New perspectives for the new year
It is common knowledge that EMS is a dangerous profession. Recent work from the joint efforts of the CDC and NIOSH published last July offers insight you may find surprising. More than 22,000 EMS workers seek treatment at EDs annually for work-related injuries. Most of the workers are full-time with less than 10 years’ experience. The breakdown was really surprising:
|Exposure to harmful substances
|Slips, trips and falls
|Motor vehicle incidents
These numbers are based on a sample from the emergency department records and are subject to sampling error. They also don’t include visits to clinics, doctors’ offices, self-treatment, or unofficial treatment given by ED staff. However, they create a reasonable perspective. EMS workers visited EDs at a rate of 8.6 per 100 full-time equivalents (FTEs) compared to 2.1 per 100 FTEs for other workers. In addition to being seen in EDs four times greater than other workers, EMS workers lose workdays secondary to injuries at a rate three times higher than the general public. Career EMS workers experience twice the number of injuries as volunteers and averaged 16 calls/week compared to 4/week for volunteers. Let’s look at these categories in greater detail.
Body motion injuries were most common. They occurred at a rate of 2.6 per 100 FTEs, but EMS workers over 40 had a rate of 3.3 per 100 FTEs. This validates the concept that cumulative wear and tear from lifting does damage. In other words, even if you lift correctly, if you do it enough times with enough load, you will harm your body. The biomechanical hazards related to lifting include:
- Heavy lifting and awkward positions
- Spinal tissue loading
- Psychological factors
- Preparation to lift
- Lack of proper self-care: rest, diet, exercise
Patient handling activities commonly associated with injuries are pulling a patient from a bed to stretcher, initializing stair descent when using a stretcher, and lifting a backboard from floor level. Pertinent administrative controls are policies that address lift assists, fatigue, and the use of engineering controls. Engineering controls should be used in a systematic fashion. Powered cots, mechanical lifts, ramps, winches, and lateral transfer aids should not be viewed as tools to be used in isolation or panaceas. Their proper application requires thoughtful consideration and incorporation into a situation-specific plan. Behavioral controls include proper evaluation of the patient and environment, acquisition of adequate resources, use of proper body mechanics, and ongoing communication among the crew and patient. Naturally, workers should receive instruction about injury prevention, the elimination of physical risks, and strength and flexibility.
Harmful exposures, the second most common form of injuries, occurred at a rate of 2.1 per 100 FTEs. Needle-sticks accounted for 21% of exposures. Being spit on accounted for 14% of events. Only 10% of EMS workers wore eye protection. A study by Dr. Bryan Bledsoe revealed that less than half of EMS providers use standard precautions upon arrival at EDs. We should note that there are other types of exposures, such as, chemical, radiation, airborne particulates/toxins, and miscellaneous situational exposures, such as, fentanyl and carfentanil. Read more on opioids here.In our next newsletter we will continue with slips, trips and falls, motor vehicle incidents, and violence/assaults.
- Bledsoe, BE, Sweeney RJ, Berkeley RP, Korey CT, Forred WJ, Johnson LD. “EMS provider compliance with infection control mechanisms is suboptimal.” Prehosp Emerg Care. 2014; 18:290-4.
- Department of Health and Human Service, “The Opioid Epidemic in the US” www.hhs.gov accessed July 7, 2017
- Drug Enforcement Agency, “Fentanyl: A Briefing Guide for First Responders”, www.dea.gov accessed June 23, 2017
- Kupas DF, “lights and Sirens Use by emergency Medical Services: Above All Do No Harm.” Submitted by Maryn Consulting, Inc. for NHTSA Contract DTNH22-14-F-00578, May , 2017.
- Reichard AA, Maarsh SM, Tonozzi TR, Konda S, Gormley MA. “Occupational injuries and exposures among emergency medical services workers. Prehosp Emerg Care. 2017;21(4); 420-431.
- Wadman M, “Biased opioids could yield safer pain relief.” Science, 2017;358: 63655; 847-8.