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3 steps to an injury-free EMS career

Reduce injury by improving movement, training properly, and increasing fitness level


I came across a study some years ago that astounded me. The conclusion was that when anonymously surveyed, nearly 60% of EMTs reported sustaining a soft tissue injury and not reporting it.

Personally I was so astounded by this that when I teach classes I ask the participants if they have had any pain, injury or spasm on the job in the past 6 months. A simple raising of the hands tells the tale; the average response is 70% of the room. With an average class size of 30, that’s around 21 people. I teach roughly 100 classes per year, and I have been asking this question to the classes for over 3 years. That’s well over 6,000 unreported injuries, just among my students.

Numerous studies show that soft tissue injury is the leading reason for medical retirements in EMS and account for over 50 percent of all line of duty injuries.

ACTAS Paramedics transport a mock-victim during a mass casualty exercise in Canberra. (Chris Wagner)
ACTAS Paramedics transport a mock-victim during a mass casualty exercise in Canberra. (Chris Wagner)

Folks, we need to step back and reevaluate what we are doing.

A novel approach to EMS provider injury prevention

As a profession, both administration and field providers, we have to pull our head out of the sand and admit there is a problem. Then we all need to understand that 60 percent injury rate is not only unacceptable, we can and have to reduce the rate and severity of injury in the pre-hospital environment.

To reduce injury, improve employee wellness, and simply not work hurt, all departments must take three steps with all employees.

Step 1: Learn to squat, lunge and kneel

EMS is a physical job. No matter how much technology we throw at the problem, the bottom line is that patients still have to be picked up off the bathroom floor, lifted from chairs, and extricated from vehicles. There is no machine that can do that for us, except the human machine. To allow the human machine to function as designed, all responders must have proper mostability.

Mostability is job-specific range of motion in the joints and muscles, plus core stability and the strength sufficient for the job. If responders lack just one of these three components, injury will occur.

As an EMT, you must be able to squat properly (feet shoulder width, heels down, back flat, head up) and be able to lift weight from the bottom of the squat position (think spine board). The same goes for lunging or kneeling – a position from which we spend a lot of time treating our patients prior to loading and transport. Any alteration in the proper motion of these integral patterns will cause injury.

Step 2: Train with the right equipment

How often do you train all aspects of patient and equipment handling? If the answer is not monthly, then your crews are using dangerous techniques. Some of the lifts and transfers that constantly need to be reviewed include:

  • Always having both responders on the foot of the powered cot during loading and unloading, with or without a patient.
  • Using a friction-reducing lateral transfer aid on all bed to bed movements and having both responders on the same side of the patient as they accomplish the transfer.
  • Plus, how many hands should be on a LSB during a lift? 8!

Also, should we be lifting below the knees at all? NO! Use your flexible stretcher or MegaMover to change the starting lift height and protect your back.

Step 3: Be fit to perform the job

Departments can no longer hire their next injury. All incoming responders should have to go through a content-valid, job-specific pre-hire physical abilities test that uses EMS equipment (not milk crates), has no examiner or gender bias, and is a true approximation of the job task.

Then we all need to have the basic strength and conditioning to perform the job tasks safely. An inflexible responder can injure a fit responder because the inflexible responder’s ergonomics are poor. Have you ever been on a two-person LSB lift where the person on the opposite side pulls you forward and you “chase the board,” placing a dangerous load on your back?

After you have proven that you have the basic job-specific physical ability, departments have to turn the final corner and begin to test all field personnel yearly. While we do not advocate outright firing responders for poor fitness, we cannot also turn a blind eye to the problems that currently confront us. Employees need to be able to work out on duty as long as they follow a structured, individualized and job-specific progressive routine. Fitness needs to become the norm, not the exception in EMS.

Invest in yourselves

EMTs, you have chosen a physical and demanding job. Only you can make the decision to not hurt anymore, to feel better, to move better and to live better. Stretch all day every day, learn to use self-massage tools to better condition your soft tissue, and just start moving. Finally, realize that how you were taught to lift and move is probably the culmination of generations of faulty mechanics that EMS has passed down. Retrain yourself in more ergonomic techniques.

Chiefs, when asked what your department’s most valuable asset is, you probably answer your employees. Put some action behind that sentiment. Invest in your assets through wellness programs, allow the crews to exercise on duty when possible, and give them the tools – both physical and through training – to be injury-free. 

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