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and help. The consequence is that we often use ourselves as the tool
to get the job done, in order to serve and be a strong, caring patient
advocate. So, we end up picking up the patient or the gear in awkward
positions or from a height that’s below the knees.
Instead, use a commercially made device to change the lift height
and allow multiple responders to get their hands on the patient. Devices
like the Titan from Taylor Medical, the MegaMover from Graham
Medical, the HILT Human Injury Limiting Tool or the Binder Lift
allow the lift height to change from floor to knee height. They also
reduce friction and trunk angle when transferring a patient from
stretcher to hospital bed.
2. Reduce friction. Friction can be a big deal, especially when tasked
with transferring a 500-plus-lb. patient from bed to bed or a patient of
normal weight from an air mattress to the cot. Common techniques
include moving the patient on a bedsheet or blanket, which will add
resistance to the transfer due to the coefficient of friction. Add to this
the extreme trunk flexion angle that must be achieved to lean over the
bed to grasp the sheet, and that some responders will have to either
stand on or kneel on the bed, and we have the trifecta for spinal disaster: shear, compression and torque.
Simply using a soft stretcher as mentioned above will both eliminate the friction issue while reducing the trunk flexion angle. These
devices have built-in handles and are made of high-strength materials that also reduce friction. Plus, the lift height is more like that of
a dead lift with greater hip involvement and less lumbar spine load.
3. Master the hip hinge and reduce trunk angle. Perspective is an interesting thing. As a paramedic, athletic trainer and a certified strength
and conditioning specialist, I’ve noted that very few responders possess
the ability to use a good hip hinge to spare the spine and reduce compressive and shear forces. This is from poor hip mobility and a lack of
coaching/awareness on the importance of the hip hinge.
A very common pattern prevalent in all first responders is that the
hip flexors become very short and tight. As they tighten they cause an
anterior pelvic rotation that inhibits the abdominal wall (i.e., the guts
and butts posture). As the abdominal wall weakens, the spine takes
additional loads. This results in the glutes become tight and weak and
the hamstrings tighten in an attempt to pull the pelvis back into place. 6
As this pattern becomes more and more severe (i.e., lower crossed syndrome), the EMT loses the ability to lift properly.
Despite training first responders to lift with their legs, hip flexor
tightness and gluteal weakness results in an inability to do so, forcing
them to use the back as a lifting device and not the hips.
As a first responder, you need to understand some truths. First,
dangerous lifting techniques are handed down from generation
to generation; we need to break this cycle. Next, safe patient and
equipment handling must be constantly trained and retrained—it’s
too easy to fall back into old habits. We must teach proper mobility
allowing us to be fit for duty: “You have to move well before you can
move objects well.” EMS and fire departments must also conduct
an annual physical abilities test to ensure providers maintain fit for
duty status. Finally, there must be a blend of engineered solutions
and awesome ergonomics.
It amazes me how many departments invest in new tools and tech-
nology, like powered cots or lift devices, yet injury rates still rise due
to poor training and a misunderstanding that most provider injuries
come from moving the patient on and off of the cot. JEMS
Bryan Fass, ATC, LAT, CSCS, EMT-P (ret.), has dedicated more than a decade to changing the
culture of fire/EMS from one of pain, injury and disease to one of ergonomic excellence and
provider wellness. Leveraging his 15-year career in sports medicine, athletic training, spine
rehabilitation, strength and conditioning, as well as experience as a paramedic, he has become
a leading expert on fire/EMS fitness and prehospital patient and equipment handling. His com-
pany, Fit Responder, works with departments across the U.S. to reduce injuries and improve
fitness for first responders.
1. Studnek JR, Ferketich A, Crawford JM. On the job illness and injury resulting in lost work time among
a national cohort of emergency medical services professionals. Am J Ind Med. 2007; 50( 12):921–931.
2. Centers for Disease Control and Prevention. (June 21, 2013.) Emergency medical services workers injury and illness data, 2011. Retrieved Aug. 5, 2017, from www.cdc.gov/niosh/topics/ems/
3. Death and injury survey. (2000.) International Association of Fire Fighters. Retrieved Aug. 5, 2017,
4. Hogya PT, Ellis L. Evaluation of the injury profile of personnel in a busy urban EMS system. Am J
Emerg Med. 1990; 8( 4):308–311.
5. Kincl L, Hess J, Hecker S. (n.d.) Firefighter and emergency medical services ergonomics curriculum.
Oregon OSHA. Retrieved Aug. 5, 2017, from http://osha.oregon.gov/OSHAGrants/ff_ergo/index.html.
6. Janda’s crossed syndromes. (n.d.) The Janda approach. Retrieved Aug. 5, 2017, from