Misconceptions in Injury Prevention

By Bryan Fass

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After giving three presentations at EMS Expo in Atlanta, Ga., and meeting a wide array of fantastic speakers and presenters, I came home with the realization that despite all the educational talks, plenty of misconceptions still exist regarding injury prevention in EMS. One of the most dire misunderstandings, I feel, is responders' assumptions that fitness should come before health, wellness, and injury prevention.

For awhile, I have been preaching that we first need to focus on injury prevention before getting physically ambitious. By doing so, we will enable ourselves to become fit and healthy. One of the best mottos to demonstrate this idea is the old saying, "Athletes do not train for their sport after the game is over." Why should we be any different?

One statistic I shared with Expo audiences is that at any one time, up to 10 percent of our workforce is out of work due to injury. In addition, once injured, you have a 31 percent increase in the chance of having an even more severe re-injury. Further, when surveyed, 46 percent of you have reported a back injury in the past six months (Studneck, J. Crawford, J. December 08, American Journal of Sports Medicine).

The most common injury we sustain in EMS is soft tissue overload, usually because our bodies are pushed to the point of failure; when we reach that failure point, soft tissue injury occurs. Common causes include placing our bodies into awkward positions to treat our patients, sitting for long periods of time, and possessing poor posture, leading to afflictions of daily stiffness and soreness. It should not be a surprise to anyone that we continue to sustain injuries at an alarming rate and that those injuries occur in the same predictable spots.

During my lectures at EMS Expo — and when I consult with agencies — I teach a series of very simple 'on duty' techniques to prevent injury. I taught some of these 'tricks of the trade' in my presentations. They are simple, inexpensive, and very effective. All of the participants at the Expo and all of the crews with whom I consult are amazed at how easy it is to practice these while on duty. I recall working with a paramedic who sustained a severe back injury lifting the patient from the floor to the cot, one of the major sources of injury for EMS workers. She had been through physical therapy, injections, nerve blocks and chiropractic treatment, all to no avail.

After quickly assessing her primary postural distortion and giving her some 'on-duty stretches' and some 'on-duty massage' techniques, her pain diminished significantly. I then taught the group some 'spine stiffening' maneuvers, which is a way to brace the abs and 'corset' the spine just prior to moving an object. By 'stiffening' the spine in a particular fashion, we can learn how to substantially prevent injury and improve our posture at the same time.

With the costs of technology rapidly increasing, injury rates holding steady, and medical expenses rising, there will come a point where the cost of the human factor will finally break the backs of many agencies. EMTs, firefighters, and law enforcement personnel need to embrace injury prevention and embrace it now. All the participants in my lectures had some form of an injury and most were experiencing pain during my talk (and no, it was not me causing the pain). It makes no sense to begin an exercise program with faulty posture and poor mechanics, let alone pain.

After showing them the simple techniques mentioned above, many were able to diminish their pain and move better. When incorporated with a pre-lift/move technique like 'bracing and stiffening the spine' they were able to better position their body and will substantially reduce their chances of an overload soft tissue injury. When we can establish a culture that embraces injury prevention and no longer mocks it, then we will be able to safely focus on fitness, but there is no point in being fit if we can't stay injury-free.

You can find more details about the techniques discussed in my book, Fit Responder.