This  article appeared in the EMS Magazine column called "Street Smarts" written by me and my co-author Denis M. Meade in January 1999.

To function effectively as an EMS provider, you need three things: a willing heart, a knowledgeable mind and a body that can handle hard, physical labor. Your willing heart helped get you into EMS. Your mind helped get you through school and continues to assist you on each call. But is your body ready and able to handle the constant wear and tear you experience on a daily basis? More specifically, is your back able to handle all the heavy, awkward lifting you have to do?

Back trouble is serious enough to halt or end a career. The pain is often severe, and even if it does go away, it tends to come back.

Back Strain Common in EMS

According to the American Joumal of Emergency Medicine, back strain (or worse) is the leading cause of on-duty injuries among EMS personnel.(1) The retrospective study analyzed 254 injuries sustained by urban EMS providers and found that 36%—a huge maiority—involved back strain, all of which were due to lifting.

Once you've had a back injury, your chance of reinjury is 3 to 5 times greater.(2) After two back injuries, you are likely to face future problems. Don't be one of those statistics! You can prevent back problems by paying attention to risk factors, such as a sense of invulnerability; chronically poor posture; lack of flexibility; obesity or excess weight; stress; and poor physical condition.(3) Fatigue, improper lifting techniques and the inadequate ergonomics of riding in an ambulance for hours on end (with sporadic, but often intense exertion) also increase the risk for back problems.

Conversely, proper lifting techniques, enhanced flexibility, rest and adequate nourishment go a long way in maintaining a healthy, powerful, resilient back for many years to come.

Safe Lifting Techniques

Proper lifting is one of the keys to maintaining a healthy back. Apply the principles of safe lifting each time you pick up a load, whether small or large:

• Position the load as close to your center of gravity as possible

• Establish good communication with your lifting partner

• Maintain good balance and firm footing

• Create a wide base of support, with one foot ahead of the other

• "Lock" in the spine (with a slight extension curve) and "set" the abdominal muscles

• Bend your knees, lower your butt and keep your chin up

• Keep your palms up whenever possible

• Allow your large leg muscle groups to do the lifting

• Exhale during the lift, and avoid twisting or turning at all costs

• Ask for help when you need it no matter what the reason

Four Keys to a Healthy Back

Back health demands a combination of flexibility, strength, rest and nutrition.

In the area of flexibility, a weightlifter with tight hamstrings is as much at risk as someone who doesn't train with weights because it is impossible to get into the correct lifting position. Stretching can increase flexibility. It can easily be done in front of the TV or while awaiting calls. Be creative. Discs need gentle compression in all planes to obtain adequate nutrition.

Back strength is also important. The best strengthening exercises benefit the "guy wires," the muscles and other connective tissue that hold your spinal column in place the way wires hold telephone poles up straight. Back, leg and abdominal muscles must also be strong.

Rest is crucial. Pay attention to the health of your intervertebral discs, which make up one-quarter of the adult spine. Without adequate amounts of non-weight-bearing rest, your discs cannot nourish themselves.

Finally, good disc nourishment also depends on a decent, balanced diet, so eat sensibly. This can also have an impact on another element of back care, which is to maintain appropriate body weight.

Conclusion

Unfortunately, most people are susceptible to "Imrie's Law," which states that a "person's interest in back pain varies inversely with the length of time since the last pain experience.” This relates back to that famous EMS trait: a sense of invulnerability. Be smarter than that! Back injury is the number one career-ending injury for EMS personnel. Prevent it from happening to you!

References

1. Hogya PT, Ellis L. Evaluation of the injury profile of personnel in a busy urban EMS system. American Joumal of Emergency Medicine 8(4): 308—311, 1990.

2. Ten-ibilini C, Dernocoeur K. Save your back: injury prevention for EMS providers. JEMS 14(10): 34—41, October 1989.

3. EMS Safety: Techniques and Applications (FEMA: FA- 144), p. 28, April 1994.