This will ensure that the entrance is not blocked and will
enable other rescuers access to the room. If they still remain on the toilet they will
need to be transferred to the floor using a similar technique as previously described
for a sitting position.

If the patient is dressed it may be helpful to grab hold of their upper clothing

Avoid entrapment of the genitalia!

24

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Dealing with a cardiac arrest in a bath

This is an extremely difficult topic to address because shapes and sizes of

bathrooms differ and access to the patient varies. Any physical technique of
removing a collapsed patient from a bath is hazardous and includes high risk of
injury. Risk assessments of this potential situation must be carried out locally,
especially for those patients who are at risk of cardiac arrest, and evacuation
procedures established.
To enable resuscitation to be attempted the patient needs to be out of the bath.
Remove the plug so that the water can begin to drain from the bath before starting
the transfer. The rationale for this is that the water will render the area hazardous
and slippery for the rescuers, whilst also making it dangerous for attempting
defibrillation. Towels, or other absorbent materials, should be placed on the floor
before removing the patient from the bath. The patient must not be lying in a puddle
of water and their chest must be dried before attempting defibrillation.
NOTE: Local evacuation procedures must also be established for birthing pools.
After 20 weeks gestation (or obvious signs of a pregnancy) a woman's uterus can
press against the inferior vena cava resulting in reduced cardiac output and
hypotension. Whenever a pregnant woman collapses the rescuers need to place
the patient either in a full left lateral position or, if this is not possible, a 15 degrees
tilt to the left to relieve caval compression. This can be achieved by using sand
bags, firm pillows, a wedge or the thighs of the kneeling rescuers to tilt the torso, or
by manually and gently displacing the uterus to the left.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 25

Resuscitation Council (UK)

Dealing with a cardiac arrest in a hydrotherapy pool

Each organisation must have a local policy in place for evacuating a collapsed
patient from the hydrotherapy pool and the procedure must be practised regularly.
Many hydrotherapy pools now have a ceiling track hoist installed and this is often
the preferred method of evacuation from the pool in an emergency.
The following describes an alternative method for a rapid evacuation from the pool:

The rescuer in the water pulls the emergency cord to summon help

An inflatable neck support is placed around the patients neck

The rescuer floats the patient to a side of the pool which enables open access

The next rescuer to arrive puts an evacuation board into the pool and joins
the other rescuer in the water to assist supporting the patient

Further rescuers take over supporting the patient from either inside or outside
the pool whilst the rescuers in the pool place the evacuation board under the
patient

26

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Secure the patient onto the board with the straps provided

Position the board so that the head-end is at the side of the pool

The two rescuers in the water press down on the foot of the board to raise the
head end high enough to rest it on the side of the pool

The board can be pushed out of the pool directly onto the floor or onto a trolley
if the pool is above ground level.

NOTE: Do not exceed the weight limit indicated on the evacuation board.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 27

Resuscitation Council (UK)

Cardiopulmonary resuscitation
and the bariatric patient

The principles for moving bariatric patients are the same as those already described
in this document. Healthcare settings must ensure suitable equipment is available
for their staff when dealing with these patients and that they are trained in its use.
The following is additional guidance that should be taken into account to provide
safer handling and effective CPR when a bariatric patient has a cardiac arrest.

Airway management and ventilation

Airway manoeuvres and maintaining an adequate airway can be difficult due to the
increased size of the head and neck and glottic oedema. Bariatric patients have a
higher risk of regurgitation and aspiration.
Inflating the lungs during ventilation can be harder due to the patients body shape,
tissue mass, and because they are lying flat. Sitting the patient up slightly can make
airway manoeuvres and ventilation easier but this will make chest compressions
more difficult. Identifying chest movement can also be difficult. Adequate ventilation
often requires early tracheal intubation by an individual who is already competent in
this skill.

Chest compressions
Identifying landmarks for chest compressions can be difficult. It is important that the
rescuer maintains a stable base and minimises the risk of extending their reach
when giving compressions. Chest compression quality may be compromised
because of the increased physical effort required to achieve the full compression
depth of 4 - 5 cm (for an adult) at a rate of 100 per minute. Adequate staff must be
available to rotate rescuers every two minutes, or sooner, to reduce fatigue and
ensure effective chest compressions.

Transferring and handling the bariatric patient

If the patient is on the floor with restricted access and has to be moved, use a
bariatric sliding sheet with extension straps

When transferring the patient following resuscitation, the hoist and associated
sling must be suitable for the bariatric patients body shape and weight

Consider the hoist and sling safe working load, wider leg opening, and sling
shape in relationship to the patients body shape and tissue mass

28

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

The use of hoists with stretcher attachments tends not to be appropriate for
bariatric patients as the stretcher attachments may not be wide enough or
have a suitable safe working load to accommodate the patient

Bariatric patients should be cared for on an appropriate electrically operated

bed

Manual lifts are not recommended with bariatric patients.

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 29

Resuscitation Council (UK)

References

1.

Hignett, S. and McAtamney, L. (2000) Rapid Entire Body Assessment (REBA)

Applied Ergonomics. 31:201-205.

2.

Health and Safety Executive (1992, as amended 2002) Manual Handling

Operations Regulations (MHOR) Guidance on Regulations L23. London: HSE
Books ISBN 071762823X.

3.

Health and Safety Executive (2008) Musculoskeletal disorders in health and

social care [online]. London: HSE [accessed on 20/01/09]. Available from
http://www.hse.gov.uk/healthservices/msd/index.htm

4.

BackCare (2008) Key Facts [online]. Teddington [accessed on 12/02/09].

Available from: http://www.backcare.org.uk/335/Facts-and-figures.html

5.

Nolan J, Soar J, Lockey A, et al (2006) Advanced Life Support Manual 5th

Edition. London: Resuscitation Council (UK).

6.

Health and Safety Executive (1974) Health and Safety at Work Act 1974
[online]. London: HSE [accessed on 20/01/09]. Available from:
http://www.hse.gov.uk/legislation/hswa.htm

7.

Health and Safety Executive (1999) Management of Health and Safety at

Work Regulations (MHSWR) Approved code of practice and guidance L21.
London: HSE Books ISBN 0717624889.

8.

Handley, A (2005) Adult Basic Life Support in Resuscitation guidelines.

London: Resuscitation Council (UK).

9.

Health and Safety Executive (1998) Provision and Use of Work equipment
Regulations (PUWER) Approved code of practice and Guidance on the
Regulations L22. (3rd edition) HSE Books ISBN 978 07176 62951.

10.

Health and Safety Executive (1998) Lifting Operations Lifting equipment

Regulations (LOLER) Approved code of practice and guidance on the
Regulations L113. London: HSE Books ISBN 978 07176 1628.

11.

Betts, M and Mowbray, C (2005) The falling and fallen person and emergency
handling In The handling of people 5th Edition Teddington: BackCare.

12.

BackCare (2005) The Handling of people (5th edition) pp263 and 266
Teddington: BackCare ISBN 0-9530582-9-8.

30

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS

Resuscitation Council (UK)

Conflict of interest declaration

Name

Organisation

Conflict of
interest

Sara Wright (Chair)

Freelance

None

Freelance and
London Borough of Sutton

None

None

Resuscitation Officer

Chelsea and Westminster

NHS Trust London

Sarah Iceton

Freelance

None

Gloucestershire Hospitals
NHS Foundation Trust
Gloucester

None

Royal Society for the

Prevention of Accidents
(RoSPA) Birmingham

None

Resuscitation Council (UK)

London

None

School of Health and

Wellbeing, University of
Wolverhampton

None

Manual Handling Trainer/Advisor

Sally Cassar
Manual Handling Trainer/Advisor
Zo Hayman

Manual Handling Trainer/Advisor

Ben King
Lead Resuscitation Officer
Melissa Lovell
Manual Handling Trainer/Advisor
Sarah Mitchell
Director, Resuscitation Council (UK)
James Pearson-Jenkins
Senior Lecturer in Adult Acute
Nursing; Manual Handling
Trainer/Advisor

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS 31

Resuscitation Council (UK)

Useful websites

Organisation

Website address

Resuscitation Council (UK)

http://www.resus.org.uk

BackCare

http://www.backcare.org.uk

Disabled Living Foundation

http://www.dlf.org.uk

Health and Safety Executive (HSE)

http://www.hse.gov.uk

National Back Exchange

http://www.nationalbackexchange.org

The Royal College of Nursing (RCN)

http://www.rcn.org.uk

The Royal Society for the Prevention of

Accidents (RoSPA)

http://www.rospa.com

32

GUIDANCE FOR SAFER HANDLING DURING RESUSCITATION IN HEALTHCARE SETTINGS