An ergonomic evaluation of equipment to support patient movement and transfer in the ambulance service

It is commonly accepted that ambulance staff undertake a large amount of lifting and handling in their daily work. Their primary role is to provide pre-hospital care and to transport sick and injured people to hospital. The emergency nature of the job means that ambulance workers have to assist people who are incapable of moving themselves in awkward and potentially hazardous environments. While safer lifting policies have been introduced ambulance workers still lift weights which other healthcare workers can avoid. However since the introduction of manual handling regulations and more recently CEN standards, ambulance services and manufacturers have been trying to find new ways of moving and transferring patients. Ambulance services have purchased new equipment to reduce musculoskeletal risks but there is little scientific evidence to support their purchasing choices. This thesis presents two case studies describing ergonomic equipment evaluations of stretcher loading systems and mobility equipment to provide a scientific basis to support purchasing decisions. Case study one is a comparative analysis of stretcher loading equipment used in UK ambulance services. The study was carried out in two phases. Phase 1 was a field study which used observation and interview methods to identify issues affecting equipment use in a range of environments. Phase 2 was a simulation study which used task simulation to assess the postures adopted during loading and unloading activities with each system. Both phases identified the tail lift as the preferred system to reduce manual handling and improve patient and operator safety. Case study two is a comparative evaluation of mobility equipment. User trials were carried out to evaluate 12 transport chairs and 4 stretchers for Accident and Emergency and Patient Transport Service staff to identify preferred equipment for each team. 16 staff assessed the equipment by conducting task simulations and completing questionnaires for each product. Postures adopted during the tasks were assessed using Rapid Entire Body Assessment. The mechanised stair climber chair was the preferred chair for both teams. The stretcher analysis was inconclusive. This thesis has used two case studies to establish a protocol for field and lab based evaluations of movement and transfer equipment in the future for the ambulance vehicle. A more comprehensive procurement process is recommended to include detailed ergonomic evaluation, ensuring that the end user is fully represented. The thesis concludes that automation is way forward to reduce manual handling risks posed to ambulance workers. The output from case study 1 (tail lift) has been included in the national specification for future Emergency Ambulances in the UK.