Another claim just came across your desk, a back injury from your EMS department from lifting a patient. A quick search shows that this is the fourth claim this month and you are on par to meet or exceed your normal claim rate for the quarter. The last meeting you had with the EMS and fire chief, while positive, presented few solutions to the recordable injury issue other than the usual request for more money to buy new equipment. You already have the new powered stretchers and tracked stair chairs yet the rate and severity of the claims continues to rise.
If the above scenario sounds familiar, that’s because we see and hear this from risk managers and chiefs on an almost daily basis. The level of frustration at the lack of change and employee buy-in is a hot topic with both risk managers and first responders. During the past 10 years, I have seen every type, model and design of EMS and fire services and the vast majority suffers from three consistent breakdowns that lead to the recordable you see.
1. Welcome to EMS/Fire; Please Let Me Teach You All My Bad Habits
The first issue I see, especially in EMS, is a lack of proper patient and patient-handling equipment training. Most, if not all EMTs, have had no ergonomics training since they hit the street and the little they had was not based on solid biomechanical principles. To further complicate the problem, patient handling is usually taught via DVD; there is no way to teach proper biomechanics while sitting in your chair.
As an example most EMTs will use a sheet to move patients onto the expensive powered stretcher you just bought. The sheet increases friction adding to patient weight and to use it requires an extreme trunk angle that can place compressive spine loads well over NIOSH recommendations. On top of that, one of the EMTs will usually be on the opposite side of the stretcher, often on their knees, placing their spine and upper extremities in a dangerous pattern. Solution = use a soft stretcher with handles to reduce spine angle and reduce friction at the same time.
The same soft stretcher can be used to change the lift height also reducing the trunk flexion angle and changing the lift height. You see the same data I do: a lot of the injuries come from getting the patient from the floor to that nice expensive powered stretcher. Let’s face it: EMS/fire is one of the few professions left where it’s ok to lift catastrophically heavy loads up off the floor all day long without the assistance of an engineered solution. What we have noticed is that most fire and EMS departments have a tool on the truck that will quickly fix this but the device has been both marketed incorrectly and never trained on in the first place. The soft stretcher I mentioned above goes by many names, “mega-mover” or the “Titan” to name just two, the name alone biases the crews thinking to only use them for bariatric patients. Yet as the NIOSH lift equation for EMS says the single person lifting the load limit is 51 lbs. because a 51 lb. object can place up to and over 751 lbs. of compressive load on the spine when lifting from the floor. We know that in most first responder injury begins to occur at around 800 lbs. of compressive load. That’s a 51 lb. object… average patient weight is now pushing 215 lbs., the deeper the lift the greater the compressive and shearing forces the spine experiences. Change your crews lift height and improve the spine flexion angle and your injuries will drop.
2. Stop Hiring Your Next Injury
Pre-hire physical abilities testing (PAT) is a hot topic, especially for EMS. Fire departments for the most part have embraced PATs, EMS on the other hand is a problem. For years there was no PAT that was specific to the industry. Thankfully now there is a well-validated and vetted PAT for pre-hire EMS employees that has no bias and is a job task simulation. The consistent breakdown I see is that either departments have avoided PAT’s do a perceived litigation risk or risk of injury or the EMS department has a ‘self-made’ PAT that was developed in house (or worse borrowed from another department) with good intentions but when help up to test construct and validation standards is a litigation waiting to happen and the ultimate question is will the PAT weed out the 5-7 percent that would have gotten hurt? The bottom line is that all perspective EMS employees must go through an externally validated PAT that is job task specific. Solution = stop hiring your injuries and then test you incumbents as well.
3. Take Away Their Pain
I started my career in physical therapy, athletic training and sports medicine. When I walked into the world of public safety, EMS, fire and police, I quickly realized that almost all first responders are in pain. As I teach in all my classes, “no one can teach you to lift, move, push, pull, carry, run or fight well if you body does not possess the underlying physical ability to do it safely.” What good is an ergonomics or biomechanical program if the employee has no mobility? If you do not possess the ability to move you well how can you expect to move objects well?
This is one of the biggest disconnects I see in every department; a complete lack of self-care and pain management. I had my eyes opened to the complexity of the issue twice in my career. First as a new paramedic, I choose to use the ambulance to stretch and stay loose so I did not get hurt, let me just say that I did not fit in and got a lot of strange looks. The biggest eye opener is when we developed some pre-shift mobility drills for industry and then asked our EMS departments to adopt pre-shift mobility/stretching, every excuse was made as to why they could not ‘invest’ in themselves and their crews yet the injuries kept piling up.
The amazing thing is that there are readily available and inexpensive tools like foam rollers and massage balls that a first responder can be taught to use pre-shift, between calls or before training to drastically reduce their risk of soft tissue trauma from both job specific tasks and or training.
Risk Management Takeaway
It’s all about systems and processes. There is not one fix for the injuries that you see in EMS, fire and law enforcement. What will begin to fix the problem and eventually change the culture of public safety with positive employee buy-in is simple: teach them to get rid of their pain but do it in a way that ties back into their job.
Using a massage ball on your glute/hip will reduce back and knee pain, teach them how the tools will benefit them. Give them the tools to improve mobility and manage pain and use them pre-shift and pre-training.
As a profession public safety departments must realize that fitness is a job requirement and a necessity; “your fitness will save your life one day and every day.” Test them at hire and annually but also have the resources available to help them get back into shape when they struggle.
Practice makes permanent, perfect practices makes perfect. You must understand that as fire and EMS providers, we are taught to help at all costs and that often means using our bodies where we should use a tool, this is where re-branding the focus of training and outcomes matters. Follow a system that reduces soft tissue torque and load not one that inadvertently increases it with the misdirected pursuit of patient and equipment handling. “Use the tool, don’t be the tool.”
This article was written by Bryan Fass, ATC, LAT, CSCS, EMPT-P(ret), president and founder of Fit Responder Injury Free. It was originally published in the February issue of Public Risk magazine; you can see the digital issue here: https://issuu.com/moiremarketing/docs/publicrisk_february2016-final-issuu
