Sizing Up Safety

As the EMS world moves toward 2020 and continues its quest to develop an overarching industrywide culture of safety, a small but vitally important study is being conducted at a venue near you. The results of this activity will provide all important data and evidence that will become a driver for change as the U.S. EMS industry matures into its new world order and ultimately becomes safer.

In 2010, an estimated 826,111 EMTs were employed in the United States. EMS workers in the United States are a “high-risk” population and have a fatality rate of 6.3 per 100,000 workers, 1.4 times greater than the national average. Among the 65 fatalities for EMS providers between 2003 and 2007, EMTs and paramedics accounted for 60 deaths, while ambulance drivers and attendants accounted for the remaining five deaths.¹ In addition to fatal injuries, around 19,900 nonfatal injuries requiring treatment occur to EMS workers each year.²

In November 2013, the Richmond (VA) Ambulance Authority became one of the first sites to participate in an applied anthropometric survey of EMS workers conducted by the National Institute for Occupational Safety and Health (NIOSH). NIOSH is the federal research agency whose mission is to provide national and world leadership to prevent work-related illness, injury and death by gathering information, conducting scientific research and translating the knowledge gained into products and services.

Applied anthropometry is defined as “the application of scientific physical measurement methods to human subjects for the development of … manufactured products for the purpose of assuring suitability of these products for the intended user population.”³ This significant piece of work, being conducted by the West Virginia-based NIOSH team, and funded by the Department of Homeland Security, Science and Technology Directorate, measures EMS workers’ body size information. It is hoped this data will be used in the design of the next-generation patient compartment in emergency vehicles. Improved workstation designs in the patient compartment should provide a safer and more comfortable work environment for EMS workers.

It has been identified that problems in workstation design and safety equipment may contribute to industry injuries. According to an article published in a 2003 issue of the CDC Morbidity and Mortality Weekly Report, “less than half of EMS workers use restraints in the patient compartment. In addition, lap-belt restraint systems commonly provided in patient compartments do not allow full access to the patient. If CPR or other procedures such as intubation or insertion of IVs must be performed, EMS personnel might need to stand over or kneel near the cot. For these reasons, EMS workers often ride unrestrained, seated on the edge of the squad bench.”⁴

Current designs of the ambulance workstation may leave EMS workers unrestrained and exposed to possible traumatic injuries. An ill-fitted restraint system may lead to serious injuries in the event of traffic incidents and crashes. Also, the improper design of an ingress/egress system at the back of the patient compartment may lead to elevated rates in incidents of slips and falls. Redesigning step height and depth may reduce the incidents of missteps around EMS vehicles.

To reduce injury potential to EMS workers, NIOSH has committed to conducting research aimed at improving the design of the workstation and ingress/egress system in the patient compartment. Collecting up-to-date anthropometric information on EMS workers is an important research effort toward achieving this goal. This data will be applied by NIOSH’s research partners, including the National Institute of Standards and Technology (NIST), to the redesign of the next generation patient compartment in EMS vehicles. In addition, the EMS industry has made a commitment to applying the data to update the National Fire Protection Agency (NFPA) Standard for Automotive Ambulance (NFPA 1917).

The NIOSH lead for the anthropometry effort is Jinhua Guan, PhD, a health scientist in the Protective Technology Branch (PTB), Division of Safety Research (DSR). His area of research is anthropometry/ergonomics. He also has extensive experience in statistics and experimental design. Guan says, “The first part of the study, which lasts about 45 minutes, is devoted to the collection of manually measured body dimensions. When participants arrive at the lab, they are asked to provide a state-issued EMS ID to establish eligibility for participating in the study. Once credentialed, participants are directed to a changing room located inside the data collection area to dress in lab attire—sport shorts for males and sports bras and shorts for females.”

All lab clothing is provided by NIOSH and subsequently cleaned after each use. To prepare for the measurement, an investigator identifies bony points on the body and marks them with an eyeliner pen or white sticky dots over the clothes. At this point, the data collection begins via anthropometric instruments recording up to 40 dimensions on the body. Guan adds, “In the second part of the survey, whole body and head scanners are used to obtain a number of 3-D images. In this very high tech half of the study, the investigator once again locates and marks spots on the body, as well as uses an eyeliner pen to trace a contour of the face. The test subject then steps into a whole-body scanner and is scanned.”

After the whole-body scanning, the provider then sits in the scanning area of a head and face scanner where a 3-D head and face image is obtained. The scanners contain safe, low-power lasers that are swept across the human body. The lasers are safe on the eyes and do not penetrate the body or the clothing to cause harm. The study intends to collect anthropometric measurements from 650 EMS workers.

The data collection continues into 2014 and is intended to take place in Albany, NY; Richmond, VA; Chicago, IL; St. Louis, MO; Dallas, TX; Tallahassee, FL; Los Angeles, CA; Ft. Worth, TX; and Seattle, WA. A peer-reviewed paper, which summarizes the major findings of the study, is expected to be published in early 2016.

References

1. U.S. Department of Labor, Bureau of Labor Statistics. Occupational Injuries/Illnesses and Fatal Injuries Profiles, https://data.bls.gov/gqt/InitialPage;jsessionid=2B443372AD3E2658B8B760149AEC2523.tc_instance3.
2. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Emergency Medical Services Workers: Injury and Illness Data, www.cdc.gov/niosh/topics/ems/data.html.
3. Roebuck JA, Kroemer KHE, Thomson WG. (1975). Engineering Anthropometry Methods (Wiley Series in Human Factors). New York: John Wiley & Sons, 1975.
4. CDC. Morbidity and Mortality Weekly Report, www.cdc.gov/mmwr/preview/mmwrhtml/mm5208a3.htm.