Showing posts with label back_injury. Show all posts
Showing posts with label back_injury. Show all posts

Tuesday, November 26, 2013

Back Injury Basics, Apathy & Education


Back Injury Basics
Apathy & Education
By Alan Perry
November 26, 2013


Spinal immobilization is a basic EMS skill that every provider should be intimately familiar with. The skill is part of most State EMT tests, as well as the National Registry practical exam.  Motor vehicle accidents (MVA’s) are responsible for the majority of back and spinal cord injuries[i].  MVA’s present unique challenges for extrication of patients while maintaining some degree of immobilization to protect the spine and spinal cord from further injury. Traumatic spinal cord injuries occur at a rate of 12,000-20,000 per year[ii]. The efficacy of spinal immobilization is debated and currently being investigated, some have even suggested that in the case of patient extractions from MVA’s it would be better for the patient to remove themselves with only a c-collar to prevent unnecessary spinal manipulation[iii].

Providers must make several decisions when confronted with a MVA patient complaining of back pain. First, consider the Urgency; is the patient’s condition critical? Will they suffer additional harm if not removed and treated immediately, such as for a major bleed? Are they in immediate danger from fire or drowning?  If the answer is yes, then spinal immobilization concerns become secondary and the patient must be removed in the most expedient way possible until immediate life threats are resolved (if they ever can be). Then choose your method; if the patient’s condition and environment are stable then you have to decide what method is best, in most places this will be determined for you by local protocol, in a few places it is left to technician discretion. Most localities have the option of using a regular long backboard (LBB) and short board or Kendrick style extrication device (KED) as their primary tools.

We are taught that with a stable patient and stable environment (the majority of MVA’s), that the KED is the most effective way to remove a patient from an automobile that has only minor damage[iv].  All too frequently this tool is left disheveled in the back of the backboard compartment in favor of the more expedient and less time consuming trauma roll onto a LBB. Why is this? I suspect a number of factors are in play; education & training, expectations & communication, laziness and complacency, leadership, and especially in the fire service, culture. While the academic world debates the efficacy of the procedure, it is important to note that the textbooks, protocols and certification processes still define what our standard of care should be.

Can you tell where I’m going with this? I’m not worried much about what a lawyer thinks about my patient care because everything I do for my patients is based on what is best for that patient and the current standard of care that I am expected to provide. This includes routine use of a KED when indicated. Can you say the same thing about your patient care? Where you even aware this might be a problem? Think of it this way; do you want to be responsible for causing a catastrophic spinal injury to a patient that otherwise might have walked home from the hospital just to save some time or because you forgot how to use the KED? When was the last time you trained with it? When was the last time you suggested using it?

The KED is but one tool of many that may be used to manage a back-injured patient. MVA’s cause the most spinal injuries, and the KED is uniquely useful in removing seated patients from automobiles which explains why it is the standard of care for these patients. Many of the tools on the medic or engine are designed for a specific purpose, the KED is no different. Take advantage of the tools you have, your correct use of the KED could make a huge difference in your patients’ outcome.

Be Safe,
Alan








[i] Mayo Clinic Website article on spinal cord injury

[ii] CDC website, statistics for spine injury

[iii] NIH study on backbording MVA patients

[iv] Limmer, O’Keefe; Emergency Care, 10th edition; Pearson Education, Inc. Upper Saddle River, NJ 07458

Sunday, June 2, 2013

Reducing lifting and moving injuries


I wrote this proposal in 2008, in an attempt to get my department motivated to reduce back injuries among my co-workers. The department will be getting powered stretchers and loaders this year, better late than never. The arguments used in this document to substantiate the need for powered cots are all still relevant and can serve as a starting point for putting together your own proposal or grant request.

Reducing Firefighter Injuries Related to Patient Lifting and Moving
Alan Perry -784 5/7/2008

PURPOSE

This proposal advocates the purchase of improved patient lifting and moving equipment for the Fire Department. This equipment will prevent or reduce work related injury, disability, monetary and human cost associated with injuries in the  Fire Department.

SUMMARY

This proposal shall demonstrate the need for improved equipment through analysis of internal and external injury patterns for firefighters and EMS personnel. Carefully identify a means for preventing or reducing the incidence of injuries related to lifting and moving patients. Thoughtfully suggest specific equipment which will accomplish the task, and examine potential funding sources to facilitate procurement of improved equipment.

INTRODUCTION

Last year in the State of Virginia over five hundred firefighters, emergency medical technicians, and paramedics were injured on the job at a cost to the state and employers of over $3,216,608.00[1]. Lifting related injuries accounted for over 10% of all injuries and involved the back, hips, knees, and ankles. In our department we currently have five employees out on long term workers compensation injuries, and five on restricted or light duty due to injuries[2]. Over the last five years this department had 20 reportable workers’ compensation claims directly related to lifting and moving patients at a cost of $53,056[3].

The human and monetary cost of work related injuries among fire and EMS personnel is great. According to the Journal of Emergency Medical Services “at any given time, almost 10% of emergency medical technicians and paramedics miss work because of injury and illness they suffered on the job”, and “far exceeds the national average of 1.3%”[4]. A large number of these injuries are related to lifting and moving patients. According to OSHA 25% of all compensation claims involve back injuries[5]. OSHA recommends engineering controls including reduction of weight lifted and use of mechanical aids such as lifts, and acknowledges that frequency and fatigue play a role². Our department is currently relying on equipment and technology for lifting and moving patients that is over forty years old and provides no mechanical assistance. Medical responses have increased and the total number of lifting and moving operations per shift has increased by nearly 20% over the last 5 years[6]. There is an obvious cost to the department in lost productivity, injury claims and permanent disability.

Not only are employees being injured, patients also become injured as a result of falls when stretcher or moving operations go bad. The use of outdated equipment and poor body mechanics makes the process of controlling patient movement down stairs, across fields, through cramped quarters difficult and dangerous for both patient and provider.

New products have become available that can significantly reduce the number of injuries by reducing fatigue, poor body mechanics, and repetitive heavy lifting. Powered stretchers on the market virtually eliminate having to dead-lift patients from a squatting position. Considering the average weight of a patient and the rated capacity of some stretchers of 700lbs. that can result in several thousand pounds of weight the crew will not have to lift in a single shift.

The stair-chair utilized on most transport units is simply inadequate for most patients even in ideal circumstances. It forces the crew to carry a patient down a flight of stairs in a hunched over position, with one crew member carrying nearly the entire weight of the patient at times. New equipment is available that has a tracked belt allowing almost all of the weight to smoothly be transferred to the staircase resulting in a much more comfortable and safe move for both the patient and crew.

A common sense solution to reduce accidents, injuries, and disabilities among both employees and patients is available. The amount of data supporting its use is compelling. The benefit to the employee, the city and the customer are obvious.



PROPOSAL

Purchase twelve new Stryker Power-PRO XT stretchers with three stage IV poles, backrest storage, wheel locks, battery charger, and rear oxygen tank mounts.

Our city has used Stryker products for many years and has been satisfied with both the quality and durability of the products they offer. Our existing cot restraining devices will work with these stretchers requiring no additional modification to our units. The Stryker product has been extensively tested and evaluated with positive results from many other departments with demonstrated reduction in injuries from over 50% to 100% and reduction in patient drop rates of up to 90%[8].

Purchase 9 new Stryker Stair-PRO stair chairs

Our city has three of these units in service and everyone who has used them has been impressed with the ease and safety of patient movement with this device. Studies have found that it can reduce both compressive and shear forces on the spine significantly. Actual use by other agencies has shown reductions of up to 100% in injuries sustained while moving patients down stairs[9].

BUDGET

The cost break down for these equipment upgrades including cost for additional options we typically use, the extended amounts and total expenditure required. It does not take into account any volume or municipal discounts we may have available to us. There are several options for funding this project; a Rescue Squad Assistance fund 50/50 grant is the most likely source at this time. The state should fund half of the cost, and if the city council approves, the city will pay half. Please take into account the savings to the city in reduced injury claims, missed time from work due to injuries, and decreased general liability associated with moving patients. The projected cost to the city in the first year is minimal, and savings throughout the life of the equipment is enormous.

The figures used below to illustrate potential direct costs savings to the city and make the following assumptions;
  1. Even though 80% of calls involve some type of patient or patient movement we will only be able to realize a 50% reduction in injuries related to lifting
  2. worker compensation cost directly related to lifting and moving patients will only be reduced by 50%
  3. Injury costs will not increase over time
  4. No discounts will be given on equipment purchases

 CONCLUSION

The City of Chesapeake has the opportunity to reduce injuries to both its employees and its citizens while also cutting cost associated with treating these injuries. The potential exists to prevent life-altering injuries by making a small investment in improved equipment. The potential monetary savings are significant, and the savings in human suffering, lost wages and disability are not measurable. Even in poor economic times this proposal makes sense. It will save money, reduce related cost associated with filling empty positions, reduce liability exposure. It will enhance the city’s professional appearance and let the employees know that they are valuable.



Appendix

Injury statistics

Virginia workers’ compensation commission 2007 annual report

Emily Caldwell, The Ohio State University, Journal of Emergency Medicine article Emergency Responders at High Risk for Work-Related Injuries, Illness. http://www.jems.com/news_and_articles/news/High_Risk_for_Injuries_and_Illness.html


U.S. Department of Labor, Occupational Safety & Health Administration, Fact sheets, OSHA 93-09 1/1/1993, Back Injuries-Nations number one workplace safety problem


Manufacturers web links:

Stryker Power-PRO PDF
http://www.ems.stryker.com/pp-mini-site/powerpro.html

Stryker saving statement PDF
http://www.ems.stryker.com/powertosave/

Stryker risk reduction studies PDF





[1] Virginia Workers Compensation Commission annual report for 2007
[2] Per Telestaff 5/7/08
[3] Richard Strouse, City of Chesapeake risk management office
[4]Emily Caldwell, The Ohio State University, Journal of Emergency Medical Services, 1/7/2008 Emergency responders at risk for work-related injuries, illness.
[5] U.S. Department of Labor, Occupational Safety & Health Administration Fact Sheet OSHA 93-09
[6] Chesapeake fire department call statistics 2002 (15136) -2007(17992)
[8] Rockingham County, North Carolina case study 2005-2006 Stryker EMS equipment
[9] Charleston County, South Carolina case study 2003-2005 Stryker EMS equipment