Reduction and prevention approaches to stress caused by passenger transport in rescue services, patient transport, transport of the disabled and funeral services

Status:

completed 12/2023

Aims:

According to data from the German Federal Office of Statistics, the average weight of persons in Germany is increasing. This has health implications not only for heavier persons themselves, but also for others whose work involves contact with them. Persons are regularly transported by ambulance and other emergency services, transport services for disabled persons and funeral services. Although assistive devices are now often adapted to make them suitable for heavy persons, little attention has been paid to date to the physical stress on employees during transport of these persons. The persons being transported are usually conveyed in a means of transport, or may be carried over parts of the transport route. Owing to differences in the location, the means of transport/assistive devices used and the condition of the person being transported (who may, for example, be uncooperative, or lacking muscle tone), blanket statements cannot be made regarding the working conditions during the transport of persons. Besides functional features for improved patient care, the available means of transport increasingly also offer features aimed at reducing the stress caused by load handling. 30% of employees in the emergency services, for example, are known to suffer disorders of the musculoskeletal system and connective tissue more frequently than the average. This is indicative of high levels of physical stress, one cause of which is the lifting and carrying of persons. In an initial study conducted at the Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA) on employees in the emergency services, physical stress data were recorded during the use of a range of means of transport for patients on flights of steps (Project No. IFA 4219 and 4224). However, the transport of persons is not limited to this situation. It encompasses an entire transport chain: travel to the individual's location, transporting them to the vehicle and transferring them to it, and transfer at the destination, each successive stage involving use of different means of transport. Before now, activities in the transport chains of patient transport, transport of disabled persons, emergency services and funeral services had not been the subject of a comprehensive analysis to identify foci of physical stresses. Employees in these sectors were to be surveyed with the initial aim of identifying the focus of stress and identifying and prioritizing the need for research in the relevant areas. Analyses by means of measurements were used to reveal the stresses in selected situations, and a range of assistive equipment was examined in comparative measurements with regard to its potential for reducing stress. The results of the studies are to be used for preventive activity to reduce stress on the musculoskeletal system.

Activities/Methods:

The survey conducted in the member companies identified two main foci of stress in the transport chain: firstly, the loading and retrieval of wheeled stretchers into and from a vehicle, and secondly, the securing of wheelchairs in the vehicle. With a focus on these two transport situations, a literature survey was conducted to determine the state of the art and scientific progress, and to identify gaps in research representing issues to be addressed by the study. The study compared conventional assistive equipment with alternatives that appear to reduce stress. The measurements involved 20 test subjects from the emergency services and 10 test subjects employed in transport of disabled persons. The musculoskeletal stresses were recorded and evaluated under laboratory conditions by means of the CUELA method based on mobile movement logging and force measurement. Raising the wheeled stretcher in stages and loading and unloading it into and from the emergency vehicle were studied. A conventional manual wheeled stretcher with stretcher platform was compared with a more modern wheeled stretcher with automatic loading and with an electro-hydraulic wheeled stretcher with sliding loading carriage. For performance of the measurements, the assistive equipment was modified to enable the action force to be measured at the usual grip position. For the transport of disabled persons, arrangements for securing wheelchairs in the vehicle were compared. Arrangements on wheelchairs with and without a force node system (an adapter system for wheelchair restraint) were compared, and in two scenarios (vehicle empty and fully occupied). Dummies weighing 75 kg were placed both on the wheeled stretchers and in the wheelchairs.

Results:

4,083 employees from the four sectors concerned took part in the online survey, the purpose of which was to identify work situations experienced as being high-stress. This figure reflects an unexpectedly high level of interest among employees. In addition to negotiating flights of steps and narrow passages, loading and unloading into and from the vehicle and securing within the vehicle were perceived as focal points of physical stress in the emergency services, patient transport and funeral services. In the area of disabled person transport, physical stress is generally considered less acute; the focus of stress stated in this area is when the wheelchair is being secured in the vehicle. Tasks involving manual wheeled stretchers are associated with physical stress; this is reflected in the lumbar moments and compression forces measured in the lower lumbar vertebrae. Comparative analysis of loading and unloading of the manual and fully automatic wheeled stretchers shows the latter to yield a reduction in the median lumbar moments at L5/S1 from 107 Nm to 51.6 Nm and in the median compression forces at L5/S1 from 2.9 kN to 1.6 kN and in the P95 value from 5.6 kN to 2.7 kN. The lumbar moments at L5/S1 during handling of the manual wheeled stretcher are rated by Tichauer as heavy work. The lumbar moments are lower during handling of the fully automatic wheeled stretcher, as weight need no longer be lifted. The P95 value for the manual wheeled stretcher exceeds the revised "Dortmund" guideline values for women and men aged 20. Securing wheelchairs in the vehicle is physically taxing for older employees. They kneel or squat in front of the wheelchair to fasten the securing straps to it. The time spent securing the wheelchair and thus in a posture placing stress upon the knees and a non-neutral forward tilt of the torso can be reduced significantly by use of the force node system on the wheelchair, which the study participants found relieved the stress. For a typical work shift in which three wheelchairs are secured, each on two journeys, the duration of the activity is reduced from 49.1 to 27.3 minutes. The time spent in a posture placing stress upon the knees is reduced from 7.5 to 4.1 minutes, and that spent with a non-neutral forward tilt of the torso from 31.9 to 15 minutes. The results of all three measurements were consistent with the test subjects' subjective impression. The results of the study show that further technical enhancements to assistive devices already available on the market can reduce physical stress upon employees. The results are to be documented in an IFA report and in national publications, and presented at events.

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