Lifting and Back Safety
for EMS Providers
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© 2006 EPS LLC
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Case Example
How to keep
Geraldine as pain
free as possible
while protecting
our own backs
during the lift and
move?
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 2006 EPS LLC
Lifting and Carrying
Reach
Carry
Assist
Lift
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47% of
respondents
had
sustained a
back injury
while
performing
EMS duties
 2006 EPS LLC
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Questions
Contact back injury prevention
program coordinator, employee
health nurse or safety officer
 2006 EPS LLC
Objectives
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Explore the incidence of lifting
related back injury in EMS
Review important spinal column
anatomy
Discuss the causes of back injury
Explain techniques and principles
for lifting
Introduce strength and flexibility
exercises to prevent back injuries
 2006 EPS LLC
Objective 1: Back Injuries in
EMS
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health care workers
had the largest
number of time loss
injuries
 2006 EPS LLC
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Back Injury Statistics
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39% of participants had sustained a
back injury performing EMS duties
13% of the injuries led to work
absenteeism
52% of the injuries interfered with
daily activity
 2006 EPS LLC
Back Pain Statistics
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90% of Americans will experience
low back pain
100 million days of lost work
Most common and expensive work
related injury
$50 billion spent on treatment
Most common cause of disability for
persons under forty-five
85% of back pain is idiopathic
 2006 EPS LLC
Back Injury Reduction
Program Components
Program
Evaluation
Training
Injury Reporting
Implement
Solutions
Identify
Problems
Involve
Employees
Management
Support
 2006 EPS LLC
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Benefits
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Reduction in work related back
injuries and associated workers'
compensation costs
Reduced staff turnover and
associated training and
administrative costs
Reduced absenteeism
Increased productivity
Improved employee morale
Increased patient satisfaction
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 2006 EPS LLC
Objective 2: Back Anatomy
and Injuries
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 2004 LifeART
 2006 EPS LLC
Vertebral Column
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Strong and
flexible
Supports weight
of head
Attachment point
Encases spinal
cord
Low back injuries
are most common
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 2006 EPS LLC
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Disks
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Support spinal
column
Maintain
elasticity
Allow
movement
Disk problems
cause 85% of
back pain
 2006 EPS LLC
Herniated Disk
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Spinal disk
degeneration begins in
20s
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Disk bulges and
impinges nerve roots
Improper lifting is most
common cause
Numbness, weakness,
reflex loss
 2006 EPS LLC
Synovial Movement
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Synovial joint
Disk and synovial
fluid allow
movement
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Forward
Backward
Sideways
Rotate
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Overtime
degeneration and
inflammation
 2006 EPS LLC
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Spinal Nerves
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31 pairs of nerves
Innervate joint
Nerve root impingement and
inflammation causes back pain
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 2006 EPS LLC
Sciatic Nerves
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Largest nerves
Sciatica is from an
impingement, pinching, or
stretching of the sciatic
nerve
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Disk herniation is the
leading cause
 2006 EPS LLC
Ligaments and Muscles
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Ligaments support
vertebrae connection
Connective tissues
tear when capacity is
exceeded
Twisting and turning,
poor muscle tone,
and pre-existing
conditions can lower
capacity of
connective tissue
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 2006 EPS LLC
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Objective 3: Back Injury
Causes
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 2006 EPS LLC
Force
Force is the amount of
physical effort required to
perform a task or to
maintain control of
equipment
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 2006 EPS LLC
Awkward Postures
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Awkward postures
place stress on the
body, such as
reaching above
shoulder height,
kneeling,
squatting, leaning
over a bed, or
twisting the torso
while lifting
 2006 EPS LLC
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Repetition
Repetition is performing the same
motion or series of motions
continually or frequently
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 2006 EPS LLC
Repetition
Single
traumatic event
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or
Micro trauma
 2006 EPS LLC
Back Injury
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…actual cause is often a combination
of the single incident with years of
weakening from repetitive microtrauma
 2006 EPS LLC
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Associated Factors
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Reaching while lifting
Poor posture
Stressful living and
working activities
Bad body mechanics
Poor physical
condition
Poor design of job or
work station
Repetitive lifting of
awkward items,
equipment, or
patients
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Twisting while lifting
Bending while lifting
Maintaining bent
postures
Heavy lifting
Fatigue
Poor footing
Lifting with forceful
movement
Vibration
 2006 EPS LLC
Symptoms
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Pain when attempting to assume
normal posture
Decreased mobility
Pain when standing or rising from a
seated position
Extremity numbness or weakness
Decreased range of motion
Decreased strength
 2006 EPS LLC
Objective 4: Lifting
Techniques and Principles
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44 y.o.
female
patient
Confined to
bed
UTI
symptoms
Hospital
transport
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 2006 EPS LLC
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Prevention Strategies
Modify Work Practices
Back
Injury
Prevention
Assistive Devices &
Equipment
Hazard Elimination &
Reduction
 2006 EPS LLC
Work Practices
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Document and
observe the
types of lifts and
other moves
that increase
risk of back
injury
 2006 EPS LLC
Work Practices
Example: Lateral transfer from bed to ambulance cot
EMS Provider assistance not
needed. Standby for safety.
Yes
Can
Patient
Assist?
Patient < 100 lbs. Lateral slide.
2 EMTs
Partially
Able or not
at all Able
Patient 100-200 lbs. Lateral slide
aid or friction reduction device.
2 EMTs
Patient > 200 lbs. Use lateral
sliding device, friction reduction
device, or mechanical device.
3+ EMTs
 2006 EPS LLC
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Assistive Devices and
Equipment
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There is an increasing number of
assistive devices and equipment to
lift and move patients
 2006 EPS LLC
Hazard Reduction
Process to remove hazards or
obstacles that may increase the risk
or lead to a back injury
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 2006 EPS LLC
Henry
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Before lifting or
moving any
patient,
determine what
the patient can
do on their own
 2006 EPS LLC
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Lifting: Is There a Need?
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Have a reason
to move the
patient
If nonemergent, wait
for proper
equipment and
personnel
 2006 EPS LLC
Lifting: Body Mechanics
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Know your limits
Summon additional personnel
Utilize equipment
Keep the patient’s weight close
Lift without twisting
Stand with feet shoulder width apart
Place dominant foot slightly forward
Power up with thighs
Keep back straight and stomach
muscles tight
 2006 EPS LLC
Lifting: Follow Local Protocols
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Follow local
protocols for safe
lifting techniques
and posture
 2006 EPS LLC
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Lifting General Principle
One person is in charge, usually at
the patient’s head
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 2006 EPS LLC
Lifting General Principle
I have found small
movements work
best
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Small increments
help rescuers
readjustgrip
Ann D., EMT-I, EMS Instructor
 2006 EPS LLC
Lifting General Principle
Think ahead before
moving
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Where do you want
patient to end up ?
Ann D., EMT-I, EMS Instructor
 2006 EPS LLC
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Lifting General Principle
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Explain procedure
Instruct patient on
how to assist
Reassure patient
before, during, and
after lift
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 2006 EPS LLC
Lifting the Cot
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Know equipment weight limitations
Lift with a partner of similar height
and strength
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 2006 EPS LLC
Power Lift
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Keep your feet flat and a
comfortable distance apart
Distribute weight to the balls of feet
or just behind them
Straddle the object
Stand as you lift
 2006 EPS LLC
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Power Grip
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Complete contact
Fingers bent at same angles
Hands at least 10” apart
 2006 EPS LLC
Carrying Patients and/or
Equipment
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Use correct lifting
techniques and
grips
Lift back in the
locked-in position
before twisting or
walking
While carrying
avoid leaning to
either side
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 2006 EPS LLC
Carrying Procedures on
Stairs
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Keep back in locked-in position
Flex at hips, not waist and bend
at the knees
Advise the patient to keep arms
in, folded across their chest
 2006 EPS LLC
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Guidelines for Reaching
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Keep back in locked-in position
When reaching overhead, avoid
hyperextension
Avoid twisting while reaching
Avoid reaching more than 15 - 20
inches in front
Avoid situations where prolonged
reaching is needed
 2006 EPS LLC
Reaching for Log Rolls
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Keep back
straight while
leaning over the
patient
Lean from hips
Use shoulder
muscles to help
roll patient
© Keith Owsley
 2006 EPS LLC
Guidelines for Pushing and
Pulling
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Keep back locked-in
Keep line of pull through center of
body
Keep weight close
Push from area between waist and
shoulder
Keep elbows bent with arms close
 2006 EPS LLC
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Practice
Practice with the people and
equipment in your system
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 2006 EPS LLC
Objective 5: Back Injury
Prevention
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Lessen the chance
of on-the-job injury
Reduce injury
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severity
Speed-up recovery
Regular exercise is
always good
Consult your doctor
 2006 EPS LLC
Back Injury Prevention
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 2006 EPS LLC
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Back Injury Prevention
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Muscles of the abdominals, lower
back, hips, and glutes make up the
“core” muscles
Every movement or body action
comes from the core
A strong core helps to prevent
injuries and problems
 2006 EPS LLC
Back Injury Prevention
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Strong abdominals
create a stable
pelvis which
prevents injury
caused by
undesired
movement when we
lift an object
 2006 EPS LLC
Back Injury Prevention
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Strengthen the
core
Use a fit or
stability ball
 2006 EPS LLC
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Back Injury Prevention
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Sit on fit ball in a
lying position
Feet on floor
Knees bent at 90o
Keep stomach
pulled inward and
tight
Maintain
throughout
exercise
 2006 EPS LLC
Back Injury Prevention
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Maintain tight
stomach
Push inward with
stomach
Begin to rise up
into a sit up
position
Bringing
shoulders off fit
ball
 2006 EPS LLC
Back Injury Prevention
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Continue moving
upward until your
shoulders are
completely off the fit
ball
 2006 EPS LLC
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Back Injury Prevention
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Lower torso
slowly back to
starting position
Begin with 10 reps
Work towards 3
sets of 10-20 reps
Rest briefly
between each set
 2006 EPS LLC
Back Injury Prevention
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Begin with fit ball
underneath hips
Maintain
shoulders at level
of the hips
Back in a flat
position
Pull the stomach
in tight
 2006 EPS LLC
Back Injury Prevention
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Bring shoulders
upward
Arching back until
shoulders are
inline with hips
Do not
hyperextend back
 2006 EPS LLC
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Back Injury Prevention
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Lower shoulders
to starting
position
Repeat 10-15
times
Complete 3 sets
with a short rest
between each rep
 2006 EPS LLC
Back Injury Prevention
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Alternate knee to
chest stretch
Lay supine
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 2006 EPS LLC
Back Injury Prevention
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Bring one knee up
to chest
Grasp knee with
both hands
Pull upward until a
stretch or pull is
felt in the low
back area
Hold stretch for
10 seconds
 2006 EPS LLC
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Back Injury Prevention
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Release knee
Slowly return to
starting position
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 2006 EPS LLC
Back Injury Prevention
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Bring opposite
knee toward chest
Repeat stretch for
a count of 10
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 2006 EPS LLC
Back Injury Prevention
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Release knee
Slowly return to
starting position
Repeat exercise
10 times with each
leg
 2006 EPS LLC
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Back Injury Prevention
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Cross over stretch
Lay supine
Arms out to side
Bring left leg towards
outstretched hand on
opposite side of body
Continue until a
stretch is felt in the
low back area
Keep shoulders flat
Hold for 10 seconds
 2006 EPS LLC
Back Injury Prevention
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Perform exercise
with opposite side
Goal is to place
your foot on the
floor toward the
outstretched
hand, while
keeping the
opposite shoulder
in contact with
floor
 2006 EPS LLC
Back Injury Prevention
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Take your time
Be patient
Increased flexibility
Improved range of
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motion
Check with your
doctor before
beginning
 2006 EPS LLC
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If an Injury Does Happen
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Report injuries ASAP
Diagnosis and intervention are important to:
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Limit the severity of injury
Improve treatment effectiveness
Minimize the likelihood of disability or permanent
damage
Reduce the amount of associated workers'
compensation claims and costs
Injury reporting helps identify problem areas
and evaluate program effectiveness
Employees may not be discriminated against for
reporting a work-related injury or illness
 2006 EPS LLC
Questions
Contact back injury prevention
program coordinator, employee
health nurse or safety officer
 2006 EPS LLC
Summary
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Back injury is a leading cause of pain,
disability, and lost productivity
Back injuries can be due to force,
awkward postures, and repetitive
trauma
Follow body mechanic principles, lifting
guidelines and local protocols
Regular strength and flexibility exercises
can reduce risk
Report back injuries as soon as possible
to initiate early evaluation and
documentation
 2006 EPS LLC
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References
National Association of Emergency Medical Technicians. “Four in Five EMS Workers Injured on the
Job”. Naemt.org. Not listed. The National Association of EMTs. 26 January 2006.
<http://www.naemt.org/forTheMedia/HarrisSurvey05.htm>.
Davis, P.M., et al. “Preventing Disability from Occupational Musculoskeletal Injuries in an Urban,
Acute and Tertiary Care Hospital: Results from a Prevention and Early Active Return-to-Work Safely
Program”. Journal of Occupational and Environmental Medicine. 46 (2004): 1253-1262.
Crill, M.T. and D. Hostler. “Back Strength and Flexibility of EMS Providers in Practicing Prehospital
Providers”. Journal of Occupational Rehabilitation. 15(2005): 105-11.
OSHA. “OSHA Technical Manual”. Osha.gov. 20 January 1999. OSHA Technical Manual. 20
January 2006. <http://www.osha.gov/dts/osta/otm/otm_vii/otm_vii_1.html>.
Fraser, W.R. “Back Pain Overview”. Emedicinehealth.com. 20 April 2005. Emedicine Health. 7
March 2006. <http://www.emedicinehealth.com/articles/4563-1.asp#>.
Mitterer, D. “Back Injuries in EMS”. EMS Magazine. (1999).
Perina, D. “Back Pain, Mechanical”. Emedicine.com. 23 January 2006. Emedicine Specialties. 7
March 2006. <http://www.emedicine.com/emerg/topic50.htm>.
OSHA. “Guidelines for Nursing Homes: Ergonomics for the Prevention of Musculoskeletal
Disorders”. Osha.gov. 12 September 2005. Safety and Health Topics: Ergonomics: Guidelines for
Nursing Homes. 20 January 2006.
<http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html>.
Scott, A.S., et al. Functional Anatomy for Emergency Medical Services. Delmar Thomson Learning.
Clifton Park, New York. 2002.
Bledsoe, B.E., et al. Essentials of Paramedic Care. Brady/Prentice Hall Health. Upper Saddle River,
New Jersey. 2003.
Deveraux, M.W. “Low Back Pain”. Primary Care Clinics in Office Practice. 31(2004): 33-51.
Lex, J.R. “Sciatica”. Emedicinehealth.com. 4 August 2005. Emedicine Health. 7 March 2006.
<http://www.emedicinehealth.com/articles/5626-1.asp#>.
 2006 EPS LLC
Credits
Author:
Greg Friese, MS, NREMT-P
Keith Owsley, MS, LAT, CSCS,
Images:
Alpine Institute
Big Sky Fire Department
EMT-P
Reviewers:
Kevin Collopy, BS, NREMT-P
Amanda Friese, RN, BSN
Gregory R. LaMay, BS,
NREMT-P
Melissa Maguire, BS, CHMM,
CPEA, Authorized OSHA General
Industry Outreach Trainer
Narration:
John A. Chamberlain, Jr.
Emergency Preparedness
Systems LLC
Keith Owsley
LifeART images copyright 2004
Lippincott Williams & Wilkins. All
rights reserved.
Med Event Mobile Medical
Occupational Safety and Health
Administration
Stryker® EMS Equipment
West Wind Studio
 2006 EPS LLC
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