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1 93 1 2,3 2, ,4 (CPR) CPR CPR % 62.6%54.1% 15.7% 40.4%44.3%CPR58.1% CPR 68.7%CPR52%CPR CPR 1.6 ( % 1.03~2.47 p<0.05)cprcpr CPR 17.6% (1) (2-5) (6) (7) (8) (9) (10,11) (CPR) 80%96% CPR (06) (06) ningping.tw@yahoo.com.tw

2 94 J Emerg Crit Care Med. Vol. 19, No. 3, % (12) (CPR) CPR CPR CPR CPR SPSS 12.0 CPR Logistic p value ( )0.05 CPR543 ( ) % % % 62.3% 80.2% 16.1%3.6% 50.8% 7.6% 62.6%() (54.1%)(23.1%)(17.9%) (28.6%) (24.9%)(16.4%) 6.4% 54.1%15.7% 12.4% 40.4% 27.0% 3.9% 44.3%6.7%

3 95 N 329 (%) ( ) / / EMT-I EMT-II EMT-P EMT-IEMT-IIEMT-P () N 329 YES

4 96 J Emerg Crit Care Med. Vol. 19, No. 3, 2008 () (n 178) N 329 CPR CPR CPR CPR CPR () CPR CPR () CPR() ( ) CPR() ( ) CPR

5 97 CPR61.7% CPR CPR CPR % CPR CPR 55.0% C P R 25.2%19.8%CPR 68.7% C P R 58.7%CPR 38.6%C P R 7.3% 5.2% ( ) CPR () CPR CPRCPR CPR CPR 1.6 ( % P 0.036) Smith DR 70%56% 45% 40% 37% (2) 85.5% 71.9% 71.3% 54.7%33.9% (3) 93.6% 74.5%72.4%62.7% (4) Jones AY 60% CPR (11) 62.6% () () ORs (95%CI) P value (57.3) 78 (51.7) 1.26( ) (77.0) 108 (71.5) 1.33( ) EMT-I 23 (12.9) 30 (19.9) EMT-II 148 (83.1) 116 (76.8) 1.67( ) EMT-III 7 (3.9) 5 (3.3) 1.83( ) CPR (51.7) 82 (54.3) 0.90( ) CPR 102 (57.3) 69 (45.7) 1.60( ) (42.7) 82 (54.3) CPR 48 (27.0) 35 (23.2) 1.04( ) (52.2) 88 (58.3) 0.80( ) (20.8) 28 (18.5) CPR (61.7) 90 (59.6) 1.18( ) CPR ORs95%CI 95%EMT-IEMT-II EMT-P

6 98 J Emerg Crit Care Med. Vol. 19, No. 3, 2008 (54.1%)(23.1%)(17.9%) (28.6%) (24.9%)(16.4%) 15.7% 40.4% 44.3% Boocock ( 1 4 ) Letendre Robinson CPR (15) CPR 58.1%CPR (11) CPR ( ) (National Institute for Occupational Safety and Health; NIOSH) (16) ( ) (17) ( ) (18) (Miller)1999 7% 20%41% 53%85% 92% (19) CPR % CPR CPR CPR CPR % (American Heart Association) (ACLS) CPR ACLSCPR (20) CPR (21,22) (manual handling operation guidelines) (23,24) CPR CPR C P R

7 % 54.1% CPR58.1% CPR 60.6% CPR 1. Guo HR, Tanaka S, Gameron LL, et al. Back pain among workers in the United States: national estimates and workers at high risk. Am J Ind Med 1995;28: Smith DR, Wei N, Kang L, Wang RS. Musculoskeletol disorders among professional nurses in Mainland China. J Prof Nurse 2004;20: Smith DR, Mihashi M, Adachi Y, Koga H, I s h i t a k e T. A d e t a i l e d a n a l y s i s o f m u s c u l o s k e l e t o l d i s o r d e r r i s k f a c t o r s a m o n g J a p a n e s e n u r s e s. J S a f e t y R e s 2006;37: Smith DR, Choe MA, Jeon MY, Chae YR, An GJ, Jeong JS. Epidemiology of musculoskeletal symptoms among Korean hospital nurse. Int J Occup Saf Ergon 2005;11: Jorgensen S, Hein HO, Gyntelberg F. Heavy lifting at work and risk of genital prolapse and herniated lumbar disc in assistant nurse. Occup Med 1994;44: Engkvist IL, Hjelm EW, Hagberg M, Menckel E, Ekenvall L. Risk indicator for reported overexertion back injuries among female nursing personnel. Epidemiology 2000;11: Mannion AF, Adams MA, Dolan P. Sudden and unexpected loading generates high forces on the lumbar spine. Spine 2000;25: Linton SJ. A review of psychological risk factors in back and neck pain. Spine 2000;25: Hoogendoorn WE, Bongers PM, de Vet HC, et al. Flexion and rotation of the trunk and lifting at work are risk factors for low back pain: results of a prospective cohort study. Spine 2000;25: Jones AY. Can cardiopulmonary resuscitation injury the back? Resuscitation 2004;61: J o n e s AY, L e e RY. C a r d i o p u l m o n a r y resuscitation and back injury in ambulance officers. Int Arch Occup Environ Health 2005;78:

8 100 J Emerg Crit Care Med. Vol. 19, No. 3, Boocock MG, Gray MI, Williams S. Patient handling in the ambulance services, case study investigations In: McCabe, P.T.(Ed), Contemporary Ergonomics. London: Taylor & Francis 2002: Letendre J, Robinson D. Final Report: Finding solution Grant 99FS-14. Evaluation of paramedic's tasks and equipment to control the risk of musculoskeletal injury. Ambulance Paramedics of British Columbia, CUPE Local : U.S. National Institute for Occupational Safety and Health. Musculoskeletal Disorder and Workplace Factors: A critical Review of Epidemiologic Evidence for Work-related Musculoskeletal Disorder of the neck, upper Extremity, and Low Back. Cincinati: U.S. Departement of Heath and Human Services. 17. Helmut S. Selected Health Risks Caused by Long-Term, Whole-Body Vibration. Am J Ind Med 1993;23: Robin W, Alan T, Phillp H. A prospective f o l l o w - u p s t u d y o f l o w b a c k p a i n i n community. Spine 2000;25: Miller JA, Shcmatz C, Schultz AB. Lumbar disc degeneration: correlation with ago, sex, and spinal leveling 600 autopsy specimens. Spine 1998;13: John MF, Mary FH, David G American heart association Guideline for cardiopulmonary Resuscitation and emergency cardiovascular Care. Circulation 2005;112: Lin MR, Tsauo JY, Wang JD. Determinants of economic cost related to low back pain among nurses at a University Hospital. Int J Occup Environ Health 1996;2: Andersson GB Epidemiological features of chronic low back pain. Lancet 1999;354: Konz S. NIOSH lifting guidelines. Am Ind Hyg Assoc J 1982;43: Chaffin DB. Manual materials handling and the biomechanical basis for prevention of low-back pain in industry-an overview. Am Ind Hyg Assoc J 1987;48:

9 Back pain and CPR 101 Cardiopulmonary Resuscitation and Back Pain among Emergency Medical Technicians Keng-Wei Hu 1, How-Ran Guo 2,3, Hsin-Ling Lee 2,3, Hung-Jung Lin 1 Chin-Kun Liao 4, Kuo-Tai Chen 1, Ning-Ping Foo 3,4 Introduction: Back pain is one of the common occupational diseases. There has been no previous study of the prevalence of back pain among emergency medical technicians (EMTs) in Taiwan. Objective: To determine the prevalence of back pain among EMTs and the relationship between back pain and the carrying out of cardiopulmonary resuscitation (CPR). Methods: This was a cross sectional study in which a questionnaire was sent to EMTs across southern Taiwan between March 2006 and May The content focused on musculoskeletal discomfort over the last year and the association between CPR and back pain. The dataset was analyzed by descriptive and logistic regression, which were used to compare the association between back pain and CPR associated factors. Result: The mean age of the EMTs was 35.59±7.96 years old and a EMT-2 level of training predominated (80.2%), More than a half of them had worked for more than 10 years as an EMT. The prevalence of musculoskeletal discomfort over the last year was 62.6% and the prevalence of back pain was 54.1%. Moreover, 15.7% of the personnel had asked for leave, 40.4% of personnel had taken bed rest and 44.3% of personnel had taken medication in order to control the pain. In addition, 58.1% of personnel had experienced back pain after CPR and 68.7% of them considered the cause of their back pain to be related to CPR. Among the respondents, 52% of them had performed CPR alone without any assistance. Overall, there was a significant risk of increased back pain among EMTs who carried out CPR alone (Odds ratio 1.60, 95% Confidence interval 1.03~2.47, p value 0.036). Notwithstanding this, there was no statistical significant correlation between back pain and age, marital status, CPR posture and frequency of carrying out CPR. Conclusions: It is clear that back pain is a common problem among EMTs who work in southern Taiwan and in some cases this has already impacted on their daily life and work. CPR without assistance was a significant risk factor for the presence of back pain. We recommend the fire bureau reconstruct the three ambulance offices where the mission rescuers work in order to reduce the prevalence of back pain among EMTs. Key words: back pain, cardiopulmonary resuscitation, emergency medical technicians Received: May 24, 2007 Accepted for publication: December 18, 2007 From the 1 Department of Emergency Medicine, Chi-Mei Medical Center 2 Department of Environmental and Occupational Health, National Cheng Kung University Hospital 3 Department of Occupational and Health Environmental Medicine College, National Cheng Kung University, Tainan, Taiwan 4 Department of Emergency Medicine, Chi-Mei Medical Center, Liouying Reprint requests and correspondence: Dr. Ning-Ping Foo Department of Emergency Medicine, Chi-Mei Medical Center, Liouying 201 Taikang Village, Liouying Township, Tainan County 736, Taiwan (R.O.C.) Tel: (06) ext Fax: (06) ningping.tw@yahoo.com.tw

Harmful Effects in Personal Assistants Client Transfer Situations

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