Abstract:
An apparatus for moving a patient lying on a sheet on a hospital bed is provided. The apparatus has a sheet gripper that is coupleable to the sheet. A strap is coupled to the sheet gripper. A winch is operable to wind up the strap to move each of the sheet gripper, the sheet, and the patient lying on the sheet. A user input is mounted to the sheet gripper and is engageable to operate the winch.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]    This application is a continuation of U.S. application Ser. No. 09/825,768 filed Apr. 4, 2001, which is a continuation-in-part of U.S. application Ser. No. 09/307,637 filed May 7, 1999 now abandoned, which is a continuation-in-part of U.S. application Ser. No. 09/174,110 filed Oct. 17, 1998 now U.S. Pat. No. 6,341,393, which is a continuation-in-part of U.S. application Ser. No. 09/057,139 filed Apr. 8, 1998 now U.S. Pat. No. 6,378,148, which is a continuation-in-part of U.S. application Ser. No. 08/713,412 filed Sep. 13, 1996 now U.S. Pat. No. 5,890,238, which is a continuation-in-part of U.S. application Ser. No. 08/527,519 now U.S. Pat. No. 5,737,781 filed Sep. 13, 1995. Additionally, this application is a continuation-in-part of U.S. application Ser. No. 09/545,538 filed Apr. 7, 2000 now U.S. Pat. No. 6,496,991, which is a continuation-in-part of U.S. application Ser. No. 09/174,110 filed Oct. 17, 1998 now U.S. Pat. No. 6,341,393, which is a continuation-in-part of U.S. application Ser. No. 09/057,139 filed Apr. 8, 1998 now U.S. Pat. No. 6,378,148, which is a continuation-in-part of U.S. application Ser. No. 08/713,412 filed Sep. 13, 1996 now U.S. Pat. No. 5,890,238, which is a continuation-in-part of U.S. application Ser. No. 08/527,519 now U.S. Pat. No. 5,737,781 filed Sep. 13, 1995. Furthermore, this application incorporates by reference the entire contents of the previously mentioned applications and patents and also the entire contents of U.S. Provisional Application Ser. No. 60/204,613 filed May 16, 2000. 
     
    
     
       FIELD OF THE INVENTION  
         [0002]    The invention relates to systems which assist with the movement of patients who are partly or completely incapacitated. The invention more particularly relates to systems which give a single health care worker the capability to move a patient between a bed and a cart, between a sitting and a standing position or between a slumped position in a chair or bed and a more elevated position.  
         BACKGROUND OF THE INVENTION  
         [0003]    Health care workers at hospitals, nursing homes, and home care programs face the challenge of moving partly or completely incapacitated patients. A typical patient weighs between 100 and 200 pounds, and two to four health care workers are usually needed to move the patient. These activities create unacceptable risks of injury, almost without regard to the number of health care workers used in the patient transfer. The risks are particularly high when a sufficient number of workers is not available to assist. Injuries to worker&#39;s backs, which account for approximately 50% of worker&#39;s compensation costs in the health care industry, are a particular problem.  
           [0004]    Patient transfers can be placed in three broad categories. The first category includes the horizontal transfer of a patient from one flat surface to another. The second category involves upright transfers where a patient is moved from a horizontal position to an upright position or a sitting position in a wheelchair, chair or commode and the return of the patient to the horizontal position from an upright or sitting position. The third category of transfer relates to the movement of patients to change their position in a bed or chair, such as pulling the patient up in the bed or rolling the patient from side to side. Although many attempts have been made to devise improved systems for patient transfer, almost all of these transfers are continue to be manually performed.  
           [0005]    Present procedures for horizontal transfers recommend that four healthcare workers participate in the transfer. Two workers are at the bed side and two workers are at the cart side. Each worker grabs an edge of a draw sheet which is under the patient. Through a combination of lifting, pulling, and pushing, the patient is transferred between the bed and the cart. An elongated plastic sheet is often used to reduce the friction during the transfer. Since the healthcare workers have to lean over either the bed or the cart, the stresses on the workers are magnified well beyond the maximum recommended lift of approximately fifty pounds. This recommended maximum lift is measured with the lift at or near the center of mass of the worker. Extremes in the health care worker&#39;s height, either too tall or too short, or any common weakness in either the arms or legs of such workers exaggerate these patient transfer problems. Most hospitals have swing type lifts, but these devices are not widely used.  
           [0006]    The upright transfer and positioning categories provide similar difficulties especially if the patient is unable to cooperate. For example, weak and elderly patients reclining in a semi-erect position tend to slide down. These patients must be pulled toward the end of the bed. Two health care workers usually attempt to do this by grasping the patient by the upper arms to elbows to hoist the patient toward the head of the bed after the bed has been flattened. This motion results in strain on the workers&#39; upper and lower back and possible contact bruises on the patient. Similar difficulties occur with upright transfers.  
           [0007]    Given these formidable difficulties, there have been other attempts to mechanize the patient transfer process. For example, U.S. Pat. No. 2,665,432 (Butler), describes a cart with a manual crank connected to an extensive pull unit. The pull unit has a large number of straps which connect at an edge by hooks to a transfer sheet. Rotation of the crank winds the pull unit onto a roller. The size of the pull unit presents many difficulties including its attachment at many locations to the sheet and the awkwardness of winding it on the roller. The pull unit must be placed under the person since it would not be kept under the person at all times. No way is provided for transferring the patient off of the cart. U.S. Pat. No. 2,827,642 (Huff) describes a similar system mounted to the head of a bed to help move a patient from the foot of the bed to the head of the bed. The &#39;642 patent does not describe the process of moving a patient from one horizontal surface to another.  
           [0008]    U.S. Pat. No. 4,970,738 (Cole) discloses another patient transfer system on a wheeled cart based on a manual crank. This system has the advantage over the system described in the &#39;432 patent in that the transfer is reversible. The crank is connected to a reversible gear box. Rotation of the crank moves belts which are attached to a semi-rigid transfer support which is transferred horizontally while supporting a patient. This system has the disadvantages that the patient must be moved onto the transfer support to move the patient from a bed onto the cart and that the transfer support does not provide sufficient support for the patient or the transfer system. Because of the complicated pulley system with six clamps just supported by a semi-rigid support which extends past the edge of the cart, considerable operator interaction would be needed as the transfer support is moved on and off the cart to ensure that the transfer support is properly supported by the intended surfaces.  
           [0009]    U.S. Pat. No. 2,733,452 (Tanney) describes a transfer system that uses a motorized pulley to transfer a patient on a metal reinforced transfer sheet. The transfer sheet has metal grommets in its corners for the attachment of cables. A motor is used to wind the cable onto reels resulting in the transfer of the sheet. The patient must be moved onto the transfer sheet to move the patient from a bed to the cart. There is nothing to support the patient on the transfer sheet.  
           [0010]    U.S. Pat. No. 4,747,170 (Knouse) reveals an alternative motorized winch type transfer system. The transfer system of the &#39;170 patent has apparent advantages over the transfer system of the &#39;452 patent including better gripping of the transfer sheet and the use of a more general type of transfer sheet. The gripping system for the transfer sheet, though, is difficult and awkward to use.  
           [0011]    U.S. Pat. No. 5,038,424 (Carter et al.) depicts a system that can transfer a patient from a bed to a cart and from a cart to a bed in equivalent fashion. The movement of a roller from the bed to the cart and vice versa extends the transfer sheeting over both surfaces or over a single surface as desired. Drive motors are located on both the bed and cart to rotate the appropriate roller to move the patient onto the desired surface. While the movable roller provides the convenience of being able to transfer the patient in either direction, it is very awkward in practice to transfer the roller from one position to another while rolling up the loose sheet straight on the roller such that it can be reattached.  
           [0012]    Therefore, while considerable effort has gone into producing horizontal patient transfer systems, all of the systems previously developed have significant drawbacks. These drawbacks relate, primarily, to the significant difficulties of the health care worker in operating the system.  
           [0013]    The patents described above relate to horizontal transfer systems. U.S. Pat. Nos. 4,700,415 and 4,837,873 (both to DiMatteo et al.) describe a system for transferring a patient onto a cart surface that converts into a chair position. The bed and the cart have independent conveyor systems, so the patient is moved by one conveyor to the edge of the surface where the next conveyor should take over. This system has the obvious problem of needing assistance to move the patient from one conveyor to the other.  
           [0014]    The conveyor system on the cart is constructed in sections to allow for folding of the apparatus into a seated position. A motor connected to a worm gear is used to raise and lower the upper and lower portions respectively to form the chair from the horizontal support. The reverse motion converts the chair form into a horizontal support. The sectioning of the conveyor system on the cart/chair has the obvious potential problems of not supporting the patient at the gaps, and risks associated with catching clothing or limbs under the edge of the conveyor at the gaps.  
           [0015]    U.S. Pat. No. 3,597,774 (Warren) describes a harness and winch mechanism for pulling up a patient within a bed. The winch is mounted on a post attached to the head of the bed and is operated by a hand crank. The harness fits under the patient&#39;s arms so that the patient is pulled under their arm pits. The attachment of the harness provides excessive stress on the shoulders of the patient.  
         SUMMARY OF THE INVENTION  
         [0016]    The present invention includes several novel devices for transferring patients. The devices are greatly simplified and provide enhanced versatility over any known related device. The adoption of these transfer devices will likely reduce the wide incidence of back injuries in health care workers. The first system for the horizontal transfer of patients is adapted to use existing transfer sheets and an appropriately modified cart. The sheet is attached to a clamping device that has a releasable catch which holds the sheet in a cavity. A plurality of straps are attached to the clamping device. The other ends of the straps are attached to reels that are part of a winch. Activation of the winch winds the straps onto the reels.  
           [0017]    If the patient is resting on a bed or cart, the winch apparatus will be located on the far side of an adjacent bed or cart. The straps will initially go across the second bed or cart such that when the winch is activated the reeling up of the straps will slide the patient from the first bed or cart to the second bed or cart.  
           [0018]    In a highly portable version of this transfer device, the winch apparatus is contained in the same housing as a clamping device for gripping the transfer sheet. The winch has a spool, and a strap is attached to the spool. Rotation of the spool winds or unwinds the strap. The free end of the strap has a fastener for attachment to a clamp fixed at the edge of a bed or cart. When the strap is attached to the clamp and the damping device is gripping a sheet under the patient, winding of the strap moves the patient toward the clamp. So if the patient is initially on an adjacent cart or bed, the patient is transferred to the cart or bed having the damp at its edge.  
           [0019]    A long narrow rectangular cushion can be placed between the bed and cart when using the portable transfer device or other horizontal transfer methods. The cushion is approximately the length of the bed. The cushion is optimally covered with a low friction surface. The cushion can have fasteners for attachment of the cushion to a bed or cart. The cushion may also be configured to hang from the side of the bed or cart by the fasteners when the cushion is not in use. The cushion can be used with any horizontal transfer system including the conventional manual system, but the cushion is particularly convenient when used with the portable transfer device of the present invention because no other modifications to the bed or cart are needed.  
           [0020]    Other embodiments of horizontal transfer devices facilitate the transfer of the patient by providing some lift to the patient as well as horizontal motion. The vertical and horizontal transfer mechanisms are both operably attached to a single bed or cart frame. The vertical lifting device includes an attachment apparatus for clamping a transfer sheet near the head and foot of the sheet. A slidable horizontal support can shift the attachment apparatus from over a first bed or cart to over a second bed or cart. By performing the lifting and transfer steps in the proper order the patient can be transferred from the first bed or cart to the second bed or cart or vice versa.  
           [0021]    One embodiment of a horizontal transfer mechanism within the invention has a transfer element that moves within tracks. Both horizontal supports have corresponding tracks that are aligned to have the transfer element move between the two horizontal supports. The transfer element has a clamping device for attachment of a transfer sheet. A docking mechanism connects one of the horizontal supports to the transfer element. The docking mechanism has a docking support that is attached to a drive mechanism. When the docking mechanism is attached to the transfer element, the drive moves the transfer element within the tracks and between the two horizontal supports. By moving between the tracks of the bed and cart, the transfer element moves the patient between the bed and cart.  
           [0022]    A horizontal transfer system of the invention moves the patient on a modularized cushion. The modularized cushion has a plurality of grips. A horizontal slide has releasable clamps to engage the grips. A drive mechanism moves the horizontal slide to provide reversible motion of the modularized cushion. In this way the modularized cushion can be moved between a first horizontal support surface and a second horizontal support surface.  
           [0023]    A harness within the invention has the significant advantage of distributing the weight of the patient without the need to lift the patient to place a portion of the harness under the patient. The harness has a support that goes across the patient&#39;s upper body. Another portion of the harness goes under the patient&#39;s arms. The harness has a fastener that attaches a lift mechanism near the back of the patient&#39;s head.  
           [0024]    A harness winch combination provides a winch within the padded portion of the harness. The harness has a padded support. Preferably, a motorized winch includes a reel, and a line is attached to the reel. The free end of the line has a fastener to attach the line appropriately depending on the desired motion of the patient. The controls for the motorized embodiment of the winch can be located on the harness so that the health care worker can stay at the patient&#39;s side while moving the patient. Alternatively, the controls can be located on a hand control unit or on the bed.  
           [0025]    A patient transport system includes a plurality of ceiling mounted winches. Each winch has a line with a fastener at the end. The line is connected to a controller which provides instruction to the winches based on an instruction to move the patient in a particular way. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0026]    [0026]FIG. 1 is a perspective view of a bed with an adjacent cart adapted with a first embodiment of a horizontal patient transfer system;  
         [0027]    [0027]FIG. 2 a  is a front, schematic view of a cart adapted with the first embodiment of a horizontal patient transfer system with side rails in a lowered storage position;  
         [0028]    [0028]FIG. 2 b  is a front, schematic view of a cart adapted with the first embodiment of a horizontal patient transfer system with side rails in a raised patient transport position;  
         [0029]    [0029]FIG. 2 c  is a front, schematic view of a cart adapted with the first embodiment of a horizontal patient transfer system with one side rail in a raised position and a second side rail in a bridge position used during patient transfer;  
         [0030]    [0030]FIG. 2 d  is a front fragmentary view of one embodiment of hinges supporting a side rail;  
         [0031]    [0031]FIG. 3 a  is an exploded view of a side rail of the first embodiment of a horizontal transfer system;  
         [0032]    [0032]FIG. 3 b  is a cut away view of a second drive system within the side rail;  
         [0033]    [0033]FIG. 4 is a perspective view of a first embodiment of a clamping device useful with a first embodiment of the horizontal transfer system in an orientation to be clamped to a transfer sheet folded over a rod;  
         [0034]    [0034]FIG. 5 is an end view of a first embodiment of the clamping device;  
         [0035]    [0035]FIG. 6 is a perspective view of a second embodiment of the clamping device;  
         [0036]    [0036]FIG. 7 is an end view of the second embodiment of the clamping device;  
         [0037]    [0037]FIG. 8 is a perspective view of a third embodiment of the clamping device;  
         [0038]    [0038]FIG. 9 is an end view of the third embodiment of the clamping device;  
         [0039]    [0039]FIG. 10 is a perspective view of the attachment of a portable horizontal transfer device for the transfer of a patient from one horizontal surface to another;  
         [0040]    [0040]FIG. 11 is a perspective view of the portable horizontal transfer device;  
         [0041]    [0041]FIG. 12 is an exploded view of the portable horizontal transfer device;  
         [0042]    [0042]FIG. 13 is a perspective view of a portable cushion attached to a horizontal surface to provide a smooth continuous surface for the transfer of a patient with the portable horizontal transfer system, with the cushion in a lowered, stored position shown in phantom lines;  
         [0043]    [0043]FIG. 14 is a perspective view of a further embodiment of a horizontal transfer system;  
         [0044]    [0044]FIG. 15 is a partial, cut away perspective view of the further embodiment of the horizontal transfer system showing the drive system for horizontal extensions;  
         [0045]    [0045]FIG. 16 is a perspective view of the further embodiment of the horizontal transfer system with a patient elevated over a cart to indicate the ranges of motion obtainable by the transfer system;  
         [0046]    [0046]FIG. 17 is a perspective view of the further embodiment of the horizontal transfer system with an alternative design for the horizontal drive;  
         [0047]    [0047]FIG. 18 is a fragmentary perspective view of a sheet clamp indicating its motion relative to a lifting support and its attachment to a transfer sheet;  
         [0048]    [0048]FIG. 19 is a perspective view of a bed equipped with the further embodiment of the horizontal transfer device with the bed in a raised position;  
         [0049]    [0049]FIG. 20 a  is a partial perspective view of one end of the embodiment of FIG. 17 with an arrow showing the disengagement of a removable panel;  
         [0050]    [0050]FIG. 20 b  is a partial perspective view of one end of the embodiment of FIG. 17 with a removable panel attached as a shelf;  
         [0051]    [0051]FIG. 21 is a perspective view of a portion of the foot board bed or cart adapted with the further embodiment of the horizontal transfer system indicating a location for the attachment of a control unit;  
         [0052]    [0052]FIG. 22 is a top view of a transfer sheet designed for use with the further embodiment of the horizontal transfer system;  
         [0053]    [0053]FIG. 23 is a perspective view of the transfer sheet of FIG. 22 shown in its folded position;  
         [0054]    [0054]FIG. 24 is perspective view of an alternative embodiment of the horizontal transfer system;  
         [0055]    [0055]FIG. 25 is a perspective view of a portion of the alternative embodiment of FIG. 24 showing extendable horizontal supports;  
         [0056]    [0056]FIG. 26 is a perspective view of the alternative embodiment of FIG. 24 being used to assist a patient to sit up;  
         [0057]    [0057]FIG. 27 is a perspective view as in FIG. 26 indicating the rotation of a lifting element;  
         [0058]    [0058]FIG. 28 is a perspective view of a transfer system with a horizontal transfer mechanism;  
         [0059]    [0059]FIG. 29 is a cut away side view of one embodiment of a docking mechanism;  
         [0060]    [0060]FIG. 30 is a cut away side view of a second embodiment of a docking mechanism;  
         [0061]    [0061]FIG. 31 is a perspective view of the transfer system of FIG. 28 with a transfer element bridging between a bed and a cart;  
         [0062]    [0062]FIG. 32 is a perspective view of a transfer bridge used with the transfer system of FIG. 28;  
         [0063]    [0063]FIG. 33 is a perspective view of the transfer bridge of FIG. 32 with the bridge in the bridging position;  
         [0064]    [0064]FIG. 34 a  is a side view of the transfer bridge in the bridging position with lever and rods removed;  
         [0065]    [0065]FIG. 34 b  is a side view of the transfer bridge in the raised position with lever and rods removed;  
         [0066]    [0066]FIG. 35 is a perspective view of a split transfer bridge;  
         [0067]    [0067]FIG. 36 is a perspective view of a mattress transfer system;  
         [0068]    [0068]FIG. 37 is a perspective view of a docking mechanism used with the mattress transfer system of FIG. 36;  
         [0069]    [0069]FIG. 38 a  is a perspective view of a gripping mechanism of the mattress transfer system in pushing position;  
         [0070]    [0070]FIG. 38 b  is a perspective view of a gripping mechanism of the mattress transfer system in pulling position;  
         [0071]    [0071]FIG. 39 is an exposed, top perspective view of a mattress and fixed cushion of the mattress transfer system indicating the location of structures within and below the mattress and cushion;  
         [0072]    [0072]FIG. 40 is a perspective view of a mattress transfer system used with a position changing cart and a folding mattress;  
         [0073]    [0073]FIG. 41 is a perspective view of the mattress transfer system and position changing cart depicting the cart in a folded position;  
         [0074]    [0074]FIG. 42 is a side view of the position changing cart in the chair orientation;  
         [0075]    [0075]FIG. 43 a  is a perspective view of a lobster claw type of bed jacket being placed on one side of a person;  
         [0076]    [0076]FIG. 43 b  is a perspective view of the bed jacket in place around a person;  
         [0077]    [0077]FIG. 43 c  is a perspective view of the bed jacket secured around a person and hooked to a hoisting mechanism;  
         [0078]    [0078]FIG. 44 is a perspective view of a motorized bed jacket attached to a stand above a wheel chair;  
         [0079]    [0079]FIG. 45 is a front view of a padded vest;  
         [0080]    [0080]FIG. 46 is a perspective view of the padded vest around a person and attached to a tether where hidden portions of the vest are depicted with phantom line;  
         [0081]    [0081]FIG. 47 is a perspective view of a motorized bed jacket being attached to a mount above a headboard;  
         [0082]    [0082]FIG. 48 is a top perspective view of the motorized bed jacket;  
         [0083]    [0083]FIG. 49 is a partial cut away view of the drive system of the motorized bed jacket;  
         [0084]    [0084]FIG. 50 is a perspective view of a bed jacket attached to three hoisting mechanism on a ceiling using a three way control cylinder;  
         [0085]    [0085]FIG. 51 is a side perspective view of the three way control cylinder; and  
         [0086]    [0086]FIG. 52 is a schematic view of the internal components of the three way control unit. 
     
    
       [0087]    These figures are intended to be merely illustrative and non-limiting.  
       DETAILED DESCRIPTION OF THE INVENTION  
       [0088]    The invention includes improved devices and methods for moving patients and other individuals who lack full mobility. Patients must be moved in a variety of ways while providing care at hospitals, at nursing homes and in home care programs. For example, patients may need to be transferred essentially horizontally from a bed to a cart or vice versa, they may need to be repositioned in a bed or chair, or they may need to go between a prone and a sitting or standing position. The unifying feature of the various embodiments of this invention is that they generally empower a single health care worker to move a patient substantially without any risk of injury to either the patient or the health care worker.  
         [0089]    The common features of the horizontal transfer systems of the invention include a support under the patient and a mechanical or electromechanical system for applying horizontal force to the support to cause the transfer. The designs of the particular embodiments incorporate varying designs while building on the common conceptual foundation. In order to reduce cost, the simplest systems are designed to be adapted for use with beds, carts and transfer sheets already commonly found in most health care facilities. Other embodiments optimize the particular characteristics of the design with less regard to adaptation to existing equipment. In all cases, the designs remain true to the goal of the safe transfer of a patient by a single health care worker.  
         [0090]    Referring to FIG. 1, the first embodiment of the horizontal transfer system  100  includes a standard patient cart  102  retro fitted with a horizontal transfer mechanism  104 . The cart  102  will generally have a base  106  with four wheels  108 . The wheels  108  preferably have lock levers  110  for applying brakes that prevent the rotation of the wheels  108 . The base  106  may have a top surface  112  that usually, but not necessarily, will have a flat portion  114 .  
         [0091]    The cart  102  has a support portion  116 . The support portion  116  is attached to the base by one or more upright supports  118 . The embodiment represented in FIG. 1 has two upright supports  118 . Some designs may have the wheels  108  attached directly to the upright supports  118  eliminating the need for a base  106 . The support portion will preferably have cushioned bumpers  120 . The cart  102  can have the capability of raising and lowering the support portion  116  relative to the base  106  and other features. The support portion  116  provides a support structure  122  for supporting a cushion or mattress  124  for holding a patient  126 .  
         [0092]    The horizontal transfer mechanism  104  includes two side rails  128 . Referring to FIG. 2 d , the side rails are mounted to the cart  102  with hinges  130  and  131 . The side rails  128  and hinges  130  are preferably adapted from existing side rails and hinges on the cart  102 . The hinges  130  can adjust to place the side rails  128  in either an elevated pull position or a lowered storage position. Preferably, hinges  131  are used to place the side rails  128  in a horizontal bridge position to provide support and a smooth surface for transferring the patient. The different positions are schematically depicted in FIGS. 2 a - c . Alternative designs for the side rail can allow for the side rail to slide straight down to a lowered position, and other variations are possible.  
         [0093]    Each side rail  128  has a handle  132 , a control panel  134  and two openings  136  for a power assembly, such as winch  138 . Other numbers of openings can be used for access to the winch unit. The control panel  134  has a plurality of switches  140  to control the operation of the winch  138 . The particular design of the side rail  128  and control panel  134  can be varied without effecting their function.  
         [0094]    Referring to FIG. 3 a , a convenient structure for the side rail  128  has a frame  142 , winch  138 , a front cover  144  and a back cover  146 . The frame  142  has extensions  148  attached to frame substructure  150  at frame hinge  152 . The frame substructure  150  has a winch mounting portion  154 . The frame substructure  150  is preferably made from metal, a rigid polymer or a composite material, although other materials exhibiting the proper strength, weight, and cost characteristics may be suitable. The back cover  146  has open portions  156  for the passage of extensions  148  and motion of frame hinges  152  as well as a portion of handle  132 . The outer surface  147  of back cover  146  (FIG. 2 d ) is a transfer surface that preferably is made from a very low friction material to assist with the transfer process and reduce the risk of injury. Front cover  144  has parts of handle  132  and openings  136 , and control panel opening  158 .  
         [0095]    The winch  138  is coupled to control panel  134  by wires  160 . A conventional manual winch can also be used without excess difficulty, but less conveniently. The drive system  143  preferably has at least one motor  162  and can use a variety of conventional designs. The motor may directly rotate the drive shaft as depicted in FIG. 3 a . Referring to FIG. 3 b , the motor  162  rotates a first drive shaft  164  which has a first gear  166 . First gear  166  engages a second gear  168  which preferably has a larger diameter than first gear  166  so that the rotation of the motor  162  is reduced. Second gear  168  is connected to a second drive shaft  170 .  
         [0096]    Two belts  172  each with a clip  174  are attached to the second drive shaft  170  at positions aligned with openings  136 . The belt preferably winds on spools  175  which help ensure that the belts  172  wind and unwind straight. The belts  172  are preferably made from very strong synthetic fabric such as the material used in seat belts for automobiles. The winch  138  can be powered by a battery pack  176  utilizing power cord  178 . Alternatively, winch  138  can be powered by alternating current using a power cord (not shown).  
         [0097]    Cart  102  of FIG. 1 is designed for use with a standard patient draw sheet  190 . The standard patient draw sheet  190  is wide so that it can be folded over the patient  126 , if desired, but typically not long enough so that it rests under the head or feet of the patient. Rather than using several people to move the patient with the draw sheet  190 , horizontal transfer mechanism  104  performs the comparable function. Clips  174  can be designed to attach directly to draw sheet  190 , but it is preferred to use clamping device  194  to provide a more even pull over the length of the sheet  190  and smoother motion to the patient. For particularly tall patients, the draw sheet  190  can be wrapped around patient  126  for added support of the patient, and both ends of the sheet are attached to clamping device  194 .  
         [0098]    Three embodiments of the clamping device  194  are presented in FIGS. 4-9. In the first embodiment shown in FIGS. 4 and 5, clamping device  194  can be used to attach draw sheet  190  to winch  138  employing rod  192 . A U-shaped portion  196  forms a cavity  198  which is covered by a spring loaded gate  200 . Rod  192  can enter the cavity  198  when pushed against the gate  200 . Force from the rod  192  against the gate  200  from inside the cavity  198  tends to force the gate  200  closed thereby preventing the withdrawal of the rod  192 . Gate  200  has an upward extension  202 . Forward force on the upward extension  202  opens the gate  200  for the withdrawal of rod  192  from cavity  198 . Clips  174  are conveniently attached to the clamping device  194  at J-shaped flanges  204 . Rod  192  can be optionally tethered to the clamping device  194  at one or more positions for convenience, and the rod  192  can be clipped to the clamping device  194  for storage.  
         [0099]    In the second and third embodiments, the clamping device  194  has an upper portion  206  and a lower portion  208  attached at a hinge  210  to form a cavity  212 . The front of the cavity  212  is closed by an L-shaped, hinged closure  214 . The two embodiments differ in their design of J-shaped flanges  216  or  218  for the attachment of clips  174 . In these two embodiments, the sheet  190  is directly placed into the cavity  212  without the need to wrap the sheet  190  around a rod  192 , although a rod  192  could still be used if desired. The sheet is held in place by the L-shaped hinge closure. A thin rigid tucking device (not shown) of any convenient length can be used if desired to assist with tucking the sheet into the clamp.  
         [0100]    Clearly, a variety of other designs for clamping device  194  are possible within the general concepts presented. For all of these embodiments, any portion of the sheet can be attached, not just the end of the sheet. This is important because the clamping device should be placed near the patient so that the transfer mechanism  104  can fully transfer the patient onto the second horizontal surface from the first.  
         [0101]    In operation, the cart  102  is wheeled up to a patient&#39;s bed  220 , as depicted in FIG. 1, or another cart. The side rail  128  facing the patient&#39;s bed  220  is placed in the bridge position with the low friction surface  147  directed upward. The draw sheet  190  is attached to a clamping device. The belts  172  are unwound from drive shafts  164  so that they are long enough to reach rod  192  at the edge of the bed  220 . The belts are unwound either by activating the motor to unwind the belts or by using a clutch to allow the belts to be freely withdrawn from the drive shaft. The clips  174  on the ends of the belts  172  are attached to a clamping device  194  and the clamping device  194  is engaged by the rod  192  and sheet  190 . Other embodiments of the damping device can be used with or without the rod  192 .  
         [0102]    The appropriate switch  140  is engaged, and the winch  138  begins winding the belts  172  onto the drive shafts  164 . The motor  162  should be designed to apply a slow, steady and constant force to move the patient  126  without jerking or applying any other inappropriate forces. The draw sheet  190  helps to distribute the forces over significant areas of the patient&#39;s body. When the patient  126  is on the cart&#39;s cushion  124 , the motor  162  is turned off. At this point, the belts  172  are disconnected from the clamping device  194 , and the sheet  190  is removed from the clamping device.  
         [0103]    In order to transfer a patient from a cart to a bed, the bed would have to be adapted with a similar winch as described on cart  102 . This bed based transfer device would preferably be adapted with the side rails of a conventional bed. These side rails may go up and down rather than folding under the bed. The winch could easily be adapted on one or both sides of the bed. It would be straightforward to retrofit a bed in a comparable fashion as a cart, based on the above description.  
         [0104]    Alternatively, a portable win&amp; unit readily carried by a single health care provider can be used to replace the winch on the bed, on the cart or both. One embodiment of such a portable winch unit  250  is shown in FIGS. 10-12. The portable winch unit  250  includes a housing  252 , a clamping device  254  and a winch  256 . The clamping device  254  serves to hold a transfer sheet  190  in the same way as clamping device  194  in the first embodiment of the horizontal transfer device  100 . The clamping device  254  also serves as a frame or a portion of the frame for the portable winch unit  250 . The housing  252  preferably has a top portion  258  and a bottom portion  260  which are preferably heavy plastic shells surrounding the clamping device  254  and the winch  256 , although other materials can be used.  
         [0105]    The winch  256  includes a motor  262  that can rotate a drive shaft (not shown) connected to a reel  263 . Belt  264  winds around reel  263 . Belt  264  is comparable to belts  172  in embodiment  100 . The free end of the belt  264  has a handle  266 . Handle  266  attaches to a clamp  268  rigidly attached to the edge of a bed or cart. The clamp  268  can be designed to fold out of the way when not in use. The belt  264  passes out of housing  252  through an opening  270 . The operation of winch  256  can be controlled through a circuit board  272  which is connected to motor  262  by wire  274 . Circuit board  272  can be similarly connected to a port  276 .  
         [0106]    A control unit  278  with switches  280  can be connected to port  276  by way of tether  282 . The operator can operate the winch  256  using control unit  278 . Alternatively, control switches  280  can be made integral with the housing  252 , as shown in FIG. 11, but this would be less desirable because the operator would have to lean over the bed or cart while the patient was being transferred. Control unit  278  can have a wireless connection with circuit board  272  using a transmitter/receiver (not shown). Winch  256  is powered by a standard wall outlet using a cord  284 . A retractable cord assembly  286  is preferably used to keep the cord out of the way when not in use and to prevent excess cord being in the way during the transfer of the patient. Alternatively, a battery, preferably rechargeable, can be used to power the winch.  
         [0107]    Referring to FIG. 10, to transfer a patient from a first bed/cart  288  to a second bed/cart  290 , a draw sheet  190  is used under the patient in the same way as in the first embodiment  100 . A portable cushion  292  can be placed between the first bed/cart  288  and the second bed/cart  290  to provide a relatively smooth continuous surface for transferring the patient, as shown in FIG. 13. Straps  294  with a hook and loop fastener can be used to attach the portable cushion  292  to the bed or cart when not in use. The portable cushion  292  can be used with other transfer devices or even as an aid during manual transfer. The cushion  292  would preferably have a top surface with a very low friction which is preferably made from a plastic material.  
         [0108]    The portable winch unit  250  is attached to draw sheet  190  using clamping device  254 , as shown in FIGS. 11 and 12. The design of the clamping device  254  can be similar to the clamping devices in FIGS. 4-9 or a comparable design based on similar concepts. The draw sheet  190  can be wrapped over a rod  192  (FIG. 4) for attachment to the clamping device  254 . Referring to FIG. 10, belt  264  is withdrawn from housing  252  so that handle  266  can be attached to clamp  268 . Clamp  268  is rigidly attached to the second bed/cart  290  on its side opposite the side near the first bed/cart  288 . Clamp  268  can be optionally reversibly detachable or lowerable to storage position. The operator uses control unit  278  to activate the motor  262 . As the motor  262  retracts belt  264 , the portable winch unit  250  and the patient are drawn toward clamp  268  which result in the patient being moved onto second bed/cart  290 .  
         [0109]    A further embodiment of a horizontal transfer system  300  involves a specially designed transfer sheet  302  and a transfer unit  304 , as shown in FIG. 14. Since the transfer unit  304  can move a patient in either of two directions, horizontal transfer system  300  has the advantage that only either the cart or the bed must be supplied with a transfer unit  304 , not both. Therefore, the cart or bed not adapted with the transfer unit  304  can be conventional.  
         [0110]    The transfer unit has a head frame  306  and a foot frame  308  attached to a drive system  310  (FIG. 15). The head frame  306  replaces or attaches to the head board of the bed or cart while foot frame  308  replaces or is attached to the foot board of the bed or cart. The head frame  306  and the foot frame  308  each have at least one vertical support  312  with a wheel  314  at the bottom of the vertical support  312 . The wheels  314  should be oriented to roll along the direction defined by the width of the bed/cart. The wheels  314  can be attached to the vertical support  312  in a way that permits shifting of the wheels out of contact with the floor so that the bed or cart can be moved without interference from the wheels  314 . The vertical supports  312  can have a removable brace (not shown) extending between the two vertical supports  312  to help compensate for the forces created by the weight of the patient.  
         [0111]    Referring to FIGS. 15-17, the head frame  306  and foot frame  308  each have at least one expandable horizontal support  316  extending from the vertical supports  312 . The expandable horizontal supports  316  have fixed portions  318  that are attached to the head(foot) board or the head(foot) board portion  320  of the head(foot) frame  306  ( 308 ). Fixed portions  318  of the expandable horizontal support  316  typically would extend at least across the width of the bed or cart. Telescoping portions  322  of expandable horizontal support  316  are attached to a vertical support  312  and slidably engage a corresponding fixed portion  318 . Typically, the telescoping portion  322  will slide into the corresponding fixed portion  318 , although other types of slidable engagement are possible.  
         [0112]    The head frame  306  and the foot frame  308  each have a lifting support  24 . The lifting support  324  is attached in a way such that it moves with the vertical support  312  and the telescoping portions  322 . Each lifting support  324  has a gripping portion  328  and generally two lifting portions  330 . The gripping portion  328  has an opening  332  into which sheet clamp  325  can be withdrawn using cables  327 , as shown in FIG. 18. Sheet clamp  325  can grasp transfer sheet  302 . Referring to FIG. 19, cables  327  permit sheet clamps  325  to remain attached to transfer sheet  302  while the mattress support  329  goes through a range of motion. In a preferred configuration, one lifting portion  330  engages vertical support  312  at a slot  336 . Another lifting portion  330  engages moving support  338  which is attached to a telescoping portion  322 .  
         [0113]    The lifting support  324  is capable of a range of vertical motion. The range of vertical motion will typically be between 6 inches and 12 inches. The range of vertical motion gives enough clearance for the horizontal transfer from a first bed/cart to a second bed/cart. In other words, the retrofitted bed/cart  326  with its attached transfer unit  304  can transfer patients from or to the retrofitted bed/cart  326 . The vertical lift is also convenient for the changing of linens, although the transfer sheet would need to be changed separately.  
         [0114]    Referring to FIG. 15, the drive system  310  includes a horizontal drive system  340  and a vertical drive system  342 . The drive system  310  is operated from a control panel  344  (FIGS. 14-16) that is located on vertical supports  312  or a portable controller  346  (FIG. 21) that is patched into the head frame  306  or foot frame  308  through connector  348 . Other arrangements for the control of the drive system  310  are possible. The drive  342  for the vertical motion of the lifting support can be adapted to operate by any conventional motor or hydraulic system, such as a motorized worm drive  343 .  
         [0115]    Two embodiments are shown for horizontal drive system  340  in FIGS. 15 and 17 respectively. The first involves a motor  350  fastened to the bottom of the bed/cart frame  352 . The motor turns drive shafts  354  which go to a transmission  356  which transfers the rotation of the drive shaft to lateral motion of a telescoping portion  322  of an expandable horizontal support  316 . The second embodiment of the drive system has a motor  358  mounted on either the head frame  306  or the foot frame  308 . The motor  358  rotates a worm drive  360  that is mounted horizontally along side of the motor  358 . The worm drive  360  transfers motion to a telescoping portion  322  of an expandable horizontal support  316 . An optional removable panel  362  can be removed, as shown in FIG. 20 a  and mounted on the foot frame  308  where it can be used as a shelf or cardiopulmonary resuscitation (CPR) board for additional equipment as shown in FIG. 20 b.    
         [0116]    An appropriate transfer sheet  302  for use in this embodiment of the horizontal transfer unit  300  is depicted in more detail in FIGS. 22 and 23. The transfer sheet  302  has wings  380  with hook and loop or comparable fasteners  382  at the edges of the wings  380 . The wings  380  can be folded over the patient and closed with fasteners  382 . The shape of the wings can be selected as desired. The top and bottom of transfer sheet  302  can have reinforced attachment portions  384  optionally with reinforced holes or grommets  334 . Alternatively, the sheet can be attached to the sheet clamps  325  similar to the attachment of the sheet to the clamps shown in FIGS. 4-9. Having grommets on the sheet can be a disadvantage during the washing process. The attachment portions  384  will generally extend to or just beyond the end of the mattress  386 . Other designs are possible for the sheet, for example a version that does not fold over the patient.  
         [0117]    Referring to FIGS. 15 and 16, in operation, the vertical supports  312  and the telescoping portion  322  of horizontal supports  316  are initially placed in their retracted position if the patient is being moved from the retrofitted bed/cart  326  and are initially placed in their extended position if the patient is being moved from a separate bed/cart  331  to the retrofitted bed/cart  326 . The transfer sheet  302  is optionally folded over the patient, and the fasteners  382  are secured. Attachment portions  384  are placed into opening  332 , and sheet clamps  325  engage reinforced holes  334 . At this point, the vertical drive system  342  originally in its lower point is engaged to its upper point to raise the patient into a suspended position.  
         [0118]    The horizontal transfer system  300  is engaged accordingly to move the patient from an original location to the transfer location. If the patient was originally on the retrofitted bed/cart  326 , the vertical supports  312  and the telescoping portion  322  move to their extended position, and if the patient was not originally located on the retrofitted bed/cart  326 , the vertical supports  312  and the telescoping portion  322  move to their retracted positions. Once the horizontal transfer is complete, the vertical drive system  342  is lowered and the transfer sheet  302  is disengaged.  
         [0119]    An alternative embodiment  400  is shown in FIG. 24. Head portion  402  and foot portion  404  are similar in construction to head frame  304  and foot frame  306  respectively except that head portion  402  and foot portion  404  lack lifting supports  324  attached to the telescoping portion  320  and have instead top supports  406  which support upper transverse support  408 . The upper transverse support  408  provides support to counter the forces from the weight of the patient.  
         [0120]    Upper transverse support  408  has transverse tracks  410  on both sides of upper transverse support  408  which support lifting elements  412 . Lifting elements  412  have track wheels  414  which rotate within the tracks  410  yielding transverse motion of the lifting elements  412 . Lifting elements  412  contain winches (not shown) for retracting cords  416 . Cords  416  have fasteners  418  at their ends for attaching to reinforced holes or grommets  420  at the corners of a draw sheet  422 . Retraction of cords  416  raises draw sheet  422  which contains a patient secured within the sheet  422 .  
         [0121]    As shown in FIG. 25, extendable horizontal supports  424  operate similarly to extendable horizontal supports  314  to allow the lateral motion of the vertical supports  426  on wheels  428  along with upper transverse support  408  and lifting elements  412 . As with the previous embodiment  300 , the alternative embodiment  400  can move a patient from the retrofitted bed/cart  400  to a second bed/cart or from a second bed/cart to the retro fitted bed/cart  400 .  
         [0122]    Alternatively, referring to FIGS. 26, 27, a single lifting element  412  can be used along with a lift jacket  430 . Lift jacket  430  fits around the torso of a patient. Fasteners  418  attach to loops  432  on lift jacket  430 . When attached to a lift jacket  430 , retraction of cords  416  lifts the patient&#39;s torso off the bed into a bent position at the patient&#39;s waist. The lifting element  412  can then be translated and rotated as shown in FIGS. 26 and 27 to place the patient in a seated position at the side of the bed. The patient&#39;s back is supported in this position. In this way the horizontal transfer device  400  serves a second purpose in assisting a patient into a sitting position from a supine position on a bed.  
         [0123]    A transfer system  500  designed for retrofitting of both the bed  502  and the cart  504  is depicted in FIG. 28. The transfer system  500  includes a horizontal transfer mechanism  508  and a transfer bridge  510  (FIG. 32-35). The horizontal transfer mechanism includes a docking mechanism  506 . FIGS. 29 and 30 depict two representative embodiments of the docking mechanism  506 . The first embodiment has a spring loaded clamp  512  with arms  514 . Arms  514  protrude from an opening  516  at the side of the foot board  518  of bed  502 . Spring loaded clamp  512  engages a cavity  520  opening into transfer bar  522 . When the angled front edge  524  of the arms  514  engage cavity  520 , the arms  514  deflect towards each other against the spring (not shown) until tips  526  clear flanges  528  at which point the arms return outward as tips  526  engage flanges  528 . Arms  514  pivot on a docking support  530  within the bed foot board  518 . The head boards (not shown) have a comparable docking mechanism. When the clamp  512  is protruding from opening  516 , the arms can be disengaged by pressing arms  514  together.  
         [0124]    In the second embodiment of the docking mechanism  506  depicted in FIG. 30, a gear  538  supported by a docking support  540  protrudes from an opening  542  in the side of the bed foot board  544 . Protruding gear  538  engages teeth  548  in the top surface  550  of cavity  552  within transfer bar  522 . Gear  538  can flex slightly on its support  540  to engage the teeth  548 . Cavity  552  within transfer bar  522  does not have flanges at its opening. The gear  538  is disengaged by pressing downward on docking support  540  when docking support  540  is protruding from opening  542 . Again, the head boards (not shown) have a comparable docking mechanism.  
         [0125]    The two embodiments of the docking mechanisms  506  are described in a particular configuration with respect to the cart and the bed. This configuration can be reversed with the bed holding the protruding gear  532  or clamp  512 . In either configuration, the protruding gear or clamp can be retracted by the worm gear drive  532  when docking is being performed.  
         [0126]    The horizontal transfer mechanism  508  includes a transfer element  556  and a drive system  558 . Transfer element  556  has a gripping mechanism  560  for gripping a transfer sheet such as transfer sheet  302  in FIGS. 22 and 23 and transfer bar  522  (FIG. 31). The gripping mechanism  560  is attached to transfer bar  522  by a plurality of support bars  564 . Gripping mechanism  560  can be similar to sheet clamp  325 . Transfer bar  522  moves within cart channel  566  and bed channel  568 . Support bars  564  slide within slots  570  and  572  within cart channel  566  and bed channel  568  respectively. The docking supports  530  or  540  can be moved laterally by drive system  558  which can comprise a worm gear drive  532  (FIGS. 29, 30). The worm gear drive  532  has a motor  534  and a worm  536 . The rotation of worm  536  moves the docking supports  530  or  540 . The motion of the docking supports  530  or  540  moves the transfer bar  522  within channels  566  and  568  (FIG. 28). The worm gear drive  532  can move the transfer bar  522  in either direction to effect the movement of the patient in either direction.  
         [0127]    Transfer bridge  510  is mounted on the side of cart  504  (FIGS. 32, 33). Transfer bridge  510  has a bridge  574 , lever  576  and mounting portions  578 . Bridge  574  is preferably molded from a low friction material such as, for example, polypropylene, to facilitate the passage of the transfer sheet. It is recognized that other low friction materials may also be suitable. Mounting portions  578  are attached to the side of the cart  504  by rods  580 . Mounting portions  578  have a hinge  582  which supports bridge  574 . Lever  576  passes through mounting portions  578 . Rotation of lever  576  changes the configuration of hinges  582  thereby moving bridge  510  between a stored position and a bridge position, as shown in FIGS. 32-34 b . In the bridge position, bridge  574  fills in the gaps between the bed  502  and cart  504 . In the storage position, the bridge  574  acts as a side rail for the cart  504 . FIG. 35 depicts a slightly different embodiment of the transfer bridge  510  having a split transfer bridge  584 . These embodiments of the transfer bridge can be adapted for use with other transfer systems including the conventional manual transfer system.  
         [0128]    To transfer a patient between the bed  502  and cart  504 , the transfer sheet  302  is attached to the gripping mechanisms  560  at the head and foot of the patient&#39;s resting place, similar to the attachment of transfer sheet  302  in the embodiment of FIG. 14. Referring to FIG. 31, the cart  504  and bed  502  are positioned to align channels  566  and  568 . Referring to FIG. 33, the transfer bridge  510  is placed in its transfer position to fill the gap between the bed  502  and the cart  504 . As shown in FIG. 31, the drive system  558  is engaged to move the transfer element  556  from the bed  502  or cart  504  where the patient was located to the bed  502  or cart  504  where the patient is being transferred. Once the patient is transferred, the cart  504  and bed  502  are undocked, and the transfer sheet  302  is disconnected from the gripping mechanisms  560 .  
         [0129]    The above transfer systems rely on supporting the patient on some type of sheet during the transfer. While relying on a sheet is similar to often used present methods with health care personnel providing the transfer forces, supporting the patient on a sheet may be inappropriate for patients with certain injuries. For these patients it would be safer to transfer the entire mattress or cushion, as described below.  
         [0130]    [0130]FIG. 36 displays a bed  600  including a mattress transfer system  602 . The bed  600  supports a modular mattress  604  and a fixed cushion  606 . The modular mattress  604  has wing  608  of padded fabric that wraps around fixed cushion  606  to form a smooth surface without any gaps, as shown in the insert of FIG. 36. Wing  608  tucks under the modular mattress  604  when not in use. Referring to FIG. 37, bed  600  connects with cart  610  by way of a docking mechanism  612  when the mattress  604  is to be transferred. The docking mechanism  612  has one or more apertures  614  for accepting projections  616 . FIG. 37 displays apertures  614  on bed  600  and projections  616  on cart  610 , but the opposite arrangement would work similarly. It is possible to have a locking mechanism (not shown) to lock projections  616  in apertures  614  to prevent relative motion of the bed  600  and cart  610  when the modular mattress  604  is being transferred, but the same effect can be accomplished by locking the wheels of the cart  610 .  
         [0131]    In one embodiment, the mattress transfer system  602  has a transverse bar  618  connected to a plurality of lateral bars  620  and at least one lateral drive bar  622 . Lateral bars  620  slide along lateral tracks  624  while lateral drive bar  620  engages lateral drive track  626 . The lateral bars  620  and lateral drive bars  622  allow the transverse bar  618  to extend just past the edge of bed  600 . Transverse bar  618  has a plurality of gripping mechanisms  628 . Each gripping mechanism  628  has a pushing position (FIG. 38 a ) and a pulling position (FIG. 38 b ) for pulling and pushing the modular mattress respectively.  
         [0132]    Referring to FIGS. 36 and 39, the gripping mechanisms  628  grip handles  630  near the edge of modular mattress  604 . The mattress transfer system is controlled from a control panel  632  mounted on the foot board  634 , as shown in FIG. 36. Operation of the mattress transfer system  602  moves the transverse bar  618  either toward or away from cart  610  by moving the lateral drive bar  622  accordingly. Of course, a variety of designs are possible for the mattress transfer system  602  besides the embodiment described.  
         [0133]    Referring again to FIG. 39, the modular mattress  604  has a channel system  636  to accommodate the transfer system  602 . The channel system includes a transverse void  638  to accommodate transverse bar  618  and longitudinal channels  640  to accommodate the lateral tracks  624  and lateral drive tracks  626 . Handles  630  are located along the upper surface of transverse void  638 . To the extent necessary, fixed cushion  606  may also have appropriate channels  642 .  
         [0134]    In order to transfer the modular mattress  604 , the cart  610  is first docked with bed  600  using docking mechanism  612 . If the modular mattress is being moved to the cart  610 , the patient is centered on the modular mattress  604 , and the gripping mechanisms  628  are set from control panel  632  in their pushing position. The mattress transfer system  602  is operated to move the transverse bar  618  toward cart  610 . When the mattress is located on cart  610 , the docking mechanism  612  is disengaged.  
         [0135]    If the modular mattress  604  is being moved from the cart  610  to the bed  600 , the cart  610  and bed  600  are docked appropriately. Then, the transverse bar  618  is placed in its extended position within transverse void  638 . The gripping mechanisms  628  are placed in their pulling position. The mattress transfer mechanism  602  is operated to move transverse bar  618  away from cart  610 . When the modular mattress  604  is in position on bed  600 , the mattress transfer system  602  is stopped, and the docking mechanism is disengaged.  
         [0136]    The bed  600  with the mattress transfer system  602  can be adapted to work with a position changing cart  650  when used with a folding mattress  652 , as shown in FIGS. 38 a - 41 . The position changing cart  650  has a base  654  and a plurality of, preferably two, arms  656 . Base  654  has a plurality of locking wheels  658  providing a relatively broad base of support for cart  650 . The base should have sufficient weight and a relatively low center of mass such that cart  650  is stable. The top  660  of base  654  provides support for the center of folding mattress  652  when the mattress  652  is positioned on cart  650 .  
         [0137]    Arms  656  have a support portion  662  and a lever portion  664 . Support portions  662  extend laterally toward bed  600  from the far edge of the cart  650 . Lever portions  664  are rigidly attached to support portions  662  at one end and are attached to a hinge mechanism  666  at base  654 . Support portions  662  support folding mattress  652  when the mattress  652  is positioned on cart  650 . The folding drive within base  654  is operated from a control panel  668  at the side of base  654 . The folding drive operates to rotate hinge mechanisms  666  to change the configuration of folding mattress  652  from a prone configuration to a seated configuration as in FIG. 42 or visa versa.  
         [0138]    When going from a supine to a seated configuration, the lever portion  664  at the head of the mattress  652  rotates upward and the lever portion  664  at the foot of the bed  400  rotates downward. Folding mattress  652  has creases  670  to accommodate the change in configurations. The movement of the folding mattress  652  on and off of position changing cart  650  is analogous to moving the modular mattress  604  on and off of cart  610 .  
         [0139]    The next devices are designed to hoist or pull up a patient on a bed or a chair. These systems are configured with at least one lifting device and at least one winch system. In a first embodiment  700  of the hoist system, the lifting device is a lobster claw shaped bed jacket  702 , as shown in FIGS. 43 a - c . The bed jacket  702  has two claw portions  704  joined at joint  706 . Claw portions  704  are, in one embodiment, made of fabric enclosing padding of some kind. Joint  706  involves folds in the fabric that yield greater flexibility at the joint  706 . The bed jacket  702  is easy to put on the patient because no part of it fits under the mid-torso of the patient. The lifting forces, however, are distributed across the patient&#39;s chest, while the neck is supported by the claw portions.  
         [0140]    Claw portions  704  have edges  708  at their ends opposite joint  706 . Edges  708  of opposing claws  704  can be joined by a hook and loop fastener  710 , with clips (not shown), or other suitable fastener. The edges  708  do not necessarily have to be joined in contact. In use, joint  706  is placed across the patient&#39;s chest, and the claw portions are placed under the patient&#39;s arms. Edges  708  are joined behind the patient&#39;s neck, if desired. If the edges are not joined, they will still be held together by their attachment at their respective ends to the same winch.  
         [0141]    Bed jacket  702  can be used with at least two embodiments of the winch system. In a first embodiment of the winch system  712 , shown in FIG. 43 c , the bed jacket  702  has a loop  714  for the attachment of a tether  716 . The tether  716  is attached to an external winch  718 . Depending on its intended use, the external winch  718  can be attached to a bed&#39;s head board  720 , located on a support  722  elevated above a bed or wheel chair  724  (FIG. 44) or mounted to a ceiling (FIG. 43 c ). External winch  718  can be operated manually with a hand crank (not shown) or with a motor (not shown) controlled by a control panel.  
         [0142]    External winch  712  can also be used with padded vest  762  shown in FIGS. 45 and 46. The padded vest  762  has the same advantages as the lobster claw bed jacket  702 . The padded vest  762  has a foam portion  764  that fits across the user&#39;s chest. Two adjustable straps  766  extend from the foam portion  764 . One strap  766  has a head support  768  attached. The free end of the head support  768  is attached with a hook and loop fastener  770  or a comparable fastener to the other strap  766 . Rings  772  attached to the end of straps  776  attach the vest  764  to a tether  716  for connection to a winch  718 .  
         [0143]    A second embodiment of the winch system  726  has a winch mechanism  728  within the bed jacket  730  itself, as shown in FIGS.  44 ,  47 - 49 . The winch mechanism  726  is preferably motorized. The winch mechanism  728  is embedded in one of the claws  732  of the bed jacket  730 , although the winch can be imbedded in other designs of bed jackets. The preferred winch mechanism  728  has a motor  734  which rotates a drive shaft  736  connected to a spool  738 . Tether  740  is attached to spool  738  and has a ring  742  on its end.  
         [0144]    Controls which can be found on claw  732  include a release switch  744 , a recoil switch  746 , a pull switch  748  and a lower switch  750 . The release switch  744  releases the spool  738  so that the tether  740  can be pulled from bed jacket  730 . The recoil switch  746  winds up tether  740  on spool  738  using a spring mechanism (not shown) assuming that there is little resistance on the tether  740 . The pull switch  748  activates the motor  734  to wind tether  740  on spool  738 , and the lower switch  750  runs the motor  734  in the opposite direction releasing tether  740  from spool  738 . Optionally, the controls may be placed external to the bed jacket such as in a remote control unit or mounted to the bed. The external control units would communicate with the winch mechanism  728  either through a wired or wireless (transmitter/receiver) communication similar to the control unit for the embodiment in FIGS. 11 and 12.  
         [0145]    The ring  742  can be attached to a head board, an elevated support on a wheel chair or a ceiling mount such that the motorized bed jacket  730  can be used in the same way as the non-motorized counterpart. The winch bed jacket combination  730  is more versatile because it can be used in a variety of ways without the need for having a variety of separate winches. Furthermore, the controls are conveniently located such that the health care worker can operate the controls while being close enough to the patient to assist in their motion.  
         [0146]    Finally, bed jacket  702  can be connected by way of a three axis control cylinder  752  to three ceiling mounted winches  754 , as shown in FIGS. 50 and 51. The control cylinder  752  connects to bed jacket  702  by way of ball  756  which fits into a ball joint  758 . Control cylinder  752  has three switches  760  controlling motion along one of three axes. Referring to FIG. 52, the switches  760  are connected to a microprocessor  753  which has been preprogrammed with the locations of winches  754 . The microprocessor  753  uses simple geometry to calculate instructions used to control winches  754  to perform the selected motions. Microprocessor  753  is connected to winches  754  by way of wires  755 . This versatile system can be used in a variety of ways including transferring a patient from a bed  762  to a wheel chair  724  or pulling a patient up in either a bed  762  or a wheel chair  724 . Padded vest  762  can also be used with a three axis control cylinder  752 .  
         [0147]    Various modifications and alterations of this invention will become apparent to those skilled in the art without departing from the scope and spirit of this invention.