In most businesses the title of this article is true: practice makes perfect. But in EMS, practice makes permanent. This is especially true when it comes to patient handling. Have you ever had a truly detailed, scientifically accurate and valid class on patient handling and patient equipment handling? Since I know you have not, then how do you know that you and your crews are using their equipment safely?
As an industry, we have invested heavily in technology to help move patients, and that technology is awesome. Powered stretchers, tracked stair chairs, air-assisted lifts and friction-reducing devices all have the potential to drastically reduce provider injury while reducing operating costs for employers. But are we using those awesome tools properly? As leaders we have never actually “invested” in our employees and their ability to do the job safely.
EMS is a physical job. Better yet, “we are in the moving business.” Every aspect of a responder’s job requires them to lift, move, push, pull and carry patients in the most challenging of positions. Patients do not come with handles. Our grip and body positioning is almost always compromised, placing massively excessive loads on the body.
Look at other labor professions, such as material handling, and we can draw some interesting parallels. Their job is heavy, requires awkward lifting and is production based, so we see a lot of speed, cutting corners and highly repetitive motions. If they distribute, then they also sit a lot; just like EMS. This is where the parallels end as most of these businesses require a physical abilities test to ensure a prospective employee is fit for duty. They mandate pre-shift stretching because it’s been proven to reduce on-the-job injury. They train constantly to ensure ergonomic excellence and if an injury occurs then the employee is remediated to make sure that they are fit to return to work and to ascertain if they have any training issues that need to be corrected.
From what I have seen nationwide in EMS, when an injury occurs, once the gatekeeper clears the employee to return to work then that’s it; the employee is left to return to the same ergonomic and biomechanical behaviors that probably caused the injury in the first place.
Lead from the Front
- Stop hiring your next injury. Every EMS department must have a content valid, scientifically accurate physical abilities test. This test needs to be a job task simulation, not a fitness test, and will have no examiner, age or gender bias. If you outsource your PAT then it’s not a true job task simulation since it’s not conducted with EMS equipment on standardized weights (i.e., no milk crates). If you conduct the test in-house there can be no examiner bias of any kind; that means no one can influence the test.
- Reduce friction. One of the few things I can tell you to adopt ASAP is a mandatory policy of frictionless lateral transfer. There are very few things we can control in the prehospital environment; lateral transfers are about the only one. If your crews do not have and are not using a small tarp/flexible stretcher with handles to facilitate bed-to-bed movements then how do you expect the injury rates to drop? Using these devices also allows the crews to do something cool: Both responders can pull from the same side, provided they know what stance to use.
- Fitness is a job requirement. Professional movers do not have to lift heavy objects off the floor like we do in EMS, nor do they have to move people who never come with handles. Technology can only help us so much, sometimes we just have to get it done. This does not mean throw caution to the wind, but in those cases often the only things preventing injury are good mobility (the ability to move safely), job-specific strength (making sure the muscles are able to buffer the external forces) and how they pre-position their body to dissipate the external torques on the spine while tricking the primary muscles of the hips, abs and back (extensor chain) to fire, further buffering the external forces.
As leaders and professionals we need to finally realize that investing in our workforce is money and time well spent. Fit employees are happier, healthier and have better morale. They are also at work more and get hurt less. So it’s time to lead the charge and get good at doing something that our industry has ignored for a long time.