Musculoskeletal Disorders in EMS Creating Employee Awareness

Musculoskeletal Disorders in EMS Creating Employee Awareness

Ergonomics Peer-Reviewed Musculoskeletal Disorders in EMS Creating Employee Awareness By Thomas F. Fisher and Stephen F. Wintermeyer osts associated with work-related muscu- complaints could be a result of awkward postures loskeletal disorders (WRMSDs) can be high when bending, reaching, twisting or performing Cfor both the employer and employee. Em- repetitive motions while completing their tasks. ployers incur medical and replacement costs when Ambulances are equipped with specific medical a trained employee is unable to work (Dailey, 2006). supplies, including airway and ventilation equip- In addition to lost wages, an employee may expe- ment, automated external defibrillators, patient rience psychological and transfer equipment and other supplies for emer- psychosocial issues among gency response. EMS equipment is often heavy IN BRIEF other issues (Keough and awkward, and can place EMS personnel at risk •SH&E professionals must understand & Fisher, 2001). WRMSDs of injury if not carried properly. This combination the need to control physical risk factors are financially burdensome and the additional weight of the stretcher and pa- in the workplace, because these may be in terms healthcare costs, tient makes maneuvering much more awkward for contributing to work-related musculo- and loss of productivity and EMS personnel. skeletal disorders (WRMSDs). wages. These costs must •Employers must learn how to prevent be controlled and preven- Statement of the Problem WRMSDs and provide injury prevention tion of these disorders may Due to the nature of job tasks such as transfer- education and training. decrease their associated ring patients, quickly loading and unloading an •Controlling and reducing physical risk expenses (Fisher, Brodzin- ambulance, call sites (confined spaces) and carry- factors may reduce WRMSDs and may ski-Andreae & Zook, 2009; ing equipment, EMS personnel are at a higher risk help the organization’s bottom line. Fisher, 2003). for WRMSDs. National Association of Emergency •Educating workers about strategies to Emergency medical ser- Medical Technicians surveyed 1,356 members and reduce physical risk factors for these vices (EMS) personnel are found that 47% of EMS personnel reported suffer- injuries, while increasing awareness at increased risk for oc- ing a back injury while performing necessary job of their body mechanics during occupa- cupational injury with re- requirements (Dailey, 2006). tional performance, is significant. ported injuries including Injuries among EMS personnel are occurring falls, being struck by objects at an alarming rate in the U.S. According to the and lifting. They frequently U.S. Department of Labor (DOL), EMS person- complain of musculoskeletal pain (Heick, Young nel have the highest rate of injury compared to any & Peek-Asa, 2009). Among EMS personnel, these other line of work (Maguire, Hunting, Guidotti, et Thomas F. Fisher, Ph.D., is professor and chair, Department of Stephen F. Wintermeyer, M.D., M.P.H., is associate professor of Occupational Therapy (OT), Indiana University (IU), Indianapo- clinical medicine at IU School of Medicine. He holds a B.S. from Yale lis, IN. He holds a B.S. in OT from Indiana University School of University, an M.D. from Harvard and an M.P.H. from University PIX Medicine; an M.S. in Education from Purdue University; and an Ed.S. of California-Berkeley. His primary clinical foci are occupational W in Educational Counseling and a Ph.D. in Education Psychology pulmonary disease and occupational health of healthcare workers. from University of Kentucky. Before his current position, Fisher was He directs the campus health center for Indiana University Purdue associate professor, Department of Occupational Science and OT, University Indianapolis (IUPUI), sees employees and students at the Eastern Kentucky University. Fisher is a recipient of the Lindy Boggs center and also serves as IUPUI’s public health officer. Wintermeyer’s Award and the True Exemplar in OT Advocacy, and he was named training and experience gives him real-world practical knowledge of Outstanding Occupational Therapist of the Year by the Indiana Oc- occupational and environmental health, both from the direct patient cupational Therapy Association in 2007. care viewpoint and the population viewpoint. ©ISTOCKPHOTO.COM/WILLO 30 ProfessionalSafety JULY 2012 www.asse.org EMS personnel are at risk for musculoskeletal injuries because they participate in patient trans- fers that require physical effort. Galinsky, Waters and Malit (2001) discussed the physical demands primarily related to patient transfers by home healthcare workers. According to the authors, patient transfers are the leading cause of work- related injuries. Lifting a human body is much dif- ferent from lifting an object because of the uneven weight distribution within the body and the fact that there is no good place to handle the body. The unpredictability of a human in terms of behavior may be a factor as well. Other factors that put home healthcare workers at risk include manipu- lating objects within their work environment and carrying heavy equipment. Lavender, Conrad, Reichelt, et al. (2007), re- ported EMS personnel often stand beside the bed or hospital gurney and use a bed sheet to lift patients during lateral transfers. This maneuver may cause friction from sliding the lifting injured person. Dragging the person across the bed to the stretcher can increase back loading and lead to potential injuries for the workers performing the maneuver. Tam and Yeung (2006) studied nonemergency ambulance personnel involved in patient trans- fers to determine physical risk factors associated with low back pain. Thirty-eight male partici- pants completed a questionnaire, performed a lifting test and were evaluated for cardiovascular fitness. This was followed by an isokinetic test on trunk muscle performance. Personal, physical, psychosocial and exposure factors were exam- ined. The results showed age, rating of perceived exertion, job satisfaction, fatigue after work, and self-perceived work load were among risk factors associated with low back pain in nonemergency ambulance personnel. Maguire, et al. (2005), investigated the epide- miology of work-related injuries among EMS al., 2005). In 2006, BLS reported that emergency personnel. They calculated the injury rate and medical technicians and paramedics had an MSD compared results with other occupational groups. incidence rate that was seven times that of private Data collected included date of incident, age, gen- industry (BLS, 2007). Research is needed to assess der, cause of injury, type of injury, body part(s) this trend and how it might be addressed. This injured, job title, lost workdays and a short narra- study was designed to determine whether EMS tive. Their retrospective analysis of incident reports personnel can identify the physical risk factors that obtained from two urban agencies showed sprains, influence WRMSDs and are aware of interventions strains and tears as the most common type of in- to decrease the physical risk factors for WRMSDs. jury, with injuries to the back occurring most often. EMS personnel were injured most frequently when Physical Risk Factors & Rate of Injury assisting patients. Results also showed that the in- Grayson, Dale, Bohr, et al. (2005), conducted jury rate for EMS personnel was 34.6 injuries per worksite evaluations of 133 injured employees at an 100 full-time workers, which was higher than the acute-care hospital, a major airline company and a injury rates for any other industry reported by the large university to determine physical risk factors U.S. DOL. associated with their job tasks. Physically stressful Heick, et al. (2009), studied occupational injuries job tasks were identified and explored through in- among EMS providers. They found that back inju- terviews and observation. After the worksite evalu- ries were the leading injuries which required medi- ations, awkward postures, repetitive motions, high cal treatments. These acute back injuries, reported force requirements and extended reaching were by 12.8% of survey respondents, led to restricted identified as physical risk factors associated with workdays and to numerous workers’ compensation their job tasks. These are the same risk factors as- claims. These researchers also discovered that near- sociated with WRMSDs (Tjepkema, 2003). ly 30% of the 675 respondents reported an injury www.asse.org JULY 2012 ProfessionalSafety 31 while on duty within fessionals have expertise in advising on environ- Table 1 the past 12 months. mental modifications/adaptations and job fit. Other sprains and Higher action categories (more possible assum- Demographics strains were re- ing of awkward postures) also were discovered No. of participants % of participants ported by 6.8% of when treating an emergency patient over a non- Gender respondents; how- emergency patient and when the ambulance was Male 66.0 57.4 ever, fewer of these stationary compared to in motion. The investiga- Female 49.0 42.6 injuries required the tors noted that the seat considered the “work seat” Total 115.0 100.0 Ethnicity level of care of the (or attendant seat) or the seat that most of the Caucasian 102.0 88.7 back injuries. equipment surrounded was not the most frequent- African American 3.0 2.6 In summary, ly used seat. The preferred working location forced Hispanic 2.0 1.7 these studies dem- personnel to sit forward or stand to treat patients in Asian 2.0 1.7 onstrate a need for order to access necessary equipment. The analyses Other 6.0 5.2 Total 115.0 100.0 employers to ad- showed more than 40% of the personnel were us- Age dress. WRMSDs ing inappropriate postures that could be corrected. 18 to 30 43.0 37.4 can be addressed In some cases, employers ask employees to per- 31 to 40 43.0 37.4 via various inter- form tasks without safe and proper lifting devices 41 to 50 12.0 10.4 51 to 60 16.0 13.9 ventions, including and/or training. Employers may cite equipment > 60 1.0 0.9 ongoing injury pre- cost and efficacy, as well as the cost of providing Total 115.0 100.0 vention education training to develop competency with lifting and Years of ambulance experience by a qualified in- handling.

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