Biomechanical risk assessment during field loading of hydraulic stretchers into ambulances

The process of loading a stretcher into an ambulance is known to cause a high incidence of back injuries among paramedics. This study aimed to assess the forces at L5/S1 during real-life stretcher loading activities and to determine the variables that contribute significantly to these forces. Analyses involved 58 paramedics (111 shifts) and 175 stretcher loading activities. Estimates of compression and shear forces at L5/S1 were calculated using the 3DSSPP program. Seventy-one percent of loading activities exceeded the safe loading level of 3.4 kN compression force at L5/S1 (mean: 3.9 kN, min–max: 2.1–7.0 kN). About 92% of the variance can be predicted from a combination of several variables, notably hand load (mean: 0.72 kN/number of paramedics) and back sagittal flexion (mean: 32°). Recommendations to reduce the risk of back injuries are proposed with regard to stretcher and ambulance loading design as well as training in stretcher lifting for paramedics.Relevance to the industryThe results of this study suggest that ambulance stretcher manufacturers should make ergonomic design changes to reduce the physical strain on paramedics’ backs during the process of loading a stretcher into an ambulance. Other preventive measures (e.g., training) must be formulated and applied to reduce the risk of back musculoskeletal disorders during the loading of stretcher patients. For instance, training should focus on back posture, teamwork and equipment/patient positioning on stretchers.     

Injury risk associated with physical demands and school environment characteristics among a cohort of custodial workers

Few epidemiological studies have investigated the relationship between work exposures and injury risk among custodians. The relationship between injury risk and occupational physical demands (e.g. pushing/pulling, lifting) and school environment characteristics (e.g. school type, season) was investigated among a cohort of 581 school custodians over a 4-year period. In the final Poisson regression models, the risk of injury was associated with time spent in pushing/pulling tasks in a dose-response manner increasing to a five-fold risk among the highest quartile of exposure (risk ratio?=?5.15, 95% CI 1.00, 26.5). Injury risk was also associated with working during the school year compared to the summer, working in a school with grass vs. gravel grounds and working in a school with detached classrooms. Results help to target interventions such as alternative methods for floor cleaning to reduce the pushing/pulling demands of custodial work and to support decisions for alternatives to detached classrooms and grass surfaces. Statement of Relevance: This study examines ergonomic factors (physical demand exposures, school environment characteristics) associated with injury risk among custodial school workers. The findings help schools to target interventions to reduce the physical demands associated with injuries and to design school environments to reduce exposures.     

Ergonomic evaluation of the ambulance interior to reduce paramedic discomfort and posture stress

OBJECTIVE: This study aims to evaluate safety and accessibility of an advanced life support (ALS) ambulance interior. BACKGROUND: The standard ambulance's interior design is unsatisfactory based on perceived discomfort and postures that constrain paramedics and medical staff, resulting in unsafe treatment of patients, mainly when being transported. METHODS: Two procedures were used to evaluate performance during a wide range of rescue tasks: a survey, based on questionnaires, interviews, and observation of paramedics performing routine tasks; and upper body and back posture analysis, based on postural considerations. RESULTS: Findings revealed that 74% of the paramedics stated that the location of the paramedic's seat is inefficient while they perform clinical procedures; 94% found the bench uncomfortable; 77% felt that the vertical distance between the bench and the stretcher is too far; and 86% needed to steady themselves when the vehicle was moving. Posture analysis showed that paramedics undergo several nonneutral back postures, including twisted back (>20 degrees) and sitting with back flexion between 20 degrees and 45 degrees. CONCLUSION: Because the interior of the ALS ambulance was found to be unsatisfactory both to paramedics and patients, alternative design issues are proposed. APPLICATION: The suggested practical layout contains four main modifications: (a) replacing the bench with two adjustable paramedic seats, (b) redesigning the medical cabinet for easy access, (c) adding an adjustable folding seat opposite the two new seats, and (d) adding a swiveling base and lifting apparatus that will accommodate the stretcher and enable better accessibility to patients by the paramedic personnel.     

Reviewing ambulance design for clinical efficiency and paramedic safety

This study aimed to review the layout of the patient compartment in a UK ambulance for paramedic efficiency and safety using: (1) link analysis; (2) postural analysis. Paramedics were observed over 16 shifts (130 h) carrying out a range of clinical tasks. The most frequently occurring clinical tasks were checking blood oxygen saturation, oxygen administration, monitoring the heart and checking blood pressure. Access to the equipment and consumables to support these tasks had been designed for the attendant seat (head end of the stretcher), however, a link analysis found that paramedics preferred to sit along side the stretcher which resulted in increased reach distances. The higher frequency tasks were found to include over 40% of working postures which required corrective measures. It was concluded that future ambulance design should be based on an ergonomics analysis (including link analysis and postural analysis) of clinical activities.     

Muscular capabilities and workload of flight attendants for pushing and pulling trolleys aboard aircraft

Increasingly in the recent years, passengers’ services are extended into the ascent and descent flight phases on short distance flights. Trolleys containing the required meal and beverage items are used for these service operations and pushed or pulled along the aisles of the aircraft. Flight attendants reported about increased musculo-skeletal disorders and had been complaining about high physical workload from handling trolleys. In order to ensure acceptable load levels for pushing or pulling operations of trolleys, the physical capabilities of the collective “flight attendants” had been investigated by means of force measurements at maximum voluntary contraction (MVC) level and associated relevant anthropometrical and biometrical data. CEN and ISO standards as well as international and national German methods were used to derive recommended force limits for pushing/pulling operations with respect to the physical capabilities of the target group “flight attendants”. Comparing these recommended limits with the force requirements per shift under various conditions of trolley handlings (inclination of the floor, type and weight of trolley, mode of handling, frequency of operation) showed that especially for higher floor inclinations and trolley weights, flight attendants work (substantially) above recommended limits. It became also apparent that the handling of half-size trolleys is unexpectedly high demanding due to high vertical force components, caused by the unfavorable location of their center of gravity.

Relevance to industry

On short-distance flights, passengers’ services are performed by means of trolleys from the ascent to the descent flight phases. Flight attendants had been complaining about high physical workload. This study offers recommendations on maximum force limits for the handling of trolleys with respect to the muscular capacities and work situations of flight attendants on short-distance flights.     

Task frequency as a function of age for the powerline technician trade

It is traditionally believed that worker productivity declines with age. The greatest contributor to this stereotype, particularly in physically demanding jobs, is that older workers can no longer maintain their sustained level of work due to the age-associated decline in physical capacity. The objective of this study was to determine the change in the frequency of task performance as a function of age in the power line technician (PLT) trade. The task requirements of the PLT occupation were determined through the use of a detailed job demands analysis (JDA) and the frequency at which these tasks were performed was acquired through a survey derived from the JDA. The results of the survey were assessed as a function of age. Older lineworkers (> or = 50 years) were found to spend more time working on the ground whereas the younger PLTs (< or = 39 years) more frequently performed the climbing tasks and the corresponding work on the poles and towers. In contrast the older PLTs performed all pushing/pulling tasks at a greater or equal frequency to that of the younger lineworkers. Despite these differences the frequency of task performance is similar across the age groups studied.     

Task frequency as a function of age for the powerline technician trade

It is traditionally believed that worker productivity declines with age. The greatest contributor to this stereotype, particularly in physically demanding jobs, is that older workers can no longer maintain their sustained level of work due to the age-associated decline in physical capacity. The objective of this study was to determine the change in the frequency of task performance as a function of age in the power line technician (PLT) trade. The task requirements of the PLT occupation were determined through the use of a detailed job demands analysis (JDA) and the frequency at which these tasks were performed was acquired through a survey derived from the JDA. The results of the survey were assessed as a function of age. Older lineworkers (? 50 years) were found to spend more time working on the ground whereas the younger PLTs (? 39 years) more frequently performed the climbing tasks and the corresponding work on the poles and towers. In contrast the older PLTs performed all pushing/pulling tasks at a greater or equal frequency to that of the younger lineworkers. Despite these differences the frequency of task performance is similar across the age groups studied.     

Postural analysis of paramedics simulating frequently performed strenuous work tasks

Paramedics who perform emergency rescue functions are highly susceptible to musculoskeletal injuries. Through an interview and survey process firefighters, many of whom are cross-trained paramedics in a consortium of 14 suburban fire departments, identified and rated tasks that were perceived to be both strenuous and frequently performed. The objective of the current study was to describe the working postures and the forces applied as firefighter/paramedics (FF/Ps) simulated specific roles within the following tasks identified by the survey: (1) transferring a patient from a bed to a stretcher using bedsheets, (2) transferring a patient from the ambulance stretcher to a hospital gurney, (3) carrying a victim down a set of stairs and around a landing using a stairchair, (4) carrying a victim down a set of stairs and around a landing using a backboard, and (5) carrying a victim down a set of stairs using a stretcher. Ten two-person teams of FF/Ps participated and were videotaped to obtain postural data for the upper and lower extremities as they performed each role in the simulated two-person tasks. Trunk postures were obtained using lumbar motion monitors. Static hand forces were estimated using a hand-held dynamometer at the most physically demanding points for each role within each task. The postural and force data were averaged across subjects performing identical roles to quantify the postures assumed by the FF/Ps at the most strenuous moments during task performance. Based on these analyses we concluded that: (1) when transferring victims from a bed to a stretcher the FF/P on the bed was able to maintain an upright and more stable posture by standing as opposed to kneeling, (2) an interface board should be used to reduce the frictional forces when transferring victims from a bed to a stretcher or from a stretcher to a gurney, thereby reducing the need to lift the victim with flexed torsos and/or shoulders, and (3) equipment and training that encourages the FF/P in the leader role to walk facing forward during victim transport, especially when descending stairs, potentially results in safer transit.     

The impact of work configuration,target angle and hand force direction on upper extremity muscle activity during sub-maximal overhead work

Overhead work has established links to upper extremity discomfort and disorders. As many jobs incorporate working overhead, this study aimed to identify working conditions requiring relatively lower muscular shoulder load. Eleven upper extremity muscles were monitored with electromyography during laboratory simulations of overhead work tasks. Tasks were defined with three criteria: work configuration (fixed, stature-specific); target angle (?15°, 0°, 15°, 30° from vertical); direction of applied hand force (pulling backwards, pushing forwards, downwards, sideways, upwards). Normalised electromyographic activity was greater for fixed configurations, particularly when pulling in a backward direction (total activity = 108.3% maximum voluntary exertion (MVE)) compared to pushing down or forward (total activity ranging from 10.5 to 17.3%MVE). Further, pulling backwards at angles of –15° and 0° showed the highest muscular demand (p < 0.05). These results suggest that, if possible, positioning overhead work in front of the body with exertions directed forwards will result in the lowest upper extremity muscle demand.

Statement of Relevance: Overhead work pervades occupational settings and is associated with risk of upper extremity musculoskeletal disorders. The muscular intensity associated with performing overhead work was assessed in several combinations of work placement and hand force direction. These findings should have utility for designing overhead work tasks that reduce muscular exposure.     

Activity analysis of English premiership rugby football union refereeing

Little is known about the physiological demands placed on officials during sporting activities. The purpose of this study was to ascertain the movement activities of referees during English Premiership rugby football union matches, and to determine the frequency and duration of these activities. Nine referees who were ranked in the top 20 referees in England were videotaped during a total of 19 matches. During playback of the videotapes, a single observer coded the referees' activities into one of six distinct categories (standing, walking forwards, walking backwards, jogging, running and sprinting) using a computerized video editing system (Observer Video-Pro). The referees were timed over a 20 m distance for the modes of locomotory activity, and the average velocity of the referee for each activity was used to calculate the total distance covered in each mode of activity during matches. The total distance covered during a match was (χ ± SD) 8581 ± 668 m. The mean percentage of total playing time spent in each activity was: standing still, 37.0 ± 11.0%; walking forward, 29.5 ± 7.2%; walking backward, 9.9 ± 3.2%; jogging, 12.8 ± 3.2%; running, 9.8 ± 2.3%; and sprinting, 1.0 ± 0.4%. There were a total of 672 transitions between modes of activity during a match. The results of this study suggest that refereeing top English rugby football union matches is physically demanding. Although the major physiological load is placed on the oxygen transport system, frequent sprint bouts and the associated requirements for acceleration and deceleration impose additional metabolic demands on referees. This information may be used in the design of physical training programmes to optimize performance in referees.     

A comparison of two physical ability tests for firefighters

Smoke diving is physically demanding, and firefighters must therefore meet certain minimum physical requirements. The aim of this study was to compare the physiological demands of two fire fitness tests: a test of 8-min treadmill walking approved by the Norwegian Labour Inspection Authority (NLIA) (a laboratory test) and a Canadian test consisting of 10 firefighting specific tasks carried out in sequence (an applied field test). If the Canadian field test is as physically demanding as the NLIA-approved laboratory test, it may be suitable for testing Norwegian firefighters. Twenty-two male professional firefighters were tested on separate days. In both tests, the subjects wore a complete firefighting outfit including a breathing apparatus. The test durations were 8 min (NLIA test) versus approximately 6 min (Canadian test). Neither the peak O₂ uptake (VO₂) of approximately 45 ml kg ^? 1 min ^? 1 nor the blood lactate concentration (BLC) at test termination ( ≈ 9 mmol L ^? 1) differed between the two tests. Rating of perceived exertion (RPE_CR-10) was lower for the Canadian test than for the Norwegian test (5.2 ± 1.5 vs. 7.0 ± 2.0, respectively), and the exercise time at a high VO₂ was also shorter. In conclusion, the Canadian test appeared to be almost as physically demanding as the NLIA-approved test, having equal peak VO₂ and BLC, but shorter time at a high VO₂ and shorter duration. It might thus be a suitable alternative to the NLIA test with some modifications. The advantage of the Canadian field test is the inclusion of specific firefighting-like tasks that are not part of the NLIA test.     

Job task characteristics of Australian emergency services volunteers during search and rescue operations

Search and rescue operations are necessary in locating, assisting and recovering individuals lost or in distress. In Australia, land-based search and rescue roles require a range of physically demanding tasks undertaken in dynamic and challenging environments. The aim of the current research was to identify and characterise the physically demanding tasks inherent to search and rescue operation personnel within Australia. These aims were met through a subjective job task analysis approach. In total, 11 criterion tasks were identified by personnel. These tasks were the most physically demanding, frequently occurring and operationally important tasks to these specialist roles. Muscular strength was the dominant fitness component for 7 of the 11 tasks. In addition to the discrete criterion tasks, an operational scenario was established. With the tasks and operational scenario identified, objective task analysis procedures can be undertaken so that practitioners can implement evidence-based strategies, such as physical selection procedures and task-based physical training programs, commensurate with the physical demands of search and rescue job roles.

Practitioner Summary: The identification of physically demanding tasks amongst specialist emergency service roles predicates health and safety strategies which can be incorporated into organisations. Knowledge of physical task parameters allows employers to mitigate injury risk through the implementation of strategies modelled on the precise physical demands of the role.     

Pushing and pulling: personal mechanics influence spine loads

This study assessed several mechanical issues related to low back loading during pushing and/or pulling tasks. Nine male participants performed two-handed pushing and pulling tasks at two handle heights with three loads, using a cable pulley system. Four of these men were professional firefighters trained in performing pushing and pulling tasks while the other five were graduate students who lacked manual work experience. The more experienced firefighters produced less spinal compression and shearing forces when compared to the less experienced students under the same conditions. The firefighters were able to create less muscle activation as compared to the students, which indicated a more efficient technique. The main contributing factors to the forces produced on the low back were the quantity of the load being pushed or pulled, handle height, experience level and the technique of the participant. Thus, attempts to set load limits for pushing and pulling tasks are difficult, since technique has such a large influence on back loading. In order to create safer working environments, education on proper pushing and pulling techniques is very important – more important than the physical variables in many cases.     

Reliability and validity of the Home Care STAT (Safety Task Assessment Tool)

Home care workers are a priority population for ergonomic assessment and intervention, but research on caregivers' exposures to hazards is limited. The current project evaluated the reliability and validity of an ergonomic self-assessment tool called Home Care STAT (Safety Task Assessment Tool). Participants (N = 23) completed a background survey followed by 10–14 days of self-monitoring with the STAT. Results showed that the most frequent task was house cleaning, and that participants regularly performed dangerous manual client moving and transferring tasks. Researcher in-home observations of 14 workers (duration ≤2 h) demonstrated that workers' self-assessments were moderately reliable. Correlational and multi-level analyses of daily self-assessment data revealed that several task exposures were significantly related to daily fatigue and/or pain. Other associations have implications for Total Worker Health™; for example, daily stress was positively associated with both pain and consumption of high calorie snacks. Findings support the STAT as a reliable and potentially valid tool for measuring home care workers' exposures to physically demanding tasks.     

A different approach for the ergonomic evaluation of pushing and pulling in practice

Recent epidemiological studies show that pushing and pulling increase the risks of shoulder complaints and not necessarily of low back complaints. Moreover, the magnitude of the exerted hand forces during pushing and pulling is poorly related to the magnitude of the mechanical loading of the low back and the shoulder. In light of that, this paper combines results of several studies to present an approach for evaluating not only the exerted hand forces, but also the low back and shoulder load during pushing and pulling in practice. The approach specifies, based on scientific evidence, that (1) in order to validly obtain exposure (frequency and duration) to pushing and pulling, 10 workers should be observed during eight periods of 30 min; (2) how the exerted hand forces and the load of the low back and shoulder can be estimated in practice based solemnly on the weight of the object, one-handed or two-handed pushing or pulling, and the height of the handle; and finally, (3) how these outcomes can be evaluated in combination with existing guidelines regarding exerted hand forces, compression forces on the low back and the moments at the shoulder. Two cases will be presented here to illustrate the application of the approach.

Relevance to industry

The presented approach is the first to offer practitioners a fairly simple method for the ergonomic evaluation of pushing and pulling carts and four-wheeled containers in practice, especially as regarding the shoulder load.     

Jerry can carriage is an effective predictor of stretcher carry performance

Carrying a casualty on a stretcher is a critical task conducted in a range of occupations. To ensure that personnel have the requisite physical capacity to conduct this task, two bilateral jerry can carries were used to predict individual performance in a four-person stretcher carry. Results demonstrated a bilateral 22-kg jerry can carry (R² = 0.59) had superior predictive ability of stretcher carry performance than a bilateral 15-kg jerry can carry (R² = 0.46). Pre- to post-carry changes in grip endurance (p > 0.05), back–leg isometric strength (p > 0.05) and leg power (p > 0.05) were not significantly different between carry tasks. There was no significant difference in heart rate (p > 0.05) and oxygen consumption (p > 0.05) between the stretcher carry and either jerry can carry. Thus, on the basis of performance correlations and physiological measures, the 22-kg jerry can carry is an appropriate predictive assessment of four-person stretcher carriage.

Practitioner Summary: This study investigated the ability of a jerry can carry to predict individual performance on a four-person stretcher carry. Performance correlations were substantiated with physiological measures to demonstrate similar physical requirements between task and test. These results can be used to set physical employment standards to assess stretcher carriage.     

Standard and alternative methods of stretcher carriage: performance,human factors,and cardiorespiratory responses

Transporting a casualty on a stretcher is a common task for medical and military personnel. Stretchers are usually carried by hand, but distributing the load to other parts of the body may have advantages. To examine alternative carriage methods, 11 soldiers walked on a treadmill at 4.8 km/h while performing two person carries of a stretcher containing an 80-kg manikin. In separate trials, soldiers carried the stretcher using: (1) hand carriage, (2) shoulder straps, (3) a specially designed harness that allowed load shifting between the hips and shoulders (hip-shoulder system), and (4) a clip that fitted on the belt of standard military load carrying equipment (LCE) and placed the stretcher mass mainly on the hips. With each system, subjects walked until volitional fatigue or 30 min. While walking, expired gases and heart rates were obtained and subjects rated their perceived exertion (Borg Scale). At the conclusion of all four trials, subjects rated each system on a number of subjective measures. Results showed that average (±SD) carriage times were 2.7±1.4, 14.5±8.3, 25.4±8.1, and 21.7±9.9 min with the hand, shoulder, hip-shoulder and LCE systems respectively (p<0.01). Hand carriage resulted in considerably more cardiorespiratory stress (higher heart rate and minute ventilation, p<0.05) than the other three systems, but there were few consistent differences among the other three systems. Perceived exertion in the upper body was less with the hip-shoulder and LCE systems than with the other two systems (p<0.05). Subjects preferred the hip-shoulder and LCE systems overall and for specific subjective characteristics such as comfort, ease of use and stability (p<0.01). These data indicate that moving the stretcher load from the hands and placing that load on the shoulders and/or hips results in improved performance, reduced cardiorespiratory stress and favourable subjective evaluations. Further developmental work should focus on the hipshoulder and LCE systems.     

Designing ergonomic interventions for EMS workers - part II: lateral transfers

The objective of the current work was to test ergonomic interventions aimed at reducing the low back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) when performing lateral transfers between a bed and a stretcher or between a stretcher and a hospital gurney. The interventions, developed using focus groups, were a bridgeboard to reduce the frictional force resisting the lateral sliding of the patient, the use of rods along each side of the patient to facilitate the grasping and handling of the bedsheet on which the patient is typically transferred, and a single rod that, when rolled in the bedsheet, resulted in the task being changed from a lifting task to a pulling task. Eleven two-person teams laterally transferred a 75 kg dummy with each intervention between a bed and simulated stretcher. Two roles were defined. For the two-sided transfers, the FFP roles were termed "stretcher-side" and "bed-side." Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, kinetic data were obtained for the FFP in the stretcher-side role. Trunk flexion moments and Erector Spinae activity were reduced for the FFP in the stretcher-side role when using the bridgeboard and the single rod both individually and in combination. The single rod reduced the Erector Spinae activity in the FFP who typically would have been on the bed. For FFPs in both roles the single rod increased Latissimus Dorsi activation relative to the standard bedsheet transfer condition, although, this effect was moderated when the single rod was used in combination with the bridgeboard. Ratings of perceived exertion also supported the use of the single rod relative to the corresponding control condition.     

Effects of vertical vibration on passenger activities: writing and drinking

Abstract

The efficiency of training programmes in handling designed to prevent injuries has rarely been demonstrated by studies in the workplace. This study aimed to identify factors that may favour or inhibit the application of safe handling principles by paramedics performing full-body transfers of patients from a stair chair to a stretcher. In an observational field study, handling methods used in 45 patient transfers from a stair chair to stretcher were characterised. Principles concerning the physical environment seem to be applied frequently, but those applicable during the transfer are neglected. Principles taught during training may not be applied due to the physical constraints of the workplace and the underestimation of risk exposure. The results suggest that training should be enhanced, not by focussing on handling techniques but by focussing on compromise and the capacity to adapt work techniques based on the working context and the team-mate.