When I decided to title my column “Back in service” several years ago, I never imagined that one of my articles would end up actually being about my back!
I have remarked many times over the years how thankful I have been that I have not suffered a back injury working in the EMS field. Well, this past summer, that changed. It began when I noticed some mild back pain after walking my dog. I considered a back strain, but decided it was just another kidney stone making its way into this world. I went about my life lifting, carrying, bending and straining as I did all the activities associated with summer. The pain worsened and I eventually went to see my primary care provider.
Renal colic, or N23 for those of you well versed in ICD-10, was ruled out and I was left wondering what else it could be. I never had a specific incident that made me think I had injured my back, but knowing all the lifting and bending I had done over 30 years as a paramedic, I did consider it the leading diagnosis. I managed to get an appointment at a local physical therapy office and limped my way over there to see what they thought.
After a quick assessment, they were confident that I did, indeed, have a bulging disk at the lumbar 4/5 level. I was started on some basic stretches and within two weeks, I was feeling better and progressing to deeper stretches and, eventually, some core strengthening exercises.
Then it all fell apart.
Duty vs. self-care
Feeling a little over-confident, I signed up for some EMS shifts again. The first shift went OK. During the night shift, we had a larger patient to move, but it went well and I had only a mild back ache after the shift.
Later that day though, while home between shifts, I was walking around my yard, picking up sticks and … well you already know what happened. You have seen it a million times. Yes, I bent over one more time and knew immediately that I had reaggravated the injury.
Intense pain returned. I did some stretches and rested for the afternoon and wondered if I should call in for my shift that night. I chose poorly. Feeling a duty to fulfill my shift commitment and hoping for no calls, I reported to the station.
Of course, we hadn’t even clocked in before the tones went off. The call was nothing major, but involved climbing in and out of the ambulance, navigating steps at the house, lifting the patient, using a stair chair and then moving the patient to the cot. I knew right away things were not going to go well. The pain returned, I could barely walk or stand, and it took everything I had to focus on the care of the patient.
I put my partner in a bad position as he had to do most of the lifting, and I risked providing poor care to the patient. As soon as the call was over, I called in sick and went home.
Thankfully, the physical therapy office was able to squeeze me in later that next day and we started all over. This time, my pain was worse, and I could not walk more than a few feet without having to sit down and do stretches to relieve the pain. I could not sit at my desk at home or do much more than lay on the floor for the next 2 weeks.
The risk of back injuries in EMS
My story is not unique. You already know that a significant percentage of EMS providers suffer back injuries, and many have their careers cut short because of them.
The NAEMT reports that one 1 of 4 EMS workers leave the field due to a back injury within four years of service. An article in “Prehospital Disaster Medicine” reported that the rate of back injuries in EMS workers was 7 times higher than the national average for all U.S. workers.
What you may not know though is just how miserable these injuries can be. It isn’t just about the spine and the disks. It is also about the nerves that run nearby and get pinched by the bulging disks. Nerve pain can be severe and it does not always respond well to ibuprofen, acetaminophen or even narcotics. You cannot sit or lay in a comfortable position and it keeps you awake at night. The pain limits doing some of the tasks of daily living and makes others difficult. Even sitting or standing at a desk to work on a computer may be impossible. It isn’t an easy or fun way to get a few weeks off work.
In my case, after several weeks of physical therapy, a course of steroids and sitting on ice packs regularly, I returned to feeling better and got back to full activities – although I still take everything slowly and consider each move. I continue my stretches and exercises, but to be honest, I am petrified that I will reaggravate the injury and be back to a very painful square one. That weighs heavily on my mind.
My plans for my career and my future with my family depend on being active and able to function as I did before all this started. One wrong move can put all that in jeopardy.
Each and every one of you are in the same position. No one wants to have their career cut short or their activities limited. So now is the time to do something about it and to take steps to limit your risk. You have most likely heard these recommendations before, particularly if your employer provides annual safety training, but the general recommendations to prevent back injuries in EMS include:
- Stay fit. You don’t have to be a competition weightlifter, but a general fitness program to include stretching and core strengthening exercises is a must. General fitness and strength training will also improve every part of your EMS work and home life.
- Lose excess weight. Asking your skeleton to carry extra bulk around every day creates wear and tear on those intervertebral disks and puts them at higher risk for herniation. It was definitely a contributing factor in my injury. Losing weight is good not only for your back, but also for your blood sugar, your cardiovascular health, your knees and hips, and your risk for many cancers.
- Use proper lifting mechanics. Bending at the knees, proper footing, keeping the weight close to you, not twisting while lifting, lifting slowly and engaging core muscles are important points of safe lifting. Seek out training to refresh yourself on these critical practices.
- Get help. The patients we lift in EMS are heavy and getting heavier. Whenever possible, use enough help to lift and move them safely. Get help from first responders, firefighters, law enforcement or another ambulance crew.
- Use lifting devices. The EMS product market is finally seeing more lift-assist devices applicable to our field. Newer products take up less space, have handles for extra help and actually fit the larger patients. Powered stair chairs and stretchers are becoming more common. They are not inexpensive, but neither are back injuries. Check them out next time you are at a conference.
Additional resources: Back injury prevention
There are many resources available to learn more about EMS provider safety and back injury prevention including:
- EMS Safety course by NAEMT
- “Occupational Safety and Health in the Emergency Services” textbook by James S. Angle
- OSHA: Lifting and Back Injury Prevention through Jones & Bartlett Learning
- 5 EMS back injury prevention tips, by Art Hsieh
Back injuries are preventable and something I hope none of you will ever have to endure. We need each and every one of you to remain in EMS for a long and healthy career. Take heed and make a commitment to implement the changes necessary to limit your risk.
Stay safe out there.
