Ask any EMT or first responder if they hurt, or if they have experienced pain in the last few months while at work, and almost all of them will slowly nod their heads yes. Some studies show that when anonymously surveyed, more than 57% of EMTs had a soft tissue injury (overexertion from lifting and moving patients) that they never reported. This is the part we need to be concerned about.
Pain while at work–i.e., pain from performing the normal tasks of the job–is a symptom of a much bigger problem. Symptoms should not be ignored, as they are your body’s way of warning you that there is a larger problem at play. It’s no different than a patient complaining of chest pain: We all know that chest pain is not normal and is a symptom of a much more lethal problem.
That is exactly how EMS must view provider injury and pain. Considering that EMS and fire-rescue are some of the highest injury-rate professions, we must step back and approach the problem from a different angle. Currently the solution to reduce provider injury is to turn to engineered solutions and technology, which is awesome. Powered cots, loading systems and self-loading cots are fantastic–and fantastically expensive. Tracked stair chairs, slide devices, lift devices are all great, but responders still must get patients on and off of these devices and that’s where we see so many injuries occur. To this point a 2008 article in the British Medical Journal concludes that there is little evidence to support only one intervention (technology, training, advice) in preventing injury. The author concluded that in order to reduce injury, a program must be comprehensive and include engineered solutions, prevention, training, monitoring and cultural change.1
Why does injury occur at such a frequent and often severe rate? Injuries are a consequence of three major factors: significant lifting forces (patient weight), repetitive movements and awkward positions. Consider a “normal” call where a patient is on the floor and non-ambulatory. There will be no less than five lifts if using a manual cot, 3—4 if powered. We need to understand the cumulative human factors that contribute to injury:
- Poor mobility
- Lack of job-specific strength
- Lifting from the floor
- Excessive leaning, bending and twisting
- Cumulative traumas
- Overexertion traumas
To avoid, reduce or remove the risk from all of the above factors, there are three things that every responder must do this year that they have never done before.
1. Make Ready: Step into other high-injury risk jobs such as beverage distribution, where employees will manually move over 10,000 lbs. of product a day in cramped spaces. Many of these high-risk professions will mandate beginning of shift and mid-shift stretching and mobility. All the data shows that this reduces the rate and severity of injury.
EMS mobility requires a blend of mobility and stability. The ankles/calves, hips and thoracic spine must move well. If they move well, risk of injury decreases and so does pain. The knee, lower back and neck are stable and should not move that much. So first, get that image of arm and neck circles out of your mind–they do not work. Modern movement-based stretching is fast, effective, feels good and reduces risk. You have to move well so you can move patients well.
2. Get Job Strong: While EMS is not the fire service, we can take some lessons from them. EMS providers and leaders must grasp the fact that fit employees get hurt less.2 Fit employees are also more resilient and tend to have better overall wellness.
Take it a step further–risk in EMS comes mostly from three areas: driving, patient handling and violence. Employee fitness can directly impact all three of these areas, as fit employees still outperform the unfit in all instances.
Being job strong means being good at pulling from the floor, so exercises like sumo-deadlifts, kettle bell training and just a good strength routine will boost EMT resiliency on both the physical and cognitive levels.
3. Become a Patient Handling Expert: The number one cause of injury and disability for EMTs and firefighters is patient handling. With over 62% of all injuries from lifting,3 EMS as a whole and EMTs as individuals must become masters at patient handling. The myths and hand-me-downs are both dangerous and invalid. Take the seemingly benign bed-to-bed transfer as an example. The bed sheet is still, after all this time, the device of choice. Yet a bed sheet fails on three fronts: it increases trunk angle (how much you lean), it increases friction (resistance) and it does not have handles, a weight rating or other components of a safe movement system. This is just one of the dozens of patient handling problems EMS has as a profession; we accept mediocrity as the status quo and rarely strive for excellence.
As systems and individuals, we can and must take it upon ourselves to reduce the risk in EMS while admitting that with three simple steps, some consistent training and an eye to the science, we can make EMS a career again–a career that you can retire from with a body that still works!
References
1. Barclay L. Advice, training in lifting techniques may not improve prevention of back pain. Medscape. Retrieved Dec. 29, 2016, from www.medscape.org/viewarticle/569657.
2. Abel M. TSAC 2015 Conference presentation. National Strength & Conditioning Association. Orlando, Fla.
3. Hogya P, Ellis L. Evaluation of the injury profile of personnel in a busy urban EMS system. Am J Emerg Med. 1990 Jul; 8(4): 308—11.
