If only humans came with handles – the undiscussed cause of back injuries

Anyone who has been in the Fire and EMS industry for more than a couple years typically knows of a few staggering statistics concerning the high back injury rate of prehospital providers. There have been studies conducted starting in the 90s through today that all say the same thing: EMS personnel consistently have more reported back injuries than any other industry. According to the NAEMT (National Association of Emergency Medical Technicians), EMS practitioners are seven times more likely than the average worker to miss work as a result of injury.

As a result of these studies, departments have taken many measures to reduce back injuries. Examples of such measures include: purchasing mechanical lift equipment, requiring pre-hire ergonomics testing, and performing a stretching routine at the beginning and end of every shift. These are all very well intentioned actions, and I commend every department that has taken any action in protecting the backs of the prehospital workers. But the fact of the matter is, back injury rates are continuing to climb.

There are a minimum of five lifts that a prehospital worker will perform on a typical transport:

1 Lifting the patient up from the floor;

2 Lifting the stretcher to waist height;

3 Loading the stretcher into the ambulance;

4 Unloading the stretcher;

5 Transferring the patient from the stretcher to the hospital bed.

Thanks to Stryker and Ferno, three out of five of those lifts can be eliminated through the use of a power stretcher.

From the year 2008 to 2011 the number of treated lower back injuries steadily increased from 4200 to 5800¹. This year 2008 was the release of the first commercialised power cot in America. This means the back injury rates continued to climb even after the invention of the power stretcher.

These statistics were not what anyone was expecting, and left people asking “do the power stretchers really save our backs like the manufactures say they will?” To my knowledge there are no published peer-reviewed studies proving that power cots reduce back injuries. The question we should be asking ourselves is, “do we really need a formal study to prove that a lifting related injury cannot happen if a lift is not performed by the caregiver?” Common sense will show that any time a prehospital worker can avoid a lift, they are adding years of health to their back. Every lift counts. The actual cause of back injury is often a series of incidents with years of weakening from repetitive micro-­trauma, rather than a single incident². Therefore, it is not difficult to see the value of power cots, which are reducing over half the amount of lifts performed on an average transport call.

We know that the majority of back injuries are caused from manually lifting patients³. If power stretchers can eliminate three of the five manual lifts, we can deduce that manually moving the patient onto, whether to a stretcher, stair chair, or other location, is the most dangerous task a prehospital provider will perform during an average transport call.

There are many occupations where manual lifting is required systematically throughout the day. One could even argue that some manufacturing jobs require more manual lifting than in EMS. If that is the case, why are back injuries so much more prevalent in EMS?

A study in the Francophone region of Switzerland was conducted to try and answer that ­question. From this study they determined what every prehospital provider already knows. Every call is different than the one before. No call is the same. The unpredictable environment in which their work will take place, coupled with awkward and constraining postures, is a major cause of back injuries⁴.

“Lift with your legs and not your back” has been preached to us since we were young. This adage is a great rule to follow, but it’s just not that simple for a prehospital provider. The environment and condition of the patient heavily contributes to:

• Reaching while lifting
• Poor posture
• Bad body mechanics
• Twisting while lifting
• Bending while lifting
• Over extending
• Single member lifts
• Poor footing
• Lifting with sudden forceful movement (shock loading)

This list delineates some of the prime reasons for injury during manual patient handling. In order to lower the risk of back injuries we need to look at what is causing prehospital providers to practice these bad habits.

A lift assist call might look like this:

Sue has been struggling for 2½ hours trying to get herself out of the bathtub. She knew due to her age and weight she shouldn’t be trying to bathe herself, but the home caregiver “hadn’t had time” and Sue wanted to feel clean. Sue is now losing sensation in her lower extremities and it is now your job to get Sue up and out of that tub.

Prehospital providers tend to utilise improper ergonomics because they have no way to grab hold of the patient during routine procedures like the one described above. If only humans came with handles! Proper lifting ergonomics cannot be properly followed when the providers have nothing to grasp.

The providers at this point have two options, they can improvise a way to get Sue out of the tub, or they can use specialized lifting equipment.

Improvised techniques might include:

1 Sending the youngest/strongest provider in to provide lift assistance by getting behind the patient and lifting by the patients armpits.

2 Using a sheet in different variations to get the patient up.

3 Using a soft stretcher to position under the patient.

Or heaven forbid

4 Attaching the KED (Kendrick Extrication Device) to help lift the patient.

Every one of these techniques is widely used, and every single one of them puts either the patient, provider, or both at extreme risk for injury. Unknowingly, we have handed down bad patient handling techniques and improper ergonomics from one generation of prehospital providers to the next.

The typical techniques utilised in lifting the patient up from the floor are outdated and play a large role in the probability of sustaining a back injury on the job. Using the right tool for the job is crucial. A wheelbarrow would never be used to move a patient to the ambulance instead of a stretcher. Just the same, we should not be using sheets, soft stretchers, or KED’s to help get the patient up off the floor.

Every ambulance needs to have a proper tool that is specifically designed to help lift patients from the floor. There are a few products on the market that are designed to help with patient lifting, but keep these factors in mind when looking into purchasing one of these devices.

1 The device needs to be easily attached to the patient. The providers will rarely use the device if it is not simple to attach to the patient.

2 There need to be multiple handles. Regardless of patient positioning, the provider will have access to multiple handles, allowing for the best lifting posture. Remember, patients are often found in inconvenient locations and positions.

3 The device needs to support the entire torso of the patient. By supporting the torso, the providers need not to rely on the patient’s core muscle strength to maintain balance and posture. Lifting devices that only go around the patient’s waist are a potential risk to both the provider and patient by creating a hinge or pivot point.

The Binder Lift is the only device on the market that fulfills the above criteria. This is because it was made specifically for the purpose of lifting the patient off the floor or out of a chair. It can also be left on the patient to help with the next manual lift of moving the patient off the stretcher onto the hospital bed.

Any department that seeks to initiate, or is already utilizing, a back injury reduction program must have protocols that require the providers to use specialized equipment to aid in manual lifting. As soon as we start using the right tool for the job that allows for proper ergonomics to be followed, back injuries will significantly decrease among prehospital providers.

For more information, go to www.binderlift.com

¹ Reichard, A. Emergency Medical Services Workers. Center for Diseasa Control & Prevention. [Online] June 21, 2013. [Cited: June 30, 2014.] http://www.cdc.gov/niosh/topics/ems/data.html

² OSHA. OSHA Technical Manual. Osha.gov. [Online] January 20, 1999. www.osha.gov/dts/osta/otm/otm_vii/otm_vii_1.html

³ Hogya, PT and Ellis, L. Evaluation of the injury profile of personnel in a busy urban EMS system. AM J Emerg Med. 8, 1990, Vol. 4, 308-11.

⁴ Arial, M. Exploring implicit prventive strategies in prehospital emergency workers: A novel approach for preventing back problems. Applied Ergonomics . [Online] December 19, 2013. http://dx.doi.org/10.1016/j.apergo.2013.12.005