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


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