Cot Safety Tips

Transport cots ( a.k.a. ambulance stretcher, gurney, litter) are one of the most frequently used EMS devices. Because of this, cots can become worn or damaged, creating hazardous conditions. This  applies to all brands, types and models without prejudice. Unfortunately, the vast majority of incidents that involve injuries have proven to be caused by OPERATOR ERROR.

Sorry, but this is also an unfortunate fact. No doubt you want to avoid harming patients, your partners and yourself. You also want to prevent serious negligence claims from being leveled at your organization and YOU! As an operator of medical devices, you have an ethical and legal obligation to minimize the possibility of injuries. Fortunately, most accidents can be avoided. It is often a matter of training and caution. Following are some reminders about cot use and care:

• NEVER RELY ON THE FLOOR HOOK (attached to ambulance floor near rear doors) to stop the cot from being pulled too far out of the ambulance, before the undercarriage is lowered and locked in-place. Contrary to its common name, the floor hook is not a “SAFTEY HOOK! The “U” catch bar under the head side of the cot, which should engage the floor hook, can fail. The “U” bars break, the return springs fail and the bars may not drop into position. Manufacturers clearly instruct users to “gently engage the floor hook – visually confirm that the hook and “U” bar are in-contact and that the cot load wheels are squarely on the ambulance floor”. It is then safe for one of the operators to lower the undercarriage (wheels). Both operators should confirm that the cot is securely locked in the open-upright position before disengaging the cot from the floor hook.
• COT COLLAPSES TO THE GROUND WITH PATIENT ON-BOARD is the most repeated cause of serious patient injury and legal grievances against owners and operators. The majority of post-incident inspections reveal that equipment malfunction is not at fault. Most cot locking mechanism designs are straightforward and easy to use. The cot is either broken or it’s not. In most reported situations, the cots are found to be operating properly. Cot locking mechanisms are not intended to be engaged or disengaged while patient weight is applied. ALL operators (more than two with heavy patients) should be supporting the patient weight (slightly lifting the cot) while operating the locks. When the lock operating handle(s) are released and the locks are engaged, the operators should continue to support the weight, releasing a tight grip only when they have confirmed that the cot is locked and stable. With patient on-board and the cot in the open/up position, operators should always be holding onto the cot, ready to support the full weight.
• Inspect the cot you are working with. Understand how it works. Develop effective communication routines with your partner(s). Do not rush through movements. Don’t be over confident and assume that equipment is working as intended. Check – be cautious – and check again.
• WHO SAID THE EQUIPMENT IS SAFE FOR USE? Just because the equipment is in the ambulance when you start your shift does not mean it is functioning properly. In the case of a cot, it’s easy to perform simple checks and tests before you begin to transport people. With the linens and mattress removed, operate the cot. Look for obvious problems; EG: broken springs, U bar in wrong position, pins or fasteners sticking out, shaky or sticking wheels, etc. Report problems immediately! Remember, you are responsible and may be accountable for avoidable injuries. The examples above show, faulty equipment may not relieve you of your responsibility, and possible liability.