When a paralyzed person falls, an immediate and measured response is required to prevent further injury to the person and strain on the caregiver. The goal of a floor transfer is to safely move the person to a seated or lying surface while maintaining the integrity of their spine and limbs. This process requires proper body mechanics and knowing when to abandon manual assistance for professional medical help.
Immediate Safety Assessment and Environmental Preparation
Before making physical contact, assess the immediate environment for hazards like sharp objects, spilled liquids, or unstable furniture. Clearing the area around the fallen person ensures a safer working space and minimizes the chance of secondary injury during the transfer.
The person’s condition must be carefully evaluated, starting with asking about pain, especially in the neck or back. If the person reports acute pain, a visible deformity, or a sudden loss of sensation, all movement must cease immediately. This suggests a possible new or exacerbated spinal injury.
A single-person lift of a non-ambulatory adult is strongly discouraged due to the high risk of injury to the caregiver and the person. Caregivers should recruit at least one other person to assist, as coordinated movement reduces strain and allows for better control of the person’s head and trunk. If no assistance is available and an injury is suspected, the safest course is to cover the person for warmth and seek professional help rather than attempting a solo transfer.
Essential Principles of Manual Lifting and Transfer
When specialized equipment is unavailable, manual lifting techniques must adhere to strict principles of body mechanics. The rescuer should position their feet shoulder-width apart, bend at the hips and knees, and engage the core muscles before initiating a lift. Keeping the person’s body close to the rescuer’s center of gravity minimizes back strain and maximizes the mechanical advantage of the leg muscles.
For a non-injured person paralyzed below the waist, a coordinated two-person lift is the preferred method for maintaining spinal alignment. The lead person, positioned at the head, stabilizes the trunk and calls the movement commands to ensure a synchronized effort. The second person supports the lower extremities by cradling the knees and ankles, and both rescuers lift simultaneously using their legs.
If a spinal injury cannot be ruled out, the log-roll maneuver is the only acceptable technique for repositioning the person. This requires multiple individuals to maintain neutral spinal alignment. One rescuer stabilizes the cervical spine at the head, while others are positioned along the torso and legs to turn the person as a single unit without twisting or bending. The movement is initiated by the person stabilizing the head and is used primarily to check for injury or position a transfer device.
When and How to Use Assistive Equipment
Assistive devices offer a safer alternative to pure manual lifting by reducing physical strain on the caregiver and improving control over the person’s body. A transfer belt, or gait belt, placed snugly around the person’s waist, provides a secure handhold for the caregiver to guide and stabilize the trunk. This belt is useful for short, controlled movements and is a prerequisite for most assisted transfers.
For lateral movements, such as sliding from the floor to a nearby surface, a slide sheet minimizes friction and shear forces on the skin. The low-friction sheet is tucked under the person using a log-roll technique, allowing rescuers to pull the person smoothly across a surface. This method requires two or more people and is effective for repositioning or moving the person onto a stable surface.
Transfer boards are rigid devices used when a person has sufficient upper-body strength to assist by pushing their weight across the board. The board bridges the gap between the floor and the target surface, which must be at a similar height. It is inserted beneath the person’s hip after they lean away from the transfer direction. For individuals with high-level injuries, such as quadriplegia, or those who cannot assist, a portable or hydraulic floor lift is the safest option. These lifts require specialized training and involve a sling carefully placed under the person.
Warning Signs and Knowing When to Seek Professional Medical Help
Recognizing contraindications for moving a paralyzed person is paramount, as inappropriate movement can result in permanent neurological damage. The person must not be moved if there is any indication of a severe head or neck injury.
Indications of Severe Injury
- Loss of consciousness
- An oddly twisted neck
- Extreme pain in the spine
- Uncontrolled bleeding
- Fractured bones
- A change in pupil size
If any of these warning signs are present, immediately call 911 or local emergency medical services (EMS). When speaking to the dispatcher, clearly state that the person is paralyzed, has fallen, and a potential spinal injury is suspected. This allows EMS to dispatch appropriate personnel and equipment.
While waiting for professional help, the person must be maintained in the position they fell, following the “leave in place” protocol for suspected spinal trauma. Caregivers should use rolled towels or clothing to gently stabilize the head and neck, preventing lateral movement until paramedics arrive. Comfort measures should be limited to covering the person with a blanket to maintain core body temperature, ensuring their airway is clear, and monitoring breathing and responsiveness.