You are dispatched to an unknown medical call at 2:18 a.m. En-route, dispatch advises that no first responders have responded to the call. The address is not known to your service and the caller was panicked and difficult to understand.
You arrive on scene, retrieve your med bag and monitor and carefully make your way to the house. After ringing the doorbell two times a distraught woman answers the door and points you down a hall to the bathroom. As you turn the corner you see an obese male patient on the floor. His lips are cyanotic and he is obviously not breathing.
No time to warm up
In EMS we do not have the luxury of stopping and taking a few minutes to ‘warm up’ prior to strenuous activities. This lack of preparation is one of the many causes of the high injury rates we see in EMS. Injuries from lifting, moving, repetitive motions and awkward positions are high on the list of injury mechanisms.
The woman on scene states that she attempted CPR for a few minutes after she heard him fall. As you radio to dispatch for assistance your partner begins getting the monitor ready. The bathroom is small and cramped, and the best way to provide care is to move the patient to the hall. This will require dragging him out. It’s at this point that you realize your flexible stretcher, which makes dragging and sliding much easier and safer, is in the truck. Your only option is to grab a leg and pull; not the safest ergonomics.
CPR at proper rate and depth for long periods of time can be challenging for even the most fit responders. Add in cramped spaces and patient size and good CPR is downright difficult. It seems like you have been performing compressions for an eternity but in reality it’s only been a few minutes. Your knees are aching, your wrist hurts and your neck is yelling at you. As your partner applies the pads you finally hear a first responder responding; ETA 10 minutes - it’s 2:42 a.m. after all.
Take responsibility for your physical health
EMS is a physical job; everything you do requires physical ability significantly greater than most labor professions. On top of that, we are frequently working on the floor and in awkward environments that increase our risk of injury, and patients don’t come with handles.
Sadly very few EMT’s take the time to invest in themselves and train to survive the job. In fact the majority of EMT’s are sedentary, dehydrated, chronically fatigued and full of muscle imbalances (weakness) that will increase the risk of injury every day and on every call.
CPR for long periods or even the pit crew style of rotating the compression person every few minutes requires good flexibility, mobility, strength and endurance. Your patient’s life depends on it and frankly so does yours. If we break down the biomechanics of CPR position it looks like this.
a. Ankle plantar flexion
b. Knee flexion past 140 degrees (full kneeling)
c. Trunk flexion with hip extension (for long periods)
d. The ability to maintain neutral spine
e. wrist flexion (weight bearing)
f. elbow extension (weight bearing)
Maintaining a compression rate of 100 per minute with proper depth requires compete contraction of the hips, trunk flexors and extensors (think core). It also requires the physical ability to transfer force from the core through the arms and into the patient while not breaking the rhythm of rate and depth. Any break in the biomechanical chain above will increase your injury risk and decrease the effectiveness of CPR. Plus any old injuries and or degenerative changes in the joints will make all the positions above very difficult. Once we change how we move to compensate for something our biomechanical risk drastically increases.
The biomechanical breakdown of something simple like CPR begs the case for proper mobility and strength for EMS. Some services have the luxury of multiple responding departments on every call; many hands make light work. Even then you still must ‘own’ the basic ability to do your job safely while providing good care.
2 things EMS employers must do
EMT’s must take responsibility for their own physical well-being and employers have to step up and do two very important things.
First provide your EMT’s with the facilities to be fit, and leave it up to the employee to do ‘self-care.’ Second, test all employees every year with an independently validated and designed EMS-specific physical abilities test. Not a fitness test but a physical abilities test, and if a responder is struggling, then have the staff and facilities available to help them get back in shape. Responders that invest in their own self care and employers that invest in their employees will have a much happier, healthier and more fit staff.
Between you and your partner, you shocked the patient three times and performed CPR for over 12 minutes before another trained rescuer arrived. Because of the patient’s size it was exceptionally difficult to achieve proper depth and both of you could only do compressions for about 90 seconds at a time. By the time the first responder arrived you were exhausted, and resuscitation efforts were unsuccessful.
