The time we spend in EMS preparing, practicing, certifying and recertifying for our jobs is enormous. The cost for that time is equally significant, yet there are so many in EMS who have to leave the profession early because of injury. To invest so many years in an education and the required "street" skills, only to lose it all to an injury, is unacceptable.

   From EMT school and throughout our careers, we are taught proper lifting techniques to prevent injury. Technology has made lifting and carrying patients easier, as assisted stair chairs and cots have hit the market (at great cost). Careful examination of the data shows an interesting trend: Yes, the incidence of injury from lifting stretchers has decreased. But most injuries occur from moving the patient and other external factors, not from lifting the cot. Do the new assisted cots decrease injury? So far the data says yes, but what about all the other sources of injury to which we are constantly exposed?

   Over the past 14-plus years of my career, both in a sports medicine clinic and as a paramedic, I have witnessed injuries occur while running calls and rehabilitated those injuries in the clinic. This has afforded me a unique perspective into the rigors and physical demands of our profession. What I have experienced, and what the data supports, is the need for injury prevention programs. Once an injury has occurred, you are much more likely to be reinjured, so preventing injury in the first place is crucial.

   Injury prevention in EMS needs to encompass three components: 1) muscular endurance, 2) stability and 3) flexibility. There is a common misconception that strength is more important than endurance. When applied to the trunk, pelvis and core, the ability to maintain a rigid and stable spine with consistent muscular firing (endurance) is better at preventing overexertion injury. Injury commonly occurs as muscles fatigue, both from use/overuse and from chronic postural distortion causing altered firing patterns. The greater your muscular endurance, the more efficiently your muscles will fire. When they fire efficiently, they do not work as hard, and the strain on soft tissue and joints is greatly reduced. To state it another way: Work smarter, not harder.