Why EMS personnel need a valid physical abilities test

A valid physical ability test specific to EMS is an important step to reduce on-the-job injuries and positively change organization cultures


A valid physical abilities test specific to EMS is an elusive unicorn EMS leaders have been attempting to capture for as long as I can remember. Pre-hire physical abilities testing and a yearly incumbent PAT is something that EMS has long needed. With the cost of worker’s compensation continuing to rise, we can no longer afford to hire the unfit and physically unable.

As a visionary risk manager once said to me, "We have to stop hiring our injuries. EMS will never get the respect it deserves as long as we hire unfit employees." Moving from sage advice from a risk specialist to designing and validating a PAT is a whole different set of hurdles.

As I look across the country at EMS departments, I consistently see injury rates continuing to increase, even as new technologies designed to make patient handling easier and more ergonomically correct. The continuing rise in on-the-job injuries is leading many EMS leaders to ask how an EMS department can design, validate and administer a PAT that is:

Equipment ready for PAT station. (Photo courtesy of Bryan Fass)
Equipment ready for PAT station. (Photo courtesy of Bryan Fass)
  • Affordable to run in house
  • Truly job specific
  • Tests human power generation
  • Assess anaerobic capacity
  • Legally defensible

This is an issue many departments struggle with and there is not a consensus on how to solve. Some departments run a pre-hire PAT that they self-validate, which means there is often candidate and examiner bias in the test. In addition, the results are not compared to a national data set. Other departments borrow tests from other public safety disciplines. Many departments outsource pre-hire physical assessment to an occupational medicine clinic where the candidates are not tested using EMS gear.

Goal of physical abilities testing
Since overexertion injuries account for a large number of all work-related injuries in EMS, it is the goal of EMS departments to reduce the potential for overexertion by hiring physically capable employees. A valid PAT test is intended to reduce injuries for which high levels of strength, mobility and power are required.

For a PAT to be valid, it must be a job task simulation using standardized gear and weights. There must be no bias to candidate's age, gender, height or from the examiner. The PAT must be reviewed for biomechanical accuracy and statistically analyzed for expected completion times.

Don't hire your next injured employee
You can learn a lot from watching someone move. You can learn a lot more about them when you load them up with weight.

I recently completed five days of physical abilities testing for a large, urban fire department's EMS division, testing over 100 candidates. Watching over 100 candidates climb stairs with gear, lift, move, pull, squat to do CPR and lift cot’s is eye-opening. The lack of job specific mobility — squatting, kneeling, stepping — was staggering and it’s often these poor movement patterns that lead to injury.

EMS is a 100 percent physical job that requires a blend of job specific mobility, strength, power and anaerobic conditioning. Without the proper blend of physical ability, first responders are at a very high risk of injury. So it begs me to ask the following questions of EMS leaders and hiring managers:

  • Are you hiring your department's next injured employee?
  • Are you OK with risk and liability exposures because employee fitness is poor?
  • How do you know if your current employees are still physically able to perform the job safely?
  • How do field personnel know what the job has done to their body?

PAT effect on staffing
EMS departments that are using a validated job task simulation that has no bias to age, gender or from the examiner hire higher-caliber employees year after year. The physical ability and attitude of their potential employees has changed for the better, because the people who know they are out of shape or injured go somewhere else for a job. They usually go to a service that does not have a PAT, usually just using a static lift test or, even worse, out-sources testing to an occupational health clinic. Lifting milk crates doesn’t simulate anything expected of EMS personnel.

For field providers, physical abilities testing is not about taking anyone’s job away. In fact, it’s all about keeping field personnel happy, healthy and uninjured. An annual physical abilities test informs field providers where they are in the physical spectrum. But before testing field providers annually, two things need to be in place.

1. Employees must have access to a fitness facility.

2. Employees should be given a scientifically accurate protocol to follow that is no less than eight weeks long to allow them to build the mobility and strength to pass the test.

Remember, our goal is a fit and injury free workforce. If field providers perceive that their employer is out to get them, then we have missed the point completely.

Risk in EMS is multifaceted
Field personnel are constantly facing risks from driving to assaults to infectious diseases to liability from ePCR documentation. I know fitness reduces risk. A fit employee:

  • Gets hurt less
  • Is more productive
  • Has lower liability exposure, especially as it pertains to patient handling.

I also know a fit company has less turnover and better morale.

All of these are goals of forward leading EMS organizations and the first step for an employer is a physical abilities test. The first step for a field provider is to accept that the job is physical. After that, acceptance, a positive organization culture and individual change is possible. I have seen it happen. 

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