Summaries of Our Applied Research: Patient Handling
A Biomechanical Evaluation Of Potential Ergonomic Solutions For Use By Firefighter And EMS Providers When Lifting Heavy Patients In Their Homes
Summary: Firefighters and EMS providers continue to be challenged when lifting heavy patients in their homes. This study investigated the biomechanical efficacy of four devices that could be used by two-person teams when lifting patients from three different situations. Spine forces were measured on 14 firefighter-paramedics as they used each of these devices. It was found that the biomechanical load on experience by EMS providers when lifting and moving patients could be reduced using devices that provide handles or mechanically raise them from floor to chair level.
Summary: The biomechanical loading on the lumbar spine was assessed as female nurses applied and removed slings used for the mechanized lifting under two patients of differing weights, using two work methods, and while working at three bed heights. Peak compression and anterior shear forces exceeded recognized thresholds when placing slings underneath heavier patients. Raising the bed to at least knuckle level helped to mitigate these spinal loads.
Summary: This laboratory study investigated biomechanical risk to the low back and shoulders during simulated wheelchair pushing. Manual wheelchair pushing posed biomechanical risk to the lumbar spine (in compression and A/P shear) and to the shoulders. Biomechanically determined wheelchair pushing thresholds are presented and are more protective than the closest psychophysically determined equivalents.
Summary: Patient handling continues to represent a high risk task for low back pain (LBP) among health caregivers. Previous studies indicated that manual transfers of patients impose unacceptable loads on the spine even when two caregivers perform the transfer. Patient lift devices are considered a potential intervention; however, few biomechanical analyses have investigated the spine loads and LBP risk associated with them. This study analyzed the 3D forces on the lumbar spine as subjects manipulated ceiling- and floor-based patient lifts through various patient handling conditions and maneuvers. The results indicated that ceiling-mounted systems imposed spine forces upon the lumbar spine that would be considered safe, whereas floor-based systems had the potential to increase anterior/posterior shear forces to unacceptable levels. Given these findings, ceiling-based lifts are preferable to floor-based patient transfer systems.
Summary: Although patient handlers suffer from low-back injuries at an alarming rate, there has been limited research quantifying the risk for specific tasks performed by them. This study used spine loading models to evaluate six transfer tasks (bed to wheelchair with arms, wheelchair with arms to bed, bed to wheelchair with one arm removed, wheelchair with one arm removed to bed, commode chair to hospital room chair, and hospital room chair to commode chair) and three transfer methods (one-person hug, two-person hook and toss, two-person gait belt). The major findings of the study are:
- As a whole, patient handling should be considered to be an extremely `risky’ job.
- There is significant risk when transferring the patient with either one or two patient handlers.
- The greatest risk was associated with the one-person transferring techniques.
- The various repositioning techniques were found to have significant risk of low back disorder (LBD) associated with them, with the single hook method having the highest LBD risk and spinal loads (which exceeded the tolerance limits).
- The two- person draw sheet technique had the lowest LBD risk and spinal loads but still had relatively high spinal loads and LBD risk.