Injuries in EMS : The Many Injuries in the EMS Workplace and how to Prevent them
As an emergency care provider, I can attest to the cold hard facts of injuries in the EMS workplace. Not only have i sustained personal injuries while in the field but I have witnessed and watched my fellow co-workers get injured throughout the years. When a paramedic gets injured, whether on or off duty, his or her life will completely change, if even for just a few months. A simple injury could easily be exacerbated by continuing to work. What once started as a simple patient lift with some shoulder tenderness could result in full blown shoulder surgery. Though a surgery to repair a torn rotator cuff typically only lasts 45 minutes the recovery is much longer. Many surgeons require the patient to stay in an arm sling with nearly no mobility for 6 weeks. After the 6 weeks is up you will then follow a 3-4 month physical therapy regimen. In most cases the time before going back to work is at the very minimum of 6 months. For someone in the EMS profession this could possibly be longer due to the physical requirements of the every day job. So now that I have your full attention, lets look at some of the injuries in the EMS workplace and what we can do to try to reduce those risks. We will be looking at back injuries, and pinch injuries. Back Injuries are the leading cause of injury in EMS and is closely followed. Pinch injuries happen but are not closely followed. Pinch injuries are brought to attention for that fact alone, they cannot be forgotten.
By far, the leading cause of injury in EMS are back injuries. According to EMSworld nearly 25% of all EMS workers experience career-ending back injuries within the first four years of their career. This is a very significant number of back injuries. The turn over that this creates is devastating not only to EMS agency's across the country but to the individual that experienced the injury and their families.
Let's look at some of the causes of back injuries. Looking at what caused myself to experience a back injury in EMS, I will start with communication. Communication was the sole factor in causing my back injury. With the average American male weighing in at 196 pounds and woman weighing 156 pounds according to a Gallup poll, lifting a patient on a stretcher that weighs in at 81 lbs for a non powered model is no easy task, especially considering that many people in america are well over 400 pounds. Communicating with your partner is one of the most important things. In my case communication was thrown out the window, my partner and I lifted at separate times causing me to strain my back. Having a plan before lifting can prevent this problem completely. This plan should include communicating on when to lift. No set standards are in place that should be followed to make this happen. Whether you say 1...2...3 lift, or, ready, set, lift, does not matter as long as you are lifting in sync.
Lack of Proper lifting technique plays a big role in back injuries as well. From lifting people currently on stretchers, to extricating someone in the floor of a closet, in a small, cluttered apartment.
First we need to look at proper position. If at all possible, you should be as close to the patient or object as possible. You want to have your toes facing straight at what you are lifting. Squat down as low as possible keeping your weight on the heels and balls of your feet.
Secondly, never lift with your back. You will be wanting to use your hips, abs, and legs to lift. Before lifting you will need to tighten your core and keep your back flat. It may feel unnatural to the untrained but it is the position you need to be using.
Third, you must pay attention while lifting. You need to make sure and keep this position through the end of the lift. Remember to push up by contracting your hips, and legs, while keeping your weight over the heels and balls of your feet.
Having a patient located in a small awkward area proves to be difficult when trying to keep proper lifting position. Due to these circumstances you may need to stray from the exact technique outlined. When this happens you need to try to stay as true to the technique as possible. Remember that you have equipment that can help aide in removing patients from these environments, use them. Also, many EMS agency's have volunteer agency's that can assist you in lifting. Do not be afraid to call for that extra help. Having two or three extra people can help spread the load, which saves your back.
In the picture above you will see some equipment. You will see a medical bag on the left weighing approximately 25 pounds, a cardiac monitor just to the right on the floor, this monitor weighs 20.1 pounds loaded. Above that you will see a suction unit and an EZ-IO drill bag. These two components together weigh around 12 pounds. To the far right you will see an oxygen cylinder with a loaded weight of 12 pounds. This is the bare minimum of equipment that must go in a business or residence in the case of a cardiac arrest. At times do to the circumstances a single provider may be caring all of this equipment. I have carried all of this equipment up several flights of stairs many times. The weights provided may not seem like much, however the equipment has odd handle placement, which proves to be awkward to carry.
An easy comparison to use here is a 5 gallon bucket of water. Many people have carried a 5 gallon bucket of water. 5 gallons of water weighs 41.7 pounds not including the bucket. With the handle being placed in a pivoted central location, one must lean over the bucket to carry it. This is no different than the odd placement of carrying locations designed in to EMS equipment.
When it comes to carrying EMS equipment while on duty there is just no easy way to do it without causing back strain that in time lead to injury. We can, however look at what can be done to lessen some of the strain.
- Spread the load - Though there are times that you will have the sole responsibility of carrying all of the equipment there are more times that your partner or other rescue personnel on scene can help. Spreading the carrying load among others at every opportunity not only decrease the chance of immediate injury, but reduce the probability of injuries sustained over years of service.
- Use the stretcher - Typically a stretcher is used on almost every call, from cardiac calls to traumatic injuries. Using a stretcher to haul all of that equipment around for you is not only beneficial to your back, but smart in terms of saving time. Yes, a stretcher can also be cumbersome to maneuver but it rolls and leaves the weight in front of you. Not only does it save you carrying equipment in to the residence but also provides a way to carry it back out. Using the stretcher saves time as well with reducing trips to and from the ambulance.
- Anticipated use - Anticipated use makes you stop and think about what equipment you are anticipating to use. All equipment is not needed on every call. For instance a psychiatric call will most likely not need a cardiac monitor. This saves you 20 pounds to and from the location of a patient. Think about the equipment that is actually needed and leave the rest in the Ambulance. This again helps to reduce the threat of immediate injury and injury in the long haul.
Have you sustained an injury in the EMS workplace? What caused the injury?
Pinch injuries are not a closely followed injury in EMS, however I feel that it should be more closely watched. No studies have been found on actual numbers, but most anybody that has been in the EMS profession for more than a few years can tell you that they have been involved with a pinch injury in one way or another.
Many places for a pinch injury to occur are associated with the equipment designed to carry patients. Whether they are folding or collapsing the probability for being pinched is likely. Two pieces of equipment that are used often are the stretcher and the stair chair. Both are designed to carry patients with mobility and space saving as a top design priority.
Stretcher - A stretcher is designed with many hinged points. They are designed this way to allow for maneuvering patients in and out of small cramped locations such as bathrooms, closets, and sharp narrow closets. Due to these designs they work fantastically for that purpose, however they pose a huge risk when looking at the potential of injury.
- The Head
- At the head of the stretcher you will find two pivot points. The top folds up to allow the change of patient position. The un-padded bottom section under the head has a lever actuated break. Using this lever allows this section a 90 degree break for maneuverability. This lever and 90 degree break are pinch points that are felt often. Keeping fingers, and hands away from this lever are important.
- At the front of the stretcher you will find a spring loaded bar that goes from left to right under the lower portion. This bar is designed to keep stretchers from rolling out of the ambulance once the back of the stretcher is lifted to load the patient in to the ambulance. This bar has pinched many fingers and hands when unloading the stretcher from the ambulance. It is best to keep your fingers away from this area whether loading or unloading.
2. The Side and Legs
- The side and legs of the stretcher have a few things going on that pose concern. The legs are designed in an x shape for maximum strength and the ability to collapse when loading or unloading a patient. Many stretchers have a designated location on the bottom of the legs for your hands when collapsing the legs. Any other hand placement are prone to a pinch injury. Most people that get there hand pinched immediately let go of what is pinching them. In this case that could cause the patient to be dropped on to your hand resulting in a crush injury. The side of the stretcher have safety rails to keep the patient from falling out of the stretcher. These must fold to allow moving a patient on to and off of the stretcher. These may not have weight on them but they will pinch you for sure. Make sure to use the action handle only when folding these to deter an injury.
According to the Centers for Disease Control and Prevention, EMS workers suffered from 24,200 injuries in 2012 alone.
3. The Foot
- At the foot of the bed a stretcher has 2 primary pinch points, the hand that actuates the lower feet previously discussed, and the hinge section of the portion of bed that raises the patients foot and leg position. As long as you are the person using the actuator handle there is not much risk, however if you are aiding in a lift from that end of the bed and someone else is using the handle you are at risk of being pinched. You must find a location to lift from, that is far from the handle. Not doing so will allow your fingers to be between the actuator and lifting section. Once that handle is squeezed they will not let go until the stretcher is in a position of safety for the patient. The foot positioning portion of the bed is the last crucial pinch point of a stretcher. The probability of injury when raising the patients feet are slim, however when lowering the patients feet you must watch your hands. Today's patients in many cases have a lot of weight in their feet and legs, if you move the lever to drop that weight without slowly letting it down you are at risk of lodging your hand under that weight, resulting in injury.
Stair Chair - A stair chair from Stryker is designed with the patients safety in mind with a healthy dose of versatility and storeability. This is an absolutely wonderful piece of equipment that will make the job much easier in a lot of situations. As you can see a handle is placed at the top of the chair along with handles at the bottom front of the chair. Tracks are placed behind the chair at an angle to help roll the patient down stairs at a well controlled speed. This tool has saved many backs throughout the years.
In the picture below you can see just how many pinch points a stair chair actually has. This thing was designed to be stuffed in to the smallest portion of an ambulance. This design is absolutely perfect for that task. Unfortunately most of the pinch points are all in action at the same time making it very tricky to fold and unfold this equipment. I can go over every pinch point on this chair but there are just way too many, and chances are your chair may vary to the product shown. My best advice is to get your services stair chair out and play with it. Have your partner sit down in it and see how it works. It is much easier to play with it now and know how it works than to get injured 4 flights up and dropping the patient.
When it comes down to it there are pros and cons to being in EMS. Injuries are the cons, but most injuries in the EMS workplace can be prevented. Whether it be back pain or pinch injuries you can use these simple steps to help reduce these injuries.
- Slow down and think about what you are doing. This will go far in all aspects of your day.
- Communicate with your partner and make the best decisions together.
- Proper lifting technique will save your back now, and in the future.
- Spreading the load among all personnel is the smartest way to lighten the load.
- Use your stretcher to carry equipment for you.
- Do not grab equipment that you do not anticipate using.
- Constantly pay attention to where your fingers are at at all times.
- Get familiar with your equipment. Train well and train often.