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Preventing disability losses in emergency services.

In the interests of public safety and self-defense, police officers and firefighters regularly place extreme, awkward physical demands on their bodies at a moment's notice. As a result, many law enforcement and fire safety employees suffer a back, ankle or knee injury during their careers, and many are inflicted by such detrimental side effects as ulcers, high blood pressure and cardiac-related disabilities. Municipalities and public agencies are left with phenomenal losses-in the case of the average back injury in one U.S. city, the cost was $8,000 before surgery or disability retirement.

This sobering situation underscores the need for a good loss control program. After discovering that physical fitness and wellness programs alone are not adequate, some municipalities and other public agencies have sought specialized loss control training programs that relate to these occupations' risk exposures. Even a half-day training session can lead to a tremendous savings in fiscal and human resources.

The key to preventing many injuries and disabilities is to provide police officers and firefighters with new work attitudes, not just symptomatic awareness, of how to properly respond to various types of incidents. New work attitudes, which employ reflexive safety margins for leverage, stability and crisis control, can enable emergency services personnel to physically respond with the greatest mechanical advantage. Similar to the work hardening concepts developed for body-contact athletes such as football players, stage professionals such as opera singers and even women preparing for the rigors of childbirth, the responses are tailored to one's exposure and occupational needs and are accompanied by a greater autonomic reflex-, or breath-, controlled adrenalin response.

Standard injury prevention training for emergency services personnel is symptomatic. For example, during standard back safety training, police officers and firefighters are told to bend their knees, bring the weight close to them and to work with their legs when they are lifting bodies. However appropriate these guidelines may be for clinical conditions or in weight lifting rooms, they may in fact cause injuries for a firefighter who reaches out for a heavy cardiac patient lying on a couch or a police officer who tries to restrain a resistant, struggling suspect. In these situations the knees are not inclined to bend, and therefore, the legs do not work as an initial response. The arms are first to load, and the back is instantly under pressure.

These are just two situations that pose serious loss potentials for emergency service personnel when, in fact, there are numerous other examples. Police officers often need to quickly exit their vehicles after sitting for a long period. They may have to pursue a suspect over an obstacle such as a fence, which may require them to land backward with momentum but without collapsing or straining the ankle. At other times they may have to strain to carry a protestor or handcuffed offender. And in another case utilize a baton with full body, not arm, power with enough recoil and control to adequately contain the aggressor without having to use deadly force.

Firefighters, who today often respond to medical emergencies dressed in full gear, may need to remove victims from bathtubs, beds and crushed vehicles. Fire emergency medical team members often have to carry cardiac patients on stretchers down narrow corridors and winding stairways and rapidly lift them over chest-high obstacles such as balcony railings. Those working a fire or practicing to do so need to pull deceptively heavy hoses and lift cumbersome equipment, such as hurst generators, fan blowers and ladders. Thus, the risk exposure in a physically demanding work arena is constantly changing.

Indeed, for most people, the ordinary act of reaching to pick up a cumbersome object from an automobile trunk and pull it over the bumper and trunk lip can be hazardous. Such situations require reaching for the object at an uncomfortable distance from the body, and therefore, they violate the first symptomatic rule of back safety: bringing the object close to the body with legs positioned underneath it.

Yet in physically demanding work environments, reaching for awkward or inaccessible weighty objects is commonplace, and employees often learn to avoid injury by the strain or discomfort of incorrect initial responses. The time to focus on proper training is now and not when employees begin to complain about habitual pain or strain.

Cumulative Disabilities

Various disabling injuries and conditions can occur when emergency service personnel are not appropriately trained. Most preventable injuries fall into one of three categories: effort-related (back), stability-related (knees and ankles) and stress-related (cardiac dysfunction).

Back injuries are perhaps the most prominent. Even the smallest amount of back pain during effort may produce damage. If this does not cause serious disability at first and incorrect work patterns continue, it may well build into later dysfunction.

To understand why this can occur, one needs to know a little about the spine. The discs separating the joints of the vertebral column act as shock absorbers. But because they do not have blood circulation or nerve endings within them, they do not directly signal pain when damaged nor do they regenerate significantly afterward.

When overloaded, the discs' multiple layers, which surround soft gelatinous centers, begin to tear from the inside out. This fluid shift causes the central nervous system to alert the body to protectively lock up muscles in that region. This spasm is a warning that damage has already occurred.

Medical studies indicate that one or more of the lower five discs of a 35-year-old male who has been in a physically demanding occupation for 15 years may well have serious degeneration. In most such cases there has been repeated trauma to the lumbar spine, or lower back, and some tearing and weakening of the layered surrounding walls of the lumbar discs has occurred. As a result, the potential for disc bulging or herniation with the inner core of gelatinous nucleus escaping out of the torn outer disc layers increases. If this occurs, pressure on the spinal nerve roots and, therefore, an inability to perform normal activities due to pain, known as neuromuscular dysfunction, will result. By the time discomfort is chronic, it may well be too late to reverse. At the very least, the causes of most back-related injuries do not disappear with first-time recovery, but leave a high probability of reoccurring and becoming a "back" condition. For employers, this translates into progressively more lost work time with each reoccurrence, repeated disability and early retirement, as well as higher disability ratings.

Similarly, with a few repeated slip or fall injuries, the supporting ligaments of the knee or ankle stretch. Ligaments do not tighten after being stretched. As a result, there is a greater probability of reoccurrence with each slip or fall.

In addition, tense and stressful physical response has often been identified as a major cause of ulcers and high blood pressure. Another side effect of too much stress is increased likelihood that emergency service personnel will make judgmental errors during crisis situations.

Proper Training

An injury prevention program for police officers and firefighters should begin with a discussion of where and how to focus the effort with the first breath of action and integrate it into the body's unified functioning from the center outward. Harnessing the breathing mechanics correctly while lowering the center of gravity through the hips triggers a unified body response, automatically transferring effort into the large muscles of the lower body and then the smaller muscles of the upper body.

To some extent, these actions occur naturally in all human beings; however, they are significantly improved in football players, opera singers and others in physically demanding occupations so they can perform with the maximum mechanical advantage, endurance and recovery capability. The emergency services employee must also adapt this response mechanism to his or her occupational skills.

Because body power and control is initiated from the hips, not the arms and shoulders, a unified or whole body response should be initiated from the greatest source of power supported by the finer controlling motor skills of the arms. This leveraged effort is particularly effective for police officers and firefighters who have minimum upper body strength.

This aspect of training not only benefits the individual, but can also have tremendous value to law enforcement agencies which face liability arising out of excessive force incidents. Some officers have been suspected of unnecessarily using weapons and excessive force because of their overreaction to perceived crises due to adrenalin combined with a lack of confidence in their own strength and capabilities. If by habit they employ the proper physical responses, they know that their full body power, recoil and control comes from the hips, center body and breath. This phenomenon is contradicted by weight training, which encourages the concept of "strong arm, strong body and big breaths" but is not occupationally correct work hardening for properly controlling struggling arrestees or lifting limp victims.

Tension and stress can also be reduced by encouraging routine center body effort while not holding the breath and discouraging arm, shoulder and chest effort as a first response. Tension should not be built up in the chest and shoulders nor is breathing controlled by the chest, but by proper diaphragm and abdominal/hip action. This breathing method simultaneously controls the body's output of adrenaline and, therefore, its need for oxygen.

Success Rate

This method of training emergency services personnel in injury prevention has been widely implemented by federal, county and city governmental agencies, as well as utility companies. For example, in California the cities of Sacramento and Pasadena and the counties of Marin and Ventura are among the many municipalities employing it. Even the emergency services fire unit at Lawrence Livermore National Laboratories, a U.S. Department of Energy facility administered by the University of California with a sophisticated hazard control system, has a program. According to a laboratory official, "Back injuries and falls at the emergency services of the facility of 10,000 have been reduced over 95 percent since implementation" of this type of training in 1986.

The programs have reduced back-related and other preventable injury losses among emergency service personnel after just one half-day training session. Furthermore, the cost of training a high-risk professional is less than the replacement costs of one lost workday. Jack S. Kanner is director of engineering and training for P.S.R. Corp., a corporate risk control and safety company in Corte Madera, CA.
COPYRIGHT 1991 Risk Management Society Publishing, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Author:Kanner, Jack S.
Publication:Risk Management
Date:Mar 1, 1991
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