Preventing Back Injuries in EMS: Causes, Costs & Solutions

Introduction: Back Injuries in the American Workplace

Twenty percent of the injuries experienced in the American workplace are back injuries. In some fields, such as Emergency Medical Services (EMS), these injuries are responsible for keeping roughly ten percent of workers off the job at any given time. Statistics from the Centers for Disease Control and Prevention reveal that EMS workers accounted for over 20% of all 27,000 work-related illnesses in the data studied, with lower back injuries specifically cited (CDC, 2015).

The nation pays dearly for back-related injuries through medical bills and lost income. This cost amounts to approximately $50 billion nationally, of which $20 billion originates from injuries occurring in the medical field. Ironically, this surpasses the cost of similar injuries in less surprising industries, such as manufacturing, mining, and construction. For an individual physician who is injured, costs are estimated at $18,000, combining medical bills with income lost by both the employer and the injured worker (Collopy, Kivlehan, & Snyder, 2014). This paper discusses the reasons that should compel employers to prioritize their employees' health, with particular attention to the back problems faced by EMS workers.

Causes of Back Injuries in EMS and Prevention

The major cause of back injuries among EMS workers is patient lifting, which accounts for 62% of cases. EMS staff are regularly required to assume awkward positions, perform repeated motions, and bear the weight of patients during lifts. Notably, these injuries continue to occur at the same rate as in previous years, despite the availability of slide boards, automatic-lift stretchers, and other safety devices. A large amount of equipment has been made available to EMS staff to assist with pre-hospital procedures, yet injuries persist — suggesting that equipment alone is not the intervention needed.

There is, in fact, no definitive proof that providing lifting equipment and training on its use can reliably prevent back injuries (Advice, 2015). As noted in a BMJ article cited by Advice (2015), these provisions are insufficient on their own to address back injuries adequately. As Collopy, Kivlehan, and Snyder (2014) argue, any effective back injury prevention program must adequately address prevention, training, and monitoring together.

Consider a typical patient transport involving a hip injury from a standing fall: as many as five separate lifts may be required. The patient is lifted onto the stretcher, the stretcher is raised to waist height, it is loaded into the ambulance, unloaded upon arrival, and finally the patient is transferred onto the hospital bed. Each lift places pressure on different parts of the body, creating multiple points of injury risk. Because of this diversity of lifting demands, no single device or generalized training can address them all uniformly. However, the mechanics of safe lifting are applicable across all lift types (Collopy, Kivlehan, & Snyder, 2014).

Back Injury Costs

Every back injury requires evaluation from the outset. Historically, reserving between $5,000 and $8,000 per back injury was considered standard practice. However, within the first few hours following an injury, indirect costs alone can exceed $6,000. Seeking emergency department evaluation generates bills for the professionals involved, diagnostic procedures such as X-rays, and prescribed medications. Added to this are employer costs in the form of wages paid to an injured worker unable to perform duties, as well as expenses associated with finding a replacement for the period of absence. Taken together, these costs represent significant organizational losses (Mitterer, 2015).

Possible Prevention Strategies

The National Institute for Occupational Safety and Health (NIOSH) has established safety limits aimed at protecting workers. Examples include a 51-pound limit for single-person lifting and a maximum spine compression force of 764 pounds. These limits are widely considered impractical in the EMS context, however, since standard patient lifts frequently exceed them — particularly with respect to spine compression. Adopting appropriate lifting mechanics is one of the most effective ways to reduce injury risk. Other preventive measures include maintaining adequate staffing levels in pre-hospital settings, using appropriate lift equipment, and eliminating single-person lifts wherever possible (Collopy, Kivlehan, & Snyder, 2014).

The following steps outline safe lifting practice:

Sizing up the load — Before any lift, evaluate the load to determine whether additional personnel are required. Staff should recognize their limits and request assistance when necessary.

Establishing firm footing — Stand with feet shoulder-width apart and place one foot slightly ahead of the other. Shifting weight toward the back foot helps maintain the center of gravity.

Keeping the back straight — To minimize spinal pressure, staff should maintain a straight back even while squatting to lift. Visualizing the spine as aligned with a vertical rod can help reinforce this posture.

Bending at the knees slowly — Avoid jerky or rapid movements, which are a common source of injury. Slow, deliberate lifting and lowering movements that concentrate force on the legs should be used instead.

Keeping the load close to the body — Holding a lifted object as close to the body as possible helps maintain the center of gravity and prevents excessive spinal pressure.

Keeping the chin up — This posture naturally promotes a straighter back during lifting.

Pulling the shoulders back — Like the chin-up position, this helps ensure the back remains straight throughout the lift.

References

Advice, B. L. (2015, November 17). Training in lifting techniques may not improve prevention of back pain. Retrieved from Medscape: www.medscape.org/viewarticle/569657

AFSCME. (2002, March). Preventing back injuries in health care. Retrieved from American Federation of State, County & Municipal Employees:

CDC. (2015, November 17). Emergency Medical Services workers injury and illness data. Retrieved from Centers for Disease Control and Prevention: www.cdc.gov/niosh/topics/ems/data2011.html

Collopy, K. T., Kivlehan, S. M., & Snyder, S. R. (2014, May 1). Preventing back injuries in EMS. Retrieved from EMS World: http://www.emsworld.com/article/11373351/back-injuries-and-protection

Mitterer, D. (2015, November 12). Back injuries in EMS. Retrieved from EZLIFTRescue: http://www.ezliftrescue.com/Back%20Injuries%20In%20EMS.pdf