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Making the Hard Moves Easier
There are many dangers to the EMS profession, but moving patients is in a class of its own. We find them in an endless variety of cramped, crazy and inconvenient positions. Often they’re broken and fragile or imposingly large. We get them up from floors, out of beds and down stairs. That takes a lot of vigorous effort in contorted body positions, which puts us at a lot of risk for musculoskeletal injuries. Predictably, there’s a high rate of those among providers.
As far back as 2000, ergonomics experts interested in the emergency services were scrutinizing the biomechanics of our more strenuous activities. After evaluating postural data and trunk motion among providers simulating various common EMS tasks, they found our more frequently performed hazardous duties included:
• laterally moving patients from bed to stretcher;
• descending stairs with a loaded stretcher, backboard or hand-carried stair chair; and
• lifting a victim on a backboard from the floor.1
Knowing that, they started to look for solutions.
Interventions
There’s a lot EMS can take from the world of ergonomics.
“We’re always looking for ways to reduce the amount of weight that’s carried or lifted,” says Steve Lavender, PhD, CPE, head of the Orthopaedic Ergonomics Laboratory at Ohio State University and lead author of that 2000 study. “From an EMS perspective, actions like lifting somebody in a bent-over posture are what put you at risk. It’s not just the trunk flexion, but the weight of a patient combined with that posture.”
The bending and lifting requirements of our jobs aren’t likely to change. The challenge, then, becomes creating better tools to assist. In 2007 Lavender led a team that tested ergonomic interventions for a trio of common scenarios: moving patients down stairs, laterally (bed to stretcher, stretcher to hospital gurney) and from bed to stair chair.
Down stairs—Interventions the group tested were a backboard footstrap to prevent patient slippage; a different stair chair handle configuration; and a pair of devices that changed the task from carrying to rolling and sliding: a backboard wheeler and a descent control system with a tank tread-like base. All but the change in handle configuration reduced activity in the erector spinae muscles of providers’ backs—that is to say, reduced the effort required for the tasks.2
Lateral transfers—Interventions tested were a bridgeboard to reduce sliding friction; grab rods along the patient’s sides; and a single rod rolled into a bedsheet that changed the task from lifting to pulling.
For the stretcher-side provider, trunk flexion and erector spinae activity were reduced using the bridgeboard and single rod both singly and together. The single rod also moved the provider who would have been on the bed to a position alongside the stretcher-side provider, significantly reducing erector spinae activity. While the single rod increased latissimus dorsi activation over the standard bedsheet transfer for all providers (though less so when used with the bridgeboard), the ergonomists didn’t feel this was a problem. The single rod also felt less taxing to providers.3
Bed to stair chair—Interventions tested were a prototype Drew People Mover and a transfer sling, which were compared to the standard under-axilla lift. In two-person transfers, the interventions led to 19 degrees less trunk flexion for the provider on the patient’s left and a trend toward less motion for the one on the right. Both showed less erector spinae activity on the side of the back nearest the patient. The sling was also tested for one-person transfers, and reduced erector spinae activity on both sides of the spine by around 20%.4
As for spine motion, with the two-person transfers, the right-hand provider showed less forward bending using the Drew device compared to the sling and underarm lift. In one-person transfers, only the twisting moment was significantly reduced by the transfer sling.4
Despite the demonstration of potential benefit to many of these ideas, not all have come to mass embrace. Some have; things like fricton-reducing transfer devices and tracked stair chairs are now pretty common. Other ideas from Lavender’s work, including a lifting strap, a backboard footrest and a stair chair on which a backboard can be mounted for rolling down stairs, have been brought to market by an Illinois-based company, Livingston Innovations.
As EMS leaders know, though, getting something made is only half the battle. The other problem with new devices is getting them adopted, even if they are potentially better.
“One of the biggest challenges in ergonomics,” says Lavender, “is that you can identify things you think work, but getting people to use them is sometimes pretty tough. There’s lots of good equipment out there, but not everybody wants to change what they’re doing or build something new into a routine that’s been established perhaps over a number of years.”
A paper published last year found the best predictors of adoption for a new ergonomic intervention were perception of an ergonomic advantage, having the intervention endorsed by “champions” and having prior experience with a similar tool or intervention.5
What’s Next?
As it’s been 13 years since that initial evaluation of common EMS task difficulty, Lavender and his colleagues hope to revisit the subject later this year and see if anything’s changed. They also want to learn more about the many “second-tier” kinds of tasks that are physically demanding to providers and might benefit from ergonomic help. (If you have suggestions, e-mail lavender.1@osu.edu.)
A comprehensive study on the benefit of tracked stair chairs could also be in the offing following some recent work examining ways to evacuate people from high-rises. That involved different types of hand-carried devices, stair chairs and sleds.
“Carrying people down the stairs is really tough,” Lavender notes. “And we were just using a 165-lb. Rescue Randy—that’s about average for the U.S. population now, and there are a whole lot of people heavier than that. It gets physically demanding doing that multiple times. So looking at ways you can alleviate some of that force—with track-type chairs, for example—is important.”
Using friction-reducing devices like transfer boards and slip sheets is a best practice too. And for keeping providers safe when moving patients, don’t forget the ultimate protective measure: having enough hands for the job.
“Wherever possible, get extra help to lift those heavy patients,” Lavender says. “Don’t be a hero. We need you tomorrow.”
References
1. Lavender SA, Conrad KM, Reichelt PA, Johnson PW, Meyer FT. Biomechanical analyses of paramedics simulating frequently performed strenuous work tasks. Appl Ergon, 2000 Apr; 31(2): 167–77.
2. Lavender SA, Conrad KM, Reichelt PA, Gacki-Smith J, Kohok AK. Designing ergonomic interventions for EMS workers, Part I: transporting patients down the stairs. Appl Ergon, 2007 Jan; 38(1): 71–81.
3. Lavender SA, Conrad KM, Reichelt PA, Kohok AK, Gacki-Smith J. Designing ergonomic interventions for EMS workers—part II: lateral transfers. Appl Ergon, 2007 Mar; 38(2): 227–36.
4. Lavender SA, Conrad KM, Reichelt PA, Kohok AK, Gacki-Smith J. Designing ergonomic interventions for emergency medical services workers—part III: Bed to stairchair transfer. Appl Ergon, 2007 Sep; 38(5): 581–9.
5. Weiler MR, Lavender SA, Crawford JM, Reichelt PA, Conrad KM, Browne MW. Identification of factors that affect the adoption of an ergonomic intervention among emergency medical service workers. Ergonomics, 2012; 55(11): 1,362–72.
