Slay the Sloth for Better Fitness

EMS has been a profession of near-constant change. It seems every year there’s new and better gear, trucks, monitors, airway and venous access devices, and a dizzying array of IT companies offering to make our lives easier. Yet when we step back and look at it, our profession still has one of the highest injury rates in the country. We have staggering turnover and staffing shortages. Those who stick around and make it a career are plagued with pain, injury, and resiliency issues. 

Why? 

Physiology

Humans are creatures of movement. Our bodies get better, burn more calories, are more alert, and generally feel better when we move. Yet EMS still has a pervasive cultural bias toward “sloth mode.” We have handed down the habit of being a couch potato for generations. God forbid you burn an extra calorie you might need for the big call that comes along every six months. 

Look at how many EMTs walk. I call it the “EMT shuffle”: Back in calorie-reserving mode, you can’t even pick up your boots, instead dragging your heels wherever you go. (At least walking in the sun has positive mental health benefits, even if you are dragging your heels!) 

All this cultural bias leads EMTs to be less active, less fit, and less healthy. That’s why I’m such a huge advocate for prehire and annual physical abilities testing. Hold the workforce accountable to a “fit for duty” standard. This also forces both employer and employee to make use of gym memberships, annual physicals with blood work, and other free stuff your health plan usually offers. 

Plus, fit employees get hurt less, are more resilient to fatigue, cost less from a health insurance standpoint, and are generally more motivated. This is why every dollar invested in a wellness program returns more than $3 to the company.¹ This means less overtime, less turnover, and fewer accidents. 

Patient Handling

EMS providers have a 60% injury rate.² A quarter leave the job in the first three years due to injury.³ Over 75% of EMTs have been hurt in the past 90 days and not reported it.⁴ All this, and we currently have the best patient-handling technology and equipment possible. So where is the breakdown? 
When I teach classes I advocate for a system of movement that does the following: 

1. Changes the lift height to reduce compressive forces on joints;

2. Reduces the trunk angle to reduce shearing forces on joints;

3. Eliminates friction so transfers are safe and effortless. 

The question is, what device can do all that and still let you transport on it? With what device can I do drags and even lift assists and still accomplish these goals? 

Recently I was talking with a training officer who’d been through one of my courses about safe patient handling. He told me about a call one of his crews ran. The crew wisely decided the safest way to move their patient from a small back bedroom was to put them on a Taylor Titan soft stretcher and slide them down the hall to a larger room with more space to work.

As they began the slide, the captain on scene said, “Stop! This looks bad—we carry all our patients.” Why? Because carrying patients was the way they’d always done it. 

Last I saw there is no section in your EMT textbook that says all patients must be carried. If the space is awkward and the patient can’t sit in a stair chair or walk to the cot, use a device that changes the lift height and reduces friction to slide the patient out to where you can get some more space as well as more hands on the lift.

As I teach in all our safe patient handling instructor classes, use the tool to slide, lift, transfer—you are not the tool and should never touch the patient when moving them. The device should do all the work.

Education vs. Employer

The biggest issue with the way we’ve always done it is the disconnect between education and employer. The schools teach old and antiquated techniques for patient handling, often using outdated equipment.

The employer assumes the student knows how to lift, move, pull, carry, and transfer safely because the school taught it. The school assumes the employer will teach the employee how to do it, and we find ourselves stuck in a revolving door of risk. 

Obviously this is not all schools or employers, but it’s common. Yes, schools need to focus on educating great EMTs, but what good is all that clinical education if they leave the profession due to injury?

The same goes for employers: What good does all that procedural and operational knowledge do someone who departs for another career? We are wasting generations, and future leaders are leaving before they have a chance to grow. 

Instead we can build it all into the day. As an example, with new hires start the day with EMS-specific stretching. Sneak in a lift, transfer, stretcher op, etc., during any and all skills.

After lunch get them on the foam rollers. After the break spend five minutes on a difficult-patient scenario and how to move them. All this will take less than 15 minutes a day. 

When your crews come in for continuing education presentations or mandatory training, follow the same pattern. After a while your crews will start to invest in their wellness on their own. Ultimately they will improve their physical abilities and get hurt less. 

Break the mold of “how we’ve always done it” by looking at the issue from another angle. If providers won’t or can’t change, it’s up to us to address the problem differently.

We need to educate them better and with scientifically accurate techniques. We need to teach them how to eat and sleep compatibly with shift work. We need them to know why they need to invest in their health and help lead them down that path.  

References

1. Society for Human Resource Management. The Real ROI for Employee Wellness Programs, www.shrm.org/resourcesandtools/hr-topics/benefits/pages/real-roi-wellness.aspx.

2. Studnek JR, Crawford JM, Wilkins JR III, Pennell ML. Back problems among emergency medical services professionals: The LEADS health and wellness follow-up study. Am J Ind Med, 2009 Nov 26; https://onlinelibrary.wiley.com/doi/abs/10.1002/ajim.20783.

3. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Emergency Medical Services Workers: Injury Data, www.cdc.gov/niosh/topics/ems/data.html.

4. Patterson PD, Jones CB, Hubble MW, et al. The longitudinal study of turnover and the cost of turnover in EMS. Prehosp Emerg Care, 2010 Apr 6; 14(2): 209–21. 

Bryan Fass, BA, ATCL, CSCS, NREMT-P,  is the author of Fit Responder, a comprehensive wellness plan for first responders, and the Fit Responder blog. He has a bachelor’s degree in sports medicine and is certified as a licensed athletic trainer and strength and conditioning specialist. He was a paramedic for more than eight years and has authored four books on fitness, wellness, and human performance. Contact him at bryan@firepoliceemsfitness.net.