Lifting an individual with paralysis from the floor presents a significant challenge that requires careful planning to prevent secondary injury to the person and to protect the caregiver from musculoskeletal strain. The mechanics of the human body and the lack of muscle control in the person being moved make this process physically demanding, placing high forces on the spine of both parties. Proper technique minimizes the risk of worsening a pre-existing condition or causing a new injury. These procedures are intended for non-emergency situations where a fall has occurred and the individual is conscious and appears uninjured, requiring a methodical approach to return them to a chair or bed.
Immediate Safety Assessment
The first action upon finding a person with paralysis on the floor is to conduct a rapid, yet thorough, safety assessment to determine if a manual lift is appropriate. You must visually inspect the person for obvious signs of trauma, such as heavy bleeding, severe deformity of limbs, or a twisted neck or back, which indicate a potential fracture or acute spinal injury. Simultaneously, check for the person’s level of consciousness, asking simple questions to gauge their responsiveness and orientation.
If the person reports severe or sharp pain, particularly in the head, neck, or back, or if they exhibit signs of a serious injury, you must immediately stop any thought of a manual lift. Further warning signs that necessitate emergency intervention include any loss of bladder or bowel control following the fall, difficulty breathing, or a sudden change in mental status. In these circumstances, the safest course of action is to call emergency medical services (911 or local equivalent) and keep the person as still as possible until professional help arrives. Do not attempt to move them, as any shifting of the spine could cause irreparable harm to the spinal cord. Only when the person is alert, reports no new or severe pain, and shows no physical signs of head or neck trauma is it appropriate to proceed with preparations for a non-emergency lift.
Preparing the Environment and Personnel
A safe manual lift almost always requires the coordinated effort of at least two caregivers to manage the person’s weight and maintain spinal alignment. Attempting a lift alone significantly increases the risk of back injury to the caregiver and loss of control during the transfer. Clear communication between the two personnel is mandatory, establishing a lead person who will call out the commands for lifting and moving.
Before the lift begins, the immediate area must be free of obstructions, such as throw rugs, loose items, or furniture that could impede movement or cause a trip hazard. Ensure the path to the destination surface, whether it is a bed or a wheelchair, is clear and direct. If using a wheeled device, it must be positioned close by, and its brakes must be firmly locked to prevent any movement during the transfer.
Simple transfer aids, such as a sturdy blanket or a slide sheet, can be carefully worked underneath the person’s torso and hips. These tools help reduce the friction, allowing the caregivers to slide the person into a more manageable position before the actual vertical lift begins.
Step-by-Step Manual Lifting Techniques
With the environment clear and two caregivers positioned, the manual lift proceeds in a series of controlled stages, emphasizing body mechanics and coordination. The lead caregiver typically takes the position at the person’s head and upper body, maintaining the head and neck in alignment with the spine throughout the entire process. The second caregiver positions themselves at the person’s lower body, near the hips and legs, to control the heaviest part of the lower torso.
The caregiver at the head will reach under the person’s armpits and grasp the opposite wrists, creating a secure hold around the upper torso. The second caregiver should reach under the person’s hips and knees, ensuring a solid base of support for the lower body. Before lifting, both caregivers must assume a safe lifting posture: feet shoulder-width apart, back straight, and knees bent in a squatting position.
The lead caregiver initiates the lift with a clear verbal command, followed by a synchronized movement. The lift must be executed slowly and smoothly, using the large muscles of the legs to drive the upward motion, keeping the person’s body as close to the caregivers’ centers of gravity as possible. Maintaining the person’s spine in a neutral, straight position is paramount to prevent shearing or rotation forces on the vertebral column.
Once the person is lifted to a height that clears the floor, the caregivers must coordinate the short transfer to the receiving surface. This movement involves controlled, small steps or a pivot, always keeping the person’s weight distributed evenly and avoiding any twisting motion. They should lower the person onto the chair or bed slowly, bending their knees again to manage the descent. The transfer is complete only after the person is fully settled and stable on the destination surface, with the caregivers ensuring proper seating depth or positioning in the bed.
Utilizing Mechanical Lifts and Transfer Aids
When available, mechanical transfer devices offer the safest and most ergonomically sound method for lifting a person with paralysis from the floor, virtually eliminating the risk of caregiver or individual injury. Devices like a mobile floor lift, often called a Hoyer lift, use hydraulic or electric power to perform the vertical lift, minimizing the physical strain on the caregiver. These lifts require the use of a specialized sling, which is designed to cradle the person’s entire body securely.
To prepare for a mechanical lift, the sling must first be carefully maneuvered beneath the person while they are still on the floor, typically by rolling the person gently from side to side. The lift is then positioned over the person, and the base legs of the device are spread to their widest setting to ensure maximum stability against tipping. Once the sling is attached to the lift’s hanger bar, the person is raised just high enough to clear the floor and any obstacles.
The person is then moved to the destination surface, such as a wheelchair or bed, with the caregiver steering the lift using the push handles. Once positioned over the target, the person is slowly lowered, and the sling is detached. For horizontal transfers, a slide board or roll board can be used to bridge the gap between two surfaces, allowing the person to be moved with minimal friction and shear forces.