Ergonomics Issues In Paramedic Duties: A Case Study. Steve Morrissey Ergonomics Consultant Oregon OSHA Consultation

Transcription

1 Ergonomics Issues In Paramedic Duties: A Case Study Steve Morrissey Ergonomics Consultant Oregon OSHA Consultation

2 Introduction Non-binding ergonomic consultation with a large ambulance service in the Pacific Northwest. Paper discusses this company and consultations with other specialized emergency services I have worked with.

3 Oregon OSHA is a State Plan Offers Consultation Program u Free u Non-regulatory (non-binding results) uconfidential uopen to ALL employers in State Requires full cooperation of both employers and employees

4 Background In early 2006, a large metropolitan EMS service requested we help them address: uback injuries in the paramedic staff whose source was not immediately apparent t Shoulder injuries whose source was understood:

5 Approach Met with management, supervisory and safety committee members to set goals for consultation Conducted 5 6 hour ride alongs with crews. u Lots of conversations, question answer periods, much observation and how come discussions Daily debriefings with supervisory personnel (how can we help!) Reports and closing meeting(s)

6 Initial Findings-Observations Two person crews, one qualified paramedic Shared driving and patient duties hour shifts, with the station approach u u u Park at different locations until told to move or get call Read, study, do recordkeeping, sleep, talk when on station Stay in vehicle. Very different demand set during response

7 Intermediate Discoveries After meetings and ride alongs, I concluded that there were a variety of issues contributing to reported musculoskeletal problems and a variety of problems not well verbalized. Physical design issues (ambulance, equipment) Task or mission profile specific issues

8 Basic Ambulance Design Ambulance design is set by economics, perceived need and Federal Regulations u Purchase E/F-350/450 or Dodge equivalent frame which is finished by specialty company for normal or special (bariatric) needs u Refurbish after about 250,000 miles of use

9 Ambulance Design, Cont. Over the years, there has been an increase in: u Engine size u Biohazard (general security) protection between patient area and crew cab Seats are higher end SUV type Patient area has bench seats on one side, gurney in center

10 Personnel and Task Factors Shifts are hours and crews rotate between locations when not on call Driving and patient care duties are shared Meals are usually eaten in vehicle Crews stay in vehicle for safety and to listen for calls When waiting, crews sit and read, do paper work, talk or try and sleep in chairs

11 Observations and Comments Increased engine size has moved the firewall backwards Increased biohazard protection has moved the patient area partition forward. u Paramedics are in the middle, or what is left of it 10-hours of sitting is an issue (pain) Reduced cab space makes any chair less effective No one single silver bullet to solve problems

12 Work Phase Analysis To understand the various problems,, need to look at work within each work stage or activity. u Sit on station u Respond to call u Arrive and handle patient u Transport to hospital u Transfer patient at hospital t Reposition

13 Sit on Station Crew sits in ambulance until told to move to new station or call comes in. u hour days rotating between sites u Locations selected and need to be close to radios minimizes crew leaving vehicle t Meals in vehicle. u Read, do paperwork, talk, sleep

14 Comments and Observations Cab space is not particularly large Duties create poor postures Lack of storage space Lack of leg room

15 Concerns: Cab Area Long periods of sitting in chairs with restricted leg room, inability to adjust chair More leg room on driver s side Larger persons have difficulties on paramedic side: u Some crew cannot sit in paramedic seat. Limited storage space for personal items, computer and keyboard No room for use of computer Computer does not always work (wireless) in every location

16 Basic Recommendations Increase cab space u Original purchase, order frames 8 to 12 longer. u During retrofit, add 8 to 12 spacer Improve seats after more space is available Mandate walk-a-rounds by crews, free lunch time Device to hold computer

17 Respond to Calls/Switch Locations When assigned to a call, significant increase in activity/stress as the route is planned, the type of call determined and time of arrival considered (coordinate with co-responders) Drive to the site can be very stressful and postures may be far from ideal Arrival on site results in (rapid) climbing out of cab, going to back of ambulance, lifting and pulling gurney from back of ambulance and pushing it to patient. u Surfaces and routes can be far from good

18 Comments Going from a sedentary posture to a tense and often static posture, then immediately beginning a variety of light, but demanding physical activities, can stress the back, knees and upper body in general.

19 Patient Contact-Handling This is the most demanding and unpredictable part of the paramedics duties u Assess state of patient-determine action plan u Coordinate with patient, co-responders, family u Move patient to gurney t Hopefully clean lift and carry to gurney t May require lift, carry, twist, move round corners, up and down steps, ramps before getting to gurney u Move gurney and patient to ambulance

20 Hazards, Concerns The unpredictability of the location and patient status creates an environment with high potential for injury Coordination with other responders and family may be an issue that can lead to injury Additional Issues/Problems: u Obesity u Resisting, struggling, or medically fragile patient u Need for speed u Very difficult locations: Stairs, turns, cluttered rooms u Lack of proper patient transport devices

21 General Recommendations The extreme unpredictability of this phase requires excellent training and coordination Chain of command training for co-responders Improved availability of transport devices such as sheets, boards, chairs in a range of sizes

22 Moving Patient-Gurney to Ambulance Moving the gurney and patient to the ambulance can be a significant issue if there are steps or ramps, irregular or soft surfaces (gravel, lawns), ice, mud, rain or hills or the ambulance itself is not on flat, stable surfaces. Heavy patients can create additional additional stresses on the back and shoulders

23 Moving Gurney Into Ambulance Lift gurney head into ambulance, catch lock Manually fold up undercarriage Lift and push gurney into ambulance Multi-step step,, coordinated activity which may require awkward postures. u Bariatric patients u Lack of flat, stable surface at ambulance door. This activity has significant potential for injury

24 Recommendations Winch on top of ambulance door frame to help lift head of gurney into ambulance u Eliminate lift, hold and fold of wheels Install winch/ramp systems used in bariatric ambulances

25 Transport to Hospital The paramedic in the back begins treatment and interacts with the patient and the hospital. u Sit on bench seat and lean forward (16 between seat and edge of gurney), or u Kneel on floor next to gurney and twist to the side Both postures have potentials for back and knee injury and safety issues

26 Concerns Sitting and leaning forward for extended periods of time u No back support and seat itself is poor u Vibration and sway from vehicle Kneeling and twisting about waist u Knee stresses u Twisting about back, vibration, sway from floor No crash protection-seat belts are poor

27 Recommendations Regular breaks to straighten up Knee pads Cautions about lifting and patient handling after extended periods of back flexion and/or twisting Investigate safety harness system

28 Processing at Hospital Remove patient and gurney from ambulance u Same issues as putting gurney into ambulance Push into emergency room Transfer to exam table/bed with lateral transfer u Very high potential for back injury, and hospital staff may not (be able to) help Transfer equipment and hospital staff should be available to help.

29 Reposition-Regroup After the patient is released to the hospital, the crew cleans up/sets up the ambulance for next call then goes to next duty station. Little time to stretch, walk around. Ideally, should be allowed to take some time and stretch, walk around.

30 Global Recommendations Increase cab space by 8, preferably 12 Crews must get out and stretch on regular basis More patient handling equipment Powered system to load gurney into ambulance Hospital staff assistance in transferring patients