Search

Introduction The development of pressure ulcers during aeromedical transport of combat casualties is an issue that continues to exist, especially during long transport flights. This study investigated the potential for a new intervention, an air-inflated insulating mattress pad (IMP) that has a pump system designed to alternate the pressurization of air cells under the patient, thus temporally shifting the pressure concentration locations. Materials and Methods In a repeated measures design study, 12 participants experienced the following four simulated transport conditions, each for 90 minutes: (1) The North Atlantic Treaty Organization (NATO) litter by itself (control condition), (2) the NATO litter covered with the standard mattress pad (Warrior Evacuation Pad), (3) the NATO litter covered with the air-inflated mattress (IMP), and (4) the NATO litter, covered with the standard mattress pad that was covered by the insulating mattress pad. Peak pressure readings were obtained every 15 seconds under the head, torso, pelvis, legs, and heels. Results While both mattress pads significantly reduced the peak pressures relative to the litter-only condition, the new IMP with the alternating cell pressurizations, by itself or in combination with the standard mattress pad, further reduced the peak pressures under the regions with the localized highest pressures, namely the head, pelvis, and heels. Moreover, the IMP with alternating pressure introduced the most variability in the peak pressure readings, which reduces the peak pressure exposure periods for specific tissue locations. Conclusions The IMP with alternating cell pressurizations could further reduce the likelihood of pressure injuries during aeromedical transport of combat casualties. [ABSTRACT FROM AUTHOR]

The objective of the current work was to test interventions aimed at reducing the low-back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) that involve transferring a patient between a bed and a stairchair. The interventions, developed or selected using focus groups, were a prototype Drew People Mover[TM], and a Transfer Sling. These interventions changed the coupling between the EMS worker and the patient. They were compared with an under-axilla lift. Eleven FFP teams transferred a 75 kg dummy between a bed and a stairchair. Both interventions were tested using two-person transfers. In addition, the Transfer Sling was tested using a one-person transfer. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, ground reaction force data obtained from two forceplates were acquired for one member of each FFP team that was used to estimate directional spine moments using a 3D linked-segment model. In the two-person transfers, there was 19[degrees] less trunk flexion (p = 0.002) for the FFP on the patient's left side and a trend towards less motion for the FFP on the patient's right side (p = 0.079) when using the interventions. Both FFPs showed reductions in the ipsilateral Erector Spinae activity using the Drew People Mover and the Transfer Sling that averaged approximately 9% MVC, which corresponds to a 21% decrease in the muscle activation levels. While the overall EMG was greater when performing a single-FFP transfer, the Transfer Sling reduced the bilateral Erector Spinae activity by approximately 20%. During the two-person transfers, the FFP on the forceplate to the right side of the patient showed a reduction in the forward bending moment using the Drew People Mover relative to the Sling and under-axilla conditions. During the single-person transfers, only the twisting moment was significantly reduced through use of the Transfer Sling. These objective measures, when combined with the subjective ratings of perceived exertion and the verbal feedback lead us to recommend the use of these interventions for bed to stairchair transfers. Keywords: Low-back disorders; Emergency medical services; Intervention; Firefighter; Back pain

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.apergo.2006.02.005 Byline: Steven A. Lavender (a)(b), Karen M. Conrad (c), Paul A. Reichelt (c), Aniruddha K. Kohok (a), Jessica Gacki-Smith (c) Keywords: LBD; EMS; Intervention; Firefighter; Back pain Abstract: 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 75kg 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. Author Affiliation: (a) Department of Industrial, Welding and Systems Engineering, The Ohio State University, 1971 Neil Avenue, Room 210, Columbus, OH 43210, USA (b) Department of Orthopaedics, The Ohio State University, Columbus, OH, USA (c) School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA Article History: Received 8 November 2005; Accepted 9 February 2006

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.apergo.2005.12.005 Byline: Steven A. Lavender (a), Karen M. Conrad (b), Paul A. Reichelt (b), Jessica Gacki-Smith (b), Aniruddha K. Kohok (a) Keywords: LBD; EMS; Intervention Abstract: The objective of the current work was to test ergonomic interventions aimed at reducing the magnitude of trunk muscle exertions in firefighters/paramedics (FFPs) providing emergency medical services (EMS) when transporting patients down the stairs. The interventions, developed using focus groups, were a footstrap to prevent the patient from sliding down on the backboard, a change in the handle configuration on the stairchair, and 2 devices, the 'backboard wheeler' and a tank tread-like device (descent control system, DCS) for a stretcher, that change the backboard and stretcher carrying tasks into rolling and sliding tasks. Eleven two-person teams transported a 75kg dummy with each intervention and its corresponding control condition down a flight of steps. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant. Results showed that the backboard footstrap reduced the erector spinae (ERS) activity for the FFP in the 'leader' role by 15 percent, on average. The change in handle configuration on the stairchair had no effect on the variables measured. The backboard wheeler reduced the ERS activity bilaterally in the FFP in the leader role and unilaterally for the FFP in the 'follower' role, by 28 and 24 percent, respectively. The DCS reduced the 90th percentile ERS activity for both FFPs from 26 to 16 percent MVC, but increased the latissimus dorsi activity in the follower from 11 to 15 percent MVC. The DCS was the only intervention tested that resulted in a reduced rating of perceived exertion relative to the corresponding control condition. In summary, the hypotheses that the proposed interventions could reduce trunk muscle loading were supported for 3 of the 4 transport interventions tested. Author Affiliation: (a) Departments of Industrial Welding and Systems Engineering and Orthopaedics, The Ohio State University, 1971 Neil Avenue, Rm. 210, Columbus, OH 43210, USA (b) School of Public Health, University of Illinois at Chicago, Chicago, IL, USA Article History: Received 19 September 2005; Accepted 30 December 2005

Firefighters performing emergency rescue functions are at an elevated risk of musculoskeletal injuries. The objective of the current study was to analyze the biomechanical stresses placed on the body based on simulations of the following strenuous and frequently performed emergency rescue tasks: (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 through a landing using a stairchair, (4) carrying a victim down a set of stairs and through a landing using a backboard, and (5) carrying a victim down a straight set of stairs using a stretcher. Postural data were analyzed using the University of Michigan's Three-Dimensional Static Strength Prediction Program and the relative risk of low back disorder (LBD) was quantified using the trunk motion model published by Marras et al. (1993, spine 18, 617-628). Peak compression values and the probabilities from the Marras et al. (1993) model indicated that the most hazardous tasks performed as part of this simulation included pulling a victim from a bed to a stretcher, the initial descent of a set of stairs when using the stretcher, and lifting a victim on a backboard from the floor. Overall, the two models were well correlated in their assessment of the task components modelled (r = 0.78). These data indicate where engineering changes to equipment regularly used by emergency rescue personnel would have the greatest impact in reducing the risk of musculoskeletal injury.

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.

INTRODUCTION Epidemiologic studies frequently cite occupational tasks that require lifting, pushing, and pulling as contributors to low-back disorders (Andersson, 1997). Most of the biomechanical studies oriented toward the prevention of […], Pulling tasks require the torso to act as a rigid link in order to facilitate the force transmission between the ground and the hands. In this study, we tested the hypothesis that a lifting belt increases the rigidity of the torso, thereby increasing pulling strength or reducing trunk muscle forces, or both, as pulling tasks are performed. Twelve volunteers performed maximal and submaximal isometric pulling exertions; the latter were performed on nonslippery and slippery surfaces. Electromyographic data from 8 trunk muscles, trunk kinematic data, and ground reaction forces were sampled during each exertion. Results indicated that the lifting belt had no effect during maximal exertions on the maximal pull forces generated or the muscle recruitment levels, irrespective of the pulling posture. The lifting belt did not affect the EMG data obtained during the submaximal (40% of maximum) exertions, even when participants pulled on a slippery surface. However, the slippery surface increased the coactivation within the trunk musculature, perhaps stiffening the torso in the event of a slip. The absence of a statistical interaction effect between the lifting belt and the footing condition (slipperiness) indicates that the belt did not alter the coactivation pattern and hence was not relied upon by the participants as a protective mechanism. The data presented here will assist those who must make decisions regarding lifting-belt use and those who train individuals in manual materials handling techniques.

INTRODUCTION Occupational low back pain represents an enormous cost to society, both financially and in terms of morbidity. Several occupational factors have been explored as to their contribution to low-back […], Whether or not lifting belts protect workers from injury is a topic of considerable interest in industry. Not only is the protective effect uncertain, but the biomechanical basis for belt function is unclear. The objective of this study was to determine if lifting belts provide a means for controlling trunk motions during asymmetric material-handling tasks. We recruited 16 nursing personnel as experienced lifters to participate in two lifting sessions. A lifting belt was worn in one session and for a week prior to this session during the subjects' routine work activities. Each session required 42 lifts, distributed across three asymmetry conditions (0, 45, and 90 deg) and temporally spaced 30 s apart. Foot motion was not permitted in half the lifts. Results indicated that during lifting, lateral bending and twisting motions were reduced by both the lifting belt and foot motion; the most pronounced effect was observed at 90 deg of asymmetry. Trunk motions in the sagittal plane during lifting were not affected by the lifting belt. These results appear to support the use of lifting belts in asymmetric lifting conditions, but more research is needed to determine whether the muscles in the torso benefit from the reduced motion or are working harder to overcome this resistance to motion, causing increased internal loads on the spine during asymmetric material-handling tasks.

A study of the effects of lifting belts on the workouts of people suggests that people do not increase the amount of weight used in workouts because of the belt. It has been shown that the belts do not offer any physical benefit to the wearer, but it has been speculated that people may gain a mental advantage by wearing the belts. Sixteen people worked out with and without belts, and the maximum weight used did not differ significantly with belts.