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Workplace Health and Safety
IYM – Participant Session
2013
Workplace Health and Safety
Welcome
Tell us about yourself!
Name
Worksite
Workplace Health and Safety
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:
Workplace Health and Safety
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
Workplace Health and Safety
Disabling Injury Stats
Workplace Health and Safety
What is a Hazard Assessment?
Identifying actual or potential
hazards we may be
exposed to at our worksite.
Workplace Health and Safety
Biological
Hazard
Physical
Hazard
Chemical
Hazard
Psychological Hazard
Workplace Health and Safety
What’s Holding Us Back?
Workload
Complacency
Resources
Perceived
Expectations
Workplace Health and Safety
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
Workplace Health and Safety
Seeing more with your mind than your eyes!
Workplace Health and Safety
Shifting Perspectives
No Unsafe Lift
IYM
Minimal Physical Effort
Maximum Equipment Use
Client Participation
Workplace Health and Safety
Body Mechanics
three for the top three for the bottom
elbows tucked in safe effective grip
comfort zone weight transfer
6 Checkpoints
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
To understand body
mechanics we must
first understand the
structures that
support us
Our muscular system
uses levers to
develop force
Body Mechanics
Workplace Health and Safety
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
Workplace Health and Safety
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.
Workplace Health and Safety
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?
Workplace Health and Safety
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
Workplace Health and Safety
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.
Workplace Health and Safety
Self Assessment
Physical status
Emotional status
Training/
experience
Communication
Workload
Workplace Health and Safety
Environmental Assessment
Room/Area
Color/Lighting
Noise/Distractions
Working Surfaces
Equipment
Workplace Health and Safety
Client AssessmentCommunication
Cognitive
Emotional/Behavioral
Medical
Functional
Assessment
Workplace Health and Safety
Functional
Assessment Cognitive
Emotional/
Behavioral
Communication
Client
Medical
Client Assessment
Workplace Health and Safety
Transfer Belts
Workplace Health and Safety
EMS Lifting
Communication is key!1-2-3-Command!
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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.
Workplace Health and Safety
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
Workplace Health and Safety
Stryker Speed Sheet
Workplace Health and Safety
Stryker Speed Sheet
Workplace Health and Safety
Stryker Speed Sheet
Workplace Health and Safety
Stryker Speed Sheet
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Functional Assessment
54
Workplace Health and Safety
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)
Functional Assessment
Regular Logo
In Transition Logo
Client stabilizes and is not discharged
Functional Assessment & Logo Process
Functional Assessment & Logo Process
Workplace Health and Safety
Client Health
Information
Functional
Assessment
Assigning a Logo
Completing the Functional Assessment Record
Workplace Health and Safety
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
Workplace Health and Safety
Exceptions to Performing the Functional AssessmentClients who may be: Physically unable
Cognitively unable
Unresponsive Clients
Workplace Health and Safety
Before the Move….
Stop
Look
Listen
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
One-person Transfer with Belt
CriteriaCan bear their body weight
through part or parts of their
body
Is cooperative, predictable and
reliable in physical and mental
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
Workplace Health and Safety
Two-person Transfer with Belt
Two-person Transfer with Belt
Criteria Can bear their body weight
through part or parts of their body
Is cooperative, predictable and
reliable in physical and mental
performance
Requires two workers to provide
hands-on assistance to move
Has difficulty maintaining balance
while walking/shuffling feet and/or
pivoting
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Bed Rest
CriteriaConfined to bed by
physician’s order or nature of their medical condition
Bed Rest
Workplace Health and Safety
In Transition Logos
Used in select areas only or if
client admission is less than 24
hours
May be changed after each
Functional Assessment
Documentation is required with
Logo change
Use regular Logos as soon as
client stabilizes
Workplace Health and Safety
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
Workplace Health and Safety
EMS
SafeClient
Handling
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Personal Fitness Levels
• Core Stability
• Flexibility
• Aerobic Conditioning
Workplace Health and Safety
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.
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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!
Workplace Health and Safety
Leg StretchesWe lift a lot of weight with our leg and compensate with our
backs
Workplace Health and Safety
Back and Neck StretchesOur backs and necks face the challenges or lifting, driving and
being sedentary. Stretching is important.
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Body Mechanics
three for the top three for the bottom
elbows tucked in safe effective grip
comfort zone weight transfer
6 Checkpoints
Workplace Health and Safety
Stretchers
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Scoop Stretcher
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Stair Chair
Workplace Health and Safety
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
Workplace Health and Safety
• 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
Workplace Health and Safety
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”
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
Additional Equipment
Workplace Health and Safety
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
Workplace Health and Safety
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
Workplace Health and Safety
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.
Workplace Health and Safety
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
Workplace Health and Safety
Ideal Manual Lifts
Workplace Health and Safety
EMS Lifting
Communication is key!1-2-3-Command!
Workplace Health and Safety
Wrap- Up
Questions
Evaluations
Certificates
Additional Resources
Updates
Workplace Health and Safety