that must be backfilled with other staff, possibly in the form of forced overtime. Overtime
shifts aren’t only expensive, they also drive up
provider fatigue, increasing healthy staff members’ risk of injury. Coupled with the fact that
many providers have second EMS jobs, the
injury risk increases even more.
INJURY FACTORS & FORCES
More than half (62%) of all prehospital provider back injuries result
from lifting patients. 4 Injuries are a
consequence of three major factors:
significant lifting forces (i.e., patient
weight), repetitive movements and
awkward positions. Prehospital back
injury statistics haven’t changed significantly in the past decade, despite
the introduction of many safe lifting
devices like automatic-lift stretchers, slide boards, slide sheets and
In the prehospital and firefighting environments, ground responders must deal with three forces that
affect the spine and can lead to injury: compression, shear and torque.
Compression forces push down on or
squeeze the spine parallel to the spine’s axis.
The intervertebral disks help us withstand
Forces that impact the spine perpendicular
to the axis are considered shear forces. Leaning
over to the side by dropping one shoulder lower
than the other and picking up a heavy pack is
an example of a shear force. Shear forces also
occur when you bend at the waist to pick up
an object. The more round your back is when
bending or the farther you reach away from
your body, the higher the shear force.
Rotational forces are referred to as torque.
Torque is calculated by multiplying force
times distance, where distance is the space
between the spine and the weighted object
in motion. Significant torque forces can cause
ligament and disk injuries as compression
occurs unevenly; they can also occur when
heavy objects are lifted with one arm.
To help protect workers, the National
Institute for Occupational Safety and Health
(NIOSH) established safe lifting limits for
healthcare providers. The load limit set for
single-person lifting is 51 lbs. and a spine
compression force of 764 lbs. 5
Unfortunately for prehospital providers,
many routine lifts far exceed the
recommended compression limits. For example, pulling a 105-lb.
patient via bedsheet between two
beds applies between 832–1,708 lbs.
of compressive force.
I can’t recall the last time I transferred a patient weighing less than
200 lbs. As obesity has increased, so
has the occupational load that first
responders must deal with. 5
Interestingly, the bed-to-bed
drag is a major cause of injury and
it’s one of the few things we can
control in the field. Using a bedsheet drag violates two of the three
injury prevention principles that we champion. It increases friction and increases trunk
angle (i.e., how much you have to lean forward), which creates a shearing force placed
on the spine, neck and shoulders, thereby causing injury.
If “sheet drags are the way we’ve always
done it” is a standard operating procedure,
then your organization hasn’t invested in your
Add to all of this compression, shear and
torque, the fact that EMS and fire are two of
the few professions left where it’s considered a
normal (i.e., required) job task to pick up catastrophically heavy loads off the floor every day.
This is akin to deadlifting 300 lbs. from the
floor with the load shifting as you lift it. After
it’s lifted, it must then be maneuvered down a
hallway, downstairs and then onto the stretcher.
No other profession allows such injurious
loads to be picked up from such a low position (i.e., hands on the floor), and that’s with
the assumption that the patient isn’t wet and
in a bathtub, which exponentially increases
the shear, torque and compressive forces in
Almost all the responders I train across the
country have deeply seated biomechanical
patterns that inhibit deep, safe lifting. I teach
There are a number of devices available that can change the lift height and allow multiple responders to
get their hands on the patient. Photo courtesy Bryan Fass
Prehospital back injury
statistics haven’t changed
significantly in the past
decade despite the
introduction of many
safe lifting devices.