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Precious cargo: tips for the safe transportation of residents.

Having staff available to accompany residents to doctors' appointments and group activities is important. But ensuring that the same staff are trained in transportation safety is a facility's number-one priority.

When it comes to safely transporting residents to and from a destination, the first step happens even before the trip is planned.

Assess how many residents, staff, and potential family members are going in the vehicle, says Cindy Frakes, regional vice president for Medicalodge Post-Acute Care Center in Kansas City, KS.

For each resident, ask yourself, "Is this resident okay with one-to-one assistance, or does the resident need three-to-one assistance?" Keep an assessment available for activities, social services, and nursing personnel to access at any time, Frakes says.

For typical residents who are both alert and oriented, generally assign one staff member for every four to six residents. For the physically or cognitively impaired resident, it's appropriate to have one staff member for every two to three residents. Sometimes, assigning one staff member to assist one resident is best, depending on the resident's needs and abilities, recommends Frakes.

Residents at risk for wandering from the group, falling, or susceptible to exploitation should always have a staff member assigned to them, she says. Update and train your staff on equipment use such as seatbelts, gait belts, lifts, and chair restraints. Educate staff on which wheelchairs are safe for transportation and which aren't.

Involve your insurance carrier. Consult with its representatives, learn their rules and how they assess a vehicle, and take their advice, Frakes emphasizes.

Your vehicle needs an assessment, too

Make sure your vehicle is in top-notch condition. Pre- and post-trip inspections are important, along with a vehicle maintenance program that corrects any underlying problems, recommends Terry Butler, vice president of operations for Carpenter Bus Sales Inc. in Franklin, TN.

It's also important to have your facility's vehicle professionally serviced on a regular basis.

Remember to assess the vehicle, which is not much different from assessing a home, Frakes says. For instance, if you have a resident with lower limb amputation, and she can self-transfer using a trapeze and other devices, make sure the vehicle is equipped for the needs of this resident.

It's important to transport acutely ill residents by ambulance, but often residents with multiple chronic conditions are transported on buses and chair cars. These residents are fragile, and you should prevent them from getting bumps, bruises, and skin tears, says Frakes.

Before each trip, take a walk through the vehicle and make sure the van doesn't have torn vinyl or protruding sharp metal objects.

When appropriate, contact a professional transportation company. Most facilities, for example, will not transfer a resident with IV poles, Frakes adds.

Who's behind the wheel?

Drivers are either hired by the facility or are current employees such as certified nursing assistants, says Stacey Scott, who performs community relations for Action Ambulance Services, Inc. in Wilmington, MA.

If the driver is not staff, he or she typically has first-aid training and is CPR certified. Occasionally, emergency medical technicians drive the vehicle, says Scott.

Although it's not required to drive a van, it's recommended that the driver obtain a commercial driver's license, Frakes says.

Smooth moves

Most falls happen getting on and off the vehicle, and lifts and steps are the frequent culprits, Frakes says. The more resident-friendly vehicles ride low to the ground for the individual who can maneuver in and out of the vehicle alone.

Frakes recommends the following steps for helping residents get comfortably seated:

* Stand beside the resident as he or she climbs the stairs

* If the resident is wearing a gait belt, hold the belt as a safety mechanism in case the resident starts to fall

* If the resident is wheelchair bound, secure the wheelchair on the lift, ensure that the resident is buckled into the chair, and keep the resident's arms and feet away from moving parts

* Stand beside the resident as he or she is raised or lowered on the lift

Use extra caution with residents who cannot sit up sufficiently, regardless of their mental status, Frakes says. Even the most oriented people cannot say fast enough that they are slipping out of their seat.

There is a difference between sitting a resident up in a stretcher and transposing a resident in a routine wheelchair. A lot of wheelchairs tilt, which helps resident sit up safely while at the facility. But this same chair on a vehicle becomes dangerous, warns Frakes.

Never transport a restrained resident in a tilted wheelchair. As long as the driver doesn't slam on the brakes, the resident is safe. But the partially reclined person buckled with a seatbelt can slide out of the wheelchair. Or worse, the seatbelt could slide up and around his or her neck and choke the resident, Frakes says.

It's best to transport residents in wheelchairs appropriate for transportation and to double-check that each resident is safely fastened in the chaff and that the chair is secure and locked down, Scott says.

Different circumstances call for different measures

Whenever you transport a resident with an oxygen tank, have another staff member present. Remember, this is a situation where outsourcing a transportation company might be the safest option, says Frakes.

If there is a motor vehicle accident, an oxygen tank poses the threat of an explosion, and having professionals familiar with those types of situations on hand is best, she says.

If outsourcing is not practical, most drivers know how to handle the tank, but Scott recommends that the resident and accompanying staff monitor the oxygen tank the entire trip.

RELATED ARTICLE: Keeping the driver and staff unharmed.

It's important to keep residents safe, but it's equally important to keep staff and the driver safe as well. Cognitively impaired residents become agitated quicker than other residents. They may act out by becoming verbally and physically abusive, says Scott.

Train your staff and driver in the following seven steps to keep them and other passengers safe:

1. Talk softly to the agitated resident

2. Let the resident know that everything will be okay

3. Inform the resident that you're almost at the destination

4. Never argue back

5. Call the facility for further instructions

6. If necessary, find a safe place to stop and wait for assistance

7. Separate the resident from the situation by taking the resident by ambulance or a separate chair van to the destination

When one resident becomes physically or verbally abusive, it scares the other residents and any accompanying family members. Informing them that everything is okay and under control is another step staff can take to calm the situation, Scott says.--Adrienne Trivers
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Author:Trivers, Adrienne
Publication:Contemporary Long Term Care
Date:Jan 1, 2007
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