Factors associated with back problems among emergency medical technicians

The Effect of Fatigue During Search and Rescue Efforts in Debris on the Quality of Cardiopulmonary Resuscitation

OBJECTIVES

Cardiopulmonary resuscitation (CPR), which is used in cases of life-threatening cardiopulmonary arrest, is a physically exhausting procedure. Adding to that, sometimes, even before performing CPR, interventions to rescue the injured person from a challenging environment have caused significant fatigue. In this study, taking a novel research approach, we generated a scenario of fatigue during a rescue from earthquake debris and aimed to measure the effect of that fatigue on the quality of CPR performed by paramedics.

METHODS

The research followed an experimental design with 2 groups (experimental/control) and 2 measurements (pretest/post-test). The study population was selected using power analysis. The sample, consisting of 84 paramedic students, was randomly divided into 42 control and 42 experimental participants. Current American Heart Association (AHA 2020) and European Resuscitation Council (ERC 2021) guidelines were strictly followed when performing CPR. In order to assess the accuracy of CPR, a General Doctor GD-CPR200S-A (2010 standard) simulator was utilized. The participants were fatigued by practicing the process of extracting and transporting earthquake victims from rubble. A personal information form with 20 questions and a CPR measurement form were used to obtain the data.

RESULTS

In the analysis performed to measure the differences between the CPR indicators for the control and experimental groups in the post-test and pretest, the difference in compression (control: 6.5 ± 50.1 and experimental: -10.3 ± 46.0) was not significant. Meanwhile, we found that the difference in ventilation (control: 0.3 ± 5.4 vs. experiment: 8.1 ± 4.6) and the difference in CPR completion times (control: 0.2 ± 1.2 vs. experiment: -0.7 ± 0.7) between the post-test and pretest were significant.

CONCLUSIONS

There was no significant difference in correct compressions between the control and experimental groups, but there was a significant difference in ventilation and CPR completion times. For this reason, it is recommended to focus on the effect of fatigue on CPR quality, especially on the ventilation process. It is also recommended to include fatigue scenarios in CPR trainings.

Musculoskeletal disorders in emergency medical services personnel: a systematic review and meta-analysis

OBJECTIVES

Emergency medical services personnel are frequently subjected to strenuous physical tasks, such as lifting and moving patients, as well as working in awkward postures. These activities can result in a variety of debilitating injuries, including musculoskeletal disorders (MSDs). As a result, this systematic review and meta-analysis study aimed to examine the frequency of MSDs among emergency medical services personnel.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

This systematic review and meta-analysis study was conducted based on the PRISMA guidelines. The protocol of this work is registered in PROSPERO with the code CRD42024506958. Searches were conducted without time limits in several databases including PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar until February 12, 2024. The I2 index was used to assess heterogeneity, and random effects model was used for meta-analysis. Data were analyzed using STATA version 14.

RESULTS

A total of 709 articles were obtained by initial search in the mentioned databases. Following a thorough screening and quality assessment, 27 articles were chosen for meta-analysis. The findings revealed that the overall prevalence of MSDs among emergency medical services personnel is 56.52% (95% CI: 35-78.04, I2 = 99.8%, P < 0.001) and the prevalence in different areas of the body are as follows: the low back (47.38%), upper back (35.15%), neck (31.19%), shoulder (30%), knee (27.07%), hand (20.70%), hip/thigh (19.48%), feet (19.11%), and elbow (17.36%).

CONCLUSION

The prevalence of MSDs among emergency medical services personnel is very high. Considering the importance of the role of these employees and the specific risk factors of their jobs, it is recommended that periodic screening is prioritized. In addition, attention should be paid to the ergonomic evaluation of the work environment and the design of appropriate ergonomic interventions.

Prevalence of work-related musculoskeletal disorders and associated factors affecting emergency medical services professionals in Jordan: a cross-sectional study

OBJECTIVES

Emergency medical services (EMSs) personnel are at high risk for developing work-related musculoskeletal disorders (WMSDs). However, no studies have yet investigated the prevalence and effect of these disorders on the Jordanian EMS personnel. Therefore, this study aimed to determine the prevalence of WMSDs among Jordanian EMS personnel and its associated factors.

DESIGN

This study used a cross-sectional design. Participants were asked to complete a self-administrated and validated questionnaire to measure the WMSDs, including a demographic survey and the Nordic Musculoskeletal Questionnaire. Descriptive and multivariable regression analyses were used.

SETTING

The Jordanian Civil Defence stations in the main cities of Jordan.

PARTICIPANTS

The sample consisted of 435 EMS workers which were obtained across the country of Jordan. A total of 79.0% of the participants were male, with a mean age of 27.9 (±4.3 SD) years.

RESULTS

The pain in the lower back (308, 70.8%) and neck (252, 57.9%) were the most reported in the last 12 months. Furthermore, about half of the participants reported having pain in their upper back (234, 53.8%), knee (227, 52.2%) and shoulder (226, 52.0%) pain in the last 12 months. Overall, WMSDs in at least one body part were significantly associated with age, experience, being a male, increased body mass index and lower educational level.

CONCLUSIONS

There is a high prevalence of musculoskeletal complaints among EMS personnel. Multiple variables may be incorporated into a national prevention campaign and professional development programme to educate EMS personnel on avoiding WMSDs.

The Prevalence of Neck and Back Pain among Paramedics in Poland

Neck Pain (NP) and low back pain (LBP) are ubiquitous musculoskeletal conditions and some of the major causes of disability worldwide. The aim of the study was to assess the incidence and risk factors of back pain among paramedics and their correlation with the nature of work, anthropometric features and the level of recreational physical activity. A group of 201 individuals (39 females (19.40%); 162 males (80.60%)), licensed to practice as paramedics in Poland completed a questionnaire containing the author's interview as well as the Neck Disability Index (NDI) questionnaire and the Revised Oswestry Disability Index (ODI). Among the examined paramedics, 92% of the subjects reported the presence of back pain in different parts of the spine (36% C; 17% Th; and 85% LBP). The pain intensity, determined by VAS, was on average 4.26 (SD 1.77). The level of disability, assessed by NDI, was 7.67 (SD 5.73) on average, while the ODI was 7.51 (5.90). Work-related spinal strain has a major impact on the intensity and incidence of spinal pain. Spinal pain in paramedics mainly occurs in the lower back.

Functional movement screen did not predict musculoskeletal injury among emergency medical services professionals

BACKGROUND: Emergency Medical Services (EMS) professionals frequently experience job-related injuries, most commonly overexertion or movement injuries. Data on injury reduction in EMS professionals is limited. The Functional Movement Screen (FMS) is a movement analysis tool suggested to predict musculoskeletal injury, but it has not previously been evaluated for EMS professionals. OBJECTIVE: To evaluate the effectiveness of the FMS to predict musculoskeletal injury among EMS professionals. METHODS: In October 2014, EMS professionals employed in an urban third-service EMS agency volunteered to participate in FMS administered by certified screeners. Age, sex, height and weight were recorded. After screening, participants were instructed on exercises to correct movement deficiencies. We reviewed recorded injuries from 2013 to 2016. We performed descriptive statistics. With logistic regression modeling, we described factors that predicted musculoskeletal injury. We generated a receiver operating curve (ROC) for FMS prediction of musculoskeletal injury. RESULTS: 147 of 240 full-time employees participated in the FMS. Participants’ mean age was 33.7 years (SD = 9.6) and the majority (65%) were male. The median initial FMS score was 14 (IQR 11–16). Area under the ROC curve was 0.603 (p = 0.213) for FMS ability to predict any musculoskeletal injury within two years. Female sex was associated higher odds of injury (OR 3.98, 95% CI 1.61–9.80). Increasing age, body mass index (BMI) category, and FMS score≤14 did not predict musculoskeletal injury. CONCLUSION: The FMS did not predict musculoskeletal injury among EMS professionals.

Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: A comprehensive narrative review

The aim of this article was to review the current knowledge relating to work-related musculoskeletal disorders (WRMDs) and non-fatal injuries in emergency medical technicians and paramedics (EMTs-Ps). A literature search was conducted in PubMed, Google Scholar, and Clinical Key. The annual prevalence of back pain ranged from 30% to 66%, and back injuries and contusions from 4% to 43%. Falls, slips, trips, and overexertion while lifting or carrying patients or instruments ranged from 10% to 56%, with overexertion being the most common injury. Risk factors were predominantly lifting, working in awkward postures, loading patients into the ambulance, and cardiopulmonary resuscitation procedures. Lack of job satisfaction and social support was associated with WRMDs and injuries. EMTs-Ps had the highest rate of worker compensation claim rates compared to other healthcare professionals. Positive ergonomic intervention results included electrically powered stretchers, backboard wheeler, descent control system, and the transfer sling.

Evaluating the effect of a strength and conditioning program to improve paramedic candidates' physical readiness for duty

BACKGROUND

The Ottawa Paramedic Physical Ability Test (OPPAT™) is a physical employment standard for the paramedic sector. If a candidate is unsuccessful in meeting the OPPAT™ performance standard they should be provided with an appropriate accommodation, such as a strength and conditioning program, to improve performance.

OBJECTIVE

Develop, implement and evaluate the effectiveness of a 4-week strength and conditioning program on improving OPPAT™ performance and associated fitness measures in paramedic candidates.

METHODS

A 4-week strength and conditioning program was developed to focus on strength and power improvements. Based on initial OPPAT™ performance, participants were divided into high and low performing groups; only the low performing group received the training intervention. OPPAT™ completion times and relevant fitness measures were compared pre- to post- intervention and between groups.

RESULTS

Over the 4-weeks, peak lower body power and grip strength did not significantly improve in the intervention group, however OPPAT™ performance improved by 10%. The control group had significantly lower OPPAT™ completion times both pre- and post-intervention (19% and 11% lower respectively), as well as greater grip strength and peak lower body power.

CONCLUSIONS

Implementation of a targeted strength and conditioning program successfully improved OPPAT™ performance in low performing candidates.

The relationship between physical fitness and occupational injury in emergency responders: A systematic review

BACKGROUND

Emergency responders have jobs with physical demands that put them at risk of musculoskeletal injuries.

OBJECTIVES

This paper systematically reviews existing literature examining the relationship between fitness and occupational injury in this group.

METHODS

Comprehensive electronic searches were conducted using key words relating to musculoskeletal injury, fitness, and emergency responders.

RESULTS

Eleven articles included in the review provided limited evidence for the relationship between physical fitness test scores and injury risk. There appears to be a correlation between better aerobic fitness and decreased risk of injury.

CONCLUSIONS

Evidence of the relationship between aspects of physical fitness and occupational injury in emergency responders is extremely limited. More research is required to expand the knowledge in this area and to draw more definitive conclusions.

Risk factors for work-related cardiovascularand musculoskeletal diseasesamong prehospital urgent care workers: a systematic review

Background

Studies conducted with prehospital urgent care workers investigated work-related stress and its repercussions on the workers' mental and physical health.

Objective

To identify risk factors for development of work-related cardiovascular (CVD) and musculoskeletal (MSD) diseases among prehospital emergency care workers.

Methods

We conducted a systematic search on databases PubMed, EBSCO, EMBASE and Science Direct. The inclusion criteria were: risk factors for CVD and MSD among prehospital emergency care workers.

Results

From 370 articles, 11 were included for review. The included studies identified risk factors for CVD, such as body mass index and sedentary lifestyle, however, with limited level of evidence. For MSD, age and working as first responder were shown to behave as risk factors, with high level of evidence. We were not able to determine the cardiovascular risk factors due to lack of studies that analyzed this aspect.

Conclusion

The most evident musculoskeletal risk factors reported in the literature are age and working as first responder. Registration PROSPERO: CRD42016042390.

A National Assessment of the Health and Safety of Emergency Medical Services Professionals

Objectives

The objectives were to assess changes in (1) health and physical fitness, (2) the prevalence of selected health problems, (3) risk behaviors, (4) ambulance safety issues, and (5) the preparedness of Emergency Medical Services (EMS) professionals. In addition, the incidence of patient-initiated violence directed toward EMS personnel and associated factors were assessed.

Methods

Data were obtained from a sample of nationally certified EMS professionals via annual questionnaires between 1999 and 2008. Stratification was based upon national certification level, self-reported race, and experience level. Weighted percentages, averages for continuous variables, and 95% confidence intervals (CIs) were calculated. Significant changes over time were noted by lack of CI overlap.

Results

The proportion reporting “excellent” health declined significantly from 1999 (38.5%) to 2008 (32.2%). High rates of sleeping problems (20%-27%), back problems (20%-24%), and hearing problems (7%-10%) were reported as having occurred in the past year. These rates remained constant over time. As a result of sleepiness, 8.0% of nationally certified EMS professionals reported difficulty in driving an emergency vehicle for short distances and 17.5% reported difficulty in driving long distances. The proportion of daily tobacco smokers significantly declined from over one-third (35.3%) to about one-fifth (20.3%). The proportion of providers who had ever been involved in an ambulance crash increased slightly from 2004 (14.5%) to 2008 (15.8%). In 2000, the majority of EMS professionals reported that they and/or their partner had been assaulted by a patient. Finally, there was a significant decrease in the amount of training time devoted to the recognition of biological, chemical, and nuclear (BCN) threats, use of personal protective equipment (PPE), and treatment and management of patients exposed to BCN from an average from 8.4 hours in 2003 to 6.2 hours in 2008.

Conclusions

The overall health and physical fitness of EMS professionals as well as their health problems, risk behaviors, ambulance safety, and patient-initiated violence in the prehospital emergency setting are areas of concern for the nation’s emergency medical system. The prevalence of these problems and overall health and physical fitness has shown little or no improvement from 1999 to 2008.

BentleyMA, LevineR. A national assessment of the health and safety of Emergency Medical Services professionals. Prehosp Disaster Med. 2016;31(Suppl. 1):s96–s104.

Relationship Between Low Back Pain With Quality of Life, Depression, Anxiety and Stress Among Emergency Medical Technicians

Background:

Musculoskeletal disorders have become increasingly common among healthcare providers. They have become the most common cause of work-related disabilities among nurses.

Objectives:

The current cross-sectional study aimed to measure the prevalence of back pains among emergency medical technicians (EMTs), and association of back pain with quality of life, depression, anxiety and stress.

Materials and Methods:

One hundred and eighty registered nurses working as EMTs at the Hamadan Emergency Medical Center were selected by consensus. Data collection tools were Demographic, Perceived Quality-of-Life, Short Form Health Survey (SF-36), and Depression Anxiety Stress Scales (DAS21) and pain scale measurements.

Results:

Data showed that while 50.7% of the participants had an average awareness of the basic principles of back care, the majority (71.8%) had at least one type of back pain. There were associations between the prevalence of pain and depression (P = 0.049), pain and awareness (P = 0.035), and stress and job satisfaction (P = 0.024).

Conclusions:

A large number (about two-thirds) of EMTs had some sort of back pain; it is highly recommended to promote the attitude and motivation of the individuals to take care to prevent back injury and inform them of the principles of back care. Implications for primary prevention and care practice include encouraging EMTs to apply accurate principles of back care.

Developing a comprehensive approach to risk management of musculoskeletal disorders in non-nursing health care sector employees

This study of selected jobs in the health care sector explored a range of physical and psychosocial factors to identify those that most strongly predicted work-related musculoskeletal disorders (WMSD) risk. A self-report survey was used to collect data on physical and psychosocial risk factors from employees in three health care organisations in Victoria, Australia. Multivariate analyses demonstrated the importance of both psychosocial and physical hazards in predicting WMSD risk and provides evidence for risk management of WMSDs to incorporate a more comprehensive and integrated approach. Use of a risk management toolkit is recommended to address WMSD risk in the workplace.

Exploring implicit preventive strategies in prehospital emergency workers: a novel approach for preventing back problems

INTRODUCTION

Back problems are a major occupational health issue for prehospital emergency care professionals. The goals of this article are to: 1) provide descriptive data about the prevalence and the severity of lower back and upper back disorders in EMTs and paramedics; 2) identify some individual and collective strategies used by EMTs and paramedics to protect their health as they perform prehospital emergency missions; 3) assess the possible effectiveness of strategies in preventing back problems by exploring associations between the use of strategies and the presence and severity of symptoms.

MATERIAL AND METHODS

The method includes a questionnaire survey (sample n = 334; paramedics and emergency medical technicians) and ergonomics work practice analysis involving shadowing ambulance crews in 12 medical emergency services (over 400 h).

RESULTS

A majority of ambulance professionals had experienced back pain in the twelve-month period before the survey. Work practice analysis revealed strategies and tricks of the trade used by ambulance professionals to reduce the chances of back strain while working. Multiple regression analyses showed that self-reported use of such strategies was associated with fewer back symptoms.

CONCLUSIONS

Preventive strategies should be integrated into specialised training programs for prehospital medical emergency professionals. This approach could also be used in other work settings.

Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers

Musculoskeletal injuries are frequently reported among Emergency Medical Services (EMS) professionals. The objective of this study was to evaluate occupational injuries in an urban EMS system before and after implementation of hydraulic stretchers. Data for this analysis were obtained from Austin Travis County EMS (A/TCEMS). In December 2006, A/TCEMS placed into service electrically powered patient stretchers. The pre-intervention period was between 01/01/1999 and 12/31/2006, and the post-intervention period was between 01/01/2007 and 4/30/2008. Incidence rate calculations were performed for four injury sub-groups and rate ratios (RRs) and corresponding 95% confidence interval (CI) were presented. There were 2087 and 706 person-years of observation pre- and post-intervention, respectively. The incidence rates for overall injury pre-intervention and post-intervention were 61.1 and 28.8 per 100 FTE, with a corresponding RR of 0.47 (95% CI 0.41-0.55) indicating a significant decrease in the rate of injury. The subcategory of stretcher-related injuries had the lowest RR (0.30; 95% CI 0.17-0.52) when comparing pre- and post-intervention time periods.

Work-related injury in the nursing profession: an investigation of modifiable factors

AIM

This paper is a report of a correlational study of the relationships between work-related injury-risk events and modifiable risk factors in a nursing population after controlling for socioeconomic factors.

BACKGROUND

Nurses are at high risk for work-related injury. Work-related injury is strongly influenced by psychosocial factors and physical job-related exposures, but the magnitude of effect from modifiable factors remains unclear.

METHOD

Data were based on the Work Outcomes Research Cost-benefit survey conducted in Australia during 2005 and 2006. The study sample of 5724 represented ~14% of nurses in Queensland, Australia. Logistic regression was used to determine the magnitude of association of psychological distress (represented by the Kessler 6 score: six-item scale of psychological distress), the number of health conditions and various socioeconomic factors with work place injury.

RESULTS

High psychological distress was associated with a 5% probability of injury. As the number of health conditions increased, the probability of injury increased; 3 and ≥ 6 health conditions increased the chance of injury by 5% and 15% compared with no health conditions. Compared with the total sample, nurses who reported high levels of psychological distress demonstrated greater sensitivity to the number of health conditions. Computation of the marginal effects showed little difference in the likelihood of injury when the total sample was compared with nurses with < 5 years of work experience.

CONCLUSION

Effective occupational health and safety workplace programmes that target modifiable factors such as psychological distress and physical health conditions may improve the health capital of nurses and productivity levels within the profession.

An assessment of key health indicators among emergency medical services professionals

INTRODUCTION

Ensuring the health and productivity of emergency medical services (EMS) professionals is important. However, there has been no known national baseline assessment of the health and wellness of EMS professionals in the United States. According to Healthy People 2010, top indicators of personal health include physical activity, body mass index (BMI), and smoking prevalence.

OBJECTIVES

The objectives of this study included quantifying existing health conditions and describing key health indicators among EMS professionals. It was hypothesized that work-life characteristics were associated with existing health conditions and key health indicators.

METHODS

Data utilized for this analysis were obtained from a 2007 questionnaire included in biennial national recertification packets. This questionnaire utilized validated items from the Behavioral Risk Factor Surveillance System (BRFSS) and the Longitudinal EMT Attributes and Demographics Study (LEADS). Along with common demographic characteristics, items inquired about existing health conditions (diabetes, asthma, hypertension, myocardial infarction, angina, stroke, and/or high blood cholesterol level), general health, physical activity, and smoking status. Descriptive analyses were performed utilizing chi-square tests, and logistic regression was utilized to describe associations between existing health conditions and the key health indicators.

RESULTS

There were 58,435 individuals who became recertified in 2007, with 30,560 (52%) returning questionnaires. Individuals with missing data were removed, leaving 19,960 individual records. There were 4,681 (23.5%) individuals who reported at least one existing health condition. The mean BMI for the study participants was 27.69 kg/m(2). There were 5,742 (28.8%) individuals classified as having normal weight and 5,146 (25.8%) who were obese. The overwhelming majority of individuals did not meet the Centers for Disease Control and Prevention (CDC) recommendations for physical activity (15,022, 75.3%). There were 3,394 (17.0%) individuals classified as current smokers. Finally, logistic regression analysis indicated that when controlling for work-life characteristics and age, BMI and level of physical fitness were associated with preexisting health conditions.

CONCLUSION

This study was the first known baseline assessment of EMS professionals regarding the key health indicators identified by Healthy People 2010. Investigations regarding the impact of health and wellness in relation to workforce stability should be undertaken. Further research should also be conducted to identify strategies to improve the health of the EMS workforce.

Hearing problems among a cohort of nationally certified EMS professionals

PURPOSE

The objectives of this study were to estimate the prevalence of hearing problems among a national cohort of emergency medical service (EMS) professionals, determine factors associated with hearing problems, and estimate the percentage of EMS professionals who utilize hearing protection.

METHODS

Utilizing results from a questionnaire, individuals who reported hearing problems were compared to individuals who had not. Multivariable logistic regression was performed to identify variables associated with hearing problems. Finally, items regarding use of hearing protection were assessed to estimate the percentage of usage among EMS professionals.

RESULTS

In total, 1,058 (57%) participants responded to the questionnaire. Of those, 1,024 (97%) who completed the hearing problems question were utilized for analysis. There were 153 (14.9%) cases of self-reported hearing problems. The final logistic regression model included lifetime occupational noise exposure 0.99 (95% CI = 0.9997-1.0002), report of previous back problems (odds ratio (OR) = 2.74, 95% CI = 1.8340-4.1042), large community size (OR = 1.67, 95% CI = 1.1211-2.4843), and minority status (OR = 0.61, 95% CI = 0.3719-0.9867). Finally, 213 (20.8%) individuals reported utilizing some form of hearing protection at their main EMS job.

CONCLUSION

The results from this analysis are the first national estimates of the prevalence of self reported hearing problems among EMS professionals. This study was also the first to estimate the percentage of EMS professionals who self reported the utilization of hearing protection.

Back problems among emergency medical services professionals: the LEADS health and wellness follow-up study

OBJECTIVE

Describe work-life and demographic characteristics associated with reporting recent back pain, and estimate back pain severity among Emergency Medical Services (EMS) professionals.

METHODS

A 58-item postal questionnaire was used to collect relevant health and wellness information from a national sample of EMS professionals. The outcome variables were self-reported pain in the back or legs, and severity of recent back pain as indicated by the Aberdeen Back Pain Scale (ABPS).

RESULTS

There were 470/930 (50.5%) participants who reported one or more days of pain in the back or legs over a 2-week period. The variables most strongly associated with recent back pain and pain severity were prior back problems, self-reported health, and job satisfaction.

CONCLUSION

This study indicated that work-life, health, and demographic characteristics of EMS professionals were associated with reporting recent back pain.