Monday, September 5, 2011

Gurney Journeys


Anybody who has ever volunteered or worked at a hospital can tell you tales of gurney misadventures. I'm not saying that anything happened to patients on gurneys. On the contrary, patients almost always get from Point A to Point B in a hospital with minimal fuss. It's the people who are transporting the patients that bare the scars of the duty. As anesthesiologists, we do a lot of patient transportation so I have plenty of first hand knowledge of gurney mishaps.

Virtually everybody can relate to a painful encounter with pushing a gurney. Whether it be a crushed toe or a pinched finger, people learn from agonizing experience to watch their digits extremely carefully when pushing a bed. I was once pushing a gurney using the built-in IV pole. I had done that a thousand times before without any repercussions. Then this one time, the IV pump that was attached to the pole suddenly slid down, crushing a finger. It felt like my finger was broken. Luckily that wasn't the case, but my finger was numb for days afterwards.

As our patient population gets bigger, our gurneys are also supersizing. They are now up to a point where they can barely fit through a doorway, with just inches to spare on either side. This creates an ever present hazard for the transporter. It is natural to push a gurney holding onto both sidebars with your fists. Many have suffered the consequences of this maneuver. One nurse was helping me push a patient with the rookie two fisted grip. When the gurney went through a doorway, she didn't move her hands in time. One hand got smashed between the bed and the door frame. The resulting pain was so excruciating she literally had tears well up and she had to take the rest of the day off to tend to her maimed hand. It only takes one incident to grasp the fact that when pushing a gurney through a door, the hands hold the inside of the side rails, never the outside.

One of the biggest dangers to a patient is being moved to or from an operating table. That is the time when a patient is most vulnerable to a gurney accident. It usually requires at least four people to safely move a patient but even that may not be enough. It seems like every month another nurse or scrub tech gets severe shoulder or back sprain trying to move a patient in the OR and has to go out on disability leave. I once had a patient who was over 400 pounds. We had just finished a gastric bypass procedure on him and was trying to move him off the OR table. Even with six people moving him, he got stuck between the table and the gurney. The gurney's brakes started giving way and it started rolling away from the table, with the patient falling into the crack that was forming under him. It took four people to keep the gurney from sliding any further out and about a total of ten people to safely move the patient properly. That was a close call and one I use as a teaching point when we can't get enough people to come to the OR to help move a patient. I'd rather have the patient wait on the OR table than try to move him without adequate manpower. Seriously, I wonder when we're going to get the first gurney with dually wheels.

The gurney stories are endless. There are the accounts about doing chest compressions on a moving gurney as a patient is being moved to the ICU, or the tales of gurneys getting sucked into the MRI machine, or finding residents crashed out on gurneys overnight from exhaustion. I even have an anecdote of getting stuck in an elevator while transporting a patient and the patient's oxygen tank ran out. So many stories, so little time.

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