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February 27, 2014
How powered cots and stair chairs can reduce EMS back injuries
The appeal of powered cots and stair chairs is that they reduce injuries to EMS providers and perhaps to patients. At any given moment, 9.4 percent of all EMTs and paramedics are out of work from an injury or illness, and busy systems often skyrocket up to 19 percent.
This is compared to 1.3 percent of the general public, which makes you readily appreciate EMS as a dangerous job[1-2]. More than half of EMS, workers compensation claims — a whopping 65 percent — involve back injuries. Do powered cots and stair chairs reduce injuries?
Oddly, there is just a single study on powered ambulance cots published in a peer-reviewed journal. That’s it: one study.
Austin Travis County (Texas) EMS studied injury rates before and after implementing use of power cots in 2006. Between 1999 and 2006, the injury rate averaged 61 percent. This rate dropped to 29 percent after power cots were placed in service.
Confounding the results were a number of other safety initiatives that may or may not have affected injury rates. Regardless, the data seems compelling.
Manufacturers such as Ferno and Stryker have testimonials and case studies demonstrating cost savings and injury reductions as some of the many advantages of their powered lifting equipment. But these are not peer-reviewed studies nor is it possible to confirm that the implementation of powered cots directly resulted in less injuries to EMS providers.
Powered cots and parachutes
But how much scientific data do we really need?
In 2003, the British Medical Journal called into question the use of parachutes to protect people jumping out of airplanes. The authors aptly noted that despite the wide use of parachutes, there was little research to support their effectiveness.
There are, in fact, numerous reports of people surviving falls from planes without the benefit of parachutes. They concluded, (quite sarcastically) that those who believe everything must first be validated by a scientific study should “come down to earth with a bump.”
Like parachutes, are the benefits of powered cots and stair chairs so obvious that we really don’t need studies to prove it? There are no magic bullets to eliminate the high incidence of back injuries among EMS workers.
Remember the back-support belt rage? Back belts were supposed to be the answer to preventing strain injuries in warehouses, shipping companies, and yes, even in EMS. While you can still purchase a back belt today, in 1994 the Centers for Disease Control informed the public that there was no good scientific evidence to support the use of back belts.
Likewise, the CDC pointed out, there was no good evidence that argued against the use of back belts. Putting all your safety eggs into the back belt basket might not be such a good idea, the CDC implied. Today, the decision of whether or not to use a back belt is best left to the individual employee.
What we do know
We know for certain is that EMS continues to sustain injuries at a faster rate than the rest of the workforce.
We also know that a significant percentage of EMS worker injuries are back injuries. A review of adverse events reported to the FDA shows that from 1996 to 2005, EMS professionals were injured in 53 percent of all ambulance stretcher adverse events.
Back injuries are expensive to both workers and employers. The costs can be staggering, especially when EMS workers are left permanently unable to perform their duties.
While the evidence favoring use of powered cots and stair chairs is slim, it seems obvious that our current equipment is injuring both patients and EMS workers9. In fact, while we often think of vehicle crashes as the most common EMS liability exposure, a 2008 study of 275 EMS liability claims paid by insurers found 41 percent involved patient handling while only 31 percent involved vehicle movement or collisions. Of the patient handling claims against EMS services, half were stretcher or stair chair tips and drops. While these data were not described in detail, there is a strong association between provider injury and patients being dropped. When an EMS worker slips trying to carry a stair chair, or injures their back attempting to load a stretcher into an ambulance, patients often fall off the chair or stretcher as a consequence. Manufacturers seem to know this and are continually evolving their designs to eliminate these injuries.
Rather than waiting for proof that powered cots and stair chairs reduce injuries, what we really need to do is implement their use on a broader scale, making note of what costs and savings are achieved. For services that have demonstrated significant advantages through the use of new technology, the data should be published so others will make an investment.
The scarcity of published data coupled with the fact that the majority of services have yet to implement powered lifts-capable patient movement, screams for those who have gone down this road to share their experience for the betterment of our profession.
1. Studnek JR, Ferketich A, Crawford JM. On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals. Am J Ind Med. 2007; 50:921-931.
2. Maguire BJ, Hunting KL, Guidotti TL, Smith GS. Occupational injuries among emergency medical services personnel. Prehosp Emerg Care 2005; 9:405–411.
3. Hogya PT, Ellis L. Evaluation of the injury profile of personnel in a busy urban EMS system. Am J Emerg Med. 1990; 8: 308–311.
4. Studnek J, Crawford J, Fernandez A. Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers. Appl Ergon. 2012;43:198–202.
5. Smith CS, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials. BMJ. 2003; 327:1459-1461. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/.
6. Centers for Disease Control and Prevention. Back Belts – Do they prevent injury? NIOSH Publication 94-127. October 1996. On-line, available at www.cdc.gov/niosh/docs/94-127/.
7. Centers for Disease Control and Prevention. Emergency Medical Services Workers Injury and Illness Data. NIOSH Workplace Health and Safety Topics. 2011. On-line, available at www.cdc.gov/niosh/topics/ems/data.html.
8. Reichard A, Marsh S, Moore P. Fatal and nonfatal injuries among emergency medical technicians and paramedics. Prehosp Emerg Care 2011;15:511–517.
9. Wang HE,Weaver MD, Abo BN, Kaliappan R, Fairbanks RJ. Ambulance stretcher adverse events. Qual Saf Health Care 2009;18:213–216.
10. Wang HE, Fairbanks RJ, Shah MN, Yealy DM. Tort Claims from Adverse Events in Emergency Medical Services. Prehosp Emerg Care 2008; 52:256-262.