Learn How to Treat & Avoid the Most Common Injuries for EMS Professionals
Every year, Emergency Medical Service (EMS) workers treat over 22 million patients in the U.S. Because of their brave service, Emergency Medical Technicians (EMTs) and paramedics experience some of the highest rates for work-related injuries, illnesses, and fatalities in our country. In fact, the injury rate for EMS workers is about 3 times the national average for all occupations, according to the Bureau of Labor Statistics.
EMS professionals perform a rigorous and dangerous job. It involves physically demanding work, high-speed transportation, dangerous equipment and environments, combative patients, and exposure to harmful substances. While a number of other professions incur higher rates of fatal injuries—including logging workers, fishing workers, and pilots—EMS workers are at the greatest risk for occupational injuries and assault compared to all other professions in the U.S.
This article identifies the most common injuries for EMTs and paramedics, discusses some of the most common treatments and outcomes, and examines some of the ways these injuries may be prevented or mitigated by both EMS workers and their employers.
Most Common Injuries for EMTs and Paramedics
In responding to a variety of emergency calls involving individual patients and mass casualty events, EMS workers are exposed to hazardous activities and environments that could result in a high rate of occupational injuries.
To preserve and protect this critical workforce, it is necessary to understand these injuries and illnesses, know how to treat them, and more importantly, how to avoid them in the future.
Below are some findings on EMS worker injuries from a report by the National Institute for Occupational Safety and Health (NIOSH).
EMS Injury Statistics
Demographics of Injured EMS Workers Treated in US Hospital Emergency Departments, 2017
Among EMS worker injuries, sprains and strains were the most common diagnosis. Most injuries affected the hands and fingers and upper trunk. The greatest portion of injuries involved overexertion and body motion. About 40% of the overexertion and body motion events were specifically identified as overexertion during lifting.
The second most common injury was exposures to harmful substances such as potentially infectious materials (e.g., bodily fluids). For all of the EMS injuries, the most common sources which directly produced the injury were the EMS workers themselves or their patients.
|Number of EMS Injuries
|Percent of all EMS Injuries
EMS Injuries by Gender
|Number of EMS Injuries
|Percent of all EMS Injuries
EMS Injuries by Age Group
|Number of EMS Injuries
|Percent of all EMS Injuries
|18 – 24
|25 – 29
|30 – 34
|35 – 39
|40 – 44
|45 and over
Most Common Injuries Among EMS Workers
|Number of EMS Injuries
|Percent of all EMS Injuries
|1. Overexertion & Body Motion
|2. Exposure to Harmful Substances
|3. Falls, Slips, Trips or Loss of Balance
|4. Motor Vehicle Incidents
|5. Assaults & Violence
* The total number of EMS injuries is larger than the sum of injury events because not all injuries were related to one of the injury events listed.
1. Overexertion & Body Motion Injuries (28%)
How to Avoid Body Motion Injuries
Body motion is the most common injury among EMS workers. Factors contributing to body motion injuries include heavy lifting, awkward postures, fatigue, spinal tissue loading, psychological factors, failure to prepare for lifting, and lack of self-care (for example, rest, diet, and exercise).
Most of the body motion injuries were among workers over 40 years of age. The age factor may be the result of the cumulative nature of body motion injuries. In other words, heavy lifting, forceful exertion, and awkward posture cause greater injury with repetition over a long period of time.
A key activity that leads to many body motion injuries among EMS workers is patient handling. Studies have shown that the most hazardous body motion tasks for EMS workers involved pulling a patient from a bed to a stretcher, initializing stair descent when using a stretcher, and lifting a patient on a backboard from floor level.
Unfortunately, injury prevention measures related to patient handling that are commonly used in other healthcare environments—such as, mechanical lifts, zero lift policies, and lift teams—are not realistic in the EMS environment.
Despite this, however, various EMS tools and techniques have been successfully used while handling patients, either while transporting them down a flight of stairs, during lateral transfers, or when transferring them from a bed to a chair.
Powered cots have also helped reduce these types of body motion injuries. Powered cots that can lift and lower their front wheels have been proven to lessen muscle activity and the necessary force required by EMTs and paramedics when transporting their patients.
Other ways to prevent body motion injuries include injury prevention training, as well as eliminating any physical risk factors when feasible. Finally, EMTs and paramedics can further protect themselves by regularly performing a variety of strength and flexibility exercises.
2. Exposure to Harmful Substances (27%)
How to Avoid Exposure to Harmful Substances
Exposure to harmful substances is the second leading injury among EMS workers. In a recent study, the most common exposure injury was the result of accidental needlesticks, which can expose workers to bloodborne pathogens including HIV and hepatitis B.
The high incidence of harmful exposure to the face highlights the importance of wearing personal protective equipment (PPE) in the line of duty. This type of exposure can be prevented by adhering to standard precautions, including the use of safety goggles, masks, or face shields when responding to medical emergencies. Unfortunately, some studies show that many EMS workers do not always comply with these precautions. In fact, one study revealed that less than 50% of EMS workers were complying with standard precautions when arriving at the hospital.
Further research is needed to better understand the barriers that could be preventing EMTs and paramedics from following some of these standard precautions. Most EMS workers recognize the importance of PPE, and most of them also report that the protective equipment that’s necessary to prevent exposure is almost always available on the ambulance.
Sometimes, EMS workers will closely adhere to these standard precautions when doing so is counted towards performance evaluations. Some people may consider this to be a harsh measure, but it has been proven to work. In the end, any strategies to promote better health must be accompanied with education and mutual understanding between our medical first responders and their employers.
Educational efforts can be directed toward increasing awareness of the importance of standard precautions, including PPE. Specifically, education and follow-up by EMS managers or supervisors could encourage the use of PPE and aid in decreasing exposures in the prehospital environment.
3. Falls, Slips, or Trips (16%)
How to Avoid Falls, Slips, or Trips
Falls, slips or trips (or loss of balance) is the third-leading injury among EMS workers.
Multiple environmental risk factors can contribute to a loss of balance. For example, changing surface conditions and variations in surface levels, such as wet or slick walkways or going up and downs stairs, all present challenging working conditions. These obstacles require you to move differently under extreme conditions. When rushing during an emergency, EMTs and paramedics can easily slip and fall, leading to other sudden injuries or trauma.
Carrying heavy loads while walking can also increase the risk of falling. You can easily lose stability when carrying patients or heavy objects at (or above) waste level. Carrying anything at that height can easily obscure your view of the surfaces you’re walking across or any hazardous obstacles that might be in your way.
Any physically strenuous activity can also increase fatigue which may further lead to excessive rushing. While falling hazards are difficult to eliminate during an emergency, EMTs can take some precautions to avoid hurting themselves. Experts have recommended that EMS workers assess the pathways to patients for hazards and adjust their routes accordingly. First responders should also try their best to wear durable, slip resistant shoes to reduce their risk when working in slippery conditions.
4. Motor Vehicle Incidents (8%)
How to Avoid Motor Vehicle Incidents
While transportation-related incidents, including ground ambulance and air ambulance crashes, are the leading cause of death among EMS workers, motor vehicle incidents accounted for only 8% of non-fatal injuries experienced by EMS workers. Although it may not be a leading cause of injury, the rate of motor vehicle incidents among EMS workers is more than 20 times higher than the average rate for all other occupations.
A study of ambulance crashes in a metropolitan area found that T-bone incidents and collisions at intersections were the most common types of car accidents resulting in injury for EMS workers. The Emergency Vehicle Operator Course curriculum instructs ambulance drivers to change siren tones when proceeding through an intersection, to stop and look both ways, or to avoid intersections altogether. Other research has recommended that training programs should emphasize that the driver of the ambulance has primary responsibility for passing safely through an intersection.
There are also factors that can increase the chances of injury for the EMTs and paramedics who are sitting inside the patient compartment of an ambulance. These injuries can result from loose or unrestrained equipment or even the layout of the patient compartment itself.
The good news is that a lot of research is being conducted to reduce these types of injuries from occurring inside the ambulance. A lot of efforts have also been made to improve the design standards of emergency vehicles, based on data gathered through extensive ambulance crash testing. These changes should lead to safer ambulances for patients and safer working conditions for EMTs and paramedics.
Finally, the lack of seat belt usage among EMS personnel continues to be a major safety concern. Ambulance crash investigations have shown that 84% of EMS personnel in the patient compartment were not restrained at the time of the crash. The study showed that the primary reason for EMS workers not wearing their seat belt was because it impeded their movement while tending to their patients.
There have been efforts to improve the design of various restraints to promote their usage inside the patient compartments. Many of these efforts have been focused on resolving the challenges of providing patient care or accessing critical equipment, all while wearing their seat belts.
Hopefully, these new design standards combined with stronger organizational policies requiring the use of seat belts while inside the ambulance will help to protect these brave men and women who put themselves in harm’s way to keep us safe.
5. Assaults & Violence (8%)
How to Avoid Assaults & Violence
While injuries related to violence or assaults are less common than other types of injuries, the risk is twice as high for EMS workers than any other private industry workers. These numbers do not reflect all incidents of assault and violence, just those that required medical attention or that resulted in lost work time.
A survey of EMS workers revealed that in one year, 67% reported experiencing verbal violence and 44% reported experiencing physical violence of some kind. In another study, 80% of EMS workers reported a work-related physical assault, but only 40% sought care at a hospital.
Several studies have identified reasons why EMS workers may under-report incidents of violence and assault. These include:
- Rationalization that such incidents are “part of the job”
- Belief that no follow-up will be performed
- Lack of policies to guide reporting
- Lack of organizational support for reporting
- Fear of being seen as unable to manage the situation
OSHA violence prevention guidelines can assist agencies in establishing a program to prevent and reduce violence in the healthcare workplace. An integral part of these guidelines is frequent employee/employer training that can reduce the likelihood of being assaulted.
For example, training could focus on risk management strategies that include recognition of types of violent behaviors and de-escalation approaches to consider when providing care to patients prone to assaultive behavior.
Preventing violence related to intoxicated patients should also involve training which addresses the impact of alcohol on a patient, development of professional confidence, and the use of appropriate verbal and non-verbal communication, that emphasize the safety of the EMT and their patient.
EMS Injury Treatments and Outcomes
The most common procedures that EMS workers underwent at the time of their emergency room visits were radiological (x-rays, MRIs, or CT scans). Almost half of injured EMS workers (45%) reported that they had to follow up with a healthcare provider after their ER visit.
More than half (55%) of respondents went back to work the day of their injury or on their next scheduled workday. Of those who reported that they missed one or more days of work because of their injury, 40% reported that they missed three or fewer days, and 16% indicated they missed 30 or more days.
Injured workers reported experiencing a variety of limitations at home and at work in the 30 days following their injury, most commonly restricted lifting. Other limitations included body motion (e.g., bending or twisting), limited use of the injured body part, and limitations in performing self-care and household activities such as driving, shopping, and childcare. A few were placed on light duty at work. A majority (85%) of injured or exposed EMS workers expected a full recovery.
How EMT Training Prepares You for Accidents and Injury
By Dave Thomas, NREMT-P (Unitek EMT Lead Instructor)
Some of the prevalent loss-time injuries seen in EMS are musculoskeletal, primarily back and knees. In fact, these injuries have been so numerous and costly to employers that it has driven demand for extensive training. At Unitek EMT, we dedicate considerable class time to topics such as proper lifting techniques and the use of powered gurneys and other assistive devices.
One powered gurney can cost over $20K per ambulance, this is a decision not lightly made by any agency, however it takes much of the workload off the personnel in the field. That being said, moving patients is what happens on a majority of calls (either by an assisted lift or having to actually lift the patient’s body off the ground), and these actions can end up in injury when done incorrectly. Proper lifting and moving is taught in most programs (most definitely ours), and education is provided by most agencies during the new hire process as well, to a certain extent.
Most of the training that an EMT gets is while on the job, unfortunately through trial and error. If they are fortunate, a new EMT gets the opportunity to work with more experienced veterans who can teach them some of the tricks to avoid injury. There is no amount of training that can prepare an individual for every situation though, as each one presents with its own challenges. Ask any prehospital provider and they will tell you that people decide to go unresponsive in the most awkward of places!
The other HUGE issue that faces EMTs is mental and emotional strain. EMS providers show up when people are at their worst: injuries, health problems, behavioral and psychiatric emergencies. EMTs see things that the average layperson can only imagine and nothing on television or out of Hollywood can prepare them for the real thing. There is no class in high school, college, or trade school that can prepare an individual to deal with the palpable grief of a parent after the death of their child. Nothing can get them ready for the recovery of the bodies of people after a tragic motor vehicle collision, or reaching over a dead body to care for the an entrapped patient in the back seat.
Many times, EMS workers do not have time to process traumatic events appropriately. By the time they are done with one call, they are on to the next, hopefully getting some critical incident debriefing by their agency. Unfortunately, this is often not the case. After a while these mental pictures can build up in a caregiver’s mind. As a result, many EMS workers turn to self-medication in the form of alcohol or other destructive behaviors. Some suffer from nightmares that haunt them after time.
Although it is getting more attention in the recent years, the overall culture does not foster an environment open to sharing mental anguish. The EMT is seen as the person who “has it together,” or isn’t affected by the things they see, somehow “above” it all because of their training. The truth is that they are just people doing a job like anyone else. Some are blessed to be able to compartmentalize the job, separating their feelings, but many others cannot. Fortunately, it is becoming a subject that is spoken about more and more, with people being encouraged to reach out to others for mental health support. It is important the prehospital provider practices good health through good food choices, exercise, avoiding destructive behaviors and finding an outlet away from work where they don’t talk “shop.”
Unitek EMT training programs also focus on the EMS worker’s mental and emotional well-being. Our curriculum emphasizes raising awareness of the high rates of mental health issues that affect EMS workers, including PTSD, depression, anxiety, substance abuse, and suicide. In addition, we provide education on multiple mental health-related topics.
EMS workers face a variety of health and wellness challenges, but through awareness and training, they can learn to recognize the risks, avoid many of the dangers, and get the treatment they need to remain healthy and excel in their important and life-saving role.
How EMT Training Prepares You for Emotional Stress
By Dan Leone, NREMT-P (Unitek Primary EMT Instructor)
EMS work is more than just physically and mentally demanding, it can also be emotionally stressful and psychologically overwhelming. Several factors combine to cause workplace stress for EMS providers, including traumatic emergencies, poor sleep, long shifts, and a lack of downtime after difficult calls. As a result, EMS providers are at a high risk for burnout, anxiety, depression, and post-traumatic stress disorder (PTSD). Sadly, the suicide rate for EMS workers is much higher than non-EMS providers.
People respond differently to certain things, and it’s the same with EMS workers. Many of the calls you will answer as an EMT may impact you emotionally, like seeing a child drown or a victim get sexually assaulted. Personally, I have responded to calls, specifically suicide, that have required me to talk with a professional counselor to deal with how it made me feel. Other times, events in your personal life may trigger an overwhelming emotional reaction and impact your performance. When my mom passed, any patient that reminded me of her had a significant impact on how I felt during that call. I had to learn to put my personal feelings aside to treat my patients effectively.
Because emotional stress and trauma is a widespread issue among EMS providers, our EMT training programs also explain the warning signs of emotional and mental distress and ways to get help. In addition to teaching EMS trainees about taking care of others, we teach them how to take care of themselves.
Recognizing the signs of emotional stress and getting help are important topics we discuss in EMT classes. Having a good support system both in and out of the field is key. You can talk about a call with someone without breaking HIPPA regulations and keeping confidentiality intact. Most EMS agencies and companies have an employee assistant program where EMS workers can receive the needed help
As an EMS provider, you will face many challenges, physically, mentally and emotionally. But with the right training, you will be well equipped to take on those challenges and excel at your profession. Like most of my students, you will graduate prepared to pursue a rewarding career helping others and saving lives.
About Unitek EMT
Unitek EMT is one of the leading EMT training providers in Arizona. Our mission is simple: training the next wave of EMT professionals.
(Click here to learn how to become an EMT).
We offer a variety of training options to fit your needs, including an EMT Boot Camp to get you mission-ready and certified fast. Unitek EMT instructors are experienced leaders in their fields, and our ultra-real-world training scenarios are ideal for both new and seasoned students, with training that covers all major aspects of emergency medical services.