Stair chair training for NEMT crews: the two-person carry, track descents, and weight limits

Stair chair work is a crew skill, and both main makers say so in their manuals: a trained pair at the handles, a rider who has been told what is about to happen, and operators who practiced before a rider was ever in the seat. This page covers that training. What a stair chair is, its specifications and how the trip is billed are in the stair chair glossary entry.

Which programs let drivers handle stairs at all differs by state and broker, and the driver scope of duties guide compares them. If a crew is going to do it, the rest of this page is how to prepare. The two-person cot skills for lie-flat riders are in stretcher training for NEMT crews.

How many trained people does a stair chair need?

At least two, and more as the rider gets heavier. These three manuals set the minimums:

On the LBS chair the manual recommends four operators for riders over about 150 kg (about 330 lb). Its braking table notes some track slippage with two operators at 150 kg and lists four operators required for every weight from 200 kg up. Check the table for the chair you own, because the number of operators changes with the rider.

What do the makers require of the operators?

Both makers put the responsibility on the operator’s training, not on the chair. Stryker’s warnings tell crews not to let untrained helpers assist in operating the chair, to use the chair only as the manual describes and to read every label before use. Its manual includes a training record page with a line per trainee, columns for the basic training and refresher dates, and a column for the method: owner’s manual, in-service session or formal class.

Ferno’s manuals go further. They say the operator must read and understand the manual, have training on the chair, have the physical ability to assist the rider, practice with the chair before using it with a rider and keep training records, with a sample sheet at the back. The 59T manual calls the chair an evacuation chair and also lists training in emergency medical service and emergency patient handling. That is the maker’s standard for its own users, so check what your state or broker expects of drivers.

Neither maker states how many practice runs are enough. Set a pass standard of your own, write it down and apply it to every operator.

How should a crew practice the descent?

Run each step below with an empty chair, then with a seated crew member, and only then with a rider. The order follows the Stryker and Ferno procedures:

1. Check the chair. The chair must be locked open, since an unlocked chair can fold in use. Confirm the lift handles are locked, the restraints are intact and, on a track chair, that the track is fully open. Test the lock rather than trusting it: Stryker has you try to fold the track back up, and Ferno’s LBS manual has you try to push the track closed.
2. Seat and strap the rider. Use all the restraint straps. Apply the wheel locks only during a transfer or with no rider aboard, since moving a locked chair can tip it. Do not push the Stryker 6252 with the upper handle fully extended.
3. Tell the rider. Stryker’s rule is not to roll the chair or start up or down stairs without advising the rider, and to stay with the rider and control the chair throughout.
4. Set the roles. One operator at the head end, one at the foot end, and a lead who directs any helper. On a Ferno chair the operators face each other going down, with the spotter behind the backward-facing operator.
5. Start the track. Tilt the chair back only far enough for the track to touch, ease it over the edge so the track grips the first step, and let it glide until the track rests across two or three steps. The head-end operator presses down lightly on the upper handle while the foot-end operator presses up lightly on the lift handles, which keeps the chair from rocking forward.
6. Carry, on chairs without a track. On the Stryker 6250 and 6251, both operators lift together by the lift handles, using proper lifting technique, and carry the chair slowly past obstructions.
7. Land and reset. Ferno suggests picturing a landing zone at the top or bottom of the stairs, with room to set the chair on all four wheels away from the edge. In a narrow stairwell, retract the handles between flights.

What weight check comes before the carry?

Add up everything on the chair, compare it with the rating and ask whether the crew can safely handle it. The rating counts the rider plus anything attached, such as an oxygen bottle or an IV pole. As an example, a 470-pound rider with 40 pounds of oxygen equipment is 510 pounds against a 500-pound rating, so the chair is over its limit even though the rider alone is not. The crew also supports the chair itself, which weighs about 32 pounds for the Stryker 6252. Ferno says to inspect a chair whose rating has been exceeded, and Stryker adds that operators should never try to carry more than they can safely lift.

OSHA’s 2014 interpretation letter cites a 2007 study that found the NIOSH lifting equation yields a recommended 35-pound maximum for patient-handling tasks, and it calls the equation a voluntary guideline, not a requirement. OSHA’s safe patient handling guidance names transfer and lifting devices as key to controlling the injury risk. A track chair is built so the crew glides down instead of lifting, and a chair without a track puts the load in the operators’ hands. Know which kind you have before taking on a heavy rider. The weight and stair questions to ask at booking are in the glossary entry.

When should the crew stop and call for more hands or EMS?

Stop when the chair, the stairs or the crew falls outside what the manual describes. Each of these follows from the makers’ warnings:

• A suspected neck, spine or fracture injury. Stryker does not recommend the Stair-PRO for these riders, so the trip needs a different level of care than a stair chair provides.
• Wet, icy or cluttered stairs. Both makers say to clear the stairs or take another route. Water, ice or debris on the track can change the load without warning, so keep the track belts clean and dry and never lubricate them.
• A rider heavier than the crew can safely lift, or over the rating. Add trained operators from the manual’s chart, book a chair and crew rated for the weight, or decline the carry.
• A track or handle that will not lock. Do not use the chair.
• Too few trained hands. Two operators is the minimum with a rider aboard. A relative or a building employee is not a substitute at the handles.

Virginia’s handbook also expects the provider to bring a Reeves or scoop stretcher, or a stair chair, when a stretcher van rider needs one. The elevator and tight-hall guide covers buildings where even the stair chair will not fit.

What goes in the training record?

Record each operator’s name, the chair model, the roles practiced (head end, foot end and spotter), the stairs or surfaces used, the load, the date, the trainer and the result. The sample sheets in the Stryker and Ferno manuals are shorter than that, so a fuller log serves you better. Stretcher training for NEMT crews explains how to build the record, and the driver training log has the columns.

Setting stair chair trips up in HealthRide

A trip in HealthRide can carry a stair chair need, so dispatch sees it when assigning the crew instead of finding out at the curb. Each driver’s certifications can hold an expiration date with reminders before it passes, so a stair chair refresher due next month is visible early. See fleet and credentials for how vehicle and driver details are tracked.