Thursday, June 4, 2020

Don't Crash That Gurney

It's all fun and games when pushing an old Gurney in a straight line.
Objects moving through space at high speed with a sense of urgency are prone to mishaps. No, I'm not talking about the space shuttle Challenger. I'm thinking of  old school hospital Gurneys which were also known as prams, trolleys, or carts. These unwieldy conveyances had tiny wheels which were really more like casters. Each wheel had an independent locking mechanism that was activated by stomping on a tiny lever.

Adding the weight of a patient to the cart  resulted in a very high center of gravity that conferred an inherent lack of stability. Vintage Gurneys had no counterweights in their base like the meticulously engineered transport devices present in today's hospital. Tiny wheels, poor brakes and a high center of gravity were the recipe for disaster.

Pushing an old fashioned Gurney in a straight line at low speed was a walk in the park. Speed, uneven terrain, sharp corners or heavy loads were complicating issues and relevant factors in Gurney crashes

Crack ups while rounding corners with a loaded hospital trolley had some of the same elements as motorcycle wrecks. I've had personal experience with both types of mishaps. High side motorcycle and Gurney crashes are among the most catastrophic because the patient I mean, rider is thrown off the vehicle ahead of the line of travel of the vehicle and risks not only the fall but the cart or bike then plowing into him. The cause of these crashes is suddenly regaining traction after sliding or skidding around a corner. In the hospital any type of liquid spilled on heavily waxed terrazzo floors is the most common hazard responsible for high side Gurney mishaps.

More benign crashes are of the low side variety where the bike or   Gurney simply skids around a corner and the conveyance  slides sideways gently spilling the patient. Thankfully, this is probably the most common type of Gurney crash and results in minimal injury because the driver is often able to contain the patient before he impacts the floor. Collateral damage from broken glass IV bottles is a common complication of low side wrecks. The Gurney driver is usually in an emotional hyper response  state with marked frontal lobe detachment  after one of these mishaps and hastily picking up glass shards can result in colorful displays. Please, don't ask me how I know about this one but the scars on my fingers are probably a dead give away.

Another factor in gurney wrecks is overloading or raising the center of gravity by personnel standing on the cart for procedures like joint reductions.https://regionstraumapro.com/page/3.  This graphic illustration of an intrepid emergency medicine physician is a good example of a high flying reduction. Hopefully the good doctor  returned safely to terra firma when the procedure was completed.

CPR perfomed on a rapidly moving Gurney always reminded me of a rodeo where a sudden fall is awaiting  the rider.  The nurse performing compressions (somehow it was always a nurse in the saddle) straddled the patient while maintaining the exquisite balance of a Brahama  bull rider as the Gurney surged forward toward more definitive care. Once again the center of mass is raised and the urgency of the situation always manages to exacerbate the propensity for a mishap. The nurse furiously doing chest compressions above the patient was the canary in the coal mine since she was likely to take a tumble before the patient fell. Caution usually prevailed when the Gurney driver sensed the CPR provider was about to take a tumble and slowed everything down befor a crash ensued.

Just like Gundam mech robots patrolling an infinite universe,Gurneys were just about everywhere in the hospital orbit. Gurneys always held a warm spot in my heart because I saw them as a symbol of unification and, oh boy,  we could sure  use some of that in these difficult times.. We are all going to take that last Gurney ride someday no matter what event terminates our earthly existence. Pay close attention to the next soul you see on a Gurney because they can show us all how to take that final ride with a dignified sense of peace. All bets are off if an OFRN like me crashes the cart.

14 comments:

  1. This gives me some background on why, after giving birth to my first child (within the last decade), I was transported from Labor and Delivery to Post-Partum in a wheelchair, with two sheets tied around me and the baby... (I went to a different hospital with baby 2, and there they moved me in something more bed-like, and the baby was transported separately.)

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  2. In low acuity situations wheelchairs are probably a better transport option than carts. Wheelchairs provide the patient an opportunity to see where they are headed as opposed to Gurneys where there is an endless view of ceiling tiles and blinding overhead lighting.

    Wheelchairs have better lateral stability than old school Gurneys, but are prone to tipping over either backwards or forward. This hazard is easily averted with anti-tipping bars on the front and/or back of the chair.

    My wife was transported from labor and delivery on a Gurney with the baby riding along. The nurses wisely declined my offer to help push the Gurney to post partum. You must be very strong to tolerate wheel chair transport after going through labor - at least the baby was close to you during the ride.

    Thanks so much for perusing my foolishness and taking the time to leave a comment. I know it sounds trite, but stay safe in these pandemic times!

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  3. That was a terrific story! I almost felt like I was going to be thrown off of something moving. Fortunately, I have never had an accident like that in a medical facility, but I did ride horses for several decades and overpowered machinery on a few occasions so I do have an inkling.

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  4. My dad loved to tell me stories about near misses (or maybe more accurately, near hits) by his horse, Old Ned. The stories always ended the same way, "If Ned's hoof had been an inch closer, you wouldn't be here today."

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  5. I had a friend who was a student nurse at a different hospital to me - apparently she was pushing a body on a gurney to the mortuary when she had some kind of accident and the body fell onto the ground - she was on her own in between two hospital buildings, outdoors - wish I could remember how she got out of it, but what an awkward moment! Sue

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    1. Pushing a gurney outdoors was a real challenge. Uneven terrain or curbs could result in a mishap just as you described.

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  6. I used to ride horses a lot too, from age 8 - I used to have the most magnificent falls for some reason - the horse knocked his legs together on a turn and fell on top of me, one bolted due to a loud noise and I got my foot caught in the stirrup and got dragged - once I fell onto my head on the road (the helmet fractured but not my head thankfully)… I used to end up in the local hospital Casualty a lot - maybe that's why I ended up nursing! It must have brought back these happy memories...!!!! Sue

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  7. Getting dragged along with your foot caught in the stirrup sounds like a real nightmare. I'm glad you survived.

    I hope you are safe and healthy in the midst of the pandemic. Restrictions were relaxed here and the numbers do not look encouraging. Putting economic interests before public health will likely be costly in the long run.

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  8. Managed to keep my head off the ground and away from flying hoofs - but still amazed I did survive that one, OFRN!

    We are opening up at a faster rate than I would like here - but I am aware it's very difficult to juggle public health and the economic implications of a longer shutdown - NZ has "eradicated" the virus (no cases for many weeks now), we have only a couple of small clusters (about 9-14 people I think) which we expect to continue happening here in Australia, mostly in NSW and Victoria, the most populated states. I'm away from any cities so probably safer than say Sydney or Melbourne!

    NZ and Australia are fortunate to be islands, we could close our borders rapidly and had less air traffic from overseas than the USA, UK etc - but we do watch the USA with concern, opening up when there are still so many cases is not a gamble I would like...

    The current demonstrations are a worry everywhere in view of covid19.

    I hope you are keeping OK OFRN - I don't know what the situation is like in Pittsburgh. I do wish you the very best in difficult times! Cheers! Sue

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  10. How are things going over there OFRN? Are you able to get out and about or staying isolating? We have a bit of a second surge starting in Victoria, so it's worrying, but we're OK here in NSW at the moment. Sending best wishes, Sue

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    1. I am doing just fine, Sue. We are still isolating as the numbers here in Allegheny County have started to rise a bit. It's not really much of a sacrifice because I was involved with self isolation before it was in vogue.

      I dug up much of my back yard for a garden so there is always something that needs done. It's refreshing to se things growing and feeling just a wee bit self sufficient.

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    2. Glad to hear that OFRN - friends in Melbourne are annoyed as they are pretty much in lockdown again - people stopped physical distancing and got complacent, but we're OK here so far - I'm enjoying long walks in the lovely winter here with Sam the dog - no snow so far which is disappointing but long walks by the river and hot chocolate sitting in the winter sun in the park - not a bad way to spend a pandemic! Not a good time for gardening here due to the frosts but glad you're enjoying the outdoors a bit too! Cheers! Sue

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