Through Work Culture Change
Article published by AGRIP - Association of Government Risk Insurance Pools -
March 2010
In the best and worst of economic times, cities across the Unites States function with basic infrastructural needs. The workforces behind these needs include Firefighters, EMT’s, Paramedics, Law Enforcement officers, Public Works & Utilities employees. These critically valuable human resources contribute to the functional organization and safety of our communities, and are woven into the very fabric of American society.
However, the labor intensive nature and often changing, uncontrolled performance demand of these work arenas is not well understood. Often not fully appreciated is the high risk of musculoskeletal injury, high likelihood of cumulative trauma disorders (CTDs) and musculoskeletal disorders (MSDs) , translating to major human capital injury losses ‘bleeding’ from the system daily. In order to preserve the inner workings of our infrastructures, physically and fiscally, we as a society have the responsibility to maintain these necessarily sustainable workforces and support their professional well being.
Firefighters, EMTs, and Paramedics perform incident mitigating and life saving activities daily, whether administering CPR in a moving ambulance, extricating a victim from a vehicular accident, transporting an agitated cardiac patient on a backboard down a narrow flight of stairs, or cutting a ventilation hole while perched on the inclined roof of a burning building.
Law Enforcement and corrections officers face survival-based work performance demands, whether restraining and subduing a resistant arrestee or inmate, pursuing a suspect on foot over an obstacle, or engaging in defensive tactics in a confrontation in the second tier of response (after communication has failed and before lethal force initiated).
Public Works and Public Utility employees perform labor-intensive tasks in constantly changing circumstances and awkward environments, whether in a bucket (truck) extended in the air and reaching far out over the side with a pole cutter or other arm lengthening tool, digging inside a narrow trench with restricted leg movement, shoveling heavy materials such as crushed rocks at elbow level from a truck, or continuously wrestling a 90-lb. paving breaker out of sticky asphalt on a hot day.
Professional Safety Response for HRIE - High Risk to Injury Employees
In order to prevent permanent injuries, CTD’s and MSD’s, particularly to the spine/back, neck/shoulders, and knees/ankles, these public sector employees must develop a professional understanding of the psychological performance demands of their jobs while simultaneously becoming highly aware, professionally, of their personal body strengths and capabilities as applied to this demand. In doing so they must learn to know, instinctively, how the body feels when the work is done correctly, like a professional athlete needs to have this knowledge in order to best respond to the performance demand with minimum risk of injury. Due to the constantly changing and often unavoidable, uncontrolled nature of their labor-intensive work circumstances, these are ‘ high risk to injury employees’ (HRIE).
Statistics for Firefighters/EMTs show the risks to be greater than 15-25% as annualized human capital injury losses. Injury loss statistics for Public Utilities/Public Works are 15%-20%, and Law Enforcement statistics are almost double the ratio of those figures associated with the general work force. These are the disturbing hidden realities behind an otherwise efficiently run society.
The extent to which the employee’s work environment can be changed or modified according to work performance demand is also an indicator of the heightened risk associated with many of these public safety and public sector functions. There are limitations to redesign or modification of any work environment that is not static. These labor intensive workforces are, thus, required to adapt to dynamic uncontrolled environments to get the job done.
NIOSH - NORA
Many safety training programs along with prevailing NIOSH (National Institute of Occupational Safety and Health) and NORA (National Occupational Research Agenda) theory are based on the premise that the most effective methodology to prevent worker injury is to modify the work environment and/or utilize technological tools or assistive devices. However, technology combined with the human element has its obvious limitations and NIOSH and NORA begin to concur, at the executive level with current coordinating director, Dr. Sid Soderholm, that certain professions such as Public safety do not fall in a category such as this and need specialized professional safeguard specific development and training.
HRIE within AGRIP
In a time when municipalities, counties and states are struggling with declining tax revenues and budget deficits, it becomes critically important to best control avoidable human capital injuries and losses in these industry sectors. Many government agencies have taken preventive measures to reduce the number and severity of injuries reported by implementing ergonomics programs. However, for those public sector employees working in the field, the injury risk exposures due to the uncontrolled changing nature of their work arena and environments, coupled with critical time constraints in emergency, make standard ergonomics body positioning a significant challenge.
Fire fighters, with the latest state-of-the art fire engine and equipment, must still resort to manually reaching for , carrying, and working with the Hurst Tool (spreader) and its’ heavy compressor to cut their way into a vehicle, then often reaching over an impedance such as the backboard to extricate a stabilized or limp human weight.
Law Enforcement officers must still resort to body strength after utilizing communication skills, judgment and timing, to restrain a resisting arrestee who is intoxicated or, perhaps if on PCP, strong enough to throw them ‘end over end’ the length of the vehicle.
These are but a few examples of situations where the work arena cannot be realistically changed or the body ergonomically positioned to adapt to work performance demands. Public safety employees must ultimately rely on their own individual strengths and professional development. These individuals spend many of their working hours in environments that disallow solutions proposed by those safety programs seeking to protect, through technical means, the HRIE employee from becoming an injury statistic.
By design and intention, safety programs focusing on the individual attitude rather than technological solutions are also self-limiting. Often the worker is left without the kinesthetic knowledge (muscle sense) and, therefore, experience of what the correct work behavior and performance ‘feels’ like. This likely occurs when the safety emphasis is on awareness campaigns by the use of inter-office posters, reward and punishment programs via employee incentives and disincentives, and “show and tell” through video and slide presentation
Imprinted Safety Response vs. Audio Visual Safety Training
Imprinting a safety response is a process whereby the experience becomes an integrated part of the employee’s work performance. Many ergonomic programs tend to be generic and lack direct applied relevance to a specific industry’s performance demands. Transporting an agitated cardiac victim down a flight of stairs, is the high side responder communicating through the legs with the backward moving responder, or, restraining a struggling arrestee is utilizing a ‘soft’ hand from the big muscle groups of the hips and legs – not ‘arm power to arm power’. This example has little to do with practicing the standard ergonomic positioning protocols of “bend your knees, use your legs, keep your back flat, bring the weight close in”. The work environment and actual work performance demands of Firefighter, Paramedic, Law Enforcement and Public Utilities differ greatly from clinical environments in their respective physical challenges and requirements.
Professional Development – HRIE Work Performance Demands
Professional development training must reflect the worker’s performance demands and effort. On the football field, a wide receiver has a different performance demand than a running back, and certainly far different than a wrestler, although they both need body contact work performance development . Public safety employees are occupationally specific and, thus, require professional development that is parallel with the demands and risks associated with their arena. They are, so to speak, “industrial athletes” whose training must be adapted and tailored to the specific physical, physiological, and psychological performance demands of their work as it relates in specific ways to their changing work environment. Those that learn to do so spontaneously, at a job specific applied level, are likely to survive through their careers without a major professionally compromising or disabling injury.
For the public sector and public safety employee, the imperative becomes an injury prevention program recognizing and applying the realities of their work situations, including for example awkward reaches over impedances for limp or struggling human weights, and the transporting of shifting human weights on uncertain or uneven surfaces. Each work arena represents a unique set of performance demands, and in order for these “industrial athletes” to perform at their professionally required level, the professional development training must have a very high relevance to their daily routines.
Industrial Athletes - Martial Arts and Biomechanical Sciences
When observing professional athletes in action they appear to perform automatically, apparently without thinking about their next move. The sports athlete’s response in physical demand is in fact reflexive because it is part of the autonomic functioning of breath and the control of intra truncal pressure. A similar, autonomic based behavioral response can be achieved in a so-called “industrial athlete” by applying the essential principles of biomechanical body intelligence. The body does not know the difference between professional athletics and professional work, it is the brain that recognizes performance demand and differentiates. An obvious example of the same and yet different psychological response would be moving an agitated cardiac patient down a narrow flight of stairs (incident mitigation/life saving), or moving an unbalanced sofa down the same stairs (physically demanding labor intensive). Both these examples, which are basically a shifting weight being moved down the stairs between multiple people, become two different performance demands as the brain identifies the issues of life saving or physical demand and triggers the ‘feeling’ of vulnerability to injury.
The ‘Eastern’ and ‘Asian’ principles of body mechanics – the martial arts and sciences - have for centuries developed the concept of a body organized to respond spontaneously, utilizing a whole body strength sequenced from the breath and core body via the lowest center of gravity outwards to the peripheries, in a non- compartmentalized manner. In this manner of performance a much greater margin exists between work performance efficiency and work performance inefficiency and, therefore, injury. This also is a spontaneously correct, self reinforcing and self strengthening imprinted body safe behavior. With enhanced biomechanical skills an individual is better equipped to meet the challenges of performance demands with a constantly changing or shifting weight, angle and/or body position. In the clinical biomechanics of protecting the spine and ‘back’, a physiologically organized body behavior combining proper muscle organization from the core outwards to the peripheries and spinal alignment with controlled intra-truncal pressure, is superior to compartmentalized physical development. This, in fact, reduces inter-discal pressure. (Clinical Biomechanics of the Spine, White and Panjabi, 2nd Edition, pp. 455-465). Physiologically well sequenced body behavior does not readily overload the spine or upper body and, therefore, does not weaken the body on demand. The imprint in the central nervous system is one of “… feeling the work experience making you stronger as opposed to not feeling the work experience and it is breaking you down”. (www.psrsafety.com, Corp literature 1984).
In the example of physical demand in the sport of Judo, which is basically the practice of wrestling with optimum leverage, the focus is on a low center of power and gravity. The focus is not on upper body positioning and strength, but rather on an entire unit body organized to the lowest center of gravity. The force is always moving outward from the core center as a leveraged unit, rather than in a compartmentalized and, therefore, disorganized manner. For a 100 pound female dealing with a 200 pound aggressor, ‘strong arm, strong body’ or ‘bend the knees, keep the back flat, draw the weight in close’ is not an effective response. Established with some developmental training in Judo is internal biofeedback which states what experientially ‘feels’ correct, just as with a professional athlete, industrial or otherwise. This biofeedback, along with the performance behaviors that occur when body mechanics are optimized, will spontaneously become “imprinted” in the body enabling it to respond to the recognized performance demands most effectively and, therefore, most safely.
“Imprinted” Biomechanics – Professional Safeguard Response®
Biomechanics applies the laws of physics to human performance including the work place. Effective biomechanics enables an employee to safely and intelligently perform strenuous work in uncontrolled environments. It is a fluid and reflexive behavior that is “imprinted” in the body. Imprinting means that psychological and physical experiences become incorporated in a professional's muscle memory. This not only occurs in all professional athletes, but anyone who performs physical tasks, including high risk workforces. Once correct body mechanics are aligned into ideal sequence, the body registers what “feels right” and “imprints” the behavior, adapting it to multiple similar experiences with the correct experience getting and making the body stronger with minimal reinforcement for the career of the employee.
There are certain types of risk safety training systems specifically designed to prevent injuries in the specialized performance demands of public safety and other public sector employees. Professional Safeguard Response®, for over 25 years and in more than 100 cities and 3 Federal agencies, has uniquely designed "imprinted" biomechanics systems for constantly changing and/or uncontrolled emergency work arenas. PSR®'s methodology develops the concepts of a spontaneous self-strengthening work experience as the viable and practical solution to the mitigation of injury loss in these high risk work arenas. This specialized agency designs systems for those work arenas which are specifically limited in their capacity for ergonomic redesign, where changing the work environment is impractical or impossible due to unanticipated and awkward weight lifting, reaching, transfers, extrications, and other work effort demands. This kinesthetic (muscle sensory) developmental imprinting into truncal pressure and breath control is autonomic reflex behavior and what makes PSR®s unique injury reduction programs succeed. It is accepted as necessary professional development particularly for Firefighters, EMT, Paramedics and Law Enforcement, and is valued for its realistic, job specific grounded approach to a safe and sustainable high risk workforce. PSR® applies its biomechanics principles across all labor intensive industries with significant loss reduction outcomes.
Partners With New Tools For Risk Financing
Public sector executives along with the managers of Finance, Insurance, Risk Management, Safety, Worker's Compensation, Benefits and Claims, all know the challenge of stabilizing fiscal resources is open ended. In a political environment this challenge becomes a ' moving target ' as understanding evolves, insurance policy premiums cycle through, new loss control programs arrive, and new tools and staff are applied to individual sectors, often at the expense of other areas of their respective budgets.
With increasing demand from intra government pools and insurers, PSR® as a specialized professional development system for Public Safety sectors, is available as a licensed system to intra government pools. The specific AGRIP pool licenses the technology as a single entity and the member cities then send municipal representatives to become certified in the PSR® work safety imprinting system. These then incorporate it into their work performance protocols and training. The cost of the license is amortized across the pool based on the individual size of the participating municipal entity. The expense is relatively minor allowed against the reserves for existing losses. The licensing of pools as entities allows certification of trainers and has direct scalable application within large organizations for large numbers of employees. The completion of PSR® Certified training has gained the recognition and attention of both insurers and CEOs of large agency pools, as it provides uniform quality, support controls, and accountability with a proven product and track record in the U.S. for over a quarter of a century.
Sustainable Workforces
In this millennium of necessarily sustainable workforces, it becomes apparent that with the high risk to injury nature of public sector work arenas, professional development is essential. In the past, standardized protocols for preventing human capital injury losses were deemed semi-uncontrollable, particularly in areas such as public safety, emergency medical services, and public works. This situation has changed with the public safety workforce, many of whom have accessed specialized biomechanics safety training programs that hold the key to reduction in human capital injury losses. As a society that continues to rely heavily on the human element of the public sector in supporting our infrastructure industries, swift and intelligent action is paramount to the protection and preservation of one of this country’s most important and, therefore, necessarily sustainable workforces.
The article appearing on this page published by AGRIP Association of Government Risk Insurance Pools, in March 2010 and was collaboratively written by:
- Jack S. Kanner - COO, PSR® Corporation,
- Amy Evans Turpin, Clinical Research Inc., Director skilled care nursing