Train until you cannot get it wrong
You should be training ergonomics just like you train for patient care procedures, fitness or even tactical situations
By Bryan Fass
Don't train till you get it right; train till you cannot get it wrong. This adage holds true for fitness, tactics, medicine and even patient handling. That's right — you should be training ergonomics just like you train for patient care procedures, fitness or even tactical situations.
But you probably do not do that, do you?
As I travel around the country working with departments in all sorts of configurations, one theme has become very, very apparent: Employees are not trained on patient and equipment handling.
Sure, maybe the new hires get a lesson on how to use the equipment, but I have never seen a department "train" employees on the right and wrong ways to apply ergonomics to the street.
What I have seen is video education on how to use your body (learning proper biomechanics while sitting down!). We cannot learn to "feel" right and wrong unless we go hands-on with the tools of our trade and are taught the proper way to lift, move, push, pull, transfer and carry.
And this is where the problem lies: departments cutting corners or outright ignoring hands-on ergonomic training while suffering catastrophic injury rates and soaring workers' compensation costs... and being OK with it.
When it comes to proper ergonomic behavior in EMS, we have to look at the problem from two perspectives:
1. Treating the body as the ultimate tool
2. Looking at current and emerging engineered solutions to reduce injury
The body: the ultimate tool
The body is the ultimate tool, BUT we must remove the physical and biomechanical barriers that lead to injury. EMTs and Firefighters are athletes, power lifters to be specific. We "pick things up and put them down," to quote a favorite commercial of mine.
You do not train, eat, stretch or prepare like an EMS power lifter, though, and herein lies the problem.
As a profession we need to stop mocking or even ignoring the importance of being fit for duty. In all my training classes, we spend six minutes on a therapeutic foam roller and two minutes on "active stretching," where we take the joint/muscle through a specific range of motion to reduce injury.
If you have been through one of my courses you know the mantra: ankles/calves, hip flexor/hamstring, glutes and thoracic spine. Without tissue mobility and joint mobility in these specific body segments, you will eventually suffer an injury while on duty. Follow the eight-minute progression, and your chance of remaining injury-free nearly doubles. It has worked for years for professional athletes, and it works for EMS athletes as well, as long as we start acting like EMS athletes.
What about scene safety? You would not let your partner get hurt on a hidden object, yet you will let him or her lift a patient in such a way that will cause injury, and you never say a word.
From a training standpoint, you must train ergonomics just like you train tactical awareness and medical competence. All responders must be trained to the same ergonomic standard just like we train clinically to the same educational standard.
This can easily be accomplished with yearly PAT (physical abilities testing) and with access to a gym with functional training equipment. I am not talking about an expensive gym or some hyper-advanced tactical training regimen; I am talking about some simple exercises that simulate the biomechanical patterns of the job.
All these exercises can be done on-duty and in uniform, using body weight and some inexpensive resistance bands. Fitness to go, injury reduction and increased wellness can all be accomplished in about 30 minutes a day.
Look back in this column's archives for videos of the fitness techniques, articles on foam rolling and more.
Ferno just launched fernoinjuryfree.com to help EMTs and departments integrate many of these "training" and "fitness" principles, and there's a free app for it, too! So the tools we need to get started are there; we just have to start using them.
This is the second piece of the puzzle. We are often in situations where we must rely on a tool to assist us: powered stretchers, powered stair chairs, stretcher lifts, lifting tarps, slide boards and now even a new spine board with handles that extend to keep us from "dead lifting" patients deeper than actual power lifters do! (ezliftrescue.com)
Even though the tools have vastly improved to assist us in moving the patient, one variable has never changed: YOU! The poor ergonomics and biomechanical cutting corners often make the technology less effective.
Let me leave you with this parting thought: Have you ever seen a defensive lineman walk up to the line of scrimmage and, just as the ball is getting ready to be snapped, put his feet close together, lock his knees, round his back and lean forward? The answer is NEVER, because nothing good would happen. Sadly, that's exactly how many of you get ready to transfer a patient.
Have you ever seen an Olympic power lifter walk up to the bar with 500pounds on it and just hurl it up from the ground? Never, but you do the same thing almost every time you lift a 250-pound patient on a spine board.
If we had all been properly trained, we would all go through a series of specific steps to ready our bodies to produce force in a controlled fashion, allowing us to move our patients from point A to point B safely and to become the EMS athletes we all can be.
Why is 1-2-3 lift causing many of our injuries? Let's hear your thoughts.