Studnek J, Crawford J, Fernandez A. Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers. Appl Ergon. 2012;43(1):198–202.
Ever wonder if those new, heavier, electrically powered stretchers (power cots) will really reduce back injuries? Researchers have just published some interesting data that seems positive. Austin-Travis County EMS (ATCEMS) has implemented power cots in 2006, and this study compared injury rates before and after implementation. Historical controls were used to calculate a pre-power cot injury rate (61.1 per 100 full-time employees (FTEs) from 1999–2006 totaling 2,087 injuries). After power cots were implemented this rate dropped to 28.8 per 100 FTEs. A total of 1,047 employee records were used. Sounds positive, right?
It should be noted that ATCEMS had a steady reduction of overall work-related injuries throughout the study period. And in some cases (particularly in 2002), this was dramatic and unexplained. ATCEMS was implementing other initiatives to reduce injuries, so it’s difficult to attribute all of the success to the power cot implementation with multiple simultaneous interventions.
But the biggest reduction in injuries came from the subcategory of stretcher-related injuries. In the podcast featured with this column, Studnek astutely suggests the need for a prospective randomized controlled trial to specifically address the benefits of the power cot.
O2 & CPAP
Bledsoe B, Anderson E, Hodnick R, et al. Low–fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting. Prehosp Emerg Care. 2011;Dec 22 [Epub ahead of print].
Evidence regarding the detrimental effects of hyperoxia continues to surface. Decreased coronary blood flow and creation of free-radicals that result in increased oxidation may be to blame. Reducing oxygen delivery should be on every EMS provider’s radar by now. Bledsoe and co-authors tackled the idea of reduced oxygen delivery by providing continuous positive airway pressure (CPAP) with low oxygen concentrations and a fraction of inspired oxygen of 28–30%). The results were, in their words, highly effective. Paramedics subjectively perceived that 71.5% of patients improved using this technique.
This was a non-randomized observational trial involving 340 patients in Las Vegas. The authors report that CPAP was stopped in 16.5% of the cases, most commonly due to anxiety/claustrophobia, the need for intubation and apnea. Initial equipment implementation difficulties were minor and easily solved by adding a smaller mask.
This study is a nice first step to move away from 100% oxygen-driven CPAP. Physiological data cited in this study correlate with paramedic perception of improvement. This is especially impressive due to transport times being short. I hope someone reading this considers undertaking a more robust randomized controlled trial with hospital outcome data.
Three out of the past four months, this column has featured a study involving Jonathon Studnek, PhD. Intraosseous, early recognition of sepsis and now stretchers are only a few of the topics of papers he’s recently published. So what’s going on? Is this columnist getting kickbacks? I wish. The simple truth is that Studnek has been churning out some great EMS-specific stuff.
The study featured this month was his doctoral thesis—a project he began while working as a research fellow at the National Registry of EMTs (NREMT). Studnek holds a doctorate in epidemiology and is a full-time EMS researcher. Kudos to Studnek, his current employer, Mecklenburg EMS, and the NREMT for dedicating the time, energy, funding and resources to EMS research. This article originally appeared in April 2012 JEMS as “Saving Your Back: Study measures whether PowerCot reduces work injuries.”