Address: West Virginia University School of Medicine, Institute of Occupational and Environmental Health, P.O. Box 9190, MSS 3801, Morgantown, WV 26506-9190
Country: United States
Phone: 1 (304) 293-3693
Fax: 1 (304) 293-2629
Past position(s): Occupational and Environmental Medicine, Boston University Medical Center Hospital
Education: BA, 1981, Hamilton College; MD, 1985, Cornell University; MPH, 1995, Boston University
Areas of interest: Occupational medicine education; clinical occupational medicine; medical center occupational health
Paramedical personnel, including emergency medical technicians (EMTs) and ambulance attendants, provide the initial medical response at the scene of an accident, disaster or acute illness, and transport patients to the point where more definitive treatment can be rendered. Advances in medical equipment and communications have increased the capabilities of these workers to resuscitate and stabilize victims en route to an emergency centre. The increased capabilities of EMTs is matched by the increase in hazards which they now face in performance of their duties. The emergency medical responder works as a member of a small unit, usually two to three persons. Job tasks must often be performed rapidly in poorly equipped locations with limited access. The work environment may present unanticipated or uncontrolled biological, physical and chemical hazards. Dynamic, rapidly changing situations and hostile patients and surroundings magnify the dangers of the work. A consideration of the health risks to paramedical personnel is important in the design of strategies to reduce and prevent injury at work.
Risks to paramedical personnel fall broadly into four main categories: physical hazards, inhalation risks, infectious exposures and stress. Physical hazards involve both musculoskeletal injuries related to job tasks, and effects of the environment in which the work takes place. Heavy and awkward lifting is the predominant physical hazard for these workers, accounting for over one-third of injuries. Back strains constitute the most common type of injury; one retrospective survey found 36% of all reported injuries were due to lower-back strain (Hogya and Ellis 1990). Patient and equipment lifting appear to be the main factors in lower-back injury; nearly two-thirds of back injuries occur at the scene of response. Recurrent back injuries are common and may lead to prolonged or permanent disability and early retirement of experienced workers. Other frequent injuries include contusions of the head, neck, trunk, legs and arms, ankle sprains, wrist and hand sprains and finger wounds. Falls, assaults (both by patients and by bystanders) and motor vehicle accidents are additional major sources of injury. Collisions account for the majority of motor vehicle accidents; associated factors may be heavy work schedules, time pressures, poor weather conditions and inadequate training.
Thermal injury from both cold and hot environments has been reported. Local climate and weather conditions, along with improper clothing and equipment, may contribute to heat stress and cold injury. Accelerated hearing loss from exposure to sirens, which produce ambient noise levels exceeding mandated thresholds, has also been observed in ambulance personnel.
Smoke inhalation and poisoning by gases, including carbon monoxide, represent significant respiratory hazards for paramedics. Though occurring infrequently, these exposures can have dire consequences. Responders arriving on the scene may initially be inadequately prepared for rescue work, and can be overcome by smoke or toxic gases before additional help and equipment are available.
In common with other health-care workers, paramedical personnel are at increased risk of infection with blood-borne pathogenic viruses, especially hepatitis B virus (HBV) and presumably hepatitis C. Serologic markers for HBV infection were found in 13 to 22% of emergency medical technicians, a prevalence level three to four times that of the general population (Pepe et al. 1986). In one survey, evidence of infection was found to correlate with years worked as an EMT. Measures for protection against HBV and HIV transmission established for health-care workers apply to paramedical technicians, and are outlined elsewhere in this Encyclopaedia. As a sidelight, use of latex gloves for protection against blood-borne pathogens may lead to an increased risk for contact urticaria and other manifestations of allergy to rubber products similar to those noted in health-care workers in hospital settings.
Paramedical and ambulance work, which involves work in uncontrolled and hazardous environments as well as responsibility for important decisions with limited equipment and time pressures, leads to high levels of occupational stress. Impaired professional performance, work dissatisfaction and loss of concern for patients, all of which may arise from the effects of stress, endanger both providers and the public. Intervention by mental health workers after major disasters and other traumatic incidents, along with other strategies to reduce burnout among emergency workers, have been proposed to mitigate the destructive effects of stress in this field (Neale 1991).
Few specific recommendations exist for screening and preventive measures in paramedical workers. Blood-borne pathogen training and immunization to HBV should be undertaken in all employees with exposure to infectious fluids and materials. In the United States, health-care facilities are required to inform an emergency response employee who sustains an unprotected exposure to a blood-borne disease or to an airborne, uncommon or rare infectious disease, including tuberculosis (NIOSH 1989). Similar guidelines and statutes exist for other countries (Laboratory Center for Disease Control 1995). Compliance with standard immunization practices for infectious agents (e.g., measles-mumps-rubella vaccine) and tetanus is essential. Periodic screening for tuberculosis is recommended if the potential for high-risk exposure is present. Properly designed equipment, instruction in body mechanics and scene hazard education have been proposed to reduce lifting injuries, although the setting in which much ambulance work is performed may render the most well-designed controls ineffective. The environment in which paramedical work occurs should be considered carefully, and appropriate clothing and protective equipment provided when necessary. Respirator training is appropriate for personnel who may be exposed to toxic gases and smoke. Finally, the erosive effects of stress on paramedical workers and emergency technicians must be borne in mind, and strategies for counselling and intervention should be developed to lessen its impact.