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Preventing Ambulance Personnel Injury

Issue 11 and Volume 11.

Recently, there has been an increasing emphasis on prevention in EMS training materials. Prevention programs have a significant effect on loss of life and property, and training EMS providers to be knowledgeable advocates for illness and injury prevention is becoming a large part of emergency medical services.

It is a natural extension of any prevention program to address EMS personnel injury prevention. While lifting and back injury programs are a part of most agencies orientation, many EMS providers do not take prevention programs for EMS personnel seriously.

The Labor Statistics Bureau describes the risk EMS personnel face: “EMTs and Paramedics work both indoors and outdoors, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as Hepatitis-B and AIDS, as well as violence from drug overdose victims or mentally unstable patients. The work is not only physically strenuous, but also stressful, involving life-or-death situations and suffering patients.”

 This is a significant problem. Many EMS personnel have had a job-related injury. Many have suffered career-ending injuries or had to take positions “off the street” due to disability.

Career Ending Injuries

EMS providers should consider the long-term effects of multiple injuries over a career that could affect the quality of life. Knee, back and shoulder strains can have long-term affects.

Let us look at a study published in the American Journal of Emergency Medicine. In July 1990, researchers in Pittsburgh examined 254 injuries over a three and a half year period. The most common injury was low back strain accounting for 36 percent of the injuries.

EMTs were injured significantly more frequently than paramedics. The injuries were recurrent in 33 percent of the injured personnel. Lifting was the cause of over 62 percent of the back injuries, with most occurring at the scene. The study also showed higher injury rates among women and personnel less than 30 years old.

Then, there’s ambulance crashes to consider.

Ambulance Crashes

In February 2003, a government Center For Disease Control report examined ambulance crash related injuries.

Between 1991 and 2000, 300 fatal ambulance crashes occurred resulting in the deaths of 82 ambulance occupants and 275 occupants of other vehicles and pedestrians.

While not able to precisely determine how many deaths were ambulance personnel, the CDC determined that 27 fatalities were likely EMS personnel, accounting for 3 percent of the total deaths and 33 percent of ambulance occupant deaths. The majority of the deaths were in the front seats of the ambulance.

Higher Fatality Rate

The overall fatality rate among EMS providers in the United States is 12.7 per 100,000 workers, which is more than twice the national average for workers in other professions. Unrestrained personnel was a major contributor to death and injury. Riding in the patient compartment was related to greater injury severity, however, 26 percent of the fatalities were drivers and 7.4 percent were passengers in the front seat.

These are unacceptable numbers and there are ways to be safer and healthier. Better training is a priority.

Many agencies have some lifting and back care training. This is an important part of any injury prevention approach. Teaching EMS providers how to properly lift and carry patients can certainly prevent injury.

Continuing Education

However, this must be more comprehensive than a provider’s orientation program. It should be part of all continuing education programs and backed up by surveillance programs monitoring provider behaviors. Those who do not follow safe practices should be retrained.

This training should be coupled with policies directing providers to call for assistance when additional personnel should be used for difficult or heavy lifting. If providers are discouraged from asking for help, they are apt to take risks resulting in injuries.

Training and policies enforcing safe practices should include the mandatory use of restraints (seat belts and shoulder harnesses) in both the front seat and the patient compartment.

Safe driving programs must be standard with remediation when drivers are involved in collisions.

Selecting and maintaining equipment can also prevent injury. Poorly maintained equipment or equipment that is used beyond its design capabilities, put EMS providers in harm’s way.

Physical Condition

There is always the factor of the EMS provider’s physical condition. This is a physical job. Couple that with the sense of urgency, and working at physical limits. In preparation, EMS personnel should be in the best possible condition to respond with quickness and strength.

EMS personnel are involved in work that calls for peak physical response capability at all times. They must rely on their training, partners, and equipment to protect them in the execution of their duty.

Committing to safety gives the best chance at coming home safe.

Editor’s Note: Will Chapleau, who has 30 years of EMS experience, is chief of the Chicago Heights (Ill.) Fire Department. He has served as the chairperson for the Prehospital Trauma Life Support (PHTLS) program since 1996 and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.

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