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EMS Injury Prevention
The time we spend in EMS preparing, practicing, certifying and recertifying for our jobs is enormous. The cost for that time is equally significant, yet there are so many in EMS who have to leave the profession early because of injury. To invest so many years in an education and the required "street" skills, only to lose it all to an injury, is unacceptable.
From EMT school and throughout our careers, we are taught proper lifting techniques to prevent injury. Technology has made lifting and carrying patients easier, as assisted stair chairs and cots have hit the market (at great cost). Careful examination of the data shows an interesting trend: Yes, the incidence of injury from lifting stretchers has decreased. But most injuries occur from moving the patient and other external factors, not from lifting the cot. Do the new assisted cots decrease injury? So far the data says yes, but what about all the other sources of injury to which we are constantly exposed?
Over the past 14-plus years of my career, both in a sports medicine clinic and as a paramedic, I have witnessed injuries occur while running calls and rehabilitated those injuries in the clinic. This has afforded me a unique perspective into the rigors and physical demands of our profession. What I have experienced, and what the data supports, is the need for injury prevention programs. Once an injury has occurred, you are much more likely to be reinjured, so preventing injury in the first place is crucial.
Injury prevention in EMS needs to encompass three components: 1) muscular endurance, 2) stability and 3) flexibility. There is a common misconception that strength is more important than endurance. When applied to the trunk, pelvis and core, the ability to maintain a rigid and stable spine with consistent muscular firing (endurance) is better at preventing overexertion injury. Injury commonly occurs as muscles fatigue, both from use/overuse and from chronic postural distortion causing altered firing patterns. The greater your muscular endurance, the more efficiently your muscles will fire. When they fire efficiently, they do not work as hard, and the strain on soft tissue and joints is greatly reduced. To state it another way: Work smarter, not harder.
Our bodies need to be able to find and maintain neutral posture. Neutral, or ideal, posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury, allowing the muscles and joints to function most efficiently. During a state of neutral posture, the muscles will function most efficiently and be able to create adequate joint stability. Improper postural alignment and its accompanying muscle imbalances set the body up for a series of trauma known as postural distortion.1 We must be able to stabilize our joints and bodies in various positions, while constantly knowing where neutral lies to avoid instability. The greater our ability to utilize our muscles in a coordinated and timely fashion, the more significantly reduced our chances of injury or strain. As I explain to my clients, strength and power is worthless unless you can stabilize your joints and body in proper position against outside forces. In EMS these forces include lifting, pulling, pushing, carrying, etc.
Adequate flexibility allows the needed range of joint motion to occur during activity, and helps with injury prevention should a limb be subjected to greater-than-normal range. By comparison, limited flexibility may lead to muscular and or joint compensations that drastically increase your chance of injury.2 We've all had it drilled into our heads to stretch and be flexible; numerous studies done on basic stretching programs for public safety employees have shown significant reductions in injury and lost work days. A study to examine the effects of six months of flexibility training on the incidence and severity of joint injuries suffered by firefighters showed that participants used fewer than half as many healthcare dollars as nonparticipants.3
So the data clearly shows that without adequate muscular endurance, joint stability and proper flexibility, EMS providers are at risk for injury. The good news is that we also have a job where, in our downtime, it's easy to exercise. Simple exercises using body weight and resistance-band exercises are not only effective, but inexpensive and portable. We have myriad objects to use for stretching throughout our shifts, and can use our partners or crews for fitness-based games.
To bolster our bodies as medics, we must learn to integrate and embrace functional movements incorporating our entire bodies when we exercise. The days of contorting into a machine and being forced to move in a certain pattern are gone. A 2004 study using an entire large-city fire department showed that by screening for and then teaching functional exercise and flexibility, there was a 42% reduction in injuries and a 62% reduction in lost work days.4
EMS is a difficult profession physically and emotionally, and it's up to us to develop a culture where fitness and injury prevention are embraced. Over time, this culture will create a fitness standard, which will lead to natural injury prevention.
References
1. Fass B, Scibetta W. Back to Feeling Great. Precision Fitness, 2006.
2. Armiger P. Preventing musculotendinous injuries: A focus on flexibility. Athletic Therapy Today 5(4): 20–25, July 2000.
3. www.nhtsa.dot.gov/.../NHTSA/Traffic%20Injury%20Control/Articles/Associated%20Files/EMS_Feb07_PMS314.pdf.
4. Peate WF, Bates G, Lunda K, Smitha F, Bellamy K. Core strength: A new model for injury prediction and prevention. J Occu Med Tox 2:3, April 11, 2007.
Bryan Fass holds a bachelor's degree in sports medicine, is a certified/licensed athletic trainer and nationally certified strength and conditioning specialist, and worked as paramedic in Charlotte, NC, for more than eight years. He is available for consulting and speaking on public safety fitness testing and injury prevention programs. Contact him at bryan@firepoliceemsfitness.net.
