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Presenter’s Notes


During this class there are two main Q’s we are going to answer.

  1. Is pain normal?  NO, pain is a symptom and it’s a symptom that must not be ignored-it must be treated.
  2. The second half of the class is all patient and equipment handling.
  3. The focus of this class is simple.  We cannot teach you to lift-push-pull-carry or move if you do not have the basic mobility and physical ability to get into a safe lift position.


When we started this program we stepped back and took a look at the biomechanics of the job. We realized that as emt’s you are medical power lifters and movers.

Did you know EMS is the only profession where its acceptable to lift incredible heavy loads from the floor.  Every shift you load your body with torque and compressive loads that will cause injury.

The only way we can combat that it to move well and move patients well and that starts with you moving well first!


We also realized that until now you have never had a tool box to pull from to keep your body primed, pain-free and moving well……because movement matters.

With a profession like EMS/Fire that has some of the highest injury rates of any job we must “invest” in ourselves through self-care.

This class will teach you a tool box approach to moving well and feeling well.

  • 2 tools for stretching
  • 2 tools for mobility and pain management



Talk about how as a profession we do a poor job of sharing the data on injuries in the field.



  1. The study that bothers us the most is #1……
  2. Ask the Question:………..Who thinks that # is LOW??????
  3. It is…we are seeing a 70% injury rate in EMS.
  4. The only profession with a 100% acceptable injury rate is the NFL and they get paid a LOT more then us.



The only profession we can be compared to on a biomechanical level are labor and municipal employees. We get hurt 83% MORE then people who labor for a living!

This study broke down the biomechanics of the jobs.  Kneeling, bending, leaning, reaching, lifting etc.

People who labor for a living get hurt 83% less then we do!


  1. The primary cause of disability is injury to the back-knees-hips-shoulders……..preventable injury
  2. Look at the IAFF fire-ems data and HALF of all injuries are soft tissue….and these are preventable.
  3. Because we do not “invest” in proper training BEFORE new responders hit the street over ¼ of all EMT’s entering the profession will get hurt in the first 4 years…..we must do a better job investing in ourselves and our training.


Use a story about cumulative traumas here…..someone that got hurt doing a seemingly normal task.

SLIDE #10:

Use a story about someone who was pain-free after using the tool box.

SLIDE #11: no notes

SLIDE #12:

Green = Areas of the body that MUST be mobile.

Blue = Areas of the body that must be stable with little movement

The problem is that we have the exact opposite relationship in the body.

SLIDE #13:

The data Is clear…..we can break the body down into 4 predictable parts.  If they are predictable then they are preventable.

  1. Calf and ankle:  not if but when you lose mobility you will have knee, Hip and LBP…the pain goes UP the kinetic chain.
  2. Glutes: tight glutes, especially imbalanced glutes will cause low back pain…..Demonstrate the hip stretch on the table.
    1. A 20% tightness = a 60% greater chance of injury on the tight side.
  3. Hip flexor: causes knee and LBP
  4. Mid-back aka. Thoracic spine causes most of our upper body injury.

SLIDE #14:

We have spent our entire life in this position…most posture is repetitive and that will cause injury.

“School example and how a career in public safety sets up this bad posture.

Cause is anterior (chest and neck) and the symptoms are posterior…your tool box will loosen up the front and calm down the back.

SLIDE #15:

Computers, phones, charting, driving….how you are sitting RIGHT NOW is causing your next injury.

SLIDE #16:

This is usually our guts and butts posture or the grand pa butt…where it looks like they stole your butt….either way it’s an imbalance in the pelvis.

  1. Hip flexor gets tight = inhibits the abs = no support for the back (strong abs/strong back)
  2. As the hip flexors pull the pelvis forward the hamstrings wake up to pull the pelvis back.
  3. The glutes…where all your power comes from weaken
  4. End result = you lift with your back and not your legs

*****Use the example of a bed to bed transfer….the ab’s do not fire to co-support the back = you use your back as a prime mover instead of your hips.

SLIDE #17:

The top picture is line backer stance = hip hinge-broomstick/neutral spine-head up.

There is load(weight) applied to the shoulders. In LB stance the load is managed and the tissue does not reach it’s failure point.

Bottom picture the knees are locked, back is rounded, head is down.  The load is NOT managed by the tissue and the “gap”/,margin of safety  is almost gone.  This is how injury occurs.

**Ask the class what can increase their risk of injury that they can control…………(hydration, healthy foods, fitness, fatigue)

SLIDE #18:

The tool box…backwards.

Show the slides and START with the glute stretch

Give disclaimer about not getting hurt, only do what you can or feel comfortable with.

***Tell them what each stretch will do for them!!!!!!!

SLIDE #19:

Sternum points out (not into your body) and the head is always up.  Do not look at the floor.

These stretches help to keep you loose & remind your body to have better biomechanics.

SLIDE #20:

**big teach point…..a 20% tightness in one hip (when the opposite side lays flat on the table) = a 60% greater chance of injury!

This is a LBP and knee pain stretch

IF someone cannot get the knee flat STOP the stretch

SLIDE #21:

This stretch can reduce back pain.

  1. Step away…further than you think you have to
  2. Squat slightly and sit back…try to get your heel and glute to touch
  3. Feel the stretch in the front of the leg (quad/hip flexor)


SLIDE #22:

The stretch height does not need to be very high….the step is ideal.

Both knees locked, feet straight and head up

Broom stick on the back and HINGE at the hip.


SLIDE #23:

The all important calf stretch…..keep this muscle group loose and mobile.

The one heel hangs off the truck is the most effective stretch

This is what allows you to squat-walk-climb safely.

If you can’t squat well you will have back pain


SLIDE #24:

Turn the feet, chest up, look up and away.

“thumb up, palm flat”

This is a head ache, neck pain, back pain stretch


SLIDE #25:

Knees bent and slightly forward of the hips

Get long, low and lazy


SLIDE #26:



SLIDE #27:

Everything we have done so far has led up to this point…the 4 functional / active stretches to get you ready for working injury free.

Demonstrate arm circles as a BAD active stretch.

ASK….?why are we the only high-risk profession that does not embrace beginning of the shift warm-up’s???


SLIDE #28:

Go slow, let the body open itself up.  Do not force it.  These feel weird, look weird and will make you feel better and move better.


SLIDE #29:

The key to all of these is focusing on your movements….don’t just go through the motions….make them work for you.

No bouncing, go slow but consistent.


SLIDE #30: no notes

SLIDE #31:

Video =Full video…you can skip the next slides into the break before ergonomics or go through the videos individually.


SLIDE #32: Calf and ankle glide

SLIDE # 33: no notes

SLIDE #34:

Emphasize blocking the elevated leg so that it does not move


SLIDE #35:

Emphasize the reach UNDER & AWAY from the hip… someone is pulling your arm.


SLIDE #36: Intro to the Tennis ball

ASK…….How do you feel?

The next tool if for at home….remember pain is a sx…do not ignore it…treat it.  Watch TV while you go after the trigger points.


SLIDE #37:

Play the video on what a TP is and how to treat it

SLIDE #38:

We believe that many programs fall short of their goals b/c they fail to address the underlying cause of pain and movement dysfunction… the trigger point.

**If you felt pain or tightness with the active stretches the best tool to deal with that symptom is the tennis ball.

**You can not stretch a trigger point, it has to be broken up.

This is a great TV technique…..stop ignoring your symptoms…treat them BEFORE they become your next injury.

SLIDE #39:

TP’s can form anywhere

In this class we will be going after what we call the usual suspects….the TP’s that cause most of your problems.

SLIDE #40:

More examples of the TP that we will target with the TB and the foam roller


SLIDE #41:

Emphasize NOT using anything firmer then a tennis ball and the places to NOT put the ball.

Healthy / normal tissue does not hurt to press on…..unhealthy / damaged tissue is very painful


SLIDE #42:

1.Lateral 1/3 of the hip.  Walk the feet out and turn the feet toward the side that has the ball.

*this is a LBP and knee pain area

  1. IT band is a cause of non-traumatic knee pain. 6 inches above the joint line and roughly 1 inch forward toward the quad.

SLIDE #43:

  1. T12-L1 junction. Below the floating rib in the soft spot between the rib and the Para spinals aka. The flank

*This is a pure LBP point

2. On the border of the scapula…trace the ‘C’ shape of the scapula all the way from the top of the shoulder to the bottom.

*This is a headache, neck pain and shoulder pain point

SLIDE #44:

Final 2 points are anterior….they do not generate a pain signal so we forget them BUT,,,they cause the majority of the pain and injury we deal with.

  1. Pect minor: Above the breast tissue in females, Tends to be very sharp and refers pain down the arm

*headaches, neck/shoulder issues all stem from this point.

2. Subscapularis: the point is at the angle of the scapula slightly back from the lat.

*headaches, elbow pain, neck pain all step from this point

SLIDE #45:

Have them re-treat the tight hip for 45 seconds.

SLIDE #46:

  1. Who felt a difference in their movement?
  2. How do you feel now?
  3. Did we do a lot to get you moving and feeling better??


SLIDE #47:

SOOOO we have a conundrum…..this is the best tool I can give you BUT if you have never used it before it hurts so much that many of you will not come back to it.

Now that you understand that a little pain makes you feel and move better then a lot of pain is even better.

The FR is where much of the science is now. It’s quick, very effective and serves as a warm-up and stretch at the same time.

**take away: if million $ athletes use it before they do anything what will it do for us?

The FR is your stretch, tennis ball and warm-up in one tool.

SLIDE #48:

People like the FR better because it’s usually faster, you have to move the whole time and your feel instantly better.

**Get on the floor and demonstrate prior to having the students try the techniques.

SLIDE #49:

To save time have them do these 4 areas.  1 minute per area.

Explain the specificity of rolling ALL the muscle, relieving pressure as needed, breathing and how we have not deviated form the 4 areas of the body that cause injury.


SLIDE #50:

Part two of the class

We spent the first half getting you mobile so we can safely lift properly.

This class will challenge your convictions and “hold the mirror” to EMS as a profession that we have all been taught wrong.

Remember it’s all about reducing tissue load.

SLIDE #51:

These are the two stances that you will learn in this class.  The stances are designed to “trick” your body into firing properly.

1.Injury occurs from 3 primary factors:

  1. the load is too heavy
  2. repetitive motions
  3. awkward lifting

2.These stances are designed to reduce the forces placed on your body by “Primally firing” the core and hips to dampen the load.

3.Give the bariatric vs. frail patient on the floor…..which one elicits the primal response to get  ready / fight.

4.That’s why the unsuspecting load often injures us.

SLIDE #52:

1.Demonstrate the stance and clearly explain that you are moving around the hip NOT the back.

2.Designed to trick your abs and glutes to fire thus “sparing/protecting your back”

3.This stance is used for frontal loads (LSB, Lat. Transfer, cot lift etc.)


SLIDE #53:

A = Spine board/scoop/tarp to cot

B = Lift from a chair, floor and bed to bed

*It engages the hips to stop you from using your back


SLIDE #54:

1.Can we all agree the system is broken?

2.EMS needs a “stop behavior” for ergonomics….give the defib. Tie in as a stop behavior

3.We need to SLOW DOWN

4.We need to become responsible for each others ergonomics and use a built-in safety stop.


SLIDE #55:

Embellish the steps


SLIDE #56:

1.NIOSH lifting equation for healthcare workers says……So what does a 300lb patient add to your spine??

2.We know injury can occur at roughly 800-1000 lbs. of compressive force in the untrained (not strong) responder.

3.Pre-sell the lateral transfer and tarp lift…foreshadow what’s to come in the class.

4.We NEED to do it BETTER!  And we CAN

5.*****If 51lbs takes us up to the safe lifting limit do we need to rethink our definition of bariatric???


SLIDE #57:

The folks at FEMA thought it important to let us know that we should stop lifting below the knees……thanks!

So it only makes sense to focus on the most dangerous lifts first.


SLIDE #58:

Here is what we are dealing with that ultimately breaks us.

Injury occurs from overload aka. Tissue failure or more common cumulative traumas

  1. Compressive load is the most damaging…..this is why we must learn to move from the hips and not the back
  2. Shear forces occur when you bend from the back with no hip engagement
  3. Moments are those instances when you get pulled or twisted (lift from the floor-pulled forward, scoop to cot twist)


SLIDE #59:

Play the video.  Explain why we hinge at the hip and not at the back.  This is why we have the linebacker stance and the Warrior.

Tie this back into what is supposed to be mobile vs. stable.


SLIDE #60:

Use the tool don’t be the tool

NO MORE lifting from the floor because we can, change the lift height


SLIDE #61:

No more dangerous patient handling techniques like this one

1.Leaning at the back not the hips

2.Hands are in the wrong position

3.What exactly is the person on the other side doing?


SLIDE #62:

Briefly explain the rules surrounding this transfer

Must secure the opposite side with a person, wall, cabinet/immovable object.

Both responders at the head and hip pulling together

Using a device that reduces friction and changes trunk angle….mega mover©/Titan©

No more using sheets to move patients.


SLIDE #63:

This is the warrior slide, no more back death from flexion moments with rotation.

The key here is to stop fighting each other on the movements and start working together.

BOTH responders working together to move the heavy side first….break the moves up and make them safer.


SLIDE #64:

Let the device provide mechanical advantage with movement occurring with a hip hinge and neutral spine.

We will teach you when and with whom you can do this technique.

Use only an approved lifting device, never us a sheet.


SLIDE #65:

1.Space = dangerous spine load = flexion moment.

2.Chasing the board meant that someone had bad ergo. And did not follow the ready-set-lift self-check.


SLIDE #66:

1.Point out the broom stick posture BUT even with good biomechanics the spines are still round, they are exceeding the safe load limits.

2.Humans are not biomechanically able to be strong from the floor, the sweet spot is above the knees….change the lift height.


SLIDE #67:

1.Power grip vs. weak grip

2.Describe what the narrow foot end of the board did to make the lift even more dangerous.


SLIDE #68:

The two most common patterns are heels up or a poor squat depth due to tight hips.


SLIDE #69:

Bad form!


SLIDE # 70:

The second lift is a two stage lift.

NOT for all lifts

This is a worst case scenario lift with a top heavy patient.

Can also be used to secure c-spine

Common errors: Think of your arms as chains and your hands as hooks.

NEVER bend the elbow UNTIL the board is above the knee.

The responder at the foot must push DOWN to create a fulcrum effect for the person at the head. (HULK SMASH)

Do not “curl” the board; instead use your legs to drive it up off the ground.


SLIDE #71:

manufacturers. did a POOR job marketing their devices.

We see them a bariatric tools…….BUT they are even better when used on ALL patients.



SLIDE #72:

Board/scoop the patient on the FS (most have pockets to secure the LSB)

Changes the lift height, now at knee level = out of the danger zone.

Allows 2-6 responders hands on with the patient.

Easier to carry.


SLIDE #73:

The Warrior Step: For spine board to cot and deep lift positions


SLIDE #75:

Note the foot…step and foot angle to “open the hips” and allow the spine to be protected

Turns the movement into a slide.

Key points:

1.BOTH responders make contact with the cot, feet close

2.ONLY the person at the head takes a step and points the foot

3.Slide the head onto the cot using the hips.

4.NOW the foot end mirrors the head.


SLIDE #75:

Video of Warrior


SLIDE #76:

IF you have to carry 2 spinal patients.


SLIDE #77:

Describe how it fits against the bench seat in most trucks.

1.Either the load wheel jumps the center channel

2.Or it fits against the top of the antler.


SLIDE #78:

Note the great broom stick posture

BOTH responders are at the head and shoulder…we do NOT care about the feet yet

Turns the lift into a slide!

With a powered cot raise it to the same height as the bench seat.


SLIDE #79:

Slide the head over, one responder balances the board.

Then slide the foot over

No lifting just slide


SLIDE #80:

In the U.S.  we use X frame cots which are 2 stage lift cots.  They are designed to go ONLY half way up to TRANSPORT HIGHT before being moved to the truck.


SLIDE #81:

Back injuries decreased and cervical, extremity traumas increased.

And now you HAVE to load and unload with BOTH responders at the foot!

Your cot has a 700 lb. weight rating….but where does that apply?  High or low?

At the “load height” the cot is weak and unstable.


SLIDE #82:

Transport Height vs. load height

Liability of tips and drops

1.Where does the weight rating apply (what position)

2.The higher it goes the weaker it becomes

3.Heavy patient = low

4.Tough terrain = low

5.ONLY raise to load height at the truck

6.When at receiving facility lower it back down to transport height!!!!!!


SLIDE #83:

Shoulder strap use is incredibly important…..use them constantly and apply them properly.

This scenario is fatal for both!


SLIDE #84:

This is why you MUST be restrained in the truck at all times.


SLIDE #85:

Chest on the foot plate! Elbows on the knees

Keep the cot against your body the entire lift.


SLIDE #86:

This is the load angle we are looking for

Easy to achieve with 2 responders lifting at the foot, difficult with just one.


SLIDE #87:

??Whats wrong with this picture?? =  spinal extension

This is what happens when you try to lift a powered cot by your self


SLIDE #88:

Mandatory with powered cots = two load and unload at all times.


SLIDE #89:

Ask the Question to see if they know?


SLIDE #90:

Conclusion and motivation to change

SLIDE # 91:

Invest in YOU


SLIDE #92:

Motivation to move and be fit.


SLIDE #93:


  1. Newsletter
  2. Facebook
  3. Fitness app


SLIDE #94-106

= Additional materials, videos and notes.

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