Job Demands Analysis (JDA) Human Resources

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Iris Clarke
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1 Job Demands Analysis (JDA) Human Resources Job Code: TW0133 PARAMEDIC LEVEL 1 JDA #: Org: Toronto Paramedic Services Affiliation: 416 JDA Status: In Progress JDA Date: Location: TPS Stations throughout the City. Contact: TPS Commander of Education Phone #: (416) Assessed by: WHITE, PAUL Note: The purpose of this JDA is for disability management and injury prevention. It provides an outline of demands specific to this location, date, division and task assignment and should be reviewed prior to application to a job with different parameters. This JDA is not intended for the purposes of compensation, benefits or as a job description. It is not to be used as a sole reference for redeployment or job matches. JDAs should be retrieved directly from the Quatro Safety database to ensure that the most current version is used. JDAs listed as "Draft" or "Archived" should not be used. If you have any questions about this JDA or if edits are required, contact the City Ergonomists at Summary of Job Demands: Level 1 Paramedics provide basic life support and are qualified to administer 10 medications via the following routes - by mouth, subcutaneous and intramuscular injection, and by inhalation. Paramedics work in pairs while driving the ambulance and attending to patients throughout a 12 hour shift with a half hour lunch/dinner break. Shifts begin at either of 7 a.m., 7 p.m., 10 a.m., or 2 p.m. Twenty (20) shifts are assigned over a 42 day period. The Paramedics start their shift at an ambulance station with a circle check of the vehicle as well as necessary interior and exterior cleaning and fluid replacement for the ambulance. Equipment bags and supplies are refilled from a supply cabinet at the station. Once the Paramedics have called dispatch to sign-in for the shift they may receive a call at any time. Typically, the Paramedics receive 5.8 calls per shift (statistics from 2008 indicate 90% of their shifts received an average of 5.8 calls; of these 3.2 resulted in patient transport). There are five levels of severity for an emergency: Alpha, Bravo, Charlie, Delta and Echo being the most critical. According to the severity, the Paramedics will attend to the call using the appropriate emergency warning systems. Driving demands are high in critical emergency cases. The Paramedic team will determine how they will share driving demands; some alternate entire shifts, some switch drivers half way through the shift and some may change following each call. When attempting to arrive as quickly as possible, the driver must maneuver through traffic and busy intersections. Often, there are vehicles in front of the ambulance who may not see or hear the ambulance approaching and obstruct the way making navigation of the ambulance difficult. In busy intersections the ambulance may proceed through a red light with extreme caution. It is the driver's responsibility to ensure the intersection is clear prior to proceeding. Frequent neck movement and good vision is required to view moving traffic and to find address numbers on houses and buildings under all environmental conditions. In addition the Paramedic must operate the radio and monitor the vehicle computer for call information and map information. Once the Paramedic is on the scene he or she may be required to perform several or few physically demanding tasks, depending on the specific situation, the nature of the injury, and the physical restraints on access/extrication. The stretcher and equipment bags are unloaded from the ambulance for each call. The foot end rail of the stretcher is grasped bilaterally; pulled out of the ambulance and supported by the Paramedic (a safety mechanism prevents complete removal). The Paramedic releases the undercarriage with a hand grip mechanism while the second Paramedic supports and lowers the undercarriage. The BLS airway bag (15.5kg), first aid kit (4kg), spinal trauma kit (6kg) and Zoll monitor (with lithium batteries - 11kg) Page 1 of

2 are placed on the stretcher (35ADT model - 34kg) before heading to the scene. The stretcher and equipment are rolled to the house/apartment/building with a Paramedic pushing/pulling at each end (approx. 18kg of force on even terrain). The stretcher is rolled as close to the patient as possible before a carry is performed (e.g. set of stairs). The stretcher is not typically lifted up stairs until the initial assessment of the patient is completed and a stretcher lift is deemed to be necessary. If the stairs are narrow and the stretcher is not maneuverable, a stair chair can be used to transport the patient, or the crew may elect to carry the patient to the stretcher using the fore and aft carry technique. According to TEMS records, patient weights vary substantially. Approximately 18% of patients weigh between 0 and 59 kg., 64% weigh between 60 and 89 kg and 18% weigh between 90 and 219 kg. About 0.1% of the patients exceed 220 kg, The stair chair (Ferno EZ Glide 59T - 15kg) keeps the patient in the seated position while being carried down the stairs. This requires one Paramedic to hold the height-adjustable handle on the backrest at approximately knuckle height while standing on the upper stair, descending forwards. The second Paramedic stands on a lower stair, performs an over hand grip, and holds the foot handles at or above waist height (hands close to hips) while descending backwards down the stairs. The stair chair has inertial treads which greatly slows the rate of descent with little physical demand being placed on the Paramedics. To carry the patient upstairs using the stair chair, the foot-end Paramedic performs a squat lift while holding the chair handles using a power grip as close to the body as possible with their arms fully flexed. The head-end Paramedic stands between the locking rear lift handles facing in the direction of travel, and grasps them using an overhand grip. Difficulty can be encountered if the stairway is narrow and/or has small landings making turning the chair difficult. If there is an elevator, a stretcher will be used instead. At each call, the Paramedic will typically be required to stoop, bend or crouch at the patient's side while examining heart rate, blood pressure, or an afflicted area. While they are examining the patient, they are constantly asking the patient/family/bystanders questions about the nature of the injury, patient history, how the injury occurred, current medications, and allergies. This information must be remembered without writing it down, in order to inform emergency staff of the patient's situation. Memory demands are also high because the Paramedic must know the appropriate treatment for the patient, remember medical information to report to emergency staff, and also know the legislation/legal situation when on the scene of an accident.. If necessary, both Paramedics will perform a lift, transfer, or assist to get the patient onto the stretcher. The stretcher has the ability to raise or lower to various heights to accommodate the transfer. Once the patient is secured, the stretcher is transported (push/pull) back to the ambulance (navigating through steps, curbs, cracks, uneven pavement, grass, gardens, doors), and loaded into the patient compartment. The foot end Paramedic lifts the stretcher and releases the undercarriage (hand grip lever) while the other Paramedic raises the undercarriage at the side of the stretcher. The foot-end Paramedic lifts and rolls the stretcher into the ambulance; the other Paramedic helps steer the stretcher toward the locking device in the back of the ambulance. If other emergency personnel are available, a three or more person lift can be performed. One of the Paramedics must take responsibility for organizing the lift. When loads are considered to be excessive (bariatric patients), a call can be made to dispatch to request a lift assist or an electric Powerflex stretcher (60kg) or additional assistance from allied emergency services such Toronto Fire Services. In exceptional circumstances Paramedics encounter patients who weigh over 115 kg which is the TEMS lifting policy cut-off for requesting assistance. Some patients will not be adversely affected by waiting for Page 2 of

3 additional equipment or personnel. However, in some critical circumstances time will be of the essence; each Paramedic will make his or her own decision as to whether to attempt an exceptionally heavy lift without extra help. This will depend on the individual's strength and judgment. Many of the tasks performed routinely by Paramedics would be considered exceptional in non-emergency jobs. Many of the exceptional tasks performed by Paramedics cannot be enumerated or assessed since any one of them is unlikely to ever be exactly repeated. An example of this would be the extraction of a person from a car wreck which will involve patient weights rated typical but the work actions will be performed in biomechanically disadvantageous postures. Throughout a call good judgment and promptness are required in order to ensure the patient is kept stable and conditions do not worsen. Tasks must be done quickly and prioritized in order to provide the best care possible. This is especially true in the case of a seriously ill patient. Responsibilities and capabilities of the Paramedic 1 position include: provision of emergency patient care, CPR, patient immobilization, oxygen therapy, basic trauma life support, blood glucose testing, and non-emergency patient care and transportation. They are also able to operate an external defibrillator and administer drugs such as Aspirin, Epinephrine, Glucagon, Gravol, Nitroglycerin, and Salbutamol. When responding to a call, the Paramedics will always transport three pieces of equipment; the Zoll monitor the BLS airway bag and a first aid kit and the stretcher. In the case of a spinal injury the spinal trauma kit (6kg), spinal board (9kg) or scoop stretcher (8.5kg) are also carried on the stretcher. The equipment is typically carried by the Paramedics when returning to the ambulance, however, when possible, the items are placed on the stretcher and pushed. While on route to the hospital, the Paramedic continues treatment and assessment in the patient compartment while the other Paramedic drives. Overhead reach, good balance, and trunk flexibility are required to use first aid equipment stored in cupboards above the patient stretcher. Upon arrival at the hospital, the Paramedics must unload the stretcher with the patient on it and eventually transfer the patient to a hospital gurney using a 'sheet transfer'. A sheet transfer requires the Paramedics to grip the edge of the sheet under the patient and use the sheet to lift (at chest height) and transfer the patient. There is a Paramedic on each side of the patient with a stretcher and a hospital gurney between them. On the count of three, the Paramedics lift and slide the patient from the stretcher onto the gurney. This involves forward flexion of the trunk, forward reaching and push/pull demands. This task has high physical demands (high spinal compression) unless a transfer board is placed under the sheet the patient is on. With the use of a transfer board, demands are significantly lower. Small transfer boards are available in each ambulance and larger boards are sometimes available at hospitals. The job demands of a Paramedic can be unpredictable and uncontrolled, involving awkward lifting postures and reaches. Although lifting requirements are not highly repetitive in nature throughout the 12 hour shift, these lifts can require awkward postures, the loads can vary with patient weight and the lifting conditions such as the weather, temperature, location of the patient and distance to the ambulance may not be ideal. Long periods of sedentary waiting are interspersed with brief, but intense and unpredictable physical activity. The activity demands outlined in this Job Demands Analysis reflect the typical activities encountered daily. They do not reflect the handling of incubators or catastrophic/extreme trauma accidents that are infrequent, but still must be attended to by any given Paramedic. Furthermore, there are occasions when Paramedics Page 3 of

4 are assigned to non-emergency patient transfers which entail similar physical demands, but with less urgency required to complete them. Strength Demands Typical Occ Eff Exceptional Occ Eff Demand Details Lifting Composite 1 M 1 H þ below knuckle Loads kg 1 L þ below knuckle Loads > kg 1 L þ below knuckle Loads > kg 1 M þ below knuckle Loads > kg 1 H þ below knuckle Loads > 30 kg 1 H þ below knuckle above chest Carrying Unilateral T: Lifting of patients and equipment in various configurations; E: Lifting patients who are among the heaviest 20% of the patient population. First aid kit - all levels used above chest inside ambulance shelving Spinal kit - all levels used above chest inside ambulance shelving Zoll monitor; BLS bag; - all levels used above chest inside ambulance shelving T: Raise stretcher to loading height, load stretcher to compartment, handling equipment T: Lift patients; raise stretcher between levels; lifting equipment. Raise stretcher to upper levels with and without patient E: Heavy patients 18% of patients weigh between 0 and 59 kg., 64% weigh between 60 and 89 kg and 18% weigh between 90 and 219 kg. About 0.1% of the patients exceed 220 kg, Above chest may occur infrequently with shorter Paramedics in some situations 1 M T: Avg kg T: Max kg T: Carry equipment bags and other equipment such as the Zoll monitor. E: Avg kg E: Max kg Carrying Bilateral Pushing / Pulling 1 M 1 H T: Avg kg T: Max kg T: Carry equipment bags, Zoll monitor. E: : Half ( paramedics) of lift assist limit 115 kg patient E: Avg kg E: Max kg M 1 H T: Avg kg T: Max kg Push & pull stretcher w/ patient on various terrains; assist patients from supine to sitting, move furniture. E: E: Avg kg E: Max kg 50th percentile male 2.1 m Snook (1991) Gripping 1 M Grips steering wheel, handles of stretcher & equipment bags. Requires precision for gripping scissors and other first aid tools for cutting bandages and gauze. Mobility Demands Typical Exceptional Occ Eff Occ Eff Sitting 3 M Sit in ambulance (front/back) for more than 1 hr with no break. Intermittent standing/walking periods. Limited support/adjustments in seats. Page 4 of

5 Mobility Demands Typical Exceptional Occ Eff Occ Eff Standing 2 L 3 M T: Short periods of standing at a scene or hospital. E: Special duties such as parades and movie sets require longer periods of standing and fewer breaks. Walking 1 M 1 H Walks briskly to a scene, pushes stretcher and carries equipment bags back to the ambulance. E: Walking over various terrains, emergency scenes. Running Jumping Climbing 1 M 1 H In/out of vehicle cab or compartment, stairs in buildings if no elevator while carrying equipment. E: Stairs with stretcher or stair chair carrying patient. Reaching 1 L 1 M Overhead supplies shelves in the back of the ambulance. E: Above Shoulder Unilateral Reaching while vehicle in motion. Above Shoulder Bilateral 1 L 1 M Overhead supplies shelves in the back of the ambulance. E: Reaching while vehicle in motion. Below Shoulder Unilateral 2 L 1 M Horizontal reaches for patient assessment & treatment, to operate radio/cell phone and light/siren controls. E: Reaching frequency increases on busier days. Below Shoulder Bilateral 3 L 1 H Handling steering wheel, loading stretcher with/without patient, assess and treat patients. E: Performing transfer lifts stretcher to hospital bed. Neck Movement 3 M 1 H Side checks while driving (especially when driving quickly), various neck postures when assessing patient. E: Difficult scenes require extreme postures Trunk Twisting 1 M 1 H Twist to assess/treat patient, for patient transfers E: Difficult scenes require extreme postures Bending/Stooping: 2 M 1 H To treat patient on ground or stretcher, in ambulance compartment. Static E: Difficult scenes require extreme postures Dynamic 2 M 1 H Low headroom in back of ambulance when standing and bends to lift stretcher or patient transfers. E: Difficult scenes require extreme postures Crouching/Kneeling 1 M 1 H To assess/treat patient lying or sitting. Can be static if patient requires extensive care. E: Prolonged duration if the patient is trapped or unconscious. Crawling 1 M E: May crawl to access trapped patients or patients in confined spaces. Balancing 1 M Balancing on stairs/slope while carrying/pushing stretcher. Balance is required when treating patient in the ambulance compartment while the vehicle is moving. Computer Input 1 L Computer at hub station to access , complete Ambulance Call Reports and other logs on ambulance computer and on tablet computer. Fine Finger Dexterity 2 M Open supplies, apply BP cuff, stethoscope, bandaging, securing splints and manipulating syringes for injections. Gloves worn, treat in moving ambulance. Cold. Foot Action 3 M Use of foot pedal when driving the ambulance to and from the scene/hospital/station. Shares driving with partner. Flips up back step of ambulance with foot. Sensory Demands Effort Typ Exc Page 5 of

6 Sensory Demands Effort Typ Exc Hearing H Must hear calls from Dispatch on radio. Listens over vehicle noise in or near ambulance. Listen for breathing, HR with stethoscope, & patient's speech. Vision H Movement and depth perception required for maneuvering through traffic at high speeds, day or night. Patient assessment (skin pallor, wounds). Feeling H Tactile assessment of patient to detect injury i.e. pulse strength, skin texture/temperature. Wears surgical gloves. Possible exposure to cold. Speech H Required to communicate with dispatch, the patient, medical staff and possible witnesses with great clarity and urgency. Work Environment Occurrence Demands Typ Exc Outside Work 1 3 Attends to calls where patients may be outdoors. E: Duration may increase for major accidents or complex scenarios. Hot 1 3 Sun exposure if treating patients outside. Rarely in direct proximity to fire. Moves between hot/cool environments when responding to call. E: Major accidents. Cold 1 3 Cold/snow if treating patients outside calls, MVAs, falls on ice. Moves between warm/cold environments to respond to calls. E: Major accidents. Proximity to Moving Objects 1 Equipment at construction sites and moving traffic at call sites including highways. Unstable Footing 1 Occasionally walks on uneven grounds (grass/gravel), slippery, icy roads/stairs/walkways/driveways during calls. Vibration/Jarring: Whole Body 3 Fairly constant low vibration with periods of prolonged driving and jarring when treating patient in back of ambulance when ambulance turns or stops. Hand/Arm 2 Pushing stretcher over uneven grounds and handling of the steering wheel. Driving 3 Drives ambulance to calls. Operates vehicle at high speeds with lights and sirens on for high priority calls. Drives in various weather conditions. Work Alone 3 Paramedic can work alone when operating a response unit. Interact with Public 3 Interacts with patients, family, bystanders, security, police, fire fighters, coroner, homecare, hospital nurses and doctors on a regular basis. Sudden/Unpredictable Movement 2 Treating patient in ambulance when vehicle makes sudden turns/stops. Treat patients who may be violent, or suddenly faint, fall or collapse. Behavioural/Cognitive Demands Demand Intensity Degree of Self-Supervision Required 4 Predominantly self supervised. May contact dispatch or quadrant supervisor if assistance/work direction is needed. Degree of Supervision Exercised 3 With training can act as Field Training Officer w/ student Paramedic (evaluates performance). Time Pressures 4 Rigid time constraints required to reach call scene, assess patient, initiate treatment as needed, and transport to medical facility. Attention to Detail Required 4 Significant attention to detail is required at calls to assess patients, determine treatment plan, prioritize and initiate treatment, entering reports on the computer and for driving. Performance of Multiple Tasks 2 Works with patient, but may simultaneously deal with bystander/allied services/radio communications. Can involve multiple subtasks, or multiple patients. Exposure to Distracting Stimuli 4 Various degrees of distracting stimuli when at scenes. Background noise, crowds of people, panic, and other environmental distractions. Need to Work Cooperatively with Others 4 Work mainly requires close cooperation with his/her partner, allied services and dispatch. (e.g. first aid treatment, report writing, lifting patient) Page 6 of

7 Behavioural/Cognitive Demands Demand Intensity Exposure to Emotional Situations 4 Frequently exposed to emotionally stressful situations or emotionally distressed individuals with whom the Paramedic must interact in order to assess and treat. Exposure to Confrontational Situations 2 Occasionally exposed to confrontational situations, with assistance available from co-worker. (e.g. psychiatric or intoxicated patients) Responsibility and Accountability Required 4 Errors in judgment or attention could have grave or life threatening consequences. (e.g. poor driving or inappropriate treatment) Reading Literacy 4 Some reading is required such as manuals, labels of medications, medical alert bracelets, reports and map directions. Writing Literacy 3 Accurate spelling and grammar required for logs, incident reports, ambulance call reports, and vehicle checklists. Numerical Skills 3 More than basic math required to calculate drug dosing. Communication 4 Required to comprehend and communicate complex medical information to dispatch, family members, the patient and other medical staff. Memory 4 Required to remember detailed patient information & recall medical treatment techniques based on the injury. Computer Literacy 3 Basic computer skills to operate a tablet computer - data entry, s, compose reports. Tools and Equipment Used: Ambulance, Radio system, First Aid supplies and equipment (BP cuff, stethoscope), Zoll monitor, stretcher, Ferno EZ Glide stair chair, spinal board, oxygen tank, suction unit and permitted drugs. Personal Protective Equipment Required: Gloves, surgical mask and/or respirator, safety boots, reflective clothing, helmet and visor (if necessary for fire emergency). In addition, Paramedics, under some conditions, must wear infection control PPE. Paramedics must be inoculated against a variety of infections. Required Training, Certification, Licensing, etc. F class license, College Ambulance & Emergency Care Certificate, AEMCA Certification, CPR, First Aid,, 1 to 2 Continuing Medical Education Sessions s per year. Must also have base hospital certification to provide delegated medical acts and manual defibrillation. JDA History: 13/11/2015 Supt. Jon Lane requested some updating of the JDA for use in recruitment process. Item Lifted Weight (kg) Lift Height Frequency BK KC AC first aid kit 4 X X X Hourly spinal trauma kit 6 X X X Hourly Zoll monitor 11 X X X Hourly BLS bag 15.5 X X X Hourly stretcher 35 X X Hourly patient weights 60 to 89 X X Daily 18% of patients weigh between 0 and 59 kg., 64% weigh between 60 and 89 kg and 18% weigh between 90 and 219 kg. About 0.1% of the patients exceed 220 kg, Item Carried Weight (kg) Unilateral Bilateral Duration Frequency first aid kit 4 X X Moderate Hourly spinal trauma kit 6 X X Moderate Hourly Zoll monitor 11 X X Moderate Hourly BLS bag 15.5 X X Moderate Hourly Page 7 of

8 Item Carried Weight (kg) Unilateral Bilateral Duration Frequency stretcher 35 X Moderate Hourly patient weights 60 to 89 X Moderate Daily See note above. Item Push/Pulled Weight (kg) Push Pull Duration Frequency stretcher 18 Page 8 of

Bock Consulting JOB ANALYSIS

Bock Consulting JOB ANALYSIS JOB ANALYSIS Job Title EMT, EMT IV, Paramedic Worker DOT Number 079.374-010 Claim Number Employer Lifeline Ambulance Employer Phone # 509-322-5859 Employer Contact Wayne Walker Date of Analysis 09/25/08