Preventing Firefighter Injuries When Handling Obsese Patients: Understanding the Patient Handling Scenarios
Authors: Lavender Steven A. , Sommerich Carolyn M. 
Published: September 2017

Karter and Molis(2014), in their recent analysis of fire service injuries, noted that overall the number of injuries experienced by firefighters has been declining over the past 20 years. Yet, in 2013 there were still an estimated 65,880 injuries; 12,535 of these injuries occurred during non-fire emergencies. From 1981 to 2013, the number of non-fire injuries increased by 31 percent, largely due to nearly a tripling in the number of non-fire response calls received. Injury risks associated with patient-handling are compounded by the obesity epidemic in the US. About one-third of American adults are now overweight (25<BMI<29.9), and another third are obese (BMI >=30) (NCHS, 2012). Given the obesity epidemic in this country, more and more of these calls are servicing overweight and obese individuals. In addition to weight, body shape and medical conditions that heighten pain or limit mobility contribute to the physical challenge of handling obese patients (Crowley and Leggett, 2010). The larger goal of this research effort is to develop control measures that are perceived by firefighters to be useful, usable, and desirable. The first step in this process requires a better understanding of the scenarios in which heavy patients are handled. The scope of this this project focused on the patient handling situations that occur in the patient’s home. Thus, the objective of the current phase of the project was to identify frequent scenarios encountered when handling obese individuals and the specific challenges associated with these scenarios that lend themselves to ergonomic solutions. A series of focus groups was conducted with 53 professional firefighters and EMS responders to identify the physically demanding scenarios firefighters frequently encounter when handling obese patients in their homes. In 9 out of the 10 focus group sessions, at least one of the described scenarios involved assisting patients in the bathroom where there is limited space for fire service personnel to assist. This included scenarios where the patient is in the tub, in a stand-up shower, on the floor between the toilet and the wall, or the toilet and the bathtub. Other frequently described scenarios involved patients on the floor between the bed and the wall, and transporting patients up the stairs. While not as common as transporting patients down the stairs, there is limited equipment available to assist with up the stairs transport. For example, the non-powered track-style stair chairs, while useful when descending the stairs, do not facilitate transporting patients up the stairs. Most of these situations were not urgent and many were “fall assist” calls. Some the factors that the participants identified that made the situations even more physically demanding included needing to transport up or down stairs, a lack of space for additional responders therein limiting the amount of assistance available, patient sensitivity (sores, prior injury, etc.), clutter in the home, difficult to firmly grasp patient, wet and slippery patients, tight turns, and narrow doorways. Thus, firefighters would have time to use ergonomic devices if such devices were available and perceived to be useful, usable, and desirable by the firefighters on the scene.