But Can They Lift?

     Anybody who screens EMS field candidates will tell you, not just anybody can do EMS. You need a good brain to pass your tests, earn your certs and think your way through calls. You need the manual dexterity and multitasking capabilities of an ED nurse. You need the maturity and psychomotor skills of a professional driver. You need a warm and willing heart. And, no matter how talented you are in all of those areas, you need to be able to lift - often, a lot.

     It's a fact that sick people are heavy, and plenty of them are very heavy. According to figures from the Centers for Disease Control and Prevention, the percentage of overweight Americans has doubled since 1980.¹ The list of disorders they face as consequences of their obesity could be used to describe our most common daily 9-1-1 calls.

     Twenty years ago, EMS crews would encounter 300-lb. patients only occasionally. In today's systems it has become fairly routine. And although modern self-lifting ambulance cots address the challenges of loading and unloading those folks at the ambulance, the cots themselves weigh more than 140 lbs. That's not an issue if all you do is transfers on flat, stable surfaces, but it's too heavy for a field cot.

     EMS crews do a lot of lifting, moving and carrying while they're not close to an ambulance. They are routinely required to help people in places a cot won't go, and eventually get those people into an ambulance - often traversing surfaces that are neither level nor stable, like hillsides, construction sites and soggy cornfields. Sooner or later, that necessitates the ingenuity (and plain physical strength) of a limited number of people (very often, only two).

     Not strong enough to do that? You're guaranteed to hurt someone. It may be a patient. It may be a colleague, and it may be you. Strong enough? Sooner or later you stand a good chance of getting hurt anyway. One of the scary things about this business is that we're all just one injury away from the ends of our careers and a complete restructuring of our lives. Our mandatory skill set is at least as preclusive as a professional athlete's.

     Unfortunately, when an EMT gets hurt, our industry's commitment is pretty much limited to standard workers' compensation. There are no tradeoffs for the risks you face in the field. And it's not enough to just keep yourself fit. In fact, the surest way to hurt yourself is to get halfway into a lifting maneuver and have your partner do something stupid - or simply fail at his or her end of the cot. Considering most of us aren't taught about body mechanics as EMTs, that's a very likely scenario.

     We've heard from more than one human resources director that lift tests can't be done. But often, can't is just a bureaucratic term for won't. Lift tests can be fair, practical and relevant to the demands of an EMT's job, and therefore legal. EMTs are valuable, and their safety more than warrants the effort.

     We work for a small community-owned hospital that operates a nonprofit 9-1-1 ALS ambulance service in an area that's home to some 30,000 people. Three years ago, we grappled with the daily consequences of EMTs who simply couldn't lift. We solicited the help of our hospital's human resources, legal and physical medicine specialists to develop a lift-testing process for new applicants.

     That resulted in a post-selection, pre-hire evaluation that takes about an hour, including a brief private health screen described below. This test is the last step in our selection process for new EMTs and paramedics. We've broken it down into five simple parts, described as follows.