Gotta love those entrapped-morbid-obese, upside down in a rollover, hanging from the seatbelt and stuck under the steering wheel, swearing "I washn't Driiiving Shir!"... I notice too, that there's always something like the aforementioned ghetto stairs, or a tight hallway, or some obstacle or other, to deal with when you've got a big pt. How come it can never never never be a straight beeline from pt's location to back of bus?
I have one in my district that truly puts Stryker's 700# limit to the test. Picture that scene of "I Now Pronounce You: Chuck & Larry", you know.. We're lucky enough to have the power-pro cots (thanks workmans comp), and we drain two batteries per run when this pt's involved. We always always call mutual aid in such a case...
I've never broken my back but came close on a transport to an optomatrist's office where my pt absoultly had to be in "the chair" and there was no lift assist availible. Next time I'm calling the local FD for assist if this facility won't have a team availible. I try to be smart and lift properly but that sometimes results in a blow-out of the crotch of my duty pants and a good deal of embarassment at the ED upon arrival. And sometimes it's a hard call if the pt at hand is in a condition that I can afford to wait for lift assist.
Bottom line..... Situation Dictates Procedure.