BHM Medical
BHM Ergolife-600 Instructions for Use rev 1 Sept 2010
Instructions for Use
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Ergolift-600 Instructions for Use
001-00133-EN rev.1 September 2010
Printed in Canada BHM Medical Inc. reserves the right to change or discontinue any specifications, design, features, model or accessories shown without notice. TM Trade-mark of BHM Medical Inc. All rights reserved. © BHM Medical Inc., 2010
Table of Contents General Information ...4 Foreword ...4 Service and Support ...4 Manufacturer Information...5 Authorized European Representative...5 Definitions Used in this Manual ...5 Intended Use ...5 Operational Life ...5 Equipment Identification...6 Verifying the Package Contents...6 How to Use this Manual...6 Policy on Number of Staff Members Required for Patient Transfer ...6 Symbols Used ...7 Safety Instructions...8 General Instructions ...8 Safe Working Load ...8 Shock Prevention ...9 Equipment Warning Labels ...9 Parts Designation...10 Compatible Slings...11 BHM Ergolift-600 Slings...11 Using the Ergolift-600 ...12 Before Approaching the Patient ...12 Power Base...12 Correct Use of the Brakes ...12 Emergency Shut-Off ...13 Raising and Lowering a Patient ...13 To Raise the Patient ...13 To Lower the Patient...13 Transferring a Patient...14 Batteries ...14 Emergency Lowering ...14 Battery Charging ...15 Maintenance Indicator...16 Batteries and Battery Charger Safety Practices ...16 Using the Slings ...17 Lifting a Patient from a Chair ...17 Lifting a Patient from a Bed...18 Lifting a Patient from the Floor ...18 Using a Loop Sling with a Two-Point Spreader Bar ...19 Methods for Transferring a Patient ...19 Digital Scale ...20 Disinfection, Cleaning and Maintenance ...21 Lift Cleaning and Care ...21 Preventive Maintenance Schedule ...22 Troubleshooting...24 Labels on the Lift...25 Technical Specifications...26 Lift Dimension ...27 Limited Warranty ...28 3
General Information Thank you for purchasing the Ergolift-600. Your Ergolift-600 is part of a series of quality products designed specially for home care, nursing homes and other health care uses. We are dedicated to serving your needs and providing the best products available along with training that will bring your staff maximum benefit from every BHM Medical product. Please read this manual thoroughly, and contact us if you have any questions about the operation or maintenance of your BHM Medical equipment.
Foreword Please read this manual in its entirety before using your Ergolift-600. The information in this manual is crucial to the proper operation and maintenance of the equipment, and will help protect your product as well as ensure that the equipment performs to your satisfaction. Lifting and transferring a person always presents a potential risk. Some of the information in this manual is important for your safety and must be read and understood to help prevent injuries. BHM Medical strongly advises and warns that to avoid injuries that can be attributed to the use of inadequate parts, only parts designated by BHM Medical should be used on equipment and other appliances supplied by BHM Medical. Furthermore, unauthorized modifications on any BHM Medical equipment may affect its safety. BHM Medical will not be held responsible for any accidents, incidents or deficiencies of performance that occur as a result of any unauthorized modification to its products.
Service and Support A service routine must be performed on your Ergolift-600 by BHM Medical qualified service personnel. This will ensure the safety and good functioning of your product. See “Disinfection, Cleaning and Maintenance” section in this manual for more details. If you require further information, please contact your local BHM Medical representative which can offer comprehensive support and service programs to maximize the long-term reliability, safety and value of the product. Contact your local BHM Medical representative for replacement parts. Your service representative stocks the parts you will need. Additional copies of this manual can be purchased from your local BHM Medical representative. When ordering, include the user manual’s product number and equipment identification number (see front page).
Manufacturer Information This product has been manufactured by: BHM Medical Inc. 2001 Tanguay Street Magog (Quebec) Canada J1X 5Y5
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General Information Authorized European Representative
specified environmental conditions described in this manual.
Huntleigh Healthcare Ltd. 310-312 Dallow rd. Luton, UK LU1 1TD
The Ergolift-600 must always be handled by a trained caregiver, who must attend the patient during lift application and operation, in accordance with the instructions outlined in these Instructions for Use.
Definitions Used in this Manual:
The Ergolift-600 is intended to be used with loop slings. Use only slings that are designed for Ergolift 600.
WARNING: WARNING: Before using the Ergolift-600, a clinical assessment of the patient’s suitability for transfer must be carried out by a qualified health professional considering that, among other things, the transfer may induce substantial pressure on the patient’s body.
Means: Failure to understand and follow these instructions may result in injury to yourself and others. CAUTION: Means: Failure to follow these instructions may cause damage to the product(s).
CAUTION: BHM Medical does not recommend usage of the lift and mounting of the charger in humid, salty, oxidizing and/or chlorinated conditions. In such cases, BHM Medical recommends a proactive regiment of frequent inspections and maintenance to be carried out.
NOTE: Means: This is important information regarding the correct use of the equipment.
Intended Use Ergolift-600 is a mobile, passive lift with a safe working load of 272 kg (600 lb), intended to be used on horizontal surfaces for lifting and transferring in hospitals, nursing homes or other health care facilities where the patient: •
sits in a wheelchair;
•
has no capacity to support him/herself;
•
cannot stand unsupported and is not able to bear weight, not even partially;
•
is dependant on the caregiver in most situations.
Operational Life The equipment is designed and tested for a useful life of seven (7) years or 10 000 transfers-whichever comes first-subject to preventative maintenance as specified in the “Disinfection, Cleaning and Maintenance” section in this manual. Time equivalence between the number of transfers versus the number of years is made clear in the table below. Years
Or where the patient:
Transfers per Day
(10,000 transfers)
•
is passive;
4
7
•
might be almost or is completely bedridden;
6
4.5
•
is often stiff or has contracted joints;
8
3.5
•
is totally dependent on the caregiver.
The lift is for transferring patients only. It is to be used for patients within the specified weight limit indicated on the lift (272 kg or 600 lb) and with the
5
General Information If anything is not completely understood, please contact your local BHM Medical representative for more details. Failure to comply with warnings in this manual may result in injuries.
WARNING: The manufacturer cannot ensure full safety for a floor lift or an accessory of which the life span has been exceeded.
Keep this manual with the lift and refer to it as required. Make sure that all operators are regularly trained in the use of the equipment according to the information found therein.
The red indicator light on the floor lift will blink when it is about halfway to its useful life, and again to indicate the end of the useful life period.
Any references to “the patient” in this document apply equally to a resident at home or in a long term care facility and refer to the person being lifted or transferred.
The operating life of this equipment corresponds directly to the safe operating time period before a complete overhaul is required. Aging of the unit, frequency of use (transfers per day), the weight of the patient and maintenance frequency are factors that have an impact on the lift’s life span. A transfer is defined as the displacement of a patient from one point to another. A transfer cycle includes a lifting and a descending action.
References to left or right in these instructions are as viewed from the caregiver’s pushing position, standing at the rear of the Ergolift-600, facing forward.
The expected life for other consumable products, such as batteries, fuses, lamps, slings, straps and cords is dependent upon the care and usage of the equipment concerned. Consumables must be maintained in accordance with published Instructions for Use and the “Preventive Maintenance Schedule”.
Equipment Identification The unit's identification number (specification, model, serial number) appears on a silver nameplate located at the bottom of the mast.Verifying the Package Contents
Left
Upon receipt of the equipment, verify it against the packing list to ensure it is complete and inspect the equipment for possible damage due to shipping. If there is any damage, notify the carrier immediately to file a claim. Provide complete information concerning damage claims or shipping errors to your local BHM Medical representative. Include all equipment identification numbers and group part numbers (if any) as described above along with a full description of damaged parts.
Right
Fig. 1
Policy on Number of Staff Members Required for Patient Transfer
How to Use this Manual
BHM Medical’s passive and active series of lifts are designed for safe usage with one caregiver. There are circumstances, such as combativness, obesity, contractures etc. of the individual that may dictate the need for a two-person transfer. It is the responsibility of each facility or medical professional to determine if a one or two person transfer is more appropriate, based on the task, resident load, environment, capability, and skill level of the staff members.
WARNING: Do not attempt to use this equipment without fully understanding the information contained in this manual. To ensure the safe operation of the Ergolift-600, read the entire manual carefully, especially the “Safety Instructions” section, before operating or servicing this equipment.
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General Information Symbols Used
Symbols
Key to Symbols This symbol is accompanied by the name and the address of the authorized representative in the European Community.
This symbol is accompanied by a date to indicate the date of manufacture and by the address of the manufacturer.
This symbol indicates the products comply with all the applicable European Directives. This symbol is accompanied by the manufacturer's catalogue number.
This symbol is accompanied by the manufacturer's serial number.
This symbol indicates “separate collection” for all batteries and accumulators as per the WEEE Directive. The black bar indicates the equipment was first placed on the market after August 13th 2005.
This symbol refers to the Instructions for Use.
This symbol indicates a risk of pinching
Fig. 2
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Safety Instructions The equipment must be used in accordance with the following safety instructions.
General Instructions WARNING: Only manufacturer designated parts designed for the purpose shall be used for the Ergolift-600, in order to avoid injuries attributable to the use of inadequate parts.
Anyone using the equipment must also have read and understood the instructions in this manual. If there is anything you are not sure about, contact your local BHM Medical representative.
WARNING: Unauthorized modifications or repairs on the Ergolift-600 will affect its safety and invalidate any warranty. The manufacturer will not accept responsibility for any accidents, incidents or lack of performance that can occur as a result of any such unauthorized modification or repair.
Safe Working Load The safe working 272 kg (600 lb).
load
of
the
Ergolift-600
is
WARNING: Do not overload the Ergolift-600 beyond the approved lifting capacity of the lowest rated attachment/accessory. If the maximum load differs between floor lift, spreader bar and body support unit (i.e. sling), then the lowest maximum load shall always be used.
•
Always carry out the “Before every use” inspection prior using the lift.
•
Always maneuver the lift with the handles located on the mast. If necessary, initiate the movement by pushing on the back of the base with your foot. Do not push on the legs.
•
Never attempt to push or pull a loaded lift over an obstruction on the floor that the castors would be unable to ride over easily, including steps, door thresholds or autowalks.
•
Do not push the lift at a speed which exceeds a slow walking pace (3 km/hour or 0.8 meter/second).
•
This mobile patient lift must be used by a caregiver trained to these instructions and qualified to work with the patient to be transferred and should never be used by a patient on their own.
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Safety Instructions •
Always ensure that controls and safety features are used only in accordance with the rules specified in this manual. Never attempt to force a control or button on the lift.
•
While the base of the lift can be opened to ease the transfer of a patient, it should be kept closed between transfer points.
•
Avoid any impact during tranfers.
•
Do not put fingers, hands or feet where space is limited (see image below). This could pinch, cut, or cause serious harm. This includes spaces between the lift base and the floor (1), between the actuator cab and the mast tubing (2), between the spreader bar block and the boom tubing (3) and between legs and the base while closing the legs (4).
Check nameplates for voltage and cycle requirements. These requirements differ by country. Do not attempt to use the lift in an area that has a different voltage and cycle requirement.
•
Do not attempt to expose, service or repair the lift, battery or charger. If any unit is malfunctioning, contact your local BHM Medical representative.
Equipment Warning Labels
Fig. 3 CAUTION: Keep all components of the lift clean and dry, and have electrical and mechanical safety checkpoints done as instructed in the “Preventive Maintenance Schedule” of this manual.
Shock prevention •
•
Do not touch a damaged power cord. Electrically live equipment can result in serious injuries. If the lift or charger has any exposed or damaged wires, contact your local BHM Medical representative immediately.
9
•
Carefully read the labels and follow the instructions.
•
Inspect all precautionary labels on the equipment. Order and replace all labels that cannot be easily read.
Part Description
Fig. 4
Legend 1) 2) 3) 4) 5) 6) 7) 8) 9)
Hand control Boom Two-point spreader bar Safety latch Actuator Emergency lowering Right leg Left leg Mast
10) Control box 11) UP button 12) DOWN button 13) Emergency shut-off button 14) LEGS OPENED button 15) LEGS CLOSED button
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Compatible Slings BHM Ergolift-600 Slings Every patient has different needs. It is very important to correctly choose the sling based on the needs of the patient to be transferred as well as their physical ability and size.
Hammock sling (THA-X & THAI –X))
Hammock 6 sling (THA6-X & THA6I –X))
Quick Fit sling (TIR–X)
Hygienic sling (THY–X))
Combi sling (62600X–X)
Limb sling (300.20005)
Fig. 5 For more information about slings and how to use them, refer to the documentation that comes with your sling.
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Using the Ergolift-600 Before Approaching the Patient
Power Base
The Ergolift-600 is delivered to you in a fully assembled state. Before using it, plug the power cord into a standard three-prong outlet. Check the charging indicator light to ensure that it is illuminated. Batteries need to be charged for a minimum of 8 hours prior to using this lift for the first time. Unplug the lift from the electrical outlet and ensure that a sling is available.
The base of the lift can be set with the legs opened or closed by using the two bottom buttons on the hand control, or the buttons located on the control box.
WARNING: Read before use. Before using your Ergolift-600, you must read and fully understand the following Instructions for Use. You must be trained on the Ergolift600 and on any accessories, as well as its functions and controls.
close open open close
CAUTION: Always carry out the items marked as “Before every use” in the “Preventive Maintenance Schedule” before using the lift. Fig. 6
Correct Use of the Brakes Foot operated brakes are fitted on both rear castors. Brakes should only be used in the following situations: •
When the lifter and the patient are momentarily at rest; for example, during preparation for transferring to a bed or a chair.
•
Whenever movement of the lift must be halted while transferring a patient.
Brakes should NOT be used in the following situation: •
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When raising a patient from a stationary position to allow the lift to auto-adjust to the patient’s center of gravity. This will then keep the patient from swaying.
Using the Ergolift-600 Brakes application and release:
Raising and Lowering a Patient
•
To apply brakes, step on the back portion of pad.
•
To release brakes, step on the front portion of pad or lift with the toe of shoe.
The electrical actuator can be operated in both directions and allows the operator to raise or lower the patient without any physical effort. The hand control can be used to operate the lift, as well as the UP and DOWN buttons located on the control box.
UP
Unlocked
DOWN
Locked Fig. 7
Emergency Shut-Off The operator can shut off the electrical power at any time by pressing the red emergency button on the front of control box. Reset the emergency shut-off function by turning the button clockwise.
UP DOWN
Fig. 9
NOTE: First-time users should practice the shut-off maneuver before operating the lift with a patient in it.
To Raise the Patient Press on the UP button on the hand control. Keep your finger on the button until the patient is at the desired height, then release the button to stop the movement.
To Lower the Patient Press on the DOWN button on the hand control. Keep your finger on the button until the patient is at the desired height, then release the button to stop the movement. Emergency shut-off
The auxiliary UP and DOWN buttons are located on the control box serve two functions: 1) They are secondary controls in the event the hand control stops functioning, or 2) if two attendants are involved in the transfer, one can use the auxiliary controls, while the other moves into a position where she/he is with the patient continuously.
Fig. 8
When you push two buttons simultaneously, the first function button pushed will override all other functions until you release one of the buttons.
14
Using the Ergolift-600 Transferring a Patient
EN 60601-1, CAN/CSA-C22-2, No. 601-1 M90 and UL 2601-1.
Most patients can be rotated a full 360 degrees with no restriction, even at elevated levels. This makes it easier for a wheelchair patient to be maneuvered using front or side entry, as required. This ability to rotate patients also allows the caregiver to properly position the patient when performing a transfer to and from a bed.
The batteries consist of two 12-volt, 5 AH (24 volts capacity), delivering at least 100 cycles per charge (272 kg or 600 lb). Battery life is variable (2-3 years) and is influenced by proper charging practices and load exertion.
Emergency Lowering
When the patient is in a sling facing the mast, lower the patient to the lowest convenient height above the floor. This will provide added stability and comfort to the patient.
The Ergolift-600 is equipped with a safety feature that allows the boom to be lowered even if the electrical system does not operate.
Handles are provided on both sides of the total lift sling to allow better positioning for the caregiver, enhancing patient’s safety.
Locate the red emergency lowering device handle directly above the plastic actuator motor cover. Following the direction of the arrow, pull straight up and hold. This will allow the actuator to slowly lower to the desired level (this component is spring loaded and will return to normal and stop the lowering process when released). There must be a load applied on the boom for the emergency lowering device to function.
For information about how to attach a sling to the lift, read the “Lifting a Patient” section. WARNING: Do not attempt to maneuver the lift by pulling on the mast, boom, actuator or patient.
WARNING: The harder you pull on the emergency lowering device handle, the faster the patient will descend. For a slow descent, pull the handle only slightly.
WARNING: Always maneuver the lift using the handles in the travel direction indicated on the picture below and with the legs closed.
Fig. 11
Batteries
Fig. 10
The batteries are medically approved according to
15
Using the Ergolift-600 Battery Charging
When using the battery charger for the first time, or if the cable has been unplugged from the charger, connect the cable fully into the charger before connecting to the main electrical socket.
The Ergolift-600 uses sealed lead-acid batteries contained in a battery pack mounted within the control box. Unlike nickel-cadmium batteries, leadacid batteries are not subject to a memory effect. Therefore, they should not be completely drained before being recharged. The control box is equipped with an automatic control shut-off after a certain period of time of inactivity to prevent the battery pack from draining while the lift is in the stand-by mode. Power to the lift is reactivated by pushing any hand control button. The lift also has a low battery indicator, located on the front of the control box (see Fig. 12).
CAUTION: Batteries need to be charged for a minimum of 8 hours prior to initial use of this lift.
WARNING: Do not drain the batteries excessively. This will dramatically reduce the batteries life span. If the low battery buzzer sounds, be sure to recharge the batteries as soon as possible.
Power indicator (green)
WARNING: Do not operate the charger unit with a damaged cord or if the unit has been damaged. Do not forcibly bend the power cord or place a heavy object on it. This will damage the cord and may cause a fire or electrical shock.
WARNING: Do not place the unit in locations that are extremely hot, dusty or dirty, very humid, moving or vibrating.
Maintenance indicator Battery charge indicator (yellow) Charger indicator (green)
Maintenance Indicator The maintenance indicator (see Fig. 12) will light after 16 hours of operation (approx. 4000 up/down cycles). A complete inspection must then be performed by a qualified technician and a proper maintenance done according to findings to prevent accidents. Otherwise, after 19 hours of operation, the indicator will also emit an audible intermittent beep until the counter is reset.
Fig. 12 To prolong battery life, plug the unit into an outlet whenever it is not in use. When the batteries are low, the green power indicator LED will begin to blink and the control box will emit an audible intermittent “beep”. Plug the unit to an electrical outlet to begin charging the battery pack. The “battery charge” indicator (yellow) will turn on, and the green “charger” indicator will show that the charger is in the process of charging the batteries. Once the batteries are fully charged, the yellow “battery charge” indicator will turn off. The unit can be unplugged and put back to use. To ensure that the Ergolift-600 is always ready for use, it is recommended that fully charged batteries always be available. This can be arranged by having additional battery packs on hand and keeping one battery pack charging while the other is in use.
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Using the Ergolift-600 • WARNING: Do not drop the battery pack. A dropped battery pack may have internal damage that is not visible. It may lose its ability to recharge. Due to internal damage caused when the battery is dropped, the battery may indicate it is fully charged, when in fact it cannot hold a full charge on a damaged battery. Never attempt to use batteries that appear to be damaged or dented. Do not store the batteries near a heat source. Heat will damage them. Always keep metal batteries contacts clean.
Batteries and Battery Charger Safety Practices •
The battery charger is for indoor use only, and should be used in a dry environment. Do not use it in a bathroom.
•
Do not charge the lift in unventilated areas.
•
The control box must not be covered or exposed to dust. The metal contacts must be kept clean.
•
The battery charger in the control box is for use only with Ergolift-600 battery packs that are supplied by BHM Medical.
•
Do not short-circuit the batteries.
•
Do not crush, puncture, open, dismantle or otherwise mechanically interfere with the batteries.
•
Do not store batteries at a temperature higher than 40 degrees C (140 degrees F). Should the battery casing crack and cause contents to come in contact with skin or clothing, rinse immediately with water. If contents come in contact with the eyes, rinse immediately with plenty of water and seek medical attention.
•
The abbreviation “Pb” shown adjacent to the recycling and trash bin symbols on the battery pack label is the element symbol for lead. It indicates that the battery contains lead, and therefore should not be disposed of, but recycled.
17
For recycling and disposal of the batteries, the rules according to local regulations must be followed. If not, they may explode, leak and cause personal injury. When returning batteries, insulate their terminals with adhesive tape, otherwise, the residual electricity in used batteries may cause fire or explosion. Picture below shows the symbols for disposal and recycling.
Using the Ergolift-600 Using the Slings
WARNING: During transfers, have someone assist you to ensure the patient’s safety at all times.
WARNING: Please read carefully the following, before using a BHM Medical Ergolift-600 sling. •
•
•
1) Place the sling around the patient so that the base of his/her spine is covered, and the head support area of the sling is behind the head.
Always carry out the “Before Every Use” check list before each use of the lift.
2) Pull each leg strap under the thighs so that they emerge on the inside of the thighs.
BHM Medical floor lifts are specifically designed for BHM Medical slings. Accessories designed by any other manufacturer are prohibited and will void BHM Medical’s warranty. Use only BHM Medical slings and accessories to maintain patient’s safety and product care utility.
3) Approach the spreader bar at or just below the shoulder level. 4) Position the spreader bar close enough to be able to connect the shoulder strap loops of the sling to the spreader bar hooks. 5) Connect these first, then attach the leg sections (some attendants prefer to connect the leg straps first. This applies in particular to patients with large thighs).
Observe a trained expert perform the transfer procedures and then practice them several times with a capable individual acting as patient before attempting a transfer with a patient with limited capabilities.
6) Ensure that all loops are securely connected, then raise the patient using the hand control.
•
Read all instructions below carefully before attempting to install a sling.
•
If you have any doubts, please contact your local representative.
•
Before transferring a patient from a stationary object (wheelchair, bath or bed), slightly raise the patient off the stationary object and check that all sling attachments are secure. If any attachment is not correct, lower the patient and correct the problem, then raise the patient and check again.
8) Before transferring, turn the patient towards you, and keep at a normal chair height. This gives confidence and dignity to the patient.
Use a sling recommended by the patient’s physician, nurse or medical specialists as appropriate for the patient’s ability and needs.
10) Support the patient to stop excessive swinging and to give a feeling of added security.
•
7) The head support area of the sling should now come into use. This is the most comfortable position for transfer, as it reduces pressure on the patient’s thighs.
9) Avoid lifting the patient higher than the attendant’s eye level to lessen the impression of height for confused patients.
11) The patient may be transferred to and placed in a chair, or on a bed. 12) Lower the patient and unfasten the sling from the spreader bar. Move the Ergolift-600 away before removing the sling from under the patient.
For detailed instructions on the transfer of patients and use of various slings, refer to the the Loop Slings Instructions for Use.
Lifting a Patient from a Bed
Lifting a Patient from a Chair
Proper body mechanics and sound ergonomic positioning should be maintained by the caregiver at all times.
Proper body mechanics and sound ergonomic positioning should be maintained by the caregiver at all times.
1) Position the patient onto the sling by rolling the patient, then folding the sling in half and placing it behind the patient’s back.
The lifting techniques described can be used for seated patients regardless of where they may be seated (on the edge of a bed, in a chair, wheelchair, etc.).
18
Using the Ergolift-600 Using a Loop Sling with a Two-Point Spreader Bar
2) Position the sling carefully so that, when rolled back, the patient will lay on the center of the sling. 3) Check that the head support area of the sling covers the patient’s neck. 4) Alternately, the patient can be brought into a sitting posture. Then, position the sling as detailed under the “Lifting From a Chair” heading. 5) Approach the bed with the spreader bar towards the patient’s head. Position the Ergolift-600 so that the spreader bar is just above and centered over the patient. 6) Attach the shoulder strap loops and connect the sling leg portions under the thighs by lifting one leg at a time (some attendants prefer to connect the leg straps first. This applies in particular to patients with large thighs). You may need to lower the spreader bar a little, using the hand control.
Fig. 13 The spreader bar has two hooks at either end of the bar; always use these for the shoulder strap loops (see Fig. 14).
7) When all the loops are securely attached, raise the patient from the bed. When attaching a loop sling to the twopoint spreader bar, always ensure the sling attachment loops are positioned correctly into the retaining hooks (see Fig. 14).
8) Transfer the patient where you need and lower him/her. 9) Unfasten the sling from the spreader bar. Move the Ergolift-600 away before removing the sling from under the patient.
Fig. 14
19
Using the Ergolift-600 Methods for Transferring a Patient Method 1
Fig. 15 Method 2
Fig. 16 Method 3
Fig. 17
20
Digital Scale For detailed instructions about the digital scale, refer to the BHM Medical scale Instructions for Use.
Fig. 18
21