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But This is the Way We Have Always Done it

But This is the Way We Have Always Done it
July 16, 2019 Bryan Fass

Author: Bryan Fass

 

EMS has been a profession of near-constant change. It seems that every year there are new and better gear, trucks, monitors, airway and venous access devices and a dizzying array of IT companies offering to make our lives easier. Yet, when we step back and take a hard look at it we still have one of the highest injury rate professions in the country. We have staggering turnover and staffing shortages. Those that do stick around and make it a profession are plagued with pain, injury and resiliency issues.

Why?

Physiology

Humans are creatures of movement. Our bodies get better, burn more calories, are more alert and generally feel better when we move. Yet EMS still has a pervasive cultural bias toward ‘sloth mode.’ We have handed down the habit of being a couch potato for generations. God forbid you burn an extra calorie…you might need for the big call that comes along every 6 months.

Look at how many EMT’s walk. I call it the ‘EMT shuffle’, where back in calorie reserving mode you can’t even pick up your boots when you walk. Dragging your heels where ever you go. Well, at least walking in the sun has positive mental health benefits, even if you are dragging your heels.

All this cultural bias to the way we have always done it leads EMT’s to be less active, less fit and less healthy. That’s why I am such a huge advocate for pre-hire and annual physical abilities testing. Hold the workforce accountable to a fit for duty standard. This also forces both employer and employee to make use of gym memberships, annual physicals with blood work and other free stuff your health plan usually offers.

Plus, fit employees get hurt less, are more resilient to fatigue, cost less from a health insurance standpoint and are generally more motivated. This is why for every dollar invested in a wellness program it will return over three dollars back to the company (4) . This means less OT, less turnover and fewer accidents.

 

 

Patient Handling

60% injury rate (1). 1 in 4 leaves the job in the first 3 years due to injury (2). Over 75% of EMT’s have been hurt in the past 90 days and not reported it (3). All this and we currently have the best patient handling technology and equipment possible. So where is the breakdown?

When I teach our Injury Free instructor classes I strongly advocate for a ‘system’ of movement that does the following.

  1. Change your lift height to reduce the compressive forces on your joints.
  2. Reduce trunk angle to reduce the shearing forces on your joints.
  3. Eliminate friction so that transfers are safe and effortless.

The magic here is what device can do all of that and still allow you to transport on it? What device can I do drags and even lift assists and still accomplishes 1-3?

Just the other week I was talking with a training officer that had been through one of my courses about safe patient handling; he told about a call one of his crews was on. The crew wisely decided that the safest way to move their patient from a small back bedroom to the main room was to put them on the Taylor Titan™ and slide them down the hall to a larger room giving them more space to work. As they began to slide the Captain on scene said “stop! This looks bad, we carry all our patients.” Why? because carrying patients is the way we have always done it. Last I saw there is no section on your EMT book that says, “all patients must be carried.” If they can not sit in a stair chair, walk to the cot or the space is awkward/confined use the device that changes lift height and reduces friction to slide the patient out where you can get some more space and more hands-on the lift.  As I teach in all our safe patient handling instructor classes “use the tool to slide, lift, transfer…YOU are not the tool and never touch the patient when moving them; the device should do all the work.”

 

Education-

The biggest issue I see is the way we have always done it disconnect between education and employer. The schools teach old and antiquated techniques for patient handling and teach it often using outdated equipment. The Employer assumes the student knows how to lift, move, pull, carry and transfer safely because the school taught it. The School assumes the employer will teach them how to do it and we find ourselves stuck in a revolving door of risk.

Now, I am not saying this is all schools or employers but in my years of experience, this is definitely the norm. Yes, the schools need to focus on educating great EMT’s but what good is all that clinical education of they leave the profession due to injury.  The same goes for employers, what good is all the procedural and operational knowledge if they leave because of injury. We are wasting generations and some of the future leaders are leaving before they have had a chance to grow. When I built our ‘injury free’ online course it was designed to help fix this divide in EMS education.

Instead let’s build it all into the day. As an example, with new hires, start the day off with EMS specific stretching. Sneak in a lift, transfer, stretcher op etc. during any and all skills. After lunch get them on the foam rollers. After the break spend 5 minutes on a difficult patient scenario and how to move them. All of this can and should be done daily and it will take less than 15 minutes day.

When your crews come in for CE’s or mandatory training follow the same pattern as I just discussed. After a while your crews will start to invest in their wellness own their own, they will get hurt less and they will smoke your annual PAT.

Break the mold of ‘this is how we have always done it’ by stepping out of the box and looking at the issue from another angle. If they won’t or can’t change it’s up to us to address the problem from a new perspective. We need to educate them better and with scientifically accurate techniques. We need to teach them how to eat and sleep specific to shift work. We need them to know why they need to invest in their health and you need to lead them down that path.

 

  1. Am J Ind Med.2010 Jan;53(1):12-22. doi: 10.1002/ajim.20783.Back problems among emergency medical services professionals: the LEADS health and wellness follow-up study.

Studnek JR1Crawford JMWilkins JR 3rdPennell ML.

  1. https://www.cdc.gov/niosh/topics/ems/data.html
  2. Prehosp Emerg Care. 2010 Apr 6; 14(2): 209–221.The longitudinal study of turnover and the cost of turnover in EMS

4. https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/real-roi-wellness.aspx

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