Back issues are not confined to EMS providers, but are commonly the number one cause of leaving the medical transportation industry. Injuries are often from cumulative wear and tear. So, even if you lift correctly, lifting too many times will hurt you.
In 2010, back symptoms were the reason for 1.3% of all visits to primary care physicians. It is estimated that 84% of adults will have low back pain in their lives. The estimated prevalence of low back pain varies depending on the source, but is thought to range from 22% to 48%. Mechanical back pain is associated with lumbar strain or sprain, degenerative fascogenic or discogenic, herniated nucleus pulposus, osteoporotic compression fractures, and spinal stenosis causes.
In addition to lifting, other risk factors include smoking, obesity, age, female gender, physically strenuous work, psychologically strenuous work, glucocorticoid steroid use, low educational attainment, having workers’ compensation insurance, job dissatisfaction, somatization disorder, anxiety, depression, and trauma. The mind body connection is really important here.
The pathophysiology of back injury is the result of chronic overuse musculoskeletal microtrauma, poor body mechanics, low bone mineral density, forceful direct trauma, infection, and systemic illness. It’s clear that lifting and moving patients can be dangerous. I am receiving with increasing frequency anecdotal reports of a linear correlation between workers’ compensation claims and patient injuries. Is it reasonable for a patient to be injured on a routine transfer or transport for non-urgent care to sustain an injury because we didn’t notice a crack in the pavement of didn’t latch the stretcher properly? We must use the same level of focus and situational awareness in moving patients that we do in performing life-saving clinical interventions.
After we perform the proper clinical evaluation and administer care, we must think about patient characteristics that impact the way we move them. Things such as age, ability and willingness of the patient to cooperate, follow instructions, and provide assistance. There are clinical conditions likely to affect patient handling. They might include: amputations, spasms, fractures, joint replacement, paralysis, cardio-respiratory compromise, edema, osteoporosis, pain, urinary or fecal stoma, and very fragile skin. We should also evaluate the environment for the presence of fixed or movable obstructions, terrain, distance, lighting, and freedom from bystander interference. On the basis of our findings, we form a plan which is communicated with the team. It is critical that we have adequate resources, such as personnel and equipment. Now let’s consider the actual lift.
What should we think about in terms of body mechanics? We must maintain balance, use the power grip, keep the feet shoulder width apart and staggered, don’t twist, bend at the knees to squat, maintain lumbar curve with torso upright, and rise slowly. Good technique mandates that the two people lifting do all of the above at the same time. If they are not trained in the same manner or practice together uncoordinated lifts and poor communication will occur. Are there crews with height disparities, differences in strength, fatigue or injuries? Should the first time crew members lift a cot be with a patient on it? At the beginning of each shift, crews should unload and load the cot a couple of times and talk about how they like to lift. Supervisory and training personnel should monitor crews loading, unloading and moving patients, document their findings and create opportunities for remediation and incentives.
- Steffens D, Ferreira ML, Latimer J, et. al., What triggers an episode of acute low back pain? A case cross-over study. Arthritis Care Research 2015:67;403.
- Driscoll T, Jacklyn G, Orchard J, et.al., The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 Study. Annals of Rheumatic Diseases. 2014. June 73 (6): 975-981
- Szczygiel, M (editor), EMS Safety, Burlington : Jones and Bartlett Learning 2017.