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Evaluation of paramedics tasks and equipment to control the risk of musculoskeletal injury
1150-20 A1999
(99FS-14)
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Issue: |
Reducing the risk of musculoskeletal injury for paramedics. |
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Agency: |
Ambulance Paramedics of British Columbia CUPE Local 873 |
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Representative: |
Donald Cragg |
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Funding: |
$49,500.00 |
Context: A paramedic’s work environment is often unpredictable. The confined space of the patient compartment, the task requirements, and the configuration of equipment within the patient compartment contribute to the risk of MSI. Currently there is little information regarding design guidance for ambulances and related equipment that is based on prevention of MSI through the application of ergonomic principles.
Objective: To evaluate aspects of the main stretcher and patient compartment of the ambulance that contribute to the risk of musculoskeletal injury for paramedics, to priortize issues and suggest possible solutions, and to evaluate two of the suggested solutions.
Design: The study had three phases. The initial phase, an evaluation of BC Ambulance Service’s (BCAS) ambulance design specifications and work performed by paramedics within the ambulance, included a questionnaire distributed to all BC paramedics, simulations of composite task scenarios, and simulations of individual task components. During the second phase, focus groups were used to prioritize issues and brainstorm possible solutions to the findings from the initial evaluation. The third phase was an evaluation of two potential solutions, the use of a mechanical lift assist (Antboxx) on the main stretcher and redesign and configurations of the jump kits.
Setting: Ambulance stations throughout British Columbia, and the Chilliwack, BC driver-training course.
Subjects: 269 BC paramedics responded to the questionnaire. The simulations, focus groups and solution evaluations involved paramedics from various BC locations and stakeholders from the union, Paramedic Academy and BCAS.
Main Outcome Measures: The questionnaire analysis provided information on discomfort and injury patterns, and perceptions regarding causation of discomfort and injury and the design of the ambulance and stretcher systems. The simulations are summarized relative to specific awkward postures that were commonly observed and implications for injury.
The focus groups prioritized the problem areas and brainstormed solutions.
The evaluation the mechanical lift assists examined the changes in load and force required by the paramedics to lift and lower the stretcher and to load and unload from the ambulance. A cost-benefit analysis was also conducted. The evaluation of jump kit features gathered paramedic opinions on the importance of different kit features.
Results: The questionnaire analysis identified lowering and lifting, pushing over rough terrain and loading into or out of the ambulance as the perceived most physically demanding aspects of using the stretcher. The most physically demanding aspects associated with transporting patients were conducting CPR, accessing patients, and accessing equipment. Paramedics identified the lower and upper back and neck as causing the greatest discomfort and the end of a typical shift, this was consistent with lost-time injury statistics. The task simulations identified ten activities that presented risk to the lower back and the concurrent risk factors and ten activities that presented risk to the upper back or shoulders and the concurrent risk factors.
The focus groups not only gathered information but also raised awareness of musculoskeletal injury prevention. Two priority activities were selected at each focus group to brainstorm solutions. The priority areas differed for focus groups but those selected were: raising and lowering main stretcher, heavy patient on stretcher, load and unload stretcher, sitting in ambulance, bracing during transport, monitoring vitals, ride suspension, accessing cupboards, jump kit too heavy, and changing main oxygen.
Evaluation of the Antboxx, a mechanical assistive device for stretchers, indicated that force levels required by paramedics to lift, lower or load the stretcher were lower that those required using an unassisted stretcher. The cost/benefit analysis showed that payback of the initial expenditure to outfit the stretchers currently used by BCAS with the Antboxx would require a 17% reduction in back injuries. Size, weight and placement of jump kits were determined to be the most important features in relation to reducing risk of MSI.
Conclusion: The project identified numerous risks and potential solutions for consideration. Several solutions have been considered or were in the process of being implemented during the study. The Antboxx appears to present a viable solution to some of the risks associated with the stretcher. However, it is suggested that a pilot project should be conducted to track its efficacy relative to reducing back injuries and to identify training and logistical issues that will need to be addressed if the system is to be successful. Design and access changes to jump kits must target reducing the weight of the kits and improving the body mechanics while lifting or carrying the kits. Novel or alternative jump kit styles should be tested across regions and stations with varying needs to ensure consensus and to allow regional consideration in the selection of a solution.