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Fit for Duty

Fit for Duty
February 7, 2018 Bryan Fass
In ems, emt, Fitness, Injury Prevention, Wellness

Paramedic and EMS wellness expert Bryan Fass can’t teach providers how to move patients properly if they don’t move correctly themselves.

“Why do we get hurt? We don’t move well,” Fass told his audience during “Rescuing Our Responders: Reducing Risk In Public Safety Employees” at ESO Wave in Austin Feb. 2. And most times, simple safety precautions are sufficient to sidestep a preponderance of adverse events on the job.

“We don’t have to become competitive powerlifters,” said Fass, who is president of Fass Consulting LLC, Charlotte, N.C., which specializes in public safety and healthcare fitness, injury prevention, wellness, human performance enhancement and fitness testing, and author of The Fit Responder series of fitness and wellness techniques for public safety professionals.

But some knowledge of common injury patterns and their origins can save agencies hundreds of thousands of dollars in lost work time, he added.

Two memorable takeaways from Fass’ presentation were: If you have to touch the patient during a transport, you’re doing something wrong; and if your hands touch the floor, “you’ve already lost.”

Paramedics and EMTs are frequently faced with deadlifting twice their bodyweight from the floor on scenes. Apart from some construction trades and materials handling jobs, EMS work is the only occupation tasked with placing such dangerous forces on the body on a daily basis, Fass said. Attention to biomechanics and avoiding damaging shear forces are critical.

Put simply, “We pick things up from the floor too much,” Fass summarized.

The National Institute for Occupational Safety and Health (NIOSH) has compiled safety algorithms for specific professions and determined that 51 pounds is the “load constant”—providers should not lift more than this amount by themselves. While Fass acknowledged that applying such specific guidelines to the variable and unpredictable profession of EMS is problematic, the numbers can provide some context surrounding spine load.

Pulling a 105-pound patient via bed sheet between two beds applies between 832 and 1708 pounds of compressive force on the spine, according to Fass. Add in friction and heavier patients, and the load quickly surpasses the commonly accepted “safe range.” The result? Overexertion injury.

“This is low-hanging safety fruit,” Fass said.

To make transfers safer, limit motion from the torso, advised Fass.  Change the lift height through the use of safe lifting equipment so you’re not lifting all the way from the floor.

Ankle and hip motion are critical. Soft tissue injuries of the knees and back arise from inflexibility in the ankle and hips, according to Fass. Deadlifts using correct form are tremendously valuable for improving hip mobility and ankle flexion, and they replicate the repetitive motions that EMS professionals perform on duty. Shoulder, core and glute exercises are also essential—train where you’re weak, not strong. “Get comfortable being uncomfortable,” Fass said.

While improvements in transport equipment have helped mitigate low-back injuries, the overall injury rate has not gone down, Fass told the audience. Why? Patients are becoming larger, posture in the computer age is getting worse, and attention to fitness and healthy work habits appears to be waning. Shoulders and necks are now the major areas of concern.

Further takeaways from Fass’ session:

  • Greater fat mass (heavier providers) impairs biomechanics and increases pressure on the spine during transfers;
  • Once you’ve been hurt once, you’re more likely to get hurt again;
  • Over 33% of all injuries sustained by fire and EMS personnel occur during training.

With all this information, how do you become a healthy first responder? Exercise, get blood work annually, eat well, insist on adequate quality sleep, train your weak points, and do whatever it takes to remain tactically and mentally sound, Fass said. Warm up before your shift, stretch and hydrate. Eat real food, not “food-like products.”

While these pointers may sound fundamental, they bear constant repetition, Fass said. Without strict attention to healthy habits, even the youngest and most invincible EMTs and paramedics will eventually succumb to symptoms.

“Time will always win,” he said.

Thanks EMS world for the great write up

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