Musculoskeletal disorders (MSDs), or sprains and strains, pose a substantial challenge to the long-term viability of a healthy, capable paramedic community. Although Canadian data are scant, according to a 2001 report by WorkSafeBC, British Columbia’s workers’ compensation agency, B.C. paramedics lost over 60,560 days of work over a three-year period. And claims costs surpassed $10 million for injuries related to the back and shoulder alone.
Unfortunately we know very little about the physical demands of paramedics’ work, compared to what we know about the work of other emergency responders.
That’s why the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD) and several paramedic services have collaborated on research aimed at mitigating career-threatening injuries for paramedics.
Paramedics across the country are exposed to a number of high demand tasks. However, the frequency and duration of the exposures depend on many factors, including the location of the service. Paramedics in high-density metropolitan areas are required to do physically demanding tasks, such as loading and unloading stretchers from ambulances, nearly twice as often as those in low-density rural areas. Conversely, those in rural areas spend more time roaming in their vehicles or standing by while awaiting calls. While the magnitude of physical exposures varies, in some instances a two-person crew may be required to lift loads that exceed 160 kilograms.
“The challenge for this profession is two-fold,” says Dr. Steven Fischer, assistant professor in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. “Paramedics need to lift heavy loads immediately after spending extended periods in seated sedentary positions. And paramedics also need to lift or reposition patients who may be in very awkward situations, where normal, commonly taught lifting techniques may not be possible.”
With funding support from CRE-MSD, a team consisting of Fischer, Dr. Renée MacPhee, assistant professor at Wilfrid Laurier University’s Kinesiology & Physical Education and Health Sciences, Brendan Coffey, a masters student at Queen's University, and Doug Socha, chief of the Hastings-Quinte Paramedic Services, have developed a unique training package for paramedics. In partnership with Paramedic Chiefs of Canada and the Paramedic Association of Canada, the team has implemented the training in five different sites across the country.
As part of that training package, paramedics are being asked to rigorously and systematically document the physical demands of their own work. This comprehensive physical demands data gathered by paramedics provides baseline knowledge to help guide MSD prevention efforts moving forward. The research team intends to use these data as the basis for an evidence-based physical abilities test for the profession. Researchers are also working together with program co-ordinators at local colleges to help ensure that paramedic candidates have a clear and detailed understanding of the physical demands of the job once they are hired.
Paramedics at the Frontenac Paramedic Service conduct a physical demands assessment, as part of a project aimed at reducing musculoskeletal disorders in the profession. (Photo: Brendan Coffey)
Of course, changing the work environment is critical to injury prevention too. There are a number of ongoing projects aimed at improving the ergonomics of the paramedic workplace. New equipment and technologies - such as powered stretchers for automated stretcher loading and unloading, “kneeling” ambulances that lower the lift height, and motorized stair chairs that reduce total lifting - are among the ongoing changes within the profession.
“New advances in equipment coupled with an opportunity to rethink ‘fitness’ in the paramedic community will likely generate an appreciable decrease in the number of injuries reported,” says Fischer. “However, rethinking fitness will require a significant cultural shift where paramedics are afforded improved access to equipment and coaching in order to effectively improve their occupational athleticism.”
This project is an example of how strengthening partnerships between paramedics and researchers allow paramedics to be directly involved in research planning and implementation. It also contributes to the growth of research culture within the profession, and ensures that evidenced-based research is timely and relevant to inform practice.
Paramedics team up with CRE-MSD to prevent musculoskeletal disorders (PDF)