Airway & Respiratory, Operations, Patient Care

Studies Show Dangers of Working in EMS

Issue 11 and Volume 36.

PEC: This journal is the official journal for the National Association of EMTs, National Association of EMS Educators, the National Association of State EMS officials and the National Association of EMS Physicians.

The Most Dangerous Job
Many in our profession read Prehospital Emergency Care (PEC), a comprehensive EMS industry journal that is peer reviewed and devoted to prehospital research. In this column, I often assume we’re all already reading PEC and therefore try to find research in other venues that EMS would not typically stumble across. This month, however, two occupational health and safety studies in PEC should be given the national spotlight. For those who’ve made the ultimate sacrifice and the many more of us who have been injured or disabled as a result of work injuries, I urge you to read these two PEC articles and help me alert the media and public about how dangerous our job really is.

Reichard A, Marsh S, Moore P. Fatal and nonfatal injuries among emergency medical technicians & paramedics. Prehosp Emerg Care. 2011;15(4):511–517.

Finally a formal study confirms what we knew in our heavy hearts: EMS has far too many line-of-duty deaths and work-related injuries. The data examined from 2003–2007 comes from a series of credible national sources: The Bureau of Labor Statistics, Census of Fatal Occupational Injuries, the National Institute for Occupational Safety and Health and the occupational supplement to the National Electronic Injury Surveillance System.

The researchers discovered a total of 65 EMS fatalities (13 per year). The EMS fatality rate was 7.0 per 100,000 full-time equivalents (FTE) EMS workers with a 95% confidence interval (CI) of 4.7–9.3.

By comparison, the average for all workers is 4.0 and 6.1 for firefighters in the same four-year period.

Forty-five percent (29) of EMS worker deaths resulted from highway incidents, mostly due to vehicle collisions, and an additional 12% (8) involved personnel being struck by vehicles. Thirty-one percent (20) of EMS fatalities involved air transportation incidents. It’s important to note that these statistics don’t take into account any civilian or patient deaths that may have occurred as a result of EMS crashes or other incidents.

It’s also possible that not all line-of-duty EMS deaths were reported as such due to lack of centralized tracking, or definition.

The majority of nonfatal injuries (84%) involved sprains and strains, mostly in the hands and fingers, and 42% affected the lower trunk. Approximately half of these incidents involved interaction with, or movement of, another person, often as a result of lifting or moving the patient.

The second most common injury was exposure to a harmful substance or environment (21%), including exposure to bodily fluids.

For comparison again, the corresponding rate for sprains/strains for EMS workers was 217.8 per 10,000 FTE, much higher than the rate of 47.3 per 10,000 FTEs reported for all private industry workers.

I recommend that you read the full paper in PEC. The authors do a great job of referencing their work and outlining more details than I can report here, including interesting gender differences. EMS managers should put this important information in their portfolios for use in reports, at public hearings and during interviews with the media. After we all take a moment of silence, we should put EMS worker safety on the top of the 2012 priority list.

Occupational Exposures
Mazen ES, Kue R, McNeil C, et al. A descriptive analysis of occupational health exposures in an urban emergency medical services system: 2007–2009. Prehosp Emerg Care. 2011;15(4):506–510.

This is a small retrospective review of reported exposures by Boston EMS workers experienced over a three-year period. A total of 397 exposures were reported, the bulk of which were to meningitis (33%), tuberculosis (17%), viral respiratory infections (15%) and body fluid splashes (14%). I was encouraged by the low number of needle sticks reported (6) and the overall fact that only 18% of all exposures required follow-up treatment.

Kudos to Boston EMS for putting together this report and keeping their sharps tucked away. Of course we can’t know how many exposures may not have been reported or missed in the documentation and review process. Nevertheless, it points to the need for a high index of suspicion for airborne infectious diseases. JEMS

Watch Box
Schmidbauer W, Ahlers O, Spies C, et al. Early prehospital use of non-invasive ventilation improves acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease. Emerg Med J. 2011;28(7):626–627.

Keep an eye out for the full paper from this German group, which examines the use of continuous positive airway pressure (CPAP) on patients with chronic obstructive pulmonary disorder. Their abstract reported good results with a small sample of 36 patients. The authors report that CPAP was feasible, that it didn’t add significant scene time, and that it reduced dyspnea and stress reactions while increasing oxygen saturation.

This article originally appeared in November 2011 JEMS as “The Most Dangerous Job: Study raises awareness about the many hazards of EMS.”