The Trip Report: On-Duty Injuries and Exposures

Reviewed This Month

Occupational Injuries and Exposures Among Emergency Medical Services Workers

Authors: Reichard AA, Marsh SM, Tonozzi TR, Konda S, Gormley MA.

Published in: Prehosp Emerg Care, 2017 Jul–Aug; 21(4): 420–31.

This month’s research review features a paper devoted to occupational injuries and exposures among EMS workers. This interesting study was conducted in response to an NHTSA consensus report that called for an injury and illness surveillance system for EMS providers.

NHTSA’s report noted there was limited literature detailing the extent to which injuries and illnesses are experienced by EMS providers. This is how a lot of really important research starts: A significant study or a group of subject matter experts identifies a topic that is not well researched and calls for scientists and researchers to publish studies that add to the topic’s body of literature. This study does an impressive job describing the challenges of remaining safe while working in EMS. It does this by surveying EMS providers who sought treatment in an ED for an injury, illness or exposure that occurred on duty. 

The study collected data by having interviewers call EMS providers who were injured while working. These individuals were identified by the National Electronic Injury Surveillance System, which is used by NIOSH to estimate nonfatal occupational injuries and illnesses treated in EDs around the country. This study was a collaborative effort by NIOSH and the NHTSA Office of EMS. On each call the interviewers administered a 20-minute survey with questions ranging from characteristics of the event to the injury outcome. The study period was from July 2010 to June 2014. National estimates of EMS providers treated in EDs for occupational injuries and exposures were calculated based on the results of the telephone interviews. 

In total, 572 interviews were completed. It is worth pausing here for a moment to emphasize that national estimates of EMS providers’ injuries were calculated based on results of interviews with 572 injured EMS providers. There were 196 individuals who declined to participate. Yes, getting 74% of those called to complete the survey was impressive; however, the more individuals who reply, the more accurate the estimates. 

There may be folks reading this who decline to participate in phone surveys. In reality, 20 minutes is a long time to spend on the phone answering questions, but the next time you get a call asking you to participate in a survey, at least listen to the purpose before declining. It could be an opportunity to have a meaningful impact in improving EMS research. 

To calculate national estimates based on a limited number of individuals, responses are weighted. Essentially what this means is that one individual’s answers are treated as responses from many individuals. In this study, the 572 interviews represented 89,100 EMS providers injured or exposed during the study period. Yes, that sounds like a pretty large jump; however, there are validated statistical methods that support the calculation of such estimates. It is beyond the scope of this review to dive into these methods, but this paper does a fantastic job describing the assumptions and adjustments used. I hope everyone who reads these columns follows up and reads the actual manuscripts behind them. This is especially true for those interested in the statistical methods behind the study results.  

Findings

Let’s discuss what the authors found out. The most common injuries were described as body motion injuries. Forty-one percent of respondents indicated their injury was a sprain or strain, totaling an estimated 37,000 sprains/strains among EMS providers during the study period. The overwhelming majority (90%) of these injuries occurred when lifting patients. About half of those injured while lifting indicated the patient being lifted was heavy, overweight or obese. 

Harmful exposures were next, representing 20% of the total diagnoses (17,400 estimated exposures nationally). Of these, needle sticks (21%) were the most common. Other than needle sticks, most exposures occurred to the eyes. There were an estimated 5,600 harmful exposures to the eyes nationally. Many of those eye exposures occurred when no eye protection was worn. 

Loss-of-balance injuries were the third most frequently reported diagnosis. The most common of these were falls from the same level (43%), representing an estimated 6,000 of these falls nationally during the study period. Other causes of loss-of-balance injuries included going up or down steps or a curb, getting in or out of the ambulance and slipping on wet surfaces. Patient-handling activities accounted for 56% of loss-of-balance injuries. 

Motor vehicle incidents accounted for about 8% of the injuries evaluated in this study. This is a good time to remember that the injuries examined in this study were nonfatal. It is well known that ground and air ambulance crashes are the leading cause of death among EMS professionals. The 8% reported here are those lucky ones who lived after their crashes. Although these individuals lived, about 66% had to miss a day or more of work. This was the highest proportion of missed work days among all injury types evaluated. The 8% also represents a much higher injury rate when compared to all workers in the general population. 

Finally there were approximately 6,400 injuries to EMS providers due to violence and assault. An estimated 3,300 involved physical violence. Seventy-one percent were directed at the EMS provider, and in all but an estimated 300 of these events, the patient was the perpetrator. Not surprisingly almost half involved a patient who appeared to be under the influence of alcohol. Police reports were made in only 42% of these events. 

Conclusion

As we discuss each month, every study has limitations. The authors here did a nice job describing theirs. Most important was that these estimates are likely an underestimation of the true number of occupational injuries and illnesses experienced by EMS providers.

The only injuries, illnesses and exposures included in this study were those where the EMS provider went to the ED for treatment. In other words, it excluded all the times someone self-treated or had a colleague assist them. There were also some limitations caused by the assumptions and adjustments to the statistical and sampling methods; I encourage you to read this paper to fully put these results into context. 

This study adds some very important data to the available literature on occupational injuries and illnesses experienced by EMS providers. These results are valuable not only to leadership and decision makers but can help all of us better understand how to keep ourselves safe on duty by increasing our understanding of the most prevalent dangers faced.   

Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North Carolina–Chapel Hill. He has been a nationally certified paramedic since 2005 and completed the EMS Research Fellowship at the National Registry of Emergency Medical Technicians.