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Introduction to Human Factors Engineering & Its Role in EMS

I am not a good housekeeper. I believe in things like the gravity theory of laundry: If you pile enough stuff on top of a shirt, the accumulated weight will squeeze all the dirt out of the clothing on the bottom. I think that if God had intended towels to be off the floor, they would float on their own accord when dropped from a soggy hand. I consider the domestic canine to be the greatest floor-cleaning aid ever devised. I tell you this so that A.J. Heightman, the fine publisher of a respected EMS journal, will understand when I say that I was blowing the dust off my pile of JEMS magazines when I noticed a past article about back health and EMS.

(Note to Mr. Heightman: I didn t really say that. I save my JEMS in an antique bookcase, hand-carved by one of the non-dancing Chippendales. On frosty moonlight nights, of which there are many in Daytona Beach, I pull one out to ponder, even savor, as I sit by a roaring fire with a snifter of brandy in my hand and my son sitting near, GameBoy in hand, proclaiming, God Bless Us Every One! )

Back health is a facet of a much larger subject known as human factors engineering. The study of human factors crosses the boundaries between psychology, sociology, ecology, physiology and engineering. Although some choose to limit the study of human factors to those interactions between men and machines, the field is much broader than this highly constrained view. In my opinion, work in human factors studies how humans, alone or with others, interact with their environment, be it natural or artificial. Human factors is the discipline that studies fatigue, ergonomics, situational awareness and the human ability to interpret and act upon information.

Human factors issues play a major role in our daily lives. Allow me to relate a story that illustrates my point. Some months ago, I started dating a wonderful woman. However, after three or four dates, I was dreading the question What are we going to do tonight? So I took advantage of one of her offhand comments to request that she plan our next date. To my surprise, she accepted the task (either that, or I spoke just fast enough that she didn t get a chance).

This beautiful, witty and exceptionally bright person (whom I care about dearly, just in case she s reading) is an admitted exercise fanatic. She is in constant motion, and her successful law practice only seems to get in the way of her elegant ballet class, fox-trotting ballroom dancing, powerful weightlifting and ferocious kickboxing. They often speak of attorneys kicking butt. This one literally will. (I learned later, after the incident I m about to recount, that her idea of a fun date is doing something active, which includes running in near freezing weather. Not that there isn t a benefit to that. I m sure that working out in the cold is invigorating, the same way Captain Robert Falcon Scott and his colleagues found it to be.)

So I appear at her house for this rendezvous and am instantly offered a pair of her shorts. We were going mountain biking, she informed me, and these were cycling shorts. If I knew what was good for me, I should wear them. Perhaps your luck is better than mine, but it s usually a few more dates into the relationship before a woman starts offering me her clothes, and even then, I m hoping that it s because she wants to get out of them, not that she wants me in them.

Her motives were pure. Unfortunately, I did not grasp the significance of cycling shorts. Mountain biking? In Florida? And cycling shorts? I ve ridden bikes since I was six. Who needs some stinkin girl shorts?

It turns out that you don t need a mountain to go mountain biking. All you need is a trail. The first mile or so was easy. But then we hit tree roots, lots of them. What nobody had told me was that when you go over a tree root, you re supposed to raise yourself off the seat of your bike so your well, regions don t get knocked about. And given that I am physically what might be referred to as a stick guy (like the one on the back of the comic book getting sand kicked in his face ... on the other hand, I never worry about the extra Twinkie), most of my weight impacts the bicycle seat on two little unpadded points of bone called the ischial tuberosities and the inferior rim of the pubic bone, not to mention the unmentionable region in between. So while she s riding ahead, whistling and chattering like an ecstatic magpie, I m falling further behind, falling off the bike, stopping and utilizing a number of phrases that suggested there were other aspects of our relationship I preferred.

Two days later, still unable to move or sit in a satisfactory fashion, I realized there was probably something to the idea of cycling shorts. But there was a significant issue of pride. How can I, in all good American male conscience, go into a cycling store and admit that my regions just aren t tough enough to handle the strain? So I came up with the idea of a pair of homemade shorts so I wouldn t have to tell anyone of my failures. I d take a pair of long basketball shorts and stick a couple of abdominal dressings in the crotch. That idea was rejected when I was reminded that if they fell out, it would seem as if I was wearing a maxi-pad.

After three more painful rides, I was out of testosterone. The pride was gone, and the pain had won. I marched into the cycling store, declared my problem and found a pair of cycling shorts with about 18 inches of gelfoam padding in them. In an episode of poetic justice, the ones with the most padding happened to be female shorts. I can truly admit that I just didn t care. Let someone insult my sexuality. At least I was still going to be functional. The next time I rode, life was good. It still is.

And this tale, my friends, helps to demonstrate what human factors are all about. My inability to accept advice, work cooperatively toward a common goal, effectively evaluate the hazards and stay on task, despite discomfort, plus the interactions between the bicycle, the trail and my painful self are all problems within the domain of human factors engineering. And it s an easy leap from my simple tale to realize how human factors are an integral part of the world of EMS. The effects of shift work, the ability to work as a team, discerning breath sounds in a moving vehicle, the need for effective communication in a hearing-hostile environment and the physiologic toll of prolonged inactivity interspersed with intense episodes of maximal effort just begin to scratch the surface of human factors issues affecting EMS operations.

Our colleagues in the fire service are aggressively addressing some of these issues in the workplace, especially in terms of personal fitness and fireground rehabilitation. Unfortunately, the EMS community has not begun to evaluate these issues in any kind of organized fashion. But I would contend that they are among the most crucial topics in EMS and that a failure to explore them will inevitably result in a decline in patient care.

Daytona Beach is also the home of Embry-Riddle Aeronautical University, the world s premier college of aviation and aeronautical science. Over the next few months, staff from the Department of Human Factors and Systems will periodically contribute to this column. They ll provide a brief review of a human factors topic, and I ll put the EMS spin on it. I m hoping that our combined efforts will make you aware of the need for EMS to closely examine the human factors that affect our practice of prehospital care. If it serves as a spur for formal research, that s great. But if it serves as an invitation to awareness, so much the better.


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