Trauma in Motion: Safer Emergency Department Patient Repositioning and Transferring

Trauma patients are often hemodynamically unstable. They’re also prone to limited mobility – sometimes situational, sometimes baseline – that increases the need for manual transferring and repositioning. Yet transferring and repositioning trauma patients is uniquely difficult, in large part because it’s uniquely fraught, and not for patients exclusively. Emergency department professionals have some of the highest rates of musculoskeletal injuries in healthcare.  

Relief awaits, however, via technologies that are making handling objectively safer and easier.

Below we’ll break down complex trauma patient transferring, repositioning, and overall handling and will introduce air-assisted devices, outlining their clinical and operational benefits as well as related evidence and guidelines. 

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TRAUMA IN THE ER: SAFE PATIENT HANDLING CHALLENGES & RISKS

As any emergency department professional can attest, a plethora of conditions common in emergency scenarios complicate patient handling:

• Unstable injuries – spinal injuries, fractures, internal injuries
• Unpredictable physiology – hemodynamic instability, respiratory compromise, altered mental status
• Obesity prevalence – higher BMI patients are increasingly common in ERs; these patients require additional resources and increase injury risk.

The conditions above intensify handling in any setting; however, in the emergency room they are often exacerbated by one or more unavoidable barriers:

• Time pressure. Patient stabilization, airway management, hemorrhage control, rapid imaging – safe patient handling often takes a backseat to all of these urgencies. The need to work quickly in emergency situations can furthermore result in fast, uneven, and uncontrolled patient movement.
• Space constraints. Trauma bays and ER rooms are typically small and crowded with personnel and equipment (monitors, IV poles, ventilators), limiting space needed to safely move and otherwise handle patients.
• Equipment accessibility. Assistive devices are frequently unavailable in ERs due to time and space constraints or cultural barriers, including lack of training.
• Frequent transfers. In the quest for a diagnosis, emergency room patients are often transferred quickly and frequently to other departments, driving the odds of fast and flawed movement.

Meanwhile, emergency department patients are a uniquely susceptible population for whom incorrect handling can cause severe and sometimes even irreparable harm. Patients at highest risk of handling-related injury and complication are those who can’t effectively communicate – about their injuries, about what occurred, about their pain levels. These patients include but aren’t limited to those with:

• Altered level of consciousness
• New or baseline neurological deficits
• Spinal deformities or distracting injury

Other vulnerable groups, all of whom require rapid stabilization, include patients with:

• Osteoporosis
• Metastatic cancer
• Rheumatoid arthritis
• Previous spinal surgery
• Compromised airways
• Inclination toward agitation
• Associated injuries such as:
  • Traumatic brain injuries (TBI)
  • Maxillofacial trauma
  • Pelvic fractures
  • Thoracic trauma
  • Calcaneal fractures
  • Seatbelt-shaped abdominal contusions

Last but not least is what’s at stake. Patients listed above have a heightened risk during transfers, repositioning, and other handling for complications including:

• Secondary injury, including secondary spinal cord injury
• Exacerbation of existing injury
• Injuries being overlooked
• Hemodynamic instability
• Respiratory compromise
• Risk of pressure injuries

A note on pressure injuries: They are generally not top of mind in emergency situations; however, pressure injury development can start in the emergency room. Risk is highest among immobile trauma patients (especially those who are critically ill) and patients with higher BMIs. Consider pressure injury interventions early in the game whenever possible.

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A CLOSER LOOK AT THE UNSTABLE SPINE

Of the patient populations mentioned above, those with unstable spines are most at-risk of handling-related injury or complication. Unstable in this context refers to a spine that’s lost its normal structural integrity and stability.

Conditions in which unstable spine is likely include:  

• Acute traumatic injuries. These include blunt trauma, unstable fractures, or ligamentous injuries (such as burst fractures, fracture dislocations, or any injury involving the disruption of two or more spinal columns). Such injuries can lead to vertebral subluxation and even spinal canal compromise.
• Spondylolisthesis. Individuals with spondylolisthesis are especially prone to unstable spine when there’s significant vertebral slippage or any associated radicular symptoms.
• Neoplastic or infectious destruction. Patients with a tumor or infection capable of causing vertebral body collapse can also experience instability and risk of spinal cord compression.
• Degenerative instability. Excessive translation or angular motion between the vertebrae creates spine vulnerability. This is sometimes seen in advanced disc disease and sometimes associated with traction spurs or vacuum phenomenon.

Care of an ER patient with an unstable spine requires added vigilance around stabilization and adherence to trauma transfer protocols, to which spinal motion restriction, or SMR, is central.  

AIR-ASSISTED TECHNOLOGY IN TRAUMA CARE

The medical industry agrees that minimizing spinal motion, reducing number of transfers, and reducing or eliminating unnecessary manipulation during transfers are all beneficial to patient and provider care.

Air-assisted technology can help make this possible.

Air-assisted devices are designed to significantly reduce friction in patient handling and movement, allowing individuals to be moved with less force compared to manual handling. Imagine transferring a hemodynamically unstable patient with a draw sheet – a task requiring at least four to six caregivers and teeming with risk. Now imagine that same patient stabilized atop an inflated cushion of air that moves smoothly and requires as little as half the necessary exertion and therefore fewer total staff.

Air-assisted technology benefits are as follows:

• Patient safety. Patient risk is minimized because movement and handling are smoother and more controlled.
• Staff safety and efficiency. Because fewer resources are needed, staff injury involvement and related risk are both reduced.
• Time sensitivity. Air-assisted technology often adds efficiency. The faster a patient is transferred – from the EMS stretcher to imaging, for example – the faster a diagnosis can be achieved.  
• Integration across workflow. If a patient arrives in the emergency department on an air-assist device, that same device remains beneath them across their continuum of care and related transfers – to imaging, to the OR, to the ICU, and so on. Such standardization is shown to improve outcomes.

For trauma scenarios, air-assisted devices offer more key benefits:

• Can minimize movement when used appropriately
• Decrease caregiver trunk flexion and muscle activity – reaching and pulling patients from stretchers, for example – diminishing injury risk

And a few additional benefits of air-assist technology:

• Allows for minimal exertion during lateral transfers (from the EMS stretcher to the imaging table to the ER bed, for example)
• Reduces risk of shearing that’s common in log rolls or supine-to-supine positioning
• Facilitates continued spinal immobilization without dragging or pulling

EVIDENCE RELATED TO AIR-ASSISTED TECHNOLOGY

Studies to date of air-assistive devices among unstable spine patients has been primarily biomechanical, performed on cadavers, and focused on motion analysis. To this end, there is a gap in research, specifically where neurological outcomes and long-term recovery are concerned.

Still, consensus across the medical profession is that patient handling should be reduced and stabilized in emergency departments whenever possible. With this mandate in mind, the first piece of related evidence worth highlighting is total motion generated in the unstable thoracolumbar spine during management of the typical trauma patient.

In a comparison method performed in cadavers, researchers observed the extent to which the unstable thoracolumbar spine around the L1 vertebrae moved during a typical trauma sequence: patient arrival, spine board inserted beneath spine, bed transfers and lateral transfers, prone turning for surgery, spinal board removal. Five cadavers with an artificially created unstable L1 burst fracture were studied. Researchers measured the angular motion – twisting, bending, rotation – between T12 and L2 vertebrae with a 3D system, testing all common manual techniques (log rolling, manual turns) as well as alternatives including air-assisted technology and the Jackson Table for the lift and slide. They observed that log rolls created more unwanted spinal motion compared to assist and the Jackson Table, which reduced motion by about 50%.

In a second comparison study, log rolls again created unnecessary harmful motion – and air-assist technology again cut that cervical spine motion by half.

• Allows for minimal exertion during lateral transfers (from the EMS stretcher to the imaging table to the ER bed, for example)
• Reduces risk of shearing that’s common in log rolls or supine-to-supine positioning
• Facilitates continued spinal immobilization without dragging or pulling

IS IT SAFE TO USE AIR-ASSIST WITH TRAUMA PATIENTS?

Determining when and whether to utilize air-assist is a case-by-case clinical decision. Risks must be weighed against benefits and product recommendation guidelines must be followed (including contraindications). Quantifiable benefits of air assist:  

• Reduces spinal motion based on the evidence
• Helps avoid unnecessary log rolling
• Translates to less caregiver strain
• Creates smoother and more controlled transfers

These byproducts are key to patient outcomes – for trauma patients but also the larger patient population. Consider elderly patients. What is preferable: dragging them manually or using air-assist devices to move them in a smooth, controlled manner?

If a clinical decision is made to utilize air assistive technology in trauma cases, keep these reminders and precautions in mind:

• Inline stabilization is still required. Air-assist does not replace immobilization. Providers still must control the head and the neck or maintain that full spinal alignment at the injury level during every single move.
• Adequate staffing is key. Although air-assisted devices generally decrease the number of caregivers needed, a minimum of four to six trained caregivers should still be on hand to ensure safe transfer.
• Ensure surface compatibility. Air-assisted devices work best on flat surfaces such as spine boards, CT/MRI tables, ED stretchers, and tables.
• Noise/air flow alerts. Let patients and team members know that air-assisted devices make noise when inflating.
• Staff should be ready to complete a coordinated, efficient move. Air doesn’t change this key fact!

From field to finish, every move matters when working with emergency patients.

Eager to learn more about improving offloading practices in your acute care setting? Earn one free contact hour by listening to the full on-demand webinar. 

Elizabeth Doherty, MSN, CRNP, FNP-BC

Elizabeth Doherty brings a broad range of clinical expertise to her role as Clinical Education Specialist at HoverTech International. Her background spans long-term care, medical-surgical ICU experience at a large academic hospital, emergency and pediatric emergency nursing in a Level I trauma center, and advanced practice as a Certified Registered Nurse Practitioner.  

This diverse foundation allows her to connect with healthcare teams across multiple specialties and understand their unique challenges in patient care and safety.

She is deeply passionate about shaping the future of nursing, supporting frontline nurses, and ensuring they have the knowledge, tools, and confidence to deliver safe, high-quality care.

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