Back strength and flexibility of EMS providers in practicing prehospital providers

The Effect of Tactical Tasks and Gear on Muscle Activation of SWAT Officers

ABSTRACT

Keeler, JM, Pohl, MB, Bergstrom, HC, Thomas, JM, and Abel, MG. The effect of tactical tasks and gear on muscle activation of SWAT officers. J Strength Cond Res 36(1): 238-244, 2022-Special Weapons and Tactics (SWAT) officers perform a variety of tactical operations while wearing tactical gear. Load carriage has been shown to alter muscle activation in the torso and is also associated with lower back pain, which is a prevalent musculoskeletal injury suffered by SWAT Officers. The purpose of this study was to quantify the effect of tactical gear on muscle activation of torso musculature while performing occupational tasks. Twenty male SWAT Officers (age: 34.7 ± 4.5 years; height: 1.79 ± 0.1 m; body mass: 91.5 ± 17.3 kg) performed 4 tasks (standing, rifle walk, sitting, and shield walk) with and without gear (mass of gear: 13.8 ± 1.9 kg). Mean electromyographic amplitude was evaluated bilaterally for the erector spinae, rectus abdominis, and external oblique muscles during the trials and expressed relative to maximal voluntary isometric contraction (MVIC). Addition of gear significantly increased erector spinae mean muscle activation during the rifle walk task (mean delta: +0.16%). However, no differences in muscle activation were identified for any other muscles between gear conditions (effect size ≤ 0.15). The shield walk produced the highest mean activation for each muscle during different tasks. The dynamic tasks yielded (0.24-4.18% MVIC) greater muscle activation levels than sitting and standing tasks. Despite minimal increases in muscle activation levels with the addition of gear, load carriage is known to increase the risk of acute and chronic injury. Collectively, these findings indicate that SWAT Officers should perform most skills without gear during tactical training to simulate task-specific movement patterns but reduce the risk of musculoskeletal injury.

Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: A comprehensive narrative review

The aim of this article was to review the current knowledge relating to work-related musculoskeletal disorders (WRMDs) and non-fatal injuries in emergency medical technicians and paramedics (EMTs-Ps). A literature search was conducted in PubMed, Google Scholar, and Clinical Key. The annual prevalence of back pain ranged from 30% to 66%, and back injuries and contusions from 4% to 43%. Falls, slips, trips, and overexertion while lifting or carrying patients or instruments ranged from 10% to 56%, with overexertion being the most common injury. Risk factors were predominantly lifting, working in awkward postures, loading patients into the ambulance, and cardiopulmonary resuscitation procedures. Lack of job satisfaction and social support was associated with WRMDs and injuries. EMTs-Ps had the highest rate of worker compensation claim rates compared to other healthcare professionals. Positive ergonomic intervention results included electrically powered stretchers, backboard wheeler, descent control system, and the transfer sling.

Injury-related hospital admission of female firefighters in South Korea

Purpose. The main objective of this study was to ascertain whether injury-related hospital admission in all South Korea female firefighters is greater than that in the general population. Methods. To perform this comparison, the standardized admission ratios (SARs) and their 95% confidence intervals (CIs) were calculated by person-years and mortality computation software. Results. Compared to the general population, the SARs for overall injury (SAR = 1.57, 95% CI [1.24, 1.96]) and for injury to the lower back (SAR = 2.78, 95% CI [1.81, 4.07]) in the female firefighters were significantly higher. The SARs for injury to the knee (SAR = 2.48, 95% CI [1.18, 4.55]) in emergency medical services (EMS) workers were significantly higher than those in the general population. Conclusions. Our study shows that the SARs of overall injury and injury to the lower back in female firefighters and knee injury in the EMS were significantly higher than those in the general population. Further studies are needed to protect the lower back of firefighters and the knees of EMS.

Using Shoulder Straps Decreases Heart Rate Variability and Salivary Cortisol Concentration in Swedish Ambulance Personnel

BACKGROUND

Previous research has shown that paramedics are exposed to risks in the form of injuries to the musculoskeletal system. In addition, there are studies showing that they are also at increased risk of cardiovascular disease, cancer, and psychiatric diseases, which can partly be explained by their constant exposure to stress. The aim of this study is to evaluate whether the use of shoulder straps decreases physical effort in the form of decreased heart rate and cortisol concentration.

METHODS

A stretcher with a dummy was carried by 20 participants for 400 m on two occasions, one with and one without the shoulder straps. Heart rate was monitored continuously and cortisol samples were taken at intervals of 0 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes. Each participant was her or his own control.

RESULTS

A significant decrease in heart rate and cortisol concentration was seen when shoulder straps were used. The median values for men (with shoulder straps) at 0 minutes was 78 bpm/21.1 nmol/L (heart rate/cortisol concentration), at 15 minutes was 85 bpm/16.9 nmol/L, and at 60 minutes was 76 bpm/15.7 nmol/L; for men without shoulder straps, these values were 78 bpm/21.9 nmol/L, 93 bpm/21.9 nmol/L, and 73 bpm/20.5 nmol/L. For women, the values were 85 bpm/23.3 nmol/L, 92 bpm/20.8 nmol/L, and 70 bpm/18.4 nmol/L and 84 bpm/32.4 nmol/L, 100 bpm/32.5 nmol/L, and 75 bpm/25.2 nmol/L, respectively.

CONCLUSION

The use of shoulder straps decreases measurable physical stress and should therefore be implemented when heavy equipment or a stretcher needs to be carried. An easy way to ensure that staff use these or similar lifting aids is to provide them with personalized, well-adapted shoulder straps. Another better option would be to routinely sewn these straps into the staff's personal alarm jackets so they are always in place and ready to be used.

Effects of Pilates and Classical Kinesiotherapy on chronic low back pain: a case study

Abstract Introduction : Chronic low back pain (LBP) is characterized by daily lower back pain lasting more than three consecutive months. It may lead to functional disability and can be treated by several physical therapy techniques, including therapeutic exercise. The aim of this study was to investigate the effects of pilates and classical kinesiotherapy on the treatment of pain and functional disability in patients with chronic low back pain. Materials and methods : The study sample consisted of five patients with a diagnosis of chronic low back pain and a mean age of 32.4 ± 15.6 years. A Visual Analogue Scale (VAS) was used for pain assessment, and the Oswestry Disability Index was used to assess functional disability at the beginning and at the end of the intervention. Patients were divided into two groups and received 20 individual sessions of therapeutic exercise at a frequency of two sessions per week. Group A was treated with classical kinesiotherapy and group B was treated with pilates exercises. Statistical analysis was performed using Wilcoxon's test. The significance level was set at 5%. Results : There was a significant reduction in pain (p = 043) and functional disability (p = 042) in both groups. We found no significant differences between the effects of pilates and classical kinesiotherapy on pain and functional disability. Conclusions : We conclude that, in the population studied here, both pilates and classical kinesiotherapy were effective in treating chronic low back pain symptoms, with no significant difference between them.

Cross-sectional survey on self-reported health of ambulance personnel

Background

The high job stress among ambulance personnel is a widely known phenomenon. Purpose: to asses the self reported health status of ambulance workers.

Methods

An anonym self-fill-in questionnaire applying SF-36 was used among workers from the northern and western regions of Hungarian National Ambulance Service.

Results

Based on the dimensions of the SF-36 questionnaire the respondents considered their “Physical Functioning” the best, while “Vitality” was regarded the worst. The more time an employee have been worked at the HNAS the worse his health was in the first four dimensions like, “Physical Functioning”, “Role-Physical”, “Bodily Pain”, “General Health”: p < 0.001. Those working in secondary part-time jobs considered their health in all dimensions worse. The respondents who did some kind of sports hold their health in all dimensions better (p < 0.001). The workers with higher BMI regarded their health status worse, in four dimensions: “Physical Functioning”: p = 0.001; “Role-Physical”: p = 0.013; “General Health”: p < 0.001; “Role-Emotional”: p = 0.05.

Conclusions

The workers health status proved to be insufficient according to the subjective perception and measurable parameters. According to the subjective perception of health and measurable parameters of health status of workers proved to be insufficient. Poor physical health can lead indirectly to psychological problems, which may lower the quality of the work and can lead to high turn-over.

Paramedics on the job: dynamic trunk motion assessment at the workplace

Many paramedics' work accidents are related to physical aspects of the job, and the most affected body part is the low back. This study documents the trunk motion exposure of paramedics on the job. Nine paramedics were observed over 12 shifts (120 h). Trunk postures were recorded with the computer-assisted CUELA measurement system worn on the back like a knapsack. Average duration of an emergency call was 23.5 min. Sagittal trunk flexion of >40° and twisting rotation of >24° were observed in 21% and 17% of time-sampled postures. Medical care on the scene (44% of total time) involved prolonged flexed and twisted postures (∼ 10s). The highest extreme sagittal trunk flexion (63°) and twisting rotation (40°) were observed during lifting activities, which lasted 2% of the total time. Paramedics adopted trunk motions that may significantly increase the risk of low back disorders during medical care and patient-handling activities.

The association of aerobic fitness with injuries in the fire service

The aim of the present study was to understand the risk of injury in relation to fitness in a retrospective occupational cohort of firefighters in Tucson, Arizona, from 2005 to 2009. Annual medical evaluations and injury surveillance data were linked to compare levels of aerobic fitness in injured employees with those in noninjured employees. The individual outcomes evaluated included all injuries, exercise-related injuries, and sprains and strains. Time-to-event analyses were conducted to determine the association between levels of fitness and injury likelihood. Fitness, defined by relative aerobic capacity (Vo2max), was associated with injury risk. Persons in the lowest fitness level category (Vo2max <43 mL/kg/minute) were 2.2 times more likely (95% confidence interval: 1.72, 2.88) to sustain injury than were those in the highest fitness level category (Vo2max >48 mL/kg/minute). Those with a Vo2max between 43 and 48 mL/kg/minute were 1.38 times (95% confidence interval: 1.06, 1.78) more likely to incur injury. Hazard ratios were found to be greater for sprains and strains. Our results suggest that improving relative aerobic capacity by 1 metabolic equivalent of task (approximately 3.5 mL/kg/minute) reduces the risk of any injury by 14%. These findings illustrate the importance of fitness in reducing the risk of injury in physically demanding occupations, such as the fire service, and support the need to provide dedicated resources for structured fitness programming and the promotion of injury prevention strategies to people in those fields.

[Health survey of ambulance workers with a generic questionnaire (SF-36)]

INTRODUCTION

The high work-related stress among ambulance workers is a widely known a phenomenon.

AIM

The aim of the authors was to asses self-reported health status of ambulance workers.

METHOD

An anonym self-fill-in questionnaire applying SF-36 was used among workers from the northern and western regions of Hungarian National Ambulance Service.

RESULTS

Based on the dimensions of the SF-36 questionnaire the responders considered their "Physical Functioning" the best, while "Vitality" was regarded the worst. The more time an employee have been worked at the Ambulance Service the worse his health was in the first four dimensions including "Physical Functioning", "Role-Physical", "Bodily Pain" and "General Health": p<0.001. Those working in part-time jobs considered their health in all dimensions worse. The respondents who did some kind of sports hold their health in all dimensions better (p<0.001). The workers with higher body mass index regarded their health status worse, in four dimensions: "Physical Functioning" (p = 0.001), "Role-Physical" (p = 0.013), "General Health" (p<0.001) and "Role-Emotional" (p = 0.05).

CONCLUSIONS

According to the subjective perception of health and measurable parameters of health status of workers proved to be insufficient. Poor physical health can lead indirectly to psychological problems, which may lower the quality of the work and can lead to high turn-over. .

Fitness characteristics of a suburban special weapons and tactics team

Special Weapons and Tactics (SWAT) operators are specialized law enforcement officers who traditionally perform their duties with higher anticipated workloads because of additional body armor, weapons, and equipment used for enhanced operations and protection. This elevated workload increases the need for SWAT operators to improve or maintain their physical fitness to consistently perform routine operations. Typical tasks require trunk rotation, overhead upper extremity use, upper and lower body strength use, and long waiting periods followed by explosive movements while wearing additional equipment. Eleven male SWAT operators from 1 SWAT team performed flexibility, strength, power, and aerobic capacity tests and a variety of job-related tasks. Data were compared with age- and gender-based normative data. Fitness testing revealed that officers ranked high on tests of muscular strength (leg strength, 90th percentile; bench press, 85th percentile); however, body composition (55th percentile), core body strength, and flexibility ranked lower. Furthermore, aerobic capacity and muscular power had a wide range of scores and were also not ideal to support maximal performance during routine operations. These data can assist exercise specialists choose fitness programs specifically for job-related tasks of SWAT operators when creating fitness programs. Fitness programming for law enforcement should focus on improving aerobic fitness, flexibility, core strength, and muscular power while maintaining muscular strength to meet the needs of these specialized officers.

Reducing lost workdays after work-related injuries: the utilization of athletic trainers in a health system transitional work program

OBJECTIVE

To determine if an internal employee health program (IEHP), including transitional work, with early access to physical medicine and rehabilitation provided by athletic trainers, will reduce missed workdays following work-related injury.

METHODS

A retrospective review of health system workers' compensation data were conducted for injuries sustained 23-month period preceding (PP) (N = 713) and following IEHP implementation (N = 661).

RESULTS

Sixty-two PP and 128 IEHP events resulted in lost workdays (LWDs), P < 0.001. For LWDs events, mean days lost decreased from 100.3 ± 119.7 PP to 44.6 ± 69.0 IEHP, P = 0.001, with 2.2 (95% confidence interval [CI]: 1.1-4.2) IEHP 3-week odds of returning to work.

CONCLUSIONS

Internal employee health program reduced LWDs. Internal employee health program was associated with more than 10% increase in LWDs events, but LWDs event mean days lost decreased by more than 50%, with 3-week odds of returning to work more than 2.0.

Major contributing factors of self perceived health in Hungarian ambulance personnel

A mentődolgozók egészségi állapota önmagában is befolyásolja a betegellátás minőségét. Magyarország egyes régióiban végzett felmérések ugyan rendelkezésre állnak a mentődolgozók egészségi állapotával összefüggő szokásaikról, azonban ezek nem az egészségi állapot dimenzióinak komplexitásával készültek. A jelenlegi tanulmány célja, hogy bemutassa a mentődolgozók észlelt egészségi állapotával összefüggő jelentősebb munkahelyi és egyéni faktorokat. Módszerek: Keresztmetszeti vizsgálat készült az Országos Mentőszolgálat dolgozói körében 2008-ban. A vizsgálatban a mentőszervezet valamennyi régiója részt vett, ezért a minta jó reprezentatív értékkel bír. A dolgozók közül 364 fő válaszai voltak értékelhetők. Adatfelvétel, -rögzítés és -kódolás után leíró adatbemutatás és Spearman-, χ2-teszt és logisztikus regressziós elemzés történt az SPSS 15.0 szoftverrel. A vizsgálat önkitöltős kérdőívvel készült, amely az észlelt egészségi állapot alábbi fő dimenzióit mérte: egészségi állapot önértékelése, fizikai fittségi állapot önértékelése, napi munkavégzésben akadályozó egészségi problémák. Eredmények: Az eredmények rámutatnak arra, hogy a mentődolgozók észlelt egészségi állapota szignifikánsan nem különbözik az ellátóegység-típusok szerint a legtöbb vizsgált paraméterben, jóllehet az általuk ellátott esetek különböző összetettségűek. Az egészségi állapotuk önértékelésében 1,9-szer (95% CI: 1,2–2,8), a fizikai fittségi állapotuk önértékelését illetően 2-szer (95% CI: 1,3–3) és a mindennapokban jelentkező munkájukat befolyásoló egészségi problémájukat illetően 1,9-szer (95% CI: 1,2–3,1) kedvezőbben élik meg azok a dolgozók, akik valamilyen sportot űznek. Általánosságban elmondható, hogy komoly stressz éri őket, alig van szabadidejük, és kevés rekreációs fizikai aktivitást végeznek. A kedvezőtlen életmódjukból következően a kóros elhízás minden ötödik dolgozónál megjelenik. Következtetések: A fizikai aktivitás képes az egészségi állapotot még akkor is pozitívan befolyásolni, ha már bizonyos panaszok jelen vannak. Rendszeres testmozgást, mely növeli a fizikai fittséget, minden mentődolgozónak végezni kellene, s ez jelentős mértékben javítaná az észlelt egészségi állapotot. Orv. Hetil., 2010, 151, 2089–2098.

Sleep quality and fatigue among prehospital providers

BACKGROUND

Fatigue is common among medical professionals and has been linked to poor performance and medical error. Objective. To characterize sleep quality and its association with severe fatigue in emergency medical services (EMS) providers.

METHODS

We studied a convenience sample of EMS providers who completed three surveys: the Pittsburgh Sleep Quality Index (PSQI), the Chalder Fatigue Questionnaire (CFQ), and a demographic survey. We used established measures to examine survey psychometrics and performed t-tests, analysis of variance (ANOVA), and chi-square tests to identify differences in PSQI and CFQ scores.

RESULTS

One hundred nineteen surveys were completed. The eight-hour shift was most commonly reported (35.4%). A majority of subjects were overweight (41.9%) or obese (42.7%), and 59.6% had been diagnosed with one or more health conditions (e.g., diabetes). Results from psychometric tests were positive. The mean (+/- standard deviation) PSQI score was 9.2 (+/- 3.7). A CFQ score > or =4, indicating severe mental and physical fatigue, was present in 44.5% of the subjects. The mean PSQI score was higher among those reporting severe fatigue (11.3 +/- 3.2) than among those not reporting fatigue (7.5 +/- 3.0, p < 0.0001).

CONCLUSIONS

The results from this study suggest that the sleep quality and fatigue status of EMS workers are at unhealthy levels. The health and safety of the EMS worker and patient population should be considered in light of these results.

Comparison of public safety provider injury rates

INTRODUCTION

During normal operations, public safety personnel may become injured, leading them to seek medical care and possible time off. Examining the nature and patterns of injury may help to identify preventive health measures for all public safety personnel and address specific needs of each discipline based on actual risk. Objective. To determine the types and severity of injuries encountered by public safety personnel during routine work conditions within a single urban population.

METHODS

De-identified workers' compensation data for emergency medical services (EMS), fire, and police providers from one urban center between January 1, 2005, and May 31, 2007, were examined. Data included type of injury, severity of injury, and date of event. Severity was categorized as follows: lost time (type 1), medical evaluation (type 2), report only (type 3), restricted duty (type 4), and not reported (type 5). Analysis of variance (ANOVA) and a pairwise t-test between groups with a Bonferroni correction was performed to determine the relative risk of injuries between groups.

RESULTS

During the 29-month interval, an average workforce of 850 firefighters, 194 EMS providers, and 850 police officers were employed. A total of 1,295 workers' compensation events were documented, with 243 (18%) reported from EMS, 477 (36%) from fire, and 608 (46%) from police. Type 1 injuries were more common in fire (39%) and police (38%) than EMS (23%). EMS had higher rates of lost work (type 1) and medical evaluations (type 2) than both fire and police. Workers' compensation events common to all bureaus were minor trauma (76%) and exposures to blood-borne pathogens (12%). Minor traumatic injuries, mostly associated with axial musculoskeletal strains and extremity injuries, were responsible for the majority of injuries resulting in missed work. Injuries more common in a specific bureau included motor vehicle crashes and gunshot wounds (police) and cardiovascular disease, burns, and heat illness (fire).

CONCLUSION

Public safety personnel are affected by both profession-specific and non-profession-specific injuries. Overall, EMS has higher rates of missed time and medical evaluations than both fire and police. These data highlight the need to make direct comparisons of various public safety personnel bureaus using a common time interval and locale in order to rationally plan interventions and apply resources.

Back problems among emergency medical services professionals: the LEADS health and wellness follow-up study

OBJECTIVE

Describe work-life and demographic characteristics associated with reporting recent back pain, and estimate back pain severity among Emergency Medical Services (EMS) professionals.

METHODS

A 58-item postal questionnaire was used to collect relevant health and wellness information from a national sample of EMS professionals. The outcome variables were self-reported pain in the back or legs, and severity of recent back pain as indicated by the Aberdeen Back Pain Scale (ABPS).

RESULTS

There were 470/930 (50.5%) participants who reported one or more days of pain in the back or legs over a 2-week period. The variables most strongly associated with recent back pain and pain severity were prior back problems, self-reported health, and job satisfaction.

CONCLUSION

This study indicated that work-life, health, and demographic characteristics of EMS professionals were associated with reporting recent back pain.

Physiological responses during graded treadmill exercise in chemical-resistant personal protective equipment

BACKGROUND

As the likelihood of terrorist acts increases, prehospital personnel have been forced to train in the proper use of chemical-resistant personal protective equipment (PPE). This protective ensemble has been reported to be physiologically taxing for the wearer, imposing an additional thermal load resulting in hypohydration, hyperthermia, and reduced work time. Victim extrication, the rescue-the-rescuer role of the rapid intervention team and rapid self-extrication, typically requires high-intensity work that can be maintained only for short time intervals. The additional physiological burden imparted by the level C PPE during high-intensity work is unknown.

OBJECTIVE

We hypothesized that the added thermal burden resulting from work in PPE would shorten work time and result in a higher core temperature during incremental treadmill exercise.

METHOD

In this prospective, crossover, laboratory study, EMS providers (n = 8, 5 male) completed a Bruce treadmill test on two occasions: once in a chemical-resistant coverall and air-purifying respirator (PPE) and once in shorts and t-shirt (CON). Oxygen consumption, vital signs, core and skin temperature, and perceptual measures of exertion, thermal sensation, and comfort were monitored throughout the test.

RESULTS

Subjects achieved maximal oxygen consumption and more than 90% of age-predicted maximum heart rate in both conditions. Heart rate, skin temperature, and measures of perceived exertion, comfort, and thermal sensation increased during the treadmill exercise but did not differ between the PPE and CON conditions. Core temperature increased in both the CON and PPE conditions (0.8 +/- 0.5 vs. 0.7 +/- 0.3, p = 0.40).

CONCLUSION

High-intensity work in level C PPE is primarily limited by cardiovascular capacity. The thermal burden associated with this short bout of work in PPE (approximately 10 minutes) is not different than high-intensity work in short pants and cotton t-shirt. Consideration should be given to cardiorespiratory fitness when assigning providers to work in chemical-resistant PPE, especially on tasks that require high-intensity work.

On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals

BACKGROUND

The objective of this study was to estimate the prevalence and incidence of job-related illness or injury resulting in lost work time among a national cohort of Emergency Medical Services (EMS) professionals. Also, it was hypothesized that individual and work life characteristics were associated with the occurrence of illnesses or injury.

METHODS

Data for this analysis were obtained from the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS), a prospective study of EMS professionals. The outcome variable of interest was self-reported absence from their EMS job due to an EMS work related illness or injury. The prevalence and incidence of injury with lost work time was estimated using cross-sectional and follow-up data. Multivariable logistic regression analyses were performed to determine if individual and work life characteristics were associated with occupational injury.

RESULTS

The prevalence of job-related illness or injury with time away from work was estimated at 9.4%, while the 1-year incidence was estimated at 8.1 per 100 EMS providers. The results from the logistic regression model fit to follow-up data indicate that increasing call volume (OR=3.12 for very high vs. moderate, 95% CI 1.40-6.97), an urban work environment (OR=2.79, 95% CI 1.65-4.72) and a history of back problems (OR=1.72, 95% CI 1.06-2.78) were associated with reporting job-related illness or injury.

CONCLUSIONS

Results from this analysis provide estimates of the prevalence and incidence of on the job illness and injury resulting in lost work time among a national cohort of EMS professionals.

Queixas osteomusculares relacionadas ao trabalho relatadas por mulheres de centro de ressocialização

Considerando as queixas de origem laboral um problema de saúde pública, objetivou-se, com o presente estudo, analisar a freqüência da população que refere queixas osteomusculares e a associação de ocorrência e severidade destas às variáveis antropométricas e de trabalho. Tomou-se 146 mulheres de um centro de ressocialização feminino, que responderam a um questionário validado contendo informações sobre dados antropométricos e queixas osteomusculares relacionadas ao trabalho. O estudo da associação entre e dentro das variáveis foi feito pelo teste de Goodman. Observou-se elevada freqüência de ocorrência de queixas após início de atividade laboral (94,19%). As participantes com necessidade de afastamento apresentaram maiores valores em idade e peso. Queixa acentuada foi mais referida na coluna do tronco. Afastamento foi mais referido para as que trabalhavam há mais tempo. Concluiu-se que é alta a freqüência de queixas relacionadas ao trabalho e que há associação entre maiores valores de peso e de estatura e nível de severidade acentuado; maiores valores de idade e de peso e necessidade de afastamento; níveis acentuados de queixas e região da coluna e entre maior tempo de serviço e necessidade de afastamento.

Factors associated with back problems among emergency medical technicians

INTRODUCTION

Back problems are a common complaint among emergency medical technicians (EMTs). It is hypothesized that the likelihood of reporting back problems will be associated with the individual and work-related characteristics of a national sample of EMTs.

METHODS

A case-control analysis was performed on 579 EMTs wherein cases were the 104 subjects who reported new back problems in 2004. Controls were 475 subjects who reported no back problems in 2003 and 2004.

RESULTS

EMTs dissatisfied with their current assignment were significantly more likely to report back problems (OR = 9.33; 95% CI = 3.04-28.67), as were EMTs reporting good or fair fitness when compared to excellent fitness (OR = 3.39; 95% CI = 1.54-7.45, OR = 3.43; 95% CI = 1.37-8.56).

CONCLUSIONS

Results from this analysis suggest that there are two modifiable factors associated with self-reported back problems among EMTs, satisfaction with current assignment and self-reported physical fitness.

Health status in the ambulance services: a systematic review

Background

Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services.

Methods

We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group.

Results

Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population.

Conclusion

Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research.

Perceived effort and low back pain in non-emergency ambulance workers: implications for rehabilitation

INTRODUCTION

This study aims to explore factors associated with low back pain (LBP) that required treatment from health care provider among non-emergency ambulance transfer workers.

METHOD

A cross-sectional study was conducted to 38 workers of a major hospital in Hong Kong. The influences of four categories of risk factors (personal, physical, psychosocial, and exposure factors) in the prevalence of LBP were investigated by objective measurement and self-reported questionnaires. A modified Nordic musculoskeletal symptoms survey and sick leave record were used to document the prevalence of LBP. Univariate analyses followed by multiple logistic regression analyses were used to explore the risk factors associated with LBP cases.

RESULTS

The results revealed that LBP was associated with age (OR=0.75, CI=0.56-1.00, P < 0.05), perceived effort (OR=7.95, CI=1.46-43.27, P < 0.05), job satisfaction (OR=4.18 CI=1.42-12.33, P < 0.01), and flexor peak torque at 120 degrees /s (OR=1.09 CI= 0.99-1.19, P=0.07).

CONCLUSION

This study suggests that workers' perceived exertion has an valuable role in assessing risk at this workplace. A high perceived exertion at work can signal the need for work adjustment or modification to avoid progression of low back disorder to persistent pain or intense pain. The effects of work adjustment or modification in affected workers needs to be systematically investigated.