[Current situation and challenges in patient transport and physical burden during emergency medical services activities].

Abstract

Objectives: Most emergency incidents in Japan occur in residential settings, requiring emergency medical services (EMS) personnel to work in confined indoor spaces. Many EMS personnel report physical strain on the lower back in transporting patients using devices that require lifting, such as tarpaulin stretchers. However, the specific transport methods chosen by EMS personnel and physical burden associated with each method remain unclear. "No Lift" practices, which avoid manual lifting and reduce lumbar strain in healthcare and welfare fields and in Australia, have attracted attention. Some Japanese fire departments have introduced the Air Stretcher, a no-lift transport device, although its effectiveness remains insufficiently evaluated. Therefore, this study aimed to elucidate current patient transport practices and related physical burden in residential indoor environments and identify challenges related to EMS patient transport.

Methods: An anonymous online questionnaire survey administered via Google Forms was conducted with 1,152 EMS personnel from 47 prefectures who consented to participate. Survey items included (1) participant characteristics, (2) transport methods, such as manual carrying and equipment-based methods, (3) physical burden (fatigue, lumbar strain, and ease of implementation), (4) actual transport practices, and (5) transport safety, including near misses and accidents. Key analytical items were (1) fatigue associated with each transport method, analyzed using the Air Stretcher as the reference, (2) proportion of personnel reporting lumbar burden, (3) ease of implementation, and (4) experience of near-misses or accidents.

Results: Many EMS personnel rely on tarpaulin stretchers and other equipment that require lifting and lowering primarily because of their ease of use. Additionally, most personnel reported experiencing lumbar strain during emergency activities, and near-misses or accidents were frequently associated with tarpaulin stretcher use. Although the Air Stretcher demonstrated lower fatigue and reduced lumbar strain, supporting the effectiveness of no-lift transport, its usage rate remained low (approximately 20%).

Conclusions: Tarpaulin stretchers are the most commonly used transport method in emergency settings. Although easy to implement, tarpaulin stretchers are associated with a higher lumbar burden and an increased risk of near-misses or accidents. No-lift transport methods may help reduce fatigue and lower back strain in EMS personnel. With the anticipated increase in the number of older and female EMS personnel in Japan, broader education and implementation of no-lift transport devices are warranted.