STAIR CHAIRS: pieces of equipment designed to safely transport alert patients down stairs or steps and are an extremely useful piece of equipment in modern day EMS.

Patients should only be moved while secured to a stair-chair if they are alert and can maintain their own airway.

Contraindications to stair-chair use include

• patients with an altered mental status who cannot follow commands, and
• patients that require spinal immobilization.

Stair-chairs are invaluable pieces of equipment that come in many forms, from manual lift and carry devices to battery powered devices with tracks that allow for much less manual labor on the providers involved.

Manual Lift and Carry Stair Chair Devices

Manual lift and carry stair chair devices should only be used by EMS personnel that are trained on and comfortable with the equipment.

Typically, the patient is secured in the seated position to the stair-chair being utilized by straps around the torso, waist, and ankles.

IMPLEMENTATION: During manual lift and carry stair chair device use,

1. the first EMS professional takes up position behind the patient and grasps the handles provided with the power grip, making sure that they are in the locked and most-extended positions.
   
   EMS professional number one will be the at the highest point on the stairs during the move and he/she will be responsible for moving the secured patient to the top of the stairs, by pushing the patient as if in a wheelchair.
    
2. EMS professional number two should be waiting, facing the patient, at the top of the stairs, as well.
   
   EMS professional number two will be lower on the stairs than the patient during the move.
    
3. EMS professional number two should position him- or herself in front of the patient and grasp the handles provided with the power grip, usually found at the level of the patient's secured ankles, making sure that the handles are in the locked position and fully extended.
4. The providers should communicate to one another that they are ready to lift the device, and while using proper body mechanics and making sure to keep their heads up and backs straight, both providers should lift at the same time.
5. EMS professional number three, positioned lowest on the stairs of all people involved, including the patient, will place one hand on the back of EMS professional number two and guide them down the steps, one at a time, while providing pertinent information about the number of stairs remaining, dangerous conditions, and any other circumstances that may arise.
   
   In essence, EMS professional number three becomes the eyes of the group and directs the team throughout the move.
   
   The patient will be instructed to keep his or her hands across the chest at all times during the move to prevent loss of balance due to shifting weight that may cause an accident, as well as to prevent the patient from grabbing onto any stationary objects during the move.
   
   When the patient has been safely lifted and all team members are in place,
    
6. EMS professional number three should give the verbal order to begin the process of carrying the patient down the stairs, one step at a time.
   
   Special attention should be given to stairs during or immediately after any adverse weather conditions as these may increase the potential for accidental slips.
   
   Once the patient and all team members have safely navigated to the bottom of the stairs,
    
7. the team slowly lowers the stair chair to the ground, while maintaining proper body mechanics and making sure to keep their heads up and backs straight, and
8. EMS professional number one resumes navigation of the device as a wheelchair to the decided transfer position where the patient will then be moved to the waiting stretcher.

Battery Powered Stair Chair with Tracks

Battery-powered stair chairs with tracks should only be used by EMS personnel that are trained on and comfortable with the equipment.

During the utilization of the battery-powered stair chair with tracks,

1. the patient is secured to the device in the same way, with straps around the torso, the waist, and the ankles.
   
   At least two EMS professionals are required for use of the battery-powered stair chair with tracks, and it is strongly recommended that at least three EMS professionals are present.
    
2. EMS professional number one takes up position behind the patient and grasps the handles provided with the power grip, making sure that they are in the locked and most extended positions.
3. EMS professional number one will be at the highest point on the stairs during the move and he/she will be responsible for moving the secured patient to the top of the stairs, by either activating the motor and steering the patient to the top of the stairs or by pushing the patient as if in a wheelchair.
4. EMS professional number two should be waiting, facing the patient at the top of the stairs, as well.
   
   EMS professional number two will be lower on the stairs than the patient during the move.
    
5. EMS professional number two should position themselves in front of the patient and grasp the handles provided with the power grip, usually found at the level of the patient's secured ankles, making sure that the handles are in the locked position and fully extended.
   
   Once both EMS professionals are in position,
    
6. the track should be released and set up per manufacturer protocols and recommendations to start the travel down the stairs.
7. The EMS professionals should communicate to one another that they are ready to initiate device movement, and while using proper body mechanics and making sure to keep their heads up and backs straight, both EMS professionals should assist the battery-powered stair chair with tracks as the device is activated to move the patient in a controlled manner down the stairs.
   
   Both EMS professionals should never release the handles of the battery-powered stair chair with tracks in case of an emergency in which the tracks fail.
    
8. EMS professional number three, positioned lowest on the stairs of all people involved, including the patient, will place one hand on the back of EMS professional number two and guide them down the steps, one at a time, while providing pertinent information about the number of stairs remaining, dangerous conditions, and any other circumstances that may arise.
   
   In essence, EMS professional number three becomes the eyes of the group and directs the team throughout the move.
    
9. The patient will be instructed to keep his/her hands across his/her chest at all times during the move to prevent loss of balance due to shifting weight that may cause an accident, as well as to prevent the patient from grabbing onto any stationary objects during the move.
   
   When the patient has been safely moved to the bottom of the stairs,
    
10. EMS professional number one resumes navigation of the device as a wheelchair or by activating the motor and steering the patient to the decided transfer position where the patient will then be moved to the waiting stretcher.

Moving Patients Without Stair Chairs

Patients can be safely moved down or upstairs while secured to a long spine board or other portable device (i.e., scoop stretcher/orthopedic stretcher, flexible stretcher, etc.) with the help of an adequate number of able-bodied personnel.

The technique is the same as with carrying a patient down the stairs in a stair chair, requiring at least an EMS professional at the head of the device, an EMS professional at the foot of the device, and a spotter.

More personnel are recommended if the distance to be carried is great or the patient is bariatric, and each provider should not exceed their own personal limitations. All EMS professionals should maintain proper body mechanics, keeping their heads up and backs straight and lift as a team.

The EMS professional at the head of the patient is in charge of the command to lift, and the spotter gives the command to start the walk down the stairs.

Patients should never be transported on a patient movement device or any type, including a long spine board, with their head lower than their feet.