 The work of firefighters and emergency medical service personnel is physically and emotionally demanding. Emergency service personnel are routinely called upon to respond at a moment's notice, lift heavy equipment and patients, and risk their lives for the good of our community. The care and well-being of people and property are often thought of as most important. However, if you are experiencing musculoskeletal pain or if you become injured, it will compromise your ability to respond safely and effectively. The most recent National Fire Department injury data shows sprains, strains, and muscular pain are a problem for fire and EMS personnel. They account for the highest percentage of injuries, even outranking injuries due to burns, stroke or heart attack, smoke inhalation, and wounds and bruises. For example, 50% of injuries due to traveling to and from incidents, 42% of injuries occurring on the fire ground, 57% of injuries during non-fire emergencies such as EMS responses, and 59% of injuries during training activities. One of the ways to reduce sprains, strains, and musculoskeletal pain is by applying ergonomics. This video is intended for fire and EMS personnel to review ergonomic principles. We will talk about what ergonomics is, what musculoskeletal injury risk factors are, what ergonomic solutions are, and finally, how these apply to you. Ergonomics is defined as modifying the task or environment to fit the anatomical, physiological, and psychological capabilities of the worker. It is about the relationship between the worker, the task, and the environment. In this example, the firefighter is removing a ladder from an engine and setting it. Some of the worker factors that could affect this relationship are his or her age, height, upper body strength, experience, fatigue level, and stress. The task he is doing is handling the ladder. Some of the task factors include the ladder's weight, length, the method he uses to lift and carry the ladder, for example carrying it on the shoulder or at the waist level, and the number of people available to assist. Finally, the environment in this example takes place at a fire scene. It may be noisy, cluttered, and the ladder may have to be carried extended distances. Beyond this example, there are other worker, task, and environmental factors that arise with the variety of work activities that you do. Can you think of any? Injury risk factors are postures or activities that can lead to acute and cumulative trauma injuries. There are several musculoskeletal injury risk factors that fire and EMS personnel commonly face at work. Awkward postures are any postures that are not in a neutral or anatomical position, such as reaching with your arms overhead or away from your body, and bending or twisting your torso at the waist or neck. Excessive force means exerting large forces such as when you push, pull, or lift. For example, lifting the fan or handling patients. Repetition is performing the same motion over and over. It can be highly repetitive over a short period of time, such as when pulling down a ceiling or low repetition over a long period of time, such as the common activity of putting the gurney into the medic unit. Impact forces are large forces transmitted to parts of the body by contact with the ground or a hard surface, such as the force on your feet, ankles, and knees when you jump out of your vehicles. Excessive temperature occurs during very hot or cold conditions, which can compromise your soft tissues, such as when you're fighting fire in your protective gear or during your training drills. Whole body and hand-armed vibration result from activities such as riding in vehicles or operating powered hand tools. These risk factors may not result in immediate injury. However, if you increase frequency, duration, or intensity, or you combine the risk factors, this increases the risk of an injury or an eventual disability. An example of combined risk factors is when you are moving a patient from their bed to the gurney, which is a common activity that involves awkward postures and forceful exertions. Once you are aware of what risk factors are present, it is important to come up with solutions to eliminate or reduce the risk factors. In general, you want to reduce the time, frequency, or intensity of the risk factor. There is a hierarchy for basic ergonomic solutions. Some solutions are very effective at reducing the injury risk, but may be very involved while others may be less effective yet easier to implement. Oftentimes, the most effective solutions are not in your personal control and take an involved departmental approach to reduce the risk. At the top of the hierarchy for being effective is equipment and engineering to eliminate the risk, followed by job organization, then personal protective equipment, and finally, body mechanics. While you may already be doing some of these things, the following examples are meant to illustrate different types of solutions in the hierarchy. The most effective ways to reduce risk are equipment selection and engineering controls. Using appropriate ergonomically designed equipment or redesigning current equipment can reduce your injury risk. One example of equipment selection is the type of medic pack carried on calls. One type is this hard case. These weigh 12 pounds empty and must be carried away from the body due to their shape. An alternative is a soft pack with shoulder straps. These weigh only 3 pounds empty and can be carried closer to the body. Also, consideration should be given to the supplies that are carried in your pack. Reducing the supplies down to only essential items can decrease the weight that has to be frequently carried. Another example of an equipment selection is a lateral transfer device. Slide sheets are made of a slick material that reduces the friction during lateral transfers. This decreases the stress to your low back. They are lightweight, can be stored quickly, and are comfortable for the patient. There are a variety of styles available for your equipment committee to consider. An example of an engineering control is this bariatric ambulance. It uses a special gurney that travels up a ramp pulled by a winch mounted inside the medic unit. This moves the patient safely and quickly into the medic unit without using any manual force from the emergency service workers. These types of interventions need to be approached through the safety committee and may involve the survey of the department's needs. Also, equipment purchasing committees should take ergonomics into consideration. Line personnel can really provide valuable input to safety and equipment committees since they know what might work best. Changes in your job organization or work practice can also reduce injury risk. An example of a job organizational change is having four people lifting the patient instead of two or three people. Even with four people lifting, using proper body mechanics is still important. Are all these people using good body mechanics? Another example of an organizational change is two people carrying the fan instead of one. Both of these examples decrease the weight being carried by each person. A work practice change could consist of using a handle and stepping down when exiting vehicles instead of jumping. This reduces the impact forced to the lower body and decreases the risk of spraining an ankle. Even in the office, the way the workstation is set up can impact stresses on your body, especially the low back and risk. Organizational changes can be complicated and difficult to implement, but working with your station, you may be able to develop ideas on how to improve your work practices. Approaching the safety committee, training coordinators, and command staff with ergonomic ideas are effective avenues for making organizational changes. Personal protective equipment is lower on the ergonomic hierarchy. Ergonomic personal protective equipment promotes neutral posture or reduces forces to the body. Examples include lumbar rolls to keep your spine in neutral posture while sitting in the vehicle, doing paperwork, or reclining. During drills without live fire, knee pads could be worn to decrease the force to the knees, a joint prone to osteoarthritis. These are items that could be requested from the equipment committee. Finally, body mechanics is an option. This is the least effective protection from risk of musculoskeletal injury, but the one that you have most personal control over. Maintaining neutral spine while lifting, such as when you are lifting your air pack, rather than bending at the waist, is an example. Similarly, when raising a patient on a gurney, you should lift with your legs, keep the gurney close to your body, and your back in a neutral posture. The most important body mechanics concept for the low back is maintaining neutral spine. Remember to keep the three curves of the back, the cervical, thoracic, and lumbar curves. One way to practice neutral spine is to hold a straight edge against your spine. You should be able to slide your hand between your low back and the straight edge, even as you move. Proper body mechanics should be practiced in all your movements at work and not just when you are lifting heavy patients. This ranges from firefighting and patient handling to housekeeping at the station and physical fitness. Now that we have talked about the risk factors and potential ergonomic solutions, let's take a look at a few scenarios to practice ergonomic skills. For each scenario, think about why it is done this way, then identify the risk factors, come up with possible solutions, and discuss barriers to successfully implementing these solutions. These scenarios won't apply to all departments or all situations, but they present an approach for identifying problems and exploring ergonomic solutions. This first scenario depicts two people carrying a patient down a stairway using a small cot with handles. Why is it done this way? The risk factors are excessive force caused by weight of the patient, awkward postures associated with keeping the patient level, and twisting to see the stairs. A potential solution for a wide stairwell is using a backboard with four people or the same cot with four people. An even better solution for most stairwells, wide or narrow, is a well designed stair chair that places little stress on your body. This model is excellent since the patient does not have to be lifted and carried down the stairs since it rolls down the steps. It can also make the patient feel more comfortable and more secure. Examples of barriers to these solutions might be the lack of storage on the ambulance, or restricted funds for purchasing the equipment, or resistance to changing equipment and work practices. Are there other solutions or barriers? The second scenario demonstrates a firefighter rolling a hose during a training drill. Why is it done this way? The risk factors associated with this are awkward and prolonged postures to the back from flexing at the waist. Depending on the size of the hose, different techniques may be used that reduce the stress on the low back. For two and a half inch hose, the firefighter could roll the hose from a kneeling position, maintaining a neutral spine. For larger, four inch hose, a combination of bending and kneeling could be used to reduce the time spent in each posture. The barriers could include the perception that it is quicker to roll the hose while walking in a stooped posture. Another barrier might be a knee problem that causes pain when kneeling. What might other solutions or barriers be? In the third scenario in the station, this firefighter is performing a routine check of the medical pack. Why is he doing it like this? The risk factors are prolonged and awkward postures to the neck, back and knees. A solution might be to place the medical pack on a table or cart about waist height to elevate the work and allow the worker to stand upright while checking the pack. Some potential barriers include space for a table in the bay or the time it takes to get the table if it is stored or walk to the table if it isn't near the vehicle. What might be other solutions or barriers? The final scenario shows a common exercise performed by fire and EMS personnel to strengthen oblique abdominal muscles. Why strengthen these muscles with this particular exercise? The risk factors to the back include repetitive twisting and flexing of the low back which are awkward postures and forceful exertion to the lumbar discs. Solutions include exercises such as the bridge which keeps the spine in neutral posture while maximizing trunk stabilization, strength and endurance. A barrier to using this exercise might include resistance to changing an existing workout routine. Can you think of another way to safely strengthen the obliques? And what are other barriers to adopting new behaviors? For ergonomics to be effective in preventing musculoskeletal injuries it must be part of a comprehensive safety and health program. An ergonomics team can be part of the existing safety committee which is the appropriate vehicle for creating change. Your role is to identify and prioritize risky job tasks, assess the hazards, develop plausible ergonomic solutions and bring them to the attention of the appropriate committees. As a review ergonomics is the relationship between the worker, the task and the environment. It is fitting the job to the worker. Musculoskeletal risk factors include awkward postures, excessive force, repetition, impact force, excessive temperature and vibration. And remember, time, intensity, frequency and combining risk factors increases the risk. The solutions in order of effectiveness are equipment or engineering changes, job organization and work practice changes, personal protective equipment and body mechanics. Attention to ergonomics can help prevent injury, disability and help you provide the best care possible to your community. The long-term benefits of ergonomics can prolong your career and enhance the quality of your retirement.