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Unfortunately, EMS has largely lagged behind in these vital areas
of patient care and occupational safety; as a result, our rates of injury
have remained unacceptably high.
The peer-reviewed journal, The Online Journal of Issues in Nursing,
published a three-pronged, evidence-based approach for reducing
musculoskeletal injury among providers. 7
The first prong is “administrative controls,” which entails the implementation of policies and protocols from management that would
minimize the risk of injury during the performance of strenuous lifting and moving tasks.
The second prong is “engineering controls,” which is the use of
patient handling technologies to limit strain on providers while performing lifting and moving tasks. The third prong is “behavioral controls,” which is the improvement in education regarding proper lifting
techniques and maintenance of a healthy lifestyle so these tasks can
be performed efficiently and safely. 7
All of these factors are currently deficient in EMS, and if there’s
any hope of minimizing injury and implementing a culture of safety,
improvements in these three areas are imperative.
The CDC reports that roughly 2 out of 3 American adults are considered over weight (i.e., body mass index [BMI] > 25) and more than
one-third of American adults are obese (i.e., BMI > 30). 8
Because of the increased cardiovascular, pulmonary and musculoskeletal risks associated with being overweight or obese, EMS providers are encountering these patients with ever-increasing frequency
and, as such, administrative procedures pertaining to these patients
must be changed from the bottom up.
A policy should be created that empowers dispatch personnel to
ascertain the estimated weight of the patient so adequate resources
and personnel can be sent to the scene.
Next, every state EMS office should create a protocol for dealing
with obese patients. (See Figure 3, p. 45.) This protocol would include
the number of providers sent to a scene based on patient weight, specialized equipment that must be utilized, and the designation of safety
officers who can oversee or assist in removing the patient from his or
her home and into the ambulance.
Removing obese patients from their homes can carry equal levels
of risk to EMS personnel as extricating a patient from their vehicle;
so, similar safeguards must be put into place.
As with any protocol, special reports justifying deviation from the
protocol must be filed and if it’s ruled that no justification exists or
there’s a pattern of neglecting the protocol, remediation and re-education must occur. If that doesn’t alleviate the issue, penalties should
be put in place.
Although repercussions for lifting and moving infractions may seem
harsh, the reality is that overestimating how much you or your partner
can lift can result in injury to both you and the patient. As with any
error in patient care, safeguards must be put into place.
One of the pitfalls of the current EMS education system is that lifting
and moving isn’t seen as a topic worthy of consideration. Although
continuing education opportunities are filled with classes on topics
like emergency cricothyrotomy and even ultrasonography, one would
be hard-pressed to find even a single class on the topic of lifting and
moving, despite the fact that this task is performed on a daily basis.
An examination of the 212-page document, National Emergency
Medical Services Education Standards: Emergency Medical Technician
Instructional Guidelines 2009, revealed only four pages containing
information regarding safety, lifting and wellness—that’s 1.88% of
the entire document. 9
The “Lifting and Moving Patients” section of these four pages
defines three types of movements: 1) emergency; 2) urgent; and
3) non-urgent. However, outside of stating common sense safety mea-
sures such as “communication” and “keeping weight close to your torso,”
no substantive discussion of how to perform these moves exists, forc-
ing instructors to teach from their own subjective experiences rather
than an empirically grounded and objective source. 9
Unfortunately, lifting and moving tends to get buried in the vastness
of the national education guidelines, resulting in instructors focusing on
topics that have been problematically characterized as “more important.”
Our early training experience demonstrates that, of the 150 hours
required to become an EMT-B, approximately 20 minutes were spent
on learning the concepts of lifting and moving. Yet, research has shown
that the three most common causes of injury are force (i.e., the weight
of a patient and/or equipment), repetition, and awkward positioning. 10
These three factors show the danger of inadequate education regarding lifting and moving: A provider who’s been improperly taught how
to lift will lift patients who exceed his or her ability (i.e., force), will