EMS Stroke Conference Session Outline OHSU June … OHSU stroke...Common Hazards to Health Care...

1 Reproduced with permission from HumanFit, LLC © 2014.

Reproduced with permission from HumanFit, LLC © 2014.

EMS Stroke Conference

OHSU June 2014

Safe Patient Mobilization

Presented by Lynda Enos, RN, BSN, MS, COHN-S, CPE

Ergonomics Consultant, HumanFit, LLC.

Tel: 503-655-3308

Email: [email protected]


Session Outline

The Safe Patient Mobilization Program at OHSU

Health Care Safety, Work Environment and Culture -

Current perspective

Why is Manual Patient Handling so Hazardous?

Effective Safe Patient Mobilization/Handling Programs

for EMS: Reducing the Risk for Musculoskeletal

Disorders

Low tech equipment demonstration during lunch

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Equipment brand names, manufacturers or vendors seen in this webinar do not constitute endorsement of the device, equipment, product or service by HumanFit, LLC.


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Find Resources at

www.hcergo.org

www.orosha.org/grants/ff_ergo/index.html

www.cdc.gov/niosh/topics/ems/pubsPatientHandling.html


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www. regonline.com/hcergo14


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Late 1990s – 2009: A Lift Team approach was used to try and prevent back injuries to health care staff

Pre Program Injury Data - Jan 2008-Dec 2011

45-60% of all cases appear to be related to patient lifting and moving activities.

65-80% of all lost time cases were related to patient mobilization cases

Average days away from work (lost time) per patient mobilization claim = 3-16 days

65-85% of all workers’ compensation costs are attributed to patient mobilization activities

OHSU

Safe Patient Mobilization Program (SPM)


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The OHSU SPM Program

‘Create a Culture of Safe Patient Mobilization

while Enhancing Health Care Provider and

Patient Safety’

2010

Interdisciplinary team formed including front line staff

Business plan for the SPM program was written

Staff trialed various patient handling and lift equipment

2011

2 pilot units implemented the SPM program: 10 K and

& 7 Neuro ICU

SPM Program Vision Statement



The OHSU SPM Program Facilitated by: Deborah Eldredge, PhD, RN, Director Quality/Research/Magnet Recognition Program

2011-2014: All patient care units (14) have SPM

program and ceiling lifts

May 2012- Lateral Transfer Program

– All dependent patients go on hovermatt between

units and imaging (CT, X-Ray, MRI)

2012-2013: North OR, IRU, Cardiac Cath, L&D/M&B,

ED, DCH - PANDA

2014: Perioperative svcs, Doernbecher’s Childrens’

hosptial and Out Patient Clinics

2014: Bariatrics workgroup


Management Commitment (visible program champion)

Employee Involvement (inc. Labor)

A Business Plan (strategic & tactical)

Program Management (program facilitator)

Worksite Analysis

Hazard Prevention & Control (SPH equipment and safe

work practices)

Education & Training

Disability Management (After Action Review)

Culture (Behavior change re equipment use and sensitivity)

Planning for Sustainability

Components of Sustainable & Effective

SPM Program at OHSU

Multifaceted programs are more effective

than any single intervention.

(NIOSH, 1997; OSHA 1991 & 2003; VAH 2010)

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SPM Programs

Best Practices (Evidence Based)

End user involved

Participatory & multifaceted programs –

interdisciplinary approach

Visible & engaged Program Champion

Program that is designed to be integrated into

business and practice culture over time and

considers patient and employee safety with equal

emphasis

The correct match between equipment and task,

patient capabilities and facility design

9

Reproduced with permission from HumanFit © 2009


SPM Programs

Best Practices (Evidence Based)

Use of patient mobilization equipment/devices

Enough equipment that is easily accessible

No manual lifting policies

Training on proper use of patient mobilization equipment/devices

Unit-based peer leaders

Clinical tools, such as algorithms and patient assessment protocols

Nelson 2008

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Purchasing Equipment Will Not Ensure a

Successful SPM Program


Evidence of Effectiveness of

Safe Patient Mobilization Programs OHSU

30-100% decrease in Patient Handling related injuries and

severity for a majority of patient care units or departments

4 units have had ‘0’ injuries and

8 units ‘0’ lost time cases since starting an SPM program

Other Hospitals and Nursing Homes - Reduced

30-95% reduced workers’ compensation injury rates

Up to 66% lost workday injury rates

Up to 38% restricted workdays

30-75% reduced workers compensation costs

Reduced number of workers suffering from repeat injuries

(Stevens et all, 2013,Waters, 2006, Back, 2006, Collins et al., 2004, Tiesman et al., 2003;; Nelson et al., 2003; OHIO BWC, 2002; Mugar, 2002, Garg, 1999, GAO reports 1997: Bruening, 1996; Empowering Workers, 1993; Fragala, 1993; Fragala, 1995; Fragala, 1996; Fragala & Santamaria, 1997; Logan, 1996; Perrault, 1995; Sacrifical Lamb Stance, 1999; Stensaas, 1992; Villaneuve, 1998; Werner, 1992).

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Health Care Safety,

Work Environment

and Culture -

Current perspective



13

Ambulatory Surgical Centers

Home Health/Home Care & Hospice

Clinics/Rehabilitation

Emergency Services (EMS)

Nursing Homes

Residential Care & Assisted

Living Facilities

Adult Foster Care

The Health Care Continuum

Hospitals


14

Common Hazards to Health Care

Workers

Biological & Infectious Hazards

– Bloodborne pathogens

(Needlestick injuries, etc)

– Tuberculosis

Chemical Hazards – Latex

– Glutaraldehyde

– Ethylene Oxide

– Antineoplastics

– Volatile organic compounds (VOCs)

Physical Hazards

1. Musculoskeletal disorders

(MSDs) - patient &

materials handling; slips,

trips & falls

– Workplace violence

– Noise

– Radiation

– Motor Vehicle Accidents

Psychosocial Hazards

– Shift work, long hours,

and overtime; lateral

hostility


15 15 15

1. Emergency Medical Technicians and Paramedics

2. Nursing Assistants

3. Firefighters

4. Laborers and Freight, Stock, Material Movers

5. Light Truck Delivery Services

18. RNs

The Incidence of Musculoskeletal

Disorders due to Overexertion 2012 (Incidence rate per 10,000 full-time workers)

(United States Department of Labor [USDOL], 2013). Reproduced with permission from HumanFit, LLC © 2014.

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Safety in Health Care: Why has it not Improved?

Organizational Culture

Patient Safety focus vs. employee safety

Focus on reimbursement, resource and ongoing

regulatory challenges (including health care reform)

etc.

Lack of systems approach to services provided (Silos)

Lack of resources to facilitate and sustain programs

long term

Problem Solving Approach = Blame the Worker

(Human Error)

Resident handling solutions in LTC = CALL EMS


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– Patient comes first (self sacrificing mentality)

– A patient that is 120lbs is a ‘light weight’

– Proper body mechanics will prevent injuries

– The old ‘hoyer’ is difficult to use

– There’s no time to use equipment (hard to find, hard to

use, etc)

– I own a ranch – lift hay/round cattle and have never

been hurt

– Professional silos e.g. nursing vs. therapy

Is getting hurt on the job –

just ‘part’ of being a health care worker?

Safety in Health Care: Why has it not Improved?

Employee Culture


“Workforce safety is inextricably

linked to patient safety. Unless

caregivers are given the protection,

respect, and support they need, they

are more likely to make errors, fail to

follow safe practices and not work well

in teams.” Through the Eyes of the Workforce: Creating Joy,

Meaning, and Safer Health Care. The Lucian Leape

Institute at the National Patient Safety Foundation Feb

2013

http://www.npsf.org/about-us/lucian-leape-institute-at-

npsf/lli-reports-and-statements/eyes-of-the-workforce/

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Creating a Culture of Safety in

Health Care

The Joint Commission

2012

http://www.npsf.org/about-us/lucian-leape-institute-at-npsf/lli-reports-and-statements/eyes-of-the-workforce/



























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Why the Increasing Focus on Safe Patient

Mobilization in Health Care?

Increasing incidence of back injuries & other

musculoskeletal disorders (MSDs) in health care

workers across the continuum

The cost of work related MSDs

The changing patient population

SPH legislation

Current research & evidence base

Aging workforce & nursing shortage

Traditional methods of addressing back injuries in

health care are ineffective

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Legislation & Guidelines

Safe Patient Handling Legislation– TX, WA, RI, MD, MN, NJ, CA, IL

(NY, OH, HI). Other states are seeking to pass legislation

ADA: Access To Medical Care For Individuals With Mobility

Disabilities Standard (2010) – Use of patient lifting equipment in

http://www.ada.gov/medcare_ta.htm

OSHA Ergonomics Guidelines for Nursing Homes (2003 rev. 2009)

Facilities Guideline Institute: Health Care Design and Construction

Guidelines (2010) – Incorporate Safe Patient Handling & Movement

www.fgiguidelines.org

NIOSH/ANA/VHA: SPM curriculum for schools of nursing

http://www.cdc.gov/niosh/docs/2009-127/

The American Nurses National Safe Patient Handling and Mobility

Standards, 2013 http://www.nursingworld.org/handlewithcare

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Back Injuries related to

Manual Patient Handling are the # 1

cause of Health Care Worker Injury in the

USA

Why is Manual Patient Handling

so Hazardous?


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What are Musculoskeletal Disorders (MSDs)?

(Cumulative Trauma Disorder, Repetitive Strain Injury

Overexertion or Overuse Injury)

Chronic or Cumulative:

Injuries that occur over a period of time (months/years)

& are caused by a combination of risk factors

Acute:

A sudden or one-time traumatic event or incident,

e.g., slip, trip, fall or car wreck

MSDs affect ligaments, muscles,

tendons, cartilage, blood vessels &

nerves & spinal discs


Some Common MSDs

Tendinitis &

Tenosynivitis (upper

extremities)

Epicondylitis (Tennis

Elbow/Golfer’s elbow)

Rotator Cuff Tear

(shoulder)

Vibration White

Finger

Computer Vision

Syndrome - CVS

(Headaches)

Strains and Sprains

(neck, back, shoulder)

Low Back Pain &

Sciatica

Bulging or Herniated

Spinal Discs

Carpal Tunnel Syndrome

Trapezius Myalgia

(tension neck syndrome)

Bursitis (shoulder or

knees)


Physical Demands in Health Care

The EMS Work Environment Risk Factors that can contribute to the development

of Musculoskeletal Disorders

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+ + + =

P o s t u r e

MSD S

Musculoskeletal

Disorders

Awkward, Static

& Poor Postures

Force

(Lift, Push,

Pull, Carry,

Grip)

Repetition Duration

Additional factors:

Contact Stress

Environmental Factors

Lack of Adequate Rest

Poor Physical Condition

Psychosocial Factors

Work Organization



The EMS Work Environment Risk Factors that can contribute to the

development of Musculoskeletal Disorders

The unpredictability of the location and

patient status

Sedentary work followed by sudden

physically demanding activities

High Risk Tasks for MSDs:

– Patient handling

– Lifting gurneys in/out ambulances

– Patient evacuation

– Materials/equipment handling

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The Cumulative Effect

When the musculoskeletal system is

exposed to a combination of these risk

factors (too quickly, too often and for too

long) without sufficient recovery or rest

time, damage occurs

Duration of Exposure to Risk Factors (Time) Affected by: Working through breaks

Overtime

Task variability


1 x 8 Hour shift = cumulative

average weight of 1.8 tons

(Tuohy-Main, 1997)

= 28 Double Decker buses

= or 150 F350 trucks

= or 1 Airbus A380 with 50% load


How Much Does A Nurse (or EMS Worker) Lift?

1 Week (40 hours) = 9 ton

50 weeks/year = 450 tons

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10 years = 4500 tons = 280 Double Decker buses


= or 7.5 Airbus A380s fully loaded

= 560 Double Decker buses


= or 15 x Airbus A380s fully loaded

20 years = 9000 tons

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How Much Does A Nurse (or EMS Worker) Lift?

Reproduced with permission from HumanFit, LLC © 2014. 29

When Physical and/or Cognitive Demands Exceed

Capabilities of Health Care Workers

Fatigue (physical & mental) which can lead to:

Cumulative Musculoskeletal Disorders (MSDs) e.g. back injuries

Accidents, Errors, Near Misses

A few seconds/mins time lost

Damaged/waste product

Quality of care issues

(Incorrect & missed care)

Traumatic or acute injury

(to user or others)

Death

$$$ Lost: Insurance costs, staff replacement costs, legal

costs, regulatory fines, loss of market share, etc.

Stress

Burnout

Impact on

Organization

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Why is Manual Patient Handling So

Hazardous?

Patient

Characteristics

- Weight (heavy load)

- Shape (bulky and

awkward)

- Behavior (unpredictable,

confused, fragile, in

pain)

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Hazardous?

Task Characteristics – High compressive force and

shear at lumbar spine L5/S1

– Awkward postures compounded by constricted space

– Static trunk flexion

– Trunk rotation

– Sudden shift in load (Resident)

– Duration of the task

– Repetitive exposure to risk factors

(Nelson et al, 2003, Marras, 1999)

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Poor Work Practices


Hazardous?

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Poor Design of the Work

Space and Equipment

Challenges


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Compression

3400-6400 N (764lbs) Limit

A-P and Lateral Shearing

1000 N (224lbs) Limit

Arrows show

direction of load or

force on lower

back (L5/S1) when

manually lifting

and moving

Residents

Repetitive exposure to risk factors can cause: Muscle, ligament and facet

joint damage

Micro-fractures in end-plates of vertebra

Disc damage

Force exceeds human

tolerance at L5/S1

Cumulative Impact of Manual Patient

Handling

Rotation


The maximum weight limit for patient handling

is 35lb if the patient is cooperative and

load close to the body

(NIOSH, 2007)

Cumulative Impact of Patient Handling

The physical effort required to repeatedly lift and

move patients manually is greater than the

musculoskeletal system can tolerate.

Therefore there is No Safe method to lift

and transfer patients manually

Using good body mechanics is not enough to prevent back injuries and other MSDs caused by

manual patient handling.

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Some Perspective…….

NIOSH Guidelines:

Load limit for lifting material (non patient) loads: 51 lb

Spine compression force: 764 lb

Spine compression forces for patient handling activities:

– Pulling 105 lb patient (with bedsheet) from

bed to stretcher: 832-1708 lb

– Carrying 105 lb patient down stairs using

stretcher: 1012-1281 lb (source: Hess 2006)


Consequences of Manual Handling For

Patients

Increase risk of

– Skin and joint damage

– Falls

– Pain

– Combative behaviors

– Loss of dignity

– Bowel & bladder dysfunction

Negative impact on clinical outcomes from decrease in ambulation and repositioning in bed (especially if patients are larger and/or lack of staff available to assist)

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Patient Handling

Higher Risk Tasks

Lifting a patient/resident

up from the floor

Repositioning patient in

bed or chair

Transfer from bed to chair

(and in/out vehicles)

Lateral Transfers (bed to

stretcher)

Transporting patients

Lifting/supporting limbs

during care tasks

Making occupied bed

Applying anti embolism

stockings

Moving occupied bed or

stretcher

Bathing a confused or

totally dependent

resident

Nelson, 2005 Reproduced with permission from HumanFit, LLC © 2014.

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How Do We Typically Address

Work Related MSDs?

Narrow Focus = Blame the Worker (Human Error)

Manual patient lifting

Body mechanics classes

Training in safe lifting techniques (inc. use of slider boards, gait belts)

Back belts

Evidence shows that these ‘fixes’ do not work (Reason, 1991,

2000 & Nelson, 2006)


Effective Safe Patient Handling

Programs: Reducing the Risk of

MSDs

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Designing Tasks, Equipment,

Work Environments &

Systems to be compatible

with the Users’

Physical & Cognitive

Capabilities and Psychosocial

Characteristics

Users in Health Care:

• Employees

• Patients

• Families

Ergonomics and Work Systems

Preventing User

Injury & Error; Improving Comfort &

Efficiency/Quality

Fitting

the

Task

to the

User

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Secondary Controls:

2. Work Practice changes

3. Administrative - Reduce exposure of person to the job

4. Warnings (not very effective)

5. Training(staff and patients)

6. Personal Protective equipment

7. Wellness & Fitness

Primary Controls:

1. Eliminate the risk factor (s) through design

Engineering of the:

Task

Tools

Equipment

Facilities Design

Examples of this approach in Healthcare: Bloodborne Pathogens &

Needlestick Policies; Hazardous Communications Program

Mo

st

Eff

ecti

ve

Least Effective

Addressing Hazards for MSDs Hierarchy of Controls


Eliminate/reduce risk factor(s) through design

e.g., use equipment such as ceiling and portable

floor lifts, friction reducing devices, etc)

Must match equipment with:

- Patient dependency

(physical and cognitive abilities),

- The type of lift, transfer or movement

- The number of staff available

- Facility and medical equipment design

Primary Solutions

Engineering Controls

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43 43 43 43

The level of injury risk reduction

varies by type of equipment

Not all interventions are created

equally!

Tare care not to create a new hazard


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Power loaders; motorized winch &

cable systems

Powered height adjustable gurneys

Ceiling Lifts in ER –

Ambulance/Vehicle Bay

Bariatric ambulance (e.g. AMR)

Loading and Unloading an

Ambulance


Friction Reducing Devices

– Air Assist mats (powered)

– Battery powered motors

Single & reusable friction reducing

sheets - Some self inflating air bag

Slider boards (Caution!)

Repositioning/ Lateral Transfer

Devices for EMS

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Lateral Transfer Devices

Use of a device reduces the stress to the low back by reducing the friction.

It eliminates the need for the 3rd person on the bed

Drawsheet only

Drawsheet with lateral transfer device


- HoverJack™ - Can also be used as an

evacuation device e.g. moving a patient

down stairways

- ELK & CAMEL (LTC)

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Equipment to Lift Patients from

the Floor - EMS


Other Tasks:

Evacuation

Wound care, Catheterization – Pannus sling

Other



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Choosing Solutions - SPH Equipment

Ergo & Safety Design Features

(Designing for the User)

Is the equipment intuitive

to use & user friendly? Is it designed to fit 90% of

the worker population physical capabilities?

Does it meet Safety Regulations & Codes?

What services will the vendor provide?

Cleaning, Storage & Maintenance Considerations


Secondary Solutions:

Work Practice Controls

Reduce employee exposure to primary risk factors by using best work methods, e.g., Plan work organization Assess the patient – ask if they can assist Assess & prepare the environment Get necessary equipment & help Perform the lift or movement safely

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Secondary Solutions:

Work Practice Controls

Use patient lifting/transfer devices if available

Use the best body mechanics possible

Take regular microbreaks and stretch when seated for

more than 30 minutes

Change position frequently (every few minutes) if

holding a limb, sitting forward over a patient, etc.

Report Ergo/Safety Related Problems to Your

Supervisor

Apply MSD Prevention Principles to Your Off -The-Job

Activities

Report Any Physical Problems Early = Quicker Recovery

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What Else Can You Do?

Exercise regularly (Strength, Flexibility,

Cardiovascular)

Maintain a balanced diet and drink plenty of water

Don't forget to relax and get enough sleep

Wash you hands!

Work smart at work & at home

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Implementation and Evaluation Plan

– Don’t forget to involve all stakeholders including patients & families

Plan for program sustainability

Choose evidence-based interventions

and use existing resources

……….don’t reinvent the wheel

Start small, test pilot and demonstrate successes

Market & communicate the program and its’ success

Best Practices for Implementing and Sustaining a SPH/SRH Program

Remember: Purchasing Equipment Will Not Ensure a

Successful SPH Program Reproduced with permission from HumanFit, LLC © 2014.

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54 Benefits of Health Care Ergonomics & Safe Patient Handling

...for Employees & Patients

(Reduced Risk of Falls; Pressure

Ulcers & Pain etc; Improved

Mobility & Dignity)

..for Health Care

Organizations

Improved

Quality Performance

Efficiency

Flexibility

Recruitment (Larger

Labor Pool) &

Retention

Reg. Compliance

Reduced WC Injury

Costs & Liability

Well-being of

Employees &

Patients

Well-being of

organization

Less absenteeism and

labor turnover.

More involvement and

commitment to

change.

Health

Safety

Comfort

Satisfaction

Adapted from: Corlett, 1995; Nelson

2008; Gallagher, 2009, Enos 2013



Potential Program Funding Sources

Employee at Injury Fund (EAIP) ($2500 per injured

worker while on transitional duty- in Oregon

http://www.cbs.state.or.us/wcd/rdrs/rau/3525eaip.

html

Preferred Worker Program – to $25,000 (Oregon)

http://www.cbs.state.or.us/wcd/rdrs/rau/pwp/pwp

_index.html

Local Foundations

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Questions


Selected References & Resources

Evaluation of Medical Cot Design Considering the

Biomechanical Impact on Emergency Response

Personnel. Tycho K. Fredericks, T.K et. al. The XXVth

Annual Occupational Ergonomics and Safety Conference,

2013

Evaluation of Back Problems Among Emergency

Medical Services Professionals. Dissertation. Jonathan R.

Studnek, The Ohio State University 2008

Handbook of Human Factors and Ergonomics in Health

Care and Patient Safety 2nd Edition (2012). Edited by

Pascale Carayon. Lawrence Erlbaum Associate

Identification of Factors that Affect the Adoption of

Ergonomic Interventions among EMS Workers. Monica

R. Johnson. Proceedings of the Human Factors and

Ergonomics Society 55th Annual Meeting 2011

57



The Illustrated Guide to Safe Patient Handling and

Movement. Nelson, A.L., Motacki , K, Menzel, N. (2009). New

York, NY: Springer Publishing.

Making the Business Case to Initiate, Sustain and Evaluate

Safe Patient Handling Programs. L. Enos (2011). Part 1,

American Journal of Safe Patient Handling and Movement, I,

(3): 8-15 and Part 2 AJSPHM, I, (4): 22-30.

National Occupational Research Agenda (NORA):National

Public Safety Agenda for Occupational Safety and Health

Research and Practice in the US Public Safety Sector

October 2013

Musculoskeletal Disorders in EMS Creating Employee

Awareness. Thomas F. Fisher and Stephen F. Wintermeyer.

Professional Safety VOL. 57, NO. 7

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Selected References & Resources Organization of work in interaction between the paramedics

and the patient. Petra Auvinena,* and Hannele Palukkab. Work

41 (2012) 42-48

Patient Care Ergonomics Resource Guide: Safe patient

handling and movement. Nelson, A.L. (Ed). (2001 rev 2005).

Tampa, FL: Veterans Administration Patient Safety Center of

Inquiry.

Safe Patient Handling and Movement: A Practical Guide For

Health Care Professionals (2006). Audrey Nelson Editor.

Springer Publishing http://www.springerpub.com/

Safe Patient Handling Equipment Purchasing Checklist. L.

Enos (2013). American Journal of Safe Patient Handling and

Movement, 3, (1): S1-16. Reproduced with permission from HumanFit, LLC © 2014.

60


The Working Back: A Systems View (2008). William S. Marras.

John Wiley & Sons, Inc.,

When is it Safe to Manually Lift a Patient? (2007).Waters, T.R.

American Journal of Nursing, 107(8), 53-59.

EMS Stroke Conference Session Outline OHSU June … OHSU stroke...Common Hazards to Health Care...

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Transcript of EMS Stroke Conference Session Outline OHSU June … OHSU stroke...Common Hazards to Health Care...