What Does Embracing Fitness Mean?

In an effort to reduce injuries from patient movement, improve practitioner health and create a safer EMS work environment, NAEMT established a formal relationship with the American Council on Exercise (ACE) to create the Task Performance and Health Improvement Recommendations for Emergency Medical Service Providers. The NAEMT Board of Directors endorsed these fitness guidelines on January 18.

ACE worked with Austin-Travis County (TX) EMS (ATCEMS), among other agencies, to develop the recommendations, sending its exercise physiologists to communities that could offer a variety of service delivery models, environments and types of patients. EMS World spoke with ATCEMS Chief Ernesto Rodriguez about the experience of working with ACE on the projects, and his agency’s commitment to fitness.

What went into the process of assisting ACE with putting together its recommendations?

Rodriguez: We were asked by NAEMT if we’d be interested in participating, but the group that had the ultimate say in everything was ACE. They were trying to select groups from a variety of areas, and we’re a third service, government-based organization. We were contacted by their investigators, who then traveled here for several days, meeting with different individuals throughout the organization, riding on ambulances and working with personnel to see how we work, the types of tools we use and the kinds of physical skills required to do their jobs.

What kind of insights into the kinds of work and movements your EMS providers engage in were you able to glean through the project?

Looking at the final document, I think I found what a lot of us have already known for many years—working in EMS really is strenuous. I think people have thought EMS is fairly light work compared to other types of public safety work, but it isn’t. It obviously involves lifting heavy patients. But our work is also a series of sporadic workouts that occur during a shift. Now, normally before a workout you’d warm up and stretch to get your body ready. What happens in EMS is we don’t warm up in between the circuits we run, and that accumulated stress adds up and leads to injury. A lot of document is focused on core strength and flexibility. But once you build that up, then you have to focus on endurance. So it’s not just being fit and having good core strength, but being able to do these movements for extended periods so of time.

Do you think the recommendations that resulted from this process can help keep providers healthier?

I do think so. The three biggest takeaways from the recommendations that seem the most important to me can be found right away on page 4: improve job-related physical capacity, improve overall wellness and create self-reliance. If we just concentrated on those three things I think it would cause phenomenal changes in EMS, from how we do our jobs to the tools we use, and also how well we prepare and to how we sustain our core strength, endurance and wellness.

How has ATCEMS incorporated the recommendations?

One of the first things we did was focus on the piece about self-reliance. To be effective this really can’t be something that’s dictated by management, it has to be owned by the people in EMS. Our providers created a “focus on fitness” work group, they’ve assigned a leader to be a company-wide champion, and we’re looking to see what kinds of organic changes can come into organization when this isn’t management driven. One of things we’re most excited about is a program called the Yard, which combines several different fitness programs. We’re planning a fitness podcast show. We’ve also added peer fitness trainers. Four of our medics got certified as trainers and are leading our academy training, so all of our new personnel are starting out on the right foot. Those are just a few examples of that self-reliance component—these programs are all management supported by not management driven.

In addition, we’re developing healthy eating classes. We learned a lot of our personnel don’t know how to eat well. So we’ve begun doing things like asking our people to take pictures of their lunch boxes and send them to us, so we can compare what everyone’s eating and start to learn how to balance meals better. We’re working with Whole Foods on culinary classes, so our providers can learn to cook better. And we’re working with some of our area hospitals, as well as the vending machine companies, to put healthier snacks in the break rooms.

From surveying our providers we’ve received some interesting results. Over 82% of our staff are already involved in some sort of fitness activity, which is encouraging. I was pleasantly surprised to hear that, whether it’s walking, biking, hiking, CrossFit or something else. We also learned 2% said they don’t need any exercise because they get enough at work. That shows us there’s still work to be done, because strenuous work is not the same as exercise.

The biggest barrier we found to fitness was time, so it’s our job to find the time for our providers to exercise. We also identified other challenges through staff surveys, like sleep—our medics don’t think sleep is important enough to actually do it. That tells us we need to provide more education about not only the importance of getting rest, but actually planning time for sleep.

Another challenge is staying mentally fit—what kinds of things do you do to relieve stress and make you happy. Spiritual wellness was also something, following the recent death of one of our medics, which we found was lacking. So now we’re building a chaplaincy program.

A lot of the things we’ve incorporated have come down to teaching our folks how to manage stress. Life in general is stressful; now add a job in EMS and everything that comes along with it. So that’s all a part of what we’re doing to help improve provider fitness throughout the organization.