A stair chair is a specialized piece of equipment designed to safely move an ambulatory or seated patient up or down stairs and through narrow hallways where a standard wheeled stretcher cannot fit. This device is integral to Emergency Medical Services (EMS) operations, offering a controlled method of patient transport in multi-level structures. Using the stair chair appropriately protects both the patient from uncontrolled movement and the EMS providers from back injuries associated with improper lifting techniques. The chair’s design provides a stable, seated position for the patient, ensuring quicker and safer movement than manual carrying.
Preparation and Securing the Patient
Before movement begins, assess the environment and the patient to ensure a clear path of travel. The team must establish clear roles, typically designating a lead operator who controls the chair’s movement and a spotter who assists and monitors the patient and environment. All moving parts of the chair, such as the telescoping handles, must be extended and securely locked into position to maximize leverage and stability.
The patient must be secured into the chair using all available restraints before moving near the stairs. This typically involves a three-point securing system using a lap belt, a chest or shoulder harness, and foot or ankle restraints to prevent the patient’s feet from dragging. Communicate the plan clearly to the patient, instructing them not to attempt to assist with the movement. The patient’s hips must be seated fully back in the chair to ensure their center of gravity remains low and stable.
Executing the Downward Movement
The downward movement, or descent, is the most common use of the stair chair, often utilizing a friction-based track system for control. The lead operator, positioned at the head of the chair, tilts the chair back to engage the rubber tracks or glides against the edges of the stairs. This track system acts as a continuous braking mechanism, converting the patient’s potential energy into frictional resistance, which slows the rate of descent.
During a controlled descent, the operator maintains a consistent angle of tilt, allowing the chair to slide smoothly down the stairs rather than being actively lifted. The foot-end operator, often facing away from the patient to better view the steps, is responsible for guiding the chair and communicating the pace. Clear verbal commands between the two operators are essential to maintain synchronization and prevent sudden shifts in momentum. The objective is to achieve a continuous, fluid motion, which minimizes jolting.
The head-end operator uses the extended handles to control the chair’s pitch and pull back slightly, keeping the majority of the patient’s weight on the track system. If the team needs to pause, the chair can be momentarily rested with the rear wheels placed in the crook of a step, allowing the operators to rest without compromising control. This controlled technique minimizes the physical strain on the providers by relying on the chair’s mechanical advantage. Once the descent is complete, the chair is wheeled to the edge of the flat landing, and the track system is retracted before proceeding to the final offloading area.
Executing the Upward Movement
The upward movement demands a different technique, relying heavily on coordinated lifting and teamwork because the chair’s track system is not typically used for climbing. The chair is positioned at the foot of the stairs, with the patient facing the top of the stairwell. Both operators extend the lifting handles at the head and foot ends, ensuring they use a proper lifting stance with their backs straight and lifting with their legs.
Since gravity works against the team during ascent, coordination is necessary to prevent muscle strain and loss of control. The team must agree on a lifting cadence, using synchronized commands such as “ready, lift” to raise the chair simultaneously onto the next step or landing. The person at the head of the chair often carries a slightly greater portion of the weight due to the patient’s center of mass, but the effort must be evenly distributed.
This procedure emphasizes short, controlled movements, moving the chair up one or two steps at a time before resting and re-establishing the grip. Communication regarding the next step and any obstacles remains a priority to ensure both providers are lifting with equal force and timing. The patient is moved up the stairs backward; the head-end operator ascends the steps facing forward, while the foot-end operator typically walks backward up the stairs, requiring careful guidance from the head-end lead.
Safe Patient Transfer and Offloading
Upon reaching the final destination, the patient must be safely transitioned from the stair chair to the primary transport stretcher. The first action is to ensure the chair is fully upright, and the foot-end wheels are locked to prevent movement during the transfer process. All extended handles and the friction track system must be retracted and stowed before attempting to maneuver the chair into position next to the main stretcher.
The primary stretcher should be lowered or raised so the patient’s sitting level is slightly higher than the stair chair’s seat, allowing for a smooth, gravity-assisted lateral slide. With both devices secured and positioned side-by-side, the team coordinates a lift and slide of the patient, aiming to move the patient’s hips first onto the stretcher mattress. This “butt-first” maneuver ensures the patient is centered and stable on the new surface. The final step involves carefully unbuckling the patient from the chair’s restraints only after they are fully secured on the primary stretcher.