Back Health for EMS

In the emergency medical services (EMS) industry there are many topics that need to be trained on a continuous basis. While many of them are important for patient care and continuing education, some topics are important for the continued health of the provider. As an emergency medical technician (EMT) and a certified National Registry of EMT (NREMT) instructor for five years training is paramount for successful EMS operations.

One of the most important tools of the EMT at every level, from student all the way to senior paramedic, is their back. EMTs are constantly lifting patients, equipment, and moving on their feet. This requires a great deal of attention be paid to correct ergonomics regardless of the situation (Limmer & O’Keefe, 2012). This can be challenging and students are often not prepared for this aspect in their initial training, which leaves them open to learning the wrong methods during internships. In this article we will discuss a Learning Needs Assessment that focuses on continuous ergonomics training, monitoring, and evaluation.

The proposal of this learning needs assessment is to implement a training plan for ergonomics that does not stop in the initial training. While correct ergonomics is common knowledge, consistent training is needed to ensure that each member of the EMS unit is protecting themselves and their patients. Of course, this needs assessment does not insinuate that any other training on a periodic basis is not needed or important, however ergonomics is not usually included, leading to increased chronic lower back issues in EMS responders (EMS World, n.d.).

For the purpose of the training plan outlined in this articla, initial EMT ergonomics training will not be included. This will be assumed to be adequate due to the need to strictly follow NREMT training standards. Ergonomics training can be compromised of the following topics: lifting and moving, obese patients, bariatric lifting, and unique situations where access to patients can cause issues with ergonomics. When it comes to specific training plans, these are very flexible based on the area of responsibility. Some EMS areas require training in metropolitan areas (think of high rise buildings) while others will need training on lifting in remote locations (think mountainside locations). Each training plan should be specific to the needs of the EMS area it is implemented in. Each training module should be given during the periodic training of the EMS unit in order to keep ergonomics and safe patient lifting effective.

According to Kirkpatrick’s model of Training Evaluation there are four levels to consider (Kirkpatrick, 2014). These levels are reaction, learning, behavior, and results, they relate to evaluation of the training. In the reaction step, it is important to measure how the members involved in the training received the information. This helps to improve the training through adaptation as learning needs are discovered. This also helps to develop the instructor through the feedback received from the audience’s reaction to the training.

In the learning step, it is important to measure how much your audience has learned. This can be accomplished through keeping detailed learning objectives and by feedback from the students. Input from the EMS unit can also assist with this step by letting the instructor know if additional objectives need to be added or strengthened in training. This may lead to changes in the curriculum, however adaptation to the learning step is important to maintaining effective training plans.

In the behavior step, the instructor must analyze how much the behavior of the audience has changed. This is incredibly dependent on the first two steps, because if inadequate attention has been paid to reaction and learning of the audience it may be wrongly assumed that behavior has not actually changed. This can be an error due to simply not seeing data to support a change in behavior outcome, even if one has occurred. Assuming adequate attention has been paid to the first two steps, and no change in behavior is noticed. There are a few reasons for this; it may be the instruction method or the students themselves (Kirkpatrick, 2014). The students may not have the desire to change the status quo and apply new knowledge; this will require a different level of training and enforcement. However, it is important to understand this and identify if this occurs.

The final step is the results step, which can be the most time consuming (Kirkpatrick, 2014). Measuring long-term results can be difficult to assess and is very dependent on the type of EMS unit and the training provided. Some long-term indicators can be reducing injuries, lower workers compensation claims, and many others. Analyzing this data and utilizing it in future training is a fluid and always changing step that cannot be neglected.

The final conclusion is that ergonomics training is an important module that needs to be included in every EMS unit’s periodic training. Each training module can be specifically designed for the area of responsibility for the EMS unit. The Kirkpatrick method of training evaluation is an effective way to evaluate how well each training plan is received by the audience, how it effects their behavior, and the long term results on the EMS unit. It is important to have an effective training plan regardless of the topic, both for our patients and our providers.




Kirkpatrick’s Four-Level Training Evaluation Model: Analyzing Training Effectiveness. (2014). Retrieved July 25, 2016, from

Limmer, Daniel and Michael F. O’Keefe. (2012). Emergency care, 12th ed. Upper Saddle River, NJ: Brady/Pearson Education.

Managing Chronic Pain | (n.d.). Retrieved July 25, 2016, from

Ergonomics in Outer Space

Ergonomics is an important aspect of every effective injury and illness prevention program. This is a concept that is easy to accomplish in many work areas; the safety professional can actively view the processes and give spot corrections as needed. However, think for a moment of a work center that is in a constant orbit 250 miles above the surface of the earth. Ergonomics is incredibly important when medical care is not an accessibility that many of us take for granted if a work-place injury occurs. The lessons learned at the International Space Station (ISS) and the ergonomics program will be a large part of future space exploration, regardless of where that is.

It is an interesting concept to examine how the ergonomics program at NASA adapts to new processes or procedures by astronauts essentially cut-off from the earth. New equipment, lab experiments, and daily tasks are always accomplished by the astronauts assigned on the ISS (Gallagher, Reinerman-Jones, Sollins & Jans, 2014). The safety professionals in charge are located on earth, completely cut-off from the daily life of the ISS. The article outlines the different simulations that were used to anticipate certain issues that can be experienced on the ISS. A mixed reality simulator was used that utilized physical structures and simulated visuals. The researchers discovered an aspect to space travel that had been previously reported by astronauts and how it related to ergonomics.

The focus is on the main area of theoretical issues that were discovered during simulations and testing. One issue was that of Awe and Wonder (AW), this led to “out of body” experiences by the astronauts and those in the study (Gallagher, Reinerman-Jones, Sollins & Jans, 2014). This relates to ergonomics during the daily operations in a large way. If an astronaut is experiencing a high factor of AW, they may not be able to focus on the tasks at hand. The Awe and Wonder factor was also found to be an issue with astronauts becoming entranced and completely losing focus and aspect of time. This raises a few concerns for the safety and ergonomics programs.

The concepts are clearly defined that issues of losing focus due to the AW factor can increase safety and ergonomics issues for the astronauts affected. The hypothesis that astronauts have reported these out of body experiences and feeling a heightened “spiritual” cognizance ever since they have started orbiting the planet led to increased research. This research and testing this has always posed a problem due to not being able to send researchers and test subjects into orbit.

The methods utilized to test the hypothesis was a simulated environment on earth that combined physical structures of the ISS and simulated visuals to give the feeling of being in orbit. The test sample size was 38 participants (13 males and 25 females) and a length of 2.5 hours of testing in the simulated environment. Pre-test questionnaires were administered and then post-test questions were answered.  The majority of the answers showed increased Awe and Wonder that related to a loss of perception in surroundings. Utilizing the simulated environment on earth allowed for greater manipulation of stimuli in the study.

The evidence found in the study supported the hypothesis that an AW factor increases the risks associated with daily operations of the astronauts aboard the ISS and in space travel. The out of body experiences lead to reduced perception in the surroundings and the tasks at hand. This is also compounded with the issues of astronauts working long hours and potentially being physiologically fatigued, which was also found to increase the AW factor.

This study impacts the space safety program to a great extent. Through the development of more comprehensive views of the surrounding aspects of being in space, the safety management team can develop training and adaptations to accommodate them. While the space industry may be immediately impacted this also has a very large potential impact to the commercial space flight industry as well. When commercial flights into space begin in the near future, passengers will experience the Awe and Wonder aspect. Understanding this will allow for safety programs to account for this and implement mitigation (Gallagher, Reinerman-Jones, Sollins & Jans, 2014).

This area of study advances the human factors of ergonomics to a great extent. Traditional safety views on earth do not typically have to account for a loss of perception due to an AW factor. As space becomes less of an untouchable frontier to organizations, understanding the differences in human’s perceptions will be required. As space exploration missions become longer and further from the planet, a comprehensive safety and ergonomics program will need to be in place. This also allows for an increased ability to anticipate the issues that will be experienced in future space exploration and colonization efforts.

In conclusion, the study began with a hypothesis from the loss of perception reported by astronauts. The hypothesis that Awe and Wonder can decrease perceptions and mental functionality was tested on earth. The test utilized a simulated environment that combined physical structures with simulated visuals of orbits, deep space, and gas clouds. The evidence gathered supported the hypothesis that an AW factor can decrease perception of an individual. This plays a large part in safety and ergonomics programs in both the space industry and in commercial space travel organizations. The research will also play a role in future space exploration and colonization efforts.



Gallagher, S., Reinerman-Jones, L., Sollins, B., & Janz, B. (2014). Using a simulated environment to investigate experiences reported during space travel. Theoretical Issues in Ergonomics Science, 15(4), 376-394. doi:10.1080/1463922X.2013.869370