IYM Participant Session Workplace Health and Safety 2013

IYM – Participant Session Workplace Health and Safety 2013

Objectives Participants will learn and apply the following: ü Responsibilities in hazard assessment ü Information on musculoskeletal injuries (MSI) and prevention ü Principles of Good Body Mechanics ü Three areas of assessment ü Safe client moving techniques Workplace Health and Safety

Why? Do we need a program to help us learn how to move clients safely? ØWorkforce needs ØSafe care for clients and healthcare workers Ø Occupational Health and Safety Legislation Workplace Health and Safety

What is a Hazard Assessment? Identifying actual or potential hazards we may be exposed to at our worksite. Workplace Health and Safety

Biological Hazard Chemical Hazard Physical Hazard Psychological Hazard Workplace Health and Safety

What’s Holding Us Back? ü Workload ü Complacency ü Resources ü Perceived Expectations Workplace Health and Safety

It’s Your Move for SAFETY We believe: • YOU are as important as the client • A change is needed • YOU already have the skills and knowledge required • YOU are the key to safety Workplace Health and Safety

Seeing more with your mind than your eyes! Workplace Health and Safety

Shifting Perspectives IYM Minimal Physical Effort Maximum Equipment Use Client Participation No Unsafe Lift Workplace Health and Safety

Body Mechanics 6 Checkpoints ü three for the top ü three for the bottom ü elbows tucked in ü safe effective grip ü comfort zone ü weight transfer Workplace Health and Safety

Musculoskeletal Injuries Defined as: Ø Damage to the various structures involved in producing force for movement of the human body, such as soft tissue Acute: Ø Immediate onset of signs and symptoms Chronic: Ø Gradual onset of signs and symptoms Workplace Health and Safety

Types of Injuries Excessive Force Injuries: Ø Caused by lifting, pulling or pushing activities that exceed the range of motion or strength of muscles, tendons and ligaments. Sustained Force Injuries: Ø Caused by prolonged activities that exceed the endurance of the muscles. Repetitive Strain Injuries: Ø Caused by activities involving repeated gripping, reaching, bending or twisting that exceed soft tissue capacity Workplace Health and Safety

Body Mechanics Ø To understand body mechanics we must first understand the structures that support us Ø Our muscular system uses levers to develop force Workplace Health and Safety

Body Mechanics Ø The purpose of the back musculature is to maintain intervertabral stability Ø Back angle is maintained by the hip extensors Ø Rigidity of the spine is maintained by the erector and trunk muscles Workplace Health and Safety

Signs & Symptoms We are empowering YOU to make a client handling decision based on the below symptoms. Listening to your body will prevent injuries while on shift. ü Inflammation ü Pain ü Swelling ü Numbness and/or Tingling ü Decreased ROM ü Weakness Workplace Health and Safety

Do you… q work without warming up? q ever not get enough sleep? q bend at the waist to lift loads? q have poor nutrition and hydration q move or lift heavy loads? q pull objects? patterns? q experience stress? q twist when turning or lifting? q slouch when walking or standing? q do repetitive actions? . . . are you at Risk? Workplace Health and Safety

Principles of Good Body Mechanics 1. 2. 3. 4. 5. 6. 7. 8. Use your brain not your back Listen to your body Maintain three natural curves Use strong thigh muscles Hands in a safe effective grip Keep the load close Maintain a proper stance Use a weight transfer Workplace Health and Safety

Observational Assessment Ø A systematic process, one we do all the time, most often subconsciously. Ø Gathering information to identify risk, analyze the information, make a decision on a solution(s) to eliminate or manage the risk, and then evaluate it. Ø Using your skill at assessing the situation. This will ultimately result in you making a good decision. Workplace Health and Safety

Self Assessment üPhysical status üEmotional status üTraining/experience üCommunication üWorkload Workplace Health and Safety

Environmental Assessment üRoom/Area üColor/Lighting üNoise/Distractions üWorking Surfaces üEquipment Workplace Health and Safety

Client Assessment üCommunication üCognitive üEmotional/Behavioral üMedical üFunctional Assessment Workplace Health and Safety

Client Assessment Medical Communication Client Functional Assessment Cognitive Emotional/ Behavioral Workplace Health and Safety

Transfer Belts Workplace Health and Safety

EMS Lifting Communication is key! 1 -2 -3 -Command! Workplace Health and Safety

Transfer Belts – Used for guiding, not lifting • Helping client get up/ sit down • Transferring between resting surfaces • Support guiding when walking with client • Applied to waist snug enough to allow for both hands to be placed under belt • Use palms up grip • Position feet/ legs outside clients stance to maintain stable base • Keep arms close to body, bend at hips and keep back in neutral position • Pivot feet to turn not twisting back Assisting Client from Floor with Transfer Belt • Assist client to seating position • Apply transfer belt to clients waist • Block clients feet with knees bent • Using palms up grip, grasp belt for stability and guidance • Stand up using legs to assist with lift, guide client to standing position • Maintain communication with client and partner to ensure safety throughout move Workplace Health and Safety

Assisted/Guided Fall A client may fall unexpectedly for any number of reasons. If the client starts to fall, the worker: • Will guide the fall only if within a distance that permits assistance, • Does not try to stop the fall • Must not work against gravity by: o Holding the client up o Stopping the client from sliding off a chair o Attempting to drag the client back to the client’s original position Workplace Health and Safety

Assisted /Guided Fall Assisted/Guided Fall Procedure • The worker moves in as close as possible to the client • The worker grasps the client (if safely possible) and guides/slides the client gently to the floor by quickly bending at the hips and knees while keeping the trunk upright (maintaining the three natural curves of the spine) • If the client is unable to get up on their own, the worker ensures that the client is made comfortable on the floor until: • The necessary equipment and/or assistance is obtained to move the client from the floor. Workplace Health and Safety

It’s Your Move Transfer Ø One and Two-person Transfer with a Belt Lift Ø Sit/Stand Total Lift Reposition Ø Ø Ø In Wheelchair Bed to Stretcher In Bed using Transitory Sheet/Tube Workplace Health and Safety

Stryker Speed Sheet Workplace Health and Safety

Stryker Speed Sheet Workplace Health and Safety

Stryker Speed Sheet Workplace Health and Safety

Stryker Speed Sheet Workplace Health and Safety

Reposition in Bed Activity Shifting, moving and/or adjusting the client’s entire body weight on the same surface or between two surfaces of equal height Requires a Minimum of Two Workers ØReposition Up in Bed ØReposition Side to Side in Bed Workplace Health and Safety

Remember… ü to use 1 -2 -3 -Command word ü the primary worker directs the move ü to always raise the height of working surface to tallest worker Workplace Health and Safety

Functional Assessment 35 Workplace Health and Safety

Functional Assessment & Logo Process Workplace Health and Safety

Completing the Functional Assessment Record Ø Client Health Information Ø Functional Assessment Ø Assigning a Logo Workplace Health and Safety

Functional Assessment Record (FAR) Ø Completed by the Regulated Health Professional upon inpatient admission Ø Choose a time when the client is at their best. If possible, avoid times when the client is in pain, uncooperative, tired or feeling unwell. Ø Repeated any time there are significant changes (improvement or decline) in functional ability Ø Record will be located in the chart Workplace Health and Safety

Exceptions to Performing the Functional Assessment Clients who may be: Ø Physically unable Ø Cognitively unable Unresponsive Clients Workplace Health and Safety

Before the Move…. Look Stop Listen Workplace Health and Safety

Independent Transfer Criteria üCan bear their body weight through part or parts of their body üIs cooperative, predictable and reliable in physical and mental Independent Transfer performance üCan safely relocate themselves with or without the use of assistive devices Workplace Health and Safety

Minimum Assistance Transfer Criteria ü Can bear their body weight through part or parts of their body ü Is cooperative, predictable and reliable in physical and mental performance ü Can safely relocate themselves with or without the use of assistive devices ü May require verbal or physical cues Minimum Assistance Transfer ü May require minimal assistance with equipment and/or personal items Workplace Health and Safety

One-person Transfer with Belt Criteria ü Can bear their body weight through part or parts of their body ü Is cooperative, predictable and reliable in physical and mental performance ü Can maintain balance when walking/shuffling feet and/or pivoting One-person Transfer with Belt ü Requires one worker to provide hands -on assistance to move Workplace Health and Safety

Two-person Transfer with Belt Criteria ü Can bear their body weight through part or parts of their body ü Is cooperative, predictable and reliable in physical and mental performance ü Requires two workers to provide hands-on assistance to move ü Has difficulty maintaining balance while Two-person Transfer with Belt walking/shuffling feet and/or pivoting Workplace Health and Safety

Sit/Stand Lift Criteria ü Is unable to stand for 15 seconds but has partial weight bearing abilities through part or parts of the body ü May be unpredictable and/or unreliable in physical and mental performance ü Is able to keep at least one arm outside the Sit/Stand Lift harness Two workers are required to operate a mechanical lift Workplace Health and Safety

Total Lift Criteria ü Cannot bear their own body weight ü May be unpredictable and/or unreliable in physical and mental performance ü May be unable to follow instructions due to cognitive or physical disability ü May be uncooperative in behavior Total Lift ü May be unable to maintain sitting position Two workers are required to operate a mechanical lift Workplace Health and Safety

Bed Rest Criteria ü Confined to bed by physician’s order or nature of their medical condition Bed Rest Workplace Health and Safety

In Transition Logos Ø Used in select areas only or if client admission is less than 24 hours Ø May be changed after each Functional Assessment Ø Documentation is required with Logo change Ø Use regular Logos as soon as client stabilizes Workplace Health and Safety

More About Logos… ØLogo placement ØNumber of Logos Ø Client needs more or less help than Logo indicates Ø Logo is assigned following completion of the Functional Assessment Record Workplace Health and Safety

EMS Safe Client Handling Workplace Health and Safety

Driving Excessive Vibrations Prolonged Sitting Acute and Chronic Symptoms: • • • Discomfort/pain to neck, lower back, shoulders and lower extremities Headache Nausea Abdominal pain Fatigue Vertigo Hunched shoulders Lumbar scoliosis Disc disease Herniated discs Nerve irritation Workplace Health and Safety

Driver/ Passenger Recommendations • Adjust seat properly to avoid lower back strain and impeding blood flow to lower extremities due to pressure on buttocks and legs • Adjust seat to avoid over stretching to reach pedals • Monitor your position – don’t use arm rests if it causes sideways leaning • Remove wallet to straighten sitting position • Utilize lumbar rolls to support the spines natural curvature Workplace Health and Safety

Driver/ Passenger Recommendations • Pay close attention to body mechanics especially during the first 2 -3 mins after exiting ambulance as tendons and discs are at high risk for injury at that time • Walk and stretch between calls or whenever possible to replenish blood flow to muscles and stretch hamstrings and hip flexors • Whenever possible perform a gentle back extension immediately after exiting the vehicle and use micro break strategies as able • Avoid going home and sitting on the couch after a long shift behind the wheel Workplace Health and Safety

Personal Fitness Levels • Core Stability • Flexibility • Aerobic Conditioning Workplace Health and Safety

Stretching • EMS involves significant physical activity by staff. • Improper or lack of stretching prior to commencing physical activity significantly increases the risk of strains. • Historically, sprains and strains have been a leading cause of injury in EMS. Particularly back, neck and shoulder strains. Workplace Health and Safety

Tips for Stretching • Stretching should last for 8 -12 minutes for full effectiveness • Must include all body parts necessary for the task to improve flexibility • It should be done: § at the beginning of the shift § before any physically demanding task, and § when muscles feel cold or stiff Workplace Health and Safety

Stretching Do’s • • • Use smooth, gentle, and controlled movements Do stretches within your comfort zone Breathe naturally and relax Hold stretches for 15 -30 seconds Use proper posture: » head upright » joints loose and relaxed » stomach in » feet shoulder width apart » knees slightly bent Workplace Health and Safety

Stretching Don'ts • • Don’t bounce or force stretches Don’t hold your breath Don’t lock your knees or elbows Know your own limits! Workplace Health and Safety

Leg Stretches We lift a lot of weight with our leg and compensate with our backs Workplace Health and Safety

Back and Neck Stretches Our backs and necks face the challenges or lifting, driving and being sedentary. Stretching is important. Workplace Health and Safety

Chest and Arm Stretches We use our chest, arms and hands to lift; sometimes with prolonged grips. Stretching can both be a warm up and rest from these activities Workplace Health and Safety

Microbreaks Periodic breaks or interruptions that give the muscles an immediate rest from the activity they have been performing. Includes: -Alternating work activities to distribute stress to other regions while improving circulation -Performing counter-balancing stretches Workplace Health and Safety

Why are they important? Microbreaks: -Restore blood flow to working muscles -Enhance recovery rates from forceful or static loads -Re-establishes balance in the muscoskeletal system -Allows for a mental break -Reduces the chances of injury by reducing wear and tear Workplace Health and Safety

Microbreak Guidelines -Last only a few seconds -Performed frequently through day -Following awkward, static or sustained postures Incorporates movements that: -Counterbalance activities -Stimulate circulation -Reduce muscle loads Workplace Health and Safety

EMS Lifting General Principles Workers must: • Inspect and prepare equipment prior to use for cleanliness, any wear & tear or flaws • Use correct body mechanics and postures during procedures (follow the 6 Checkpoints) • Communicate appropriately and effectively to client and other workers throughout the moving technique • Ensure safety, comfort and dignity of the client during and after procedures. • Select primary worker to lead a two-person move while workers perform the move together Workplace Health and Safety

Equipment Handling • Get as close as possible to equipment to avoid excessive reaching • Remove items that are in the way • Slide object to the edge before lifting • Distribute load evenly on both sides of body • Take only necessary equipment • Load on stretcher if possible • Remove obstacles wherever appropriate • Use micro breaks to counteract static postures Workplace Health and Safety

Body Mechanics 6 Checkpoints ü three for the top ü three for the bottom ü elbows tucked in ü safe effective grip ü comfort zone ü weight transfer Workplace Health and Safety

Stretchers Workplace Health and Safety

Stretcher Handling • Always Two person handling requirement (minimum) • Always palms up grip (biceps) • Communication – actions, levels etc. • Assessment and awareness of surfaces for moving stretcher • Guiding/ steering is done by front person usually with one hand to avoid twisting with load • If pulling is required use both arms and walk backwards Workplace Health and Safety

EMS Lifting • • Use a wide, balanced stance not less than shoulder width apart Position yourself as close to the load as possible Keep feet flat on floor; don’t raise up onto your toes Bend at your hips to lower yourself and to keep your back in a strong and neutral posture; the knees will bend slightly If you need to squat fully to the ground to perform your lift, try offsetting your legs with the strongest leg forward Contract your abdominal muscles Lift the head first then the hips when rising up, in order to keep the back straight Workplace Health and Safety

EMS Lifting • Lift the head first then the hips when rising up, in order to keep the back straight • Consider a two-stage approach for lifts that begin below knuckle height; lift from the lowest position to an intermediate height, then reposition and lift to the final height • Pivot with feet instead of twisting with your back • Use palms up grip/ to use biceps Workplace Health and Safety

Two-person Lift with Stretcher • • • Identify the primary worker Primary worker explains procedure to the client Both workers will place themselves on either end of the stretcher. Tallest worker at the head The handles of the stretcher are grasped with palms up The primary worker will instruct the other worker(s) that they will lift the stretcher into a loading position by using the command words” 1 -2 -3 -Lift” During the lift the worker on the foot end of the stretcher while gripping the handle will pull the release trigger to lower the legs of the stretcher Workplace Health and Safety

Scoop Stretcher Workplace Health and Safety

Two-person Lift with Scoop Stretcher • Identify the primary worker • Primary worker explains procedure to the client • Both workers will place themselves on either end of the Scoop Stretcher • Both workers will ready themselves by getting into a lifting position and grasping the handles of the Scoop Stretcher with palms up Workplace Health and Safety

Two-person Lift with Scoop Stretcher • The primary worker will instruct the other worker(s) that they will lift the scoop stretcher by using the command words” 1 -2 -3 -Lift” • Client should be lifted onto a stretcher for transport. The stretcher should be at waist height in the comfort zone of the tallest worker and have the wheels locked when possible Workplace Health and Safety

Stair Chair Workplace Health and Safety

Stretcher/ Stair Chair Carry Up/ Down Stairs • Use a spotter to communicate location of steps and other hazards • Use as many staff as possible to do action safely • Taller person at foot end to maintain load in comfort zone • Use stair chair whenever possible when doing stairs Workplace Health and Safety

Two-person Lift with Stair Chair • Identify the primary worker • Primary worker explains procedure to the client • Both workers will place themselves on either end of the Stair Chair. The taller of the two workers should be at the foot end to maintain load in comfort zone • Assist client onto the Stair Chair • both workers will ready themselves by getting into a lifting position and grasping the handles of the Stair Chair with palms up Workplace Health and Safety

Two-person Lift with Stair Chair • When both workers and client are ready, the primary worker will instruct the other worker(s) that they will tilt the client into position by using the command words” 1 -2 -3 Tilt” • Once the client is tilted back ready to go up or down the stair the primary worker will instruct the other worker(s) that they will lift the Stair Chair by using the command words” 1 -2 -3 -Lift” Workplace Health and Safety

Manual Lifts It’s Your Move – Safe Client Handling does not recommend manual lifting. However, there are some situations where manual client handling and moving is required. A manual lift is appropriate: • for the client whose medical treatment or quality of life is being compromised due to their position on a particular surface • in an evacuation situation (e. g. , due to a fire or chemical spill) • in an emergency situation where a clear airway is vital to the client’s survival • in a disaster situation where several victims are involved, and decisions are being made as to • transportation and delivery of clients to specific areas and/or treatment surfaces/centres Workplace Health and Safety

Manual Lifts • A transfer sheet, rescue seat, lift sheet, back board or spine board should be used if available and if time permits during a manual lift Workplace Health and Safety

Additional Equipment Workplace Health and Safety

Ferno Rescue Seat -It constructed of tough reinforced vinyl that is easy to clean and resists blood and bodily fluids. -Four handles assist in moving patient short distances -The Rescue Seat can remain underneath the patient when placed onto cot to avoid additional transfer. -The rescue seat can frequently be used in place of an extremity lift/carry. -Weight limit of 350 lbs/159 kgs Workplace Health and Safety

Ferno Patient Carry Sheet -Special ordered by AHS to ensure a 1000 lbs carrying capacity -Has multiple hand holds to facilitate additional staff to assist with lifting -Can be used for bariatric patients, confined space rescue or basic floor to cot lifts Workplace Health and Safety

Manual Lifts Procedure for manual lift, supine, from floor to stretcher • While kneeling on the floor, the workers Log Roll the client on to a secure lift sheet, emergency evacuation blanket, canvas stretcher or rigid full-length board with grip handles • The four workers position themselves two on each side and near the corners of the client’s body. The tallest two workers should be near the head of the client so that the client’s head remains elevated throughout the lift • It is critical that workers use good body mechanics during an emergency manual lift. Workplace Health and Safety

Manual Lifts • Kneeling on one knee, each worker grasps the sheet using a palms-up grip with wrists properly aligned and rolls it as closely as possible to the client and/or grasps the board appropriately The primary worker counts “ 1 -2 -3 -Lift” and everyone stands on the “Lift” command • The workers move in unison to position the client over the stretcher. On the primary worker’s count of “ 1 -2 -3 -Down, ” the team lowers the client on to the stretcher • As time allows, and as appropriate, the assistive device is removed from under the client by Log Rolling the client from side to side Workplace Health and Safety

Ideal Manual Lifts Workplace Health and Safety

EMS Lifting Communication is key! 1 -2 -3 -Command! Workplace Health and Safety