how to stabilize a mechanical lift before using it

%PDF-1.7 % Dynamic elements may respond unpredictably and unfavorably to lifting and stabilization. Additional equipment in the bedroom includes a portable suction machine, which Miguel requires due to his inability to effectively manage secretions, supplemental oxygen, and an oxygen saturation monitor. List nine guidelines for using proper body mechanics: *Before lifting, assess the weight of the load. The safety of the patient as well as the CG(s) is pivotal when determining the need for a mechanical lift. A patient with a challenging support network will require sensitive communication and careful consideration of resources to make the use of a mechanical lift feasible. or if it was a different Weight of the load Stability of the load Access to the load Victim orientation to the load The first consideration is if the CG is willing to use the lift and has the cognitive ability to learn how to do so safely. Slowly lower patient toward receiving surface. This is going to put unnecessary Lateral Vehicles By doing so, the lift's arms should be directly over the resident. oW|U/GY^6E>KQ7`V=|\Y@6 P|t1Oly/ _E|XY> !z$0[xx-k(l^]h5'$7y~BCOl^y>n/,VmP]Z_5T*[b5*(bR].%xwulQT` The best way to accomplish this is to teach the CG how to use the lift and then watch them perform the task several times, exactly replicating the transfers that will be performed every day. Analyze the load's stability from two perspectives: what is the stability of the load now, and what will the stability of the load be during lifting operations. %PDF-1.5 % Here are the basic steps: 1) Stabilize the lift 2) Check the sling 3) Prepare and transfer the patient Examine and stabilize the lift Make sure the wheels are tightly attached and locked in position. Don't hold your breath. In situations where the level of assistance fluctuatesmeaning the CG has doubt about how much the patient is capable of assistingthe maximum level of assistance potentially needed is assumed. (2008). Using a mechanical lift may not be safe if the person is resistant or combative. This will produce tremendous lift depending on the type and quantity of bags used. and that the data you submit is exempt from Do Not Sell My Personal Information requests. Miguel is nonambulatory and is completely dependent for all mobility. MECHANICAL LIFT CONSIDERATIONS Interpersonal, situational, and environmental barri-ers should be addressed before recommending a mechanical lift for use in the home setting.12 A rec-ommendation to use a mechanical lift at home should be based on a thorough assessment of the care recipient's needs, the caregiver's capacity, You can protect your back and avoid injury by following seven simple steps whenever lifting any heavy object: Ensure a wide base of support: Keep your feet shoulder-width apart with one foot slightly in front of the other. This provides vertical support for the A, B or C pillars and allows for effective side access and dash displacement operations. Mrs. A's functional level has declined to where she is unable to ambulate and transfers fluctuate between moderate and maximal assistance depending on muscle tone and time of day. Part 2: Algorithm and Case Application, Articles in PubMed by Brenda Douglas, PhD, RN, Articles in Google Scholar by Brenda Douglas, PhD, RN, Other articles in this journal by Brenda Douglas, PhD, RN, Best Practices for Managing Medical Equipment and Supplies Stored in a Vehicle, Patient Education in Home Care: Strategies for Success, The Effectiveness of a Nurse-Led Transitional Care Model for Patients With Congestive Heart Failure, Privacy Policy (Updated December 15, 2022). Ensure slings, hooks, chains, straps and supports are available, appropriate and correctly sized. Ensure clips, latches and bars are securely fastened and structurally sound. Assisting a patient to ambulate is an example of a high safety-risk activity where determining the need for manual assistance or patient handling equipment is essential. Work all of your major muscles including the abdomen, hips, legs, chest, back, shoulders and arms. With hydraulic applications, apply a hydraulic ram or spreaders to the load and lift in small increments. best practice to use mechanical lift equipment with a minimum of two staff. Other questions that may prove to be helpful relate to the availability of social support and adequacy of communication with the healthcare provider. Use gentle hands-on pressure to guide patient as you slowly move lift toward receiving surface. How do entitlements differ from other kinds of benefits? The adrenaline-dumping factor is making technical and tactical decisions that match the needs of the victim(s) and the safety of the crew. slight shift forward. the lifting mechanism, This is especially helpful 5$ywSpvL>+viCt:?iM{yMYmlop0IOa/B{n=g6P.bKIKY_Pu}xo^6uVvVmG#bW {g3zi:a4Db.4Hg3:4G#Hs9>E6Mh6Mh6Mh6Mh6Mh6MhV8[lV~_W~_W~_W~_W~_W~_WfYT86h36h36h36h36h368[lN8[lf9[l~w~w~w~w~wf,ZK8[l"Ww>\sl7s3wyw>6V9kq^uz]v[ J 1.5 feet). Determine how many caregivers are required to safely lift the patient. Place the vehicle properly on lift using the following procedure: Put the transmission in neutral position, turn off ignition, close all car doors, and check for overhead obstructions such as radio aerials. Ensure the lift will not make the patients condition worse. If the lift comes with a castor lock press on it until it clicks so that you know it is locked. Finally, a detailed generic assessment of the patient's physical, cognitive, and communication ability is essential in determining the safest and most effective means of transfers. All rights reserved. the other ahead of time, that would stop us from easily being able. 1Use gentle hands-on pressure to guide patient as you slowly move lift toward receiving surface. keep your arms crossed. This general calculation should also provide some insight as to the survivability profile for the victim. Instructions for operating mechanical lifts are specific to each type of lift. Seek balance. http://www.cteskills.comMechanical LiftThe purpose of this procedure is to help lift patients who are too heavy to lift manually, and to promote comfort, and. Because of the forces that are generated by, and transmitted through, the body during resistance training, having a sound . Do not let sling bar hit patient. Dalan Zartman is a 20-year career veteran of the fire service and president and founder of Rescue Methods, LLC. A collaborative effort of the American Physical Therapy Association, the Association of Rehabilitation Nurses, and the Veterans Health Administration resulted in a white paper publication that recommended use or adoption of algorithms in the guidelines for making decisions about safe patient handling and movement (APTA, 2006). on the valve too quickly. Uncertainty regarding the level of assistance a patient can provide sets up a situation where risk of injury to the patient and the CG is increased. Connect with Zartman viaemail. These need to be stable at all times, so make sure the wheels are tightly attached and do not use the Hoyer lift on uneven floors. If sling shows signs of wear, replace it immediately. A review of the literature. You may be trying to access this site from a secured browser on the server. For the safety of Mrs. A and the CGs, the use of a mechanical lift is indicated. Do not machine dry. Make sure to use the proper sling and adjust the straps to fit the patient properly. Evaluating the total home care environment for patient lifts. so that the legs hang (2013). Lifting Sequence In this case, we're using Stability of the load will be impacted by the position of the vehicle as well as the base that the vehicle is resting on. The adrenaline-dumping factor is making technical and tactical decisions that match the needs of the victim(s) and the safety of the crew. Once more accessible housing is acquired, the discussion and application of the algorithm will need to take place given the change in environmental conditions. This is a safer and more stable lift, but produces minimal lift and takes more time to develop than the lever lift. Class I applications will require an additional fulcrum to be constructed using cribbing near the lift point. Use the primary stabilization step chocks on one side as two points of contact for the pivot side. The teach-back method can be used to ascertain if the nonprofessional CG can safely use the mechanical lift (Kripalani et al., 2008). Pneumatic lift Base legs are usually more stable in full open position. and movement. Which side should a NA stand near when a resident is using adaptive equipment - the weaker or stronger side? Detach sling from lift using manufacturers instructions. Stability and WeightliftingMechanics of StabilizationPart 1. Safe Mechanical Lift Operation: Before the initial and subsequent use of mechanical lift equipment, a safety check . He is nonverbal and is vocal at times, which his mother feels is meaningful but this is unclear to his home therapist and nurse. Especially useful for residents who are unable to walk. and in this case, he does Slide the base of the lift under the resident's bed on the side to which you will be moving the resident. Javascript is disabled on your browser. A:w }0 ? Two case scenarios are presented to assist the reader with the . Applying the fundamentals. Gravity will cause every potential load to seek a zero energy state. The fastest, safest and most efficient lift will not lift the entire vehicle, but only the portion that is preventing access to extricate the victim. patient lift to tip over. Also, it is imperative that lifting progress be captured throughout the lift as these implements may fail. The Boom of the lift does not swivel. Two case scenarios were used to illustrate the algorithm's application and special considerations that influence the ultimate decision. Equipment. The class focused on advanced techniques using the Paratech equipment, eDraulic tools, grip hoists, vehicle stabilization methods, airbags for lifting, power tools, and the use of heavy wreckers for extrication. B+ so that we slowly lower the The bladder empties more efficiently when a person is able to use the toilet. Use a sling bar that is appropriate for the patients size. Likewise, for the patient who can partially bear weight, a lift is indicated for those with cognitive impairments that preclude the ability to comprehend and follow directions, or with impairments that are manifested by combativeness, agitation, or uncooperativeness (Haglund et al., 2010; Radawiec et al., 2009). Hydraulic and Mechanical Lift Waters T. R. (2007). Maybe it's a toilet where Eliminate voids between stable ground and the vehicle as needed with box cribs. Nelson A., Fragala G., Menzel N. (2003). Lifting sequence Place leg straps flat under patient; do not let material fold. These training videos are the same videos you will experience when you take the full Healthcare Ergonomics program. Login to rate this! Transferring the Patient When elevated a few inches off the surface of the stationary object (wheelchair, commode, or bed) and before moving the patient, check again to make sure that the sling is properly connected to the hooks of the . How much of the burden of transferring a patient will fall to the informal CG as opposed to the healthcare professional such as a HHA (Gonzalez et al., 2011)? For example, outer body panels, bumper covers, roofs and deck lids may have to be skinned or removed to gain access to more structural metal when applying struts as stabilizing or lifting equipment. The objective is to start simple and add complexity and capability as the situation dictates. as the pressure is applied to The two step chocks on the lifting side can be converted to progress capture box cribs once the lift commences or two short struts can be placed in the wheel wells to capture progress. endstream endobj 113 0 obj <>stream He presents with severe hypertonia in bilateral upper and lower extermities; and severe hypotonia in the trunk and neck musculature. Once these four basic components have been addressed rescuers can start applying some stabilization and lifting fundamentals while they finalize the action plan. He has abnormal muscle tone and no voluntary control, which makes effective weight-bearing through his legs nonexistent. In which position is a resident in a semi-sitting position (45 - 60 degrees) with the head and shoulders elevated? Dynamic elements may respond unpredictably and unfavorably to lifting and stabilization. Follow manufacturer instructions to clean and disinfect lift. Ensure that progress is captured and that personnel adhere to the established safe working zones involving potential kick out. For example, in a lateral vehicle placement, when applying a strut to the undercarriage side and a strut to the roof side, rescuers may need to run a ratchet strap from strut to strut under the vehicle. The ability to follow directions includes the willingness to cooperate as well as the physical capability to follow directions. What is one benefit of using the toilet rather than a bedpan or urinal? Ensure receiving surface is stable and locked. (07:45), How to Transfer a Patient from a Bed (05:13), we're going to say that By submitting your information, you agree to be contacted by the selected vendor(s) He is assigned to a heavy rescue and is anactive leader as a member of both local and national tech rescue response teams. endstream endobj 304 0 obj <>/Metadata 28 0 R/Outlines 44 0 R/PageLayout/OneColumn/Pages 301 0 R/StructTreeRoot 49 0 R/Type/Catalog>> endobj 305 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 306 0 obj <>stream Lifting objects that exceed the design loads of your equipment can result in catastrophic failures. These patients are candidates for the use of a lift because unpredictable movements increase the risk of injury to the patient as well as the CG. In which position is a resident lying flat on his back? Procedure Video. Here are some basic examples of this approach. Miguel appears to respond to his mother's voice, touch, and motion indicated by eye widening and a brighter appearance. Make sure sling opening is not large enough to let patient slip out or too small to let patient fall out. Mechanical alternatives to manual handling of materials should also be used whenever possible to minimize lifting and bending requirements. Zartman is a member of and instructor for the Central Ohio Strike Team and the Washington Township Fire Department. It is imperative that lifting progress be captured throughout the lift as this lift is highly unstable. This is a possible progression. Move lift base legs near or around patients device. after a vehicle has been properly spotted on the lift, the vehicle should be raised slightly and checked for stability true if a lift is not working it should be checked by a qualified lift service technician before use true you should read the lift's safety and operating instructions only if youve never used an automotive lift before false A discussion of key elements on the decision-making process is provided to illustrate the application of the algorithm to the case of Mrs. A. Tip: knowing the lift and how to use it correctly can prevent patient falls from lifts- which may cause injuries, including head trauma, fractures and death. 3) Check that the valves are working on the lift before using it. Haglund K., Kyle J., Finkelstein M. (2010). If a resident has a weaker side, which side moves first in a transfer - the weaker or stronger side? in length (50th percentile for age). Move patient's body into correct position on. Vehicles should be lifted from structural points, not cosmetic or dynamic points. The physical environment in the home setting must also be considered as diminished space can increase the risk for musculoskeletal injury to the CG (Gonzalez et al., 2009; Wright, 2005). Some types of Hoyer lifts offer an adjustable base that can be widened for a sturdier transfer. A common example of this is four step chocks placed directly under the frame rails or rocker panels directly behind the front wheel wells and directly in front of the rear wheel wells. Gravity will cause every potential load to seek a zero energy state. For more information, please refer to our Privacy Policy. The ambulation algorithm incorporates scientific evidence, concepts of ergonomic safety, space requirements, and patient factors such as weight, ability to follow directions and cooperate, and medical conditions including neurologic deficits and comorbidities (Radawiec et al., 2009). The rescue driver cannot produce an all-inclusive working cache of equipment in the blink of an eye nor can a crew leader or officer demand an all-inclusive resource cache all at once. Disinfect and scrub areas that contact patients skin. Once these four basic components have been addressed rescuers can start applying some stabilization and lifting fundamentals while they finalize the action plan. If the CG believes they will be lifting more than 35 lbs, an assistive device such as a mechanical lift should be used. how to stabilize a mechanical lift before using it. Through the patient/CG interview process questions should be asked that test the CG's short- and long-term memory and problem-solving skills. D. Mechanical lifting devices and other equipment/aids: 1. All rights reserved. By providing a systematic methodology for clinical problem solving, algorithms can prove effective in dealing with critical problematic areas such as safe patient handling particularly in the patient's home. A. This is the primary stabilization. The lift should have 2 "legs" parallel to the floor, supported by 4 wheels. *Check you base of support and be sure you have firm footing. It is imperative that lifting progress be captured throughout the lift as this lift is highly unstable. This particular sling, which Dalan Zartman is a technical-rescue curriculum subject-matter expert for the Ohio Emergency Management Agency and Department of Homeland Security. I want to assure you, For example, an upright vehicle on all four wheels may be deemed as relatively stable provided the base or roadway is flat. If a person cannot support his or her own weight, you would need at least two people to perform the lift. to maintaining your privacy and will not share your personal information without iC"G$7UeEprh;F+Lhe\y#jv(-),=ugEY/+zU?>Q?i_>n[gV+NoHz{.)WkVvOs,6UNCtW G For instance, is the patient confined to a single room and transferred from bed to chair or commode, or is the desire to transport the patient between rooms in the home such as the bedroom to the living room or the bathroom? (2005). Mechanical Lift Safety. H+?*,b`$@g = if this is a person that is. A good functional test is to have the patient attempt to lift their body while sitting by pushing on the arms of the chair. CAUTION: A MECHANICAL LIFT IS NEVER USED TO LIFT A CLIENT FROM THE FLOOR There are many types of lifts. Given his weight, currently under the 35-lb limit, his CG should be able to safely transfer him. Sling Care Disinfect slings after every use. Remove metal or plastic reinforcements if required. transferred to a mobile chair. Air dry only. hWYo6+|LP)E 'Y'0D-3#d;E8,), ,i\b&tk,L;L%C,U@_J(&W7Je0"6g,b*g;r @0Aq$Fc-9?7j~{g$wL57P-s>Y/s7Yekwz The 2007 Revised NIOSH Lifting Equation of 35 lbs is the current recommended standard of practice to help healthcare workers determine when assistive devices are needed to safely meet a patient's mobility needs (Waters, 2007). Try to use a three-point approach apply three contact points to the vehicle to form a load triangle. Our newsletter features meeting opener clips, free safety downloads, & safety news. In this case, we're gonna Biology - Chapter 25: The Origin and Diversit, Elliot Aronson, Robin M. Akert, Samuel R. Sommers, Timothy D. Wilson, Elliot Aronson, Robin M. Akert, Timothy D. Wilson, Cours 2 - intervention en situation de crise, Triangles of the neck and root of the neck. Position lift and receiving surface at correct height to transfer patient easily. The use and value of algorithms for safe patient handling has been widely established and integrated into the standards of practice in a multitude of inpatient healthcare settings. If the client is non-weight bearing, the nurse assistant should transfer him using a mechanical lift (see Figure 26.3). Often, patients who require a mechanical lift receive some personal care from a HHA or personal care assistant who has been trained to use a mechanical lift. List nine guidelines for using proper body mechanics: *Before lifting, assess the weight of the load. All of these factors have been included in the clinical decision-making algorithm described in this article. Based on a review of the literature, the algorithm in Figure 1 is offered to guide clinical decision making on the use of a mechanical lift in the home environment. The final decision to use a lift involves patient considerations and the ability and willingness of the informal CG and a home environment that can accommodate the use of a lift. 2) Keep the chair/wheelchair to which the resident is to be moved close to be, so the resident will only move a short distance in the lift. communicate with the person. All rights reserved. In the case of Mrs. A, she is alert and oriented and motivated to return to her prior level of function; however, her limited ability to control her movements or engage in purposeful movement makes her a candidate for the use of a lift. Eliminate voids between stable ground and the vehicle as needed with box cribs. Also, it is imperative that lifting progress be captured throughout the lift as these implements may fail. Applying the fundamentals the person that you're moving. When analyzing the load to lift consider these four factors. Release patients weight. An algorithm can guide the decision of the need for a lift by providing a step-by-step approach where responses to specific questions about a patient's functional and cognitive ability determine the decision pathway. Before each use, make sure the lift is in good working However, a systematic approach to these decisions allows personnel on scene to quickly progress through a menu of options that are well rehearsed and founded in sound engineering and equipment operations. If all rescue personnel know they are going to start with one equipment system and progress to another, then another and so on, then all personnel will be capable of staging, deploying and operating those systems in a much more timely and efficient manner. forward just a little bit? The weight of the load should be quickly calculated to formulate safety parameters for what equipment and techniques can be safely applied. making sure not to pinch This process is so fast and so complex that the central nervous system must use virtually all of its components (e.g., spinal cord, brain stem, sub- He is also aninternational leader in fire-based research, testing, training and consulting related to energy storage. The heaviest portion of the vehicle will always be the engine compartment. Stabilizing muscles are the most important muscles for support and holding your body upright. Use matching loops from each side to ensure sling is balanced. Lifting and moving patients either in a healthcare institution or at home can be dangerous task, as doing so improperly can injure the patient or damage the lift. Ensure there is space for lift to pivot and move freely to receiving area. Tilt the mast backward slightly to stabilize the load and lift. This content provided in partnership with FireRescue1.com, Glass Management: Its More Than Smashing Windows. lift, move himself forward. When turning residents' that have neck or back problems, spinal cord injuries, or back or hip surgeries. With hydraulic applications, apply a hydraulic ram or spreaders to the load and lift in small increments. Place a strut to the roof side and a strut to the undercarriage side directly across from one another near the rear of the vehicle, resulting in three points of contact. 13 Cognitive impairment can also limit a care recipient's capacity to comply with caregiver instructions, creating additional safety concerns. Note: Your progress in watching these videos WILL NOT be tracked. xz:V5-762Z>W3|R\C[GbZMC%(;1 OE^wv_-xSmw;nu{(AYXkb54 &0|Sb8NIR NQQ&VD2 R76>EK`11` The weight of the load should be quickly calculated to formulate safety parameters for what equipment and techniques can be safely applied. In-home medical equipment consists of a power wheelchair (w/c), power bed, power recliner, walker, and transfer board. Choose size of sling based on manufacturer recommendation for patients measurements. In which position is a resident lying on his stomach? We also want to If you are in over your head and are facing a load that you cannot calculate, stop and get help. usually a tightening knob. At this point, there's This is a very fast lifting application but relatively risky and minimal in lift if applied safely to not damage the lever or lose the load. Stretchers may be used for serious injuries and illnesses and/or when a person cannot or should not walk but need to be transported somewhere. When analyzing the load to lift consider these four factors. Diane Fitzpatrick, PT, DPT, MS, GCS, is an Associate Clinical Professor, Department of Physical Therapy, Northeastern University, Boston, Massachusetts. The National Institute for Occupational Safety and Health (NIOSH) recommends the use of assistive technology including the use of a lift if it is likely that the CG will lift more than the maximum limit of 35 lbs of the patient's weight for patient handling tasks. :R|tx!dtJ0,6y}q1Hnt]L K\R8.rHiy#8WsLMLs nbmz3+ gG7}{p%nFR*M-4Tik{2jJ}v6yWaDAb4 fH#|g7zMt6T435y.p;7=TX_gs4D8"'a##mOlU;g$5 ]I place the transfer belt over he resident's clothing and around the waist. As you will quickly discover, if you have not . Banging the lift will stretch the seal bolts and allow oil to leak. Select the option or tab named Internet Options (Internet Explorer), Options (Firefox), Preferences (Safari) or Settings (Chrome). Myths and facts about back injuries in nursing. In healthcare, algorithms have the ability to increase worker and patient safety and decrease variation in practice. Step Number Two Which type of adaptive device for walking can be used when a resident can bear no weight on one leg - cane, walker, or crutches? If at any time, sir, you feel Miguel's plan of care should include a discussion of alternative living arrangements, access to social services to support accessible housing, and teaching the mother and older sibling safe lifting/handling and positioning. Use the vehicle nose as the pivot point or one point of contact and apply additional wedges. Lowe S., Douglas B., Fitzpatrick D., Golub-Victor A. Ensure patients head and/or back is supported, if needed. Double-check position and stability of straps and other equipment before lifting patient. Nope, I think we're gonna These weights will typically range from 20,000 to 80,000 pounds; most commercial vehicles are classified based on their gross vehicle weight. Given his abilities, both motor and communication, he is unable to follow directions. Keep manufacturers instructions close to your lift and always follow them. The algorithm presented in this article should serve to guide the healthcare worker's decision making via a step-by-step, logical process that takes into account the critical factors associated with safe patient transfers. Should my patient use a mechanical lift? the back of this sling. Assess the lift point and apply versatile stabilization equipment that will travel with the load as it is lifted. mechanical process that requires the analysis of a massive amount of sensory-motor information (e.g., tactile, proprioceptive, vestibular, visual) to dictate bodily movements (6). These techniques include use of: . Check out Houston Fire Departments new Trailer 11 purchased fromMetro Fire Apparatus Specialists, Inc. Its packed for of Paratech equipment with room for more! As soon as the vehicle position or the supporting base is altered, kinetic or potential energy exists. Wright (2005) outlines multiple salient steps and questions that can be used to determine the capability and limitations of informal CGs to identify short- and long-term risk. Lifting objects that exceed the design loads of your equipment can result in catastrophic failures. not have a sling in place. At this point in the algorithm, the home healthcare worker should consider a mechanical lift. To do more than going to the snug point means you will ruin your jack in short order. This provides vertical support for the A, B or C pillars and allows for effective side access and dash displacement operations. For example, in a lateral vehicle placement, when applying a strut to the undercarriage side and a strut to the roof side, rescuers may need to run a ratchet strap from strut to strut under the vehicle. There are four of the B+ Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel. Who is the Chief Justice of the United States now? It requires a careful assessment of the patient's motor, communication, and cognitive abilities; physical characteristics; and the physical environment of the home. Choose loops that provide best angle and position for patient. Use lifts for these activities to avoid sustaining a back injury: Lifting from floor Bed-chair transfer Lateral transfer Lifting limbs Toileting/bathing Repositioning Do NOT push, pul or lift while: Off balance or leaning forward Twisting and/or reaching Entrapped in a confined space Pediatric safe patient handling. Her height is 64 in, weight is 160 lbs, and body mass index is 27.3 BMI kg/m2. FireRescue1 is revolutionizing the way the fire service community hr8wG%33i\m)8Jc-O#B-;;\t$K?%Z$"Fi!s!~/aV(rjV*Q\G4{O[tv+WD'hyr_4x7kOOOq:=~CBNRzvy:OW1IWOw)}R4UL1KIBKMp[0kWzgeV[A]3x_Q8~]Ijhy^vN}%}]KES_Q?#&FM*j7hS]zF{I ^KzEiJo-4\yP7eyr4TtB5tJ L_+\Gu_(|$hqg~Dl|3e :\z FE[V]Y-jUJYN{$>L$DQ0UUm[u'=N P9p+O_N~Q1!\_kz68>n5%5 Is\{> _a+OCqj^vo="^u[d\MP>"p=)i6xsNBKD|IShoRJAfG*%hJhz.BhT"Z!CQF v 1MaG?>Qwk!'SbKe*8$5Y'\k*2da*t+PAUPM*m)

how to stabilize a mechanical lift before using it 2023