Tell us about yourself! Name Worksite Responsibilities in hazard assessment Information on...

Workplace Health and Safety

IYM – Participant Session

2013


Welcome

Tell us about yourself!

Name

Worksite


Objectives

Responsibilities in hazard assessment

Information on musculoskeletal injuries (MSI) and

prevention

Principles of Good Body Mechanics

Three areas of assessment

Safe client moving techniques

Participants will learn and apply the following:


Do we need a program to help us learn how to move clients safely?

Why?

Workforce needs

Safe care for clients and healthcare

workers

Occupational Health and Safety

Legislation


Disabling Injury Stats


What is a Hazard Assessment?

Identifying actual or potential

hazards we may be

exposed to at our worksite.


Biological

Hazard

Physical

Hazard

Chemical

Hazard

Psychological Hazard


What’s Holding Us Back?

Workload

Complacency

Resources

Perceived

Expectations


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


Seeing more with your mind than your eyes!


Shifting Perspectives

No Unsafe Lift

IYM

Minimal Physical Effort

Maximum Equipment Use

Client Participation


Body Mechanics

three for the top three for the bottom

elbows tucked in safe effective grip

comfort zone weight transfer

6 Checkpoints


Defined as: Damage to the various structures involved in

producing force for movement of the human body, such as soft tissue

Acute: Immediate onset of signs and

symptoms

Chronic: Gradual onset of signs and

symptoms

Musculoskeletal Injuries


Types of Injuries

Caused by lifting, pulling or pushing activities that exceed the range of motion or strength of muscles, tendons and ligaments.

Excessive Force Injuries:

Sustained Force Injuries: Caused by prolonged activities that exceed the

endurance of the muscles.

Repetitive Strain Injuries:Caused by activities involving repeated gripping,

reaching, bending or twisting that exceed soft tissue capacity


To understand body

mechanics we must

first understand the

structures that

support us

Our muscular system

uses levers to

develop force

Body Mechanics


The purpose of the

back musculature

is to maintain

intervertabral

stability

Back angle is

maintained by the

hip extensors

Rigidity of the

spine is

maintained by the

erector and trunk

muscles

Body Mechanics


Inflammation

Pain

Swelling

Numbness and/or

Tingling

Decreased ROM

Weakness

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.


work without warming up?

bend at the waist to lift loads?

move or lift heavy loads?

pull objects?

twist when turning or lifting?

slouch when walking or

standing?

do repetitive actions?

ever not get enough sleep?

have poor nutrition and

hydration patterns?

experience stress?

Do you…

...are you at Risk?


Principles of Good Body Mechanics

1. Use your brain not your back

2. Listen to your body3. Maintain three natural

curves4. Use strong thigh muscles5. Hands in a safe effective

grip6. Keep the load close7. Maintain a proper stance8. Use a weight transfer


Observational Assessment

A systematic process, one we do all the time,

most often subconsciously.

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.

Using your skill at assessing the situation. This

will ultimately result in you making a good

decision.


Self Assessment

Physical status

Emotional status

Training/

experience

Communication

Workload


Environmental Assessment

Room/Area

Color/Lighting

Noise/Distractions

Working Surfaces

Equipment


Client AssessmentCommunication

Cognitive

Emotional/Behavioral

Medical

Functional

Assessment


Functional

Assessment Cognitive

Emotional/

Behavioral

Communication

Client

Medical

Client Assessment


Transfer Belts


EMS Lifting

Communication is key!1-2-3-Command!


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

Transfer Belts


Assisted/Guided FallA 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 upo Stopping the client from sliding off a chairo Attempting to drag the client back to the client’s original

position


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.


It’s Your MoveTransfer One and Two-person Transfer with a Belt

Reposition In Wheelchair Bed to Stretcher In Bed using Transitory Sheet/Tube

Lift Sit/Stand and Total Lift


Stryker Speed Sheet


Stryker Speed Sheet


Stryker Speed Sheet


Stryker Speed Sheet


Reposition Up in Bed

Reposition Side to Side in Bed

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

Reposition in Bed Activity


Remember…

to use 1-2-3-Command

word

the primary worker

directs the move

to always raise the

height of working

surface to tallest worker


Functional Assessment

54


Performed at every instance of Client Handling

Refer to It’s Your Move Functional Assessment

Algorithm

In Transition Logos are appropriate for: Clients who are admitted for less than 24

hours AND/OR

Clients who are rapidly changing in functional status (i.e. ER, Day Surgery, Acute Care)

Based on: Functional Assessment Observation(s) Client medical documents Client report

Moving technique is communicated using In Transition Logos, posted near client

Logo becomes a baseline for the next assessment Narrative note required if logo is changed

Regular Logos are appropriate for: Clients who are admitted and are stable in

functional status (i.e. Continuing Care, inpatient Acute Care)

Performed at first instance of Client Handling or within 24 hours of admission:

Review of medical information Perform Functional Assessment Complete the Record Assign a Logo Post the Regular Logo at client bedside

Reassessment

As indicated by consistent change in client function (improve or decline)

OR At minimum timeframe (department

specific)


Regular Logo

In Transition Logo

Client stabilizes and is not discharged

Functional Assessment & Logo Process

Functional Assessment & Logo Process


Client Health

Information

Functional

Assessment

Assigning a Logo

Completing the Functional Assessment Record


Functional Assessment Record (FAR) Completed by the Regulated Health

Professional upon inpatient admission

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.

Repeated any time there are significant

changes (improvement or decline) in functional

ability

Record will be located in the chart


Exceptions to Performing the Functional AssessmentClients who may be: Physically unable

Cognitively unable

Unresponsive Clients


Before the Move….

Stop

Look

Listen


Independent Transfer

Independent Transfer

CriteriaCan bear their body weight

through part or parts of

their body

Is cooperative, predictable

and reliable in physical and

mental performance

Can safely relocate

themselves with or without

the use of assistive devices


Minimum Assistance Transfer

Minimum Assistance Transfer

Criteria Can bear their body weight through

part or parts of their body

Is cooperative, predictable and

reliable in physical and mental

performance

Can safely relocate themselves with

or without the use of assistive

devices

May require verbal or physical cues

May require minimal assistance with

equipment and/or personal items


One-person Transfer with Belt

CriteriaCan bear their body weight

through part or parts of their

body



performance

Can maintain balance when

walking/shuffling feet and/or

pivoting

Requires one worker to provide

hands-on assistance to move

One-person Transfer with Belt


Two-person Transfer with Belt

Two-person Transfer with Belt

Criteria Can bear their body weight

through part or parts of their body



performance

Requires two workers to provide

hands-on assistance to move

Has difficulty maintaining balance

while walking/shuffling feet and/or

pivoting


Sit/Stand LiftCriteria

Is unable to stand for 15 seconds but

has partial weight bearing abilities

through part or parts of the body

May be unpredictable and/or

unreliable in physical and mental

performance

Is able to keep at least one arm

outside the harness

Sit/Stand Lift

Two workers are required to operate a mechanical lift


Total LiftCriteria

Cannot bear their own body weight

May be unpredictable and/or

unreliable in physical and mental

performance

May be unable to follow

instructions due to cognitive or

physical disability

May be uncooperative in behavior

May be unable to maintain sitting

position

Total Lift

Two workers are required to operate a mechanical lift


Bed Rest

CriteriaConfined to bed by

physician’s order or nature of their medical condition

Bed Rest


In Transition Logos

Used in select areas only or if

client admission is less than 24

hours

May be changed after each


Documentation is required with

Logo change

Use regular Logos as soon as

client stabilizes


More About Logos…Logo placement

Number of Logos

Client needs more or less help than

Logo indicates

Logo is assigned following completion

of the Functional Assessment Record


EMS

SafeClient

Handling


DrivingExcessive 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


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


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


Personal Fitness Levels

• Core Stability

• Flexibility

• Aerobic Conditioning


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.


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


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


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!


Leg StretchesWe lift a lot of weight with our leg and compensate with our

backs


Back and Neck StretchesOur backs and necks face the challenges or lifting, driving and

being sedentary. Stretching is important.


Chest and Arm StretchesWe use our chest, arms and hands to lift; sometimes with prolonged grips. Stretching can both be a warm up and rest

from these activities


MicrobreaksPeriodic 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


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


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


EMS LiftingGeneral PrinciplesWorkers 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


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


Body Mechanics

three for the top three for the bottom

elbows tucked in safe effective grip

comfort zone weight transfer

6 Checkpoints


Stretchers


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


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


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


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


Scoop Stretcher


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


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


Stair Chair


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


• 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

Two-person Lift with Stair Chair


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”


Manual LiftsIt’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


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


Additional Equipment


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 350lbs/159kgs


Ferno Patient Carry Sheet

-Special ordered by AHS to ensure a 1000lbs 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


Manual LiftsProcedure 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.


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


Ideal Manual Lifts


EMS Lifting

Communication is key!1-2-3-Command!


Wrap- Up

Questions

Evaluations

Certificates

Additional Resources

Updates


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