An Analysis of Tube Thoracostomy in Combat Implications for Improved Prehospital Recognition and Treatment.

BACKGROUND: Thoracic trauma occurs frequently in combat and is associated with high mortality. Tube thoracostomy (chest tube) is the treatment for pneumothorax resulting from thoracic trauma, but little data exist to characterize combat casualties undergoing this intervention. We sought to describe the incidence of these injuries and procedures to inform training and materiel development priorities. METHODS: This is a secondary analysis of a Department of Defense Trauma Registry (DoDTR) data set from 2007 to 2020 describing prehospital care within all theaters in the registry. We described all casualties who received a tube thoracostomy within 24 hours of admission to a military treatment facility. Variables described included casualty demographics; abbreviated injury scale (AIS) score by body region, presented as binary serious (=3) or not serious (<3); and prehospital interventions. RESULTS: The database identified 25,897 casualties, 2,178 (8.4%) of whom received a tube thoracostomy within 24 hours of admission. Of those casualties, the body regions with the highest proportions of common serious injury (AIS >3) were thorax 62% (1,351), extremities 29% (629), abdomen 22% (473), and head/neck 22% (473). Of those casualties, 13% (276) had prehospital needle thoracostomies performed, and 19% (416) had limb tourniquets placed. Most of the patients were male (97%), partner forces members or humanitarian casualties (70%), and survived to discharge (87%). CONCLUSIONS: Combat casualties with chest trauma often have multiple injuries complicating prehospital and hospital care. Explosions and gunshot wounds are common mechanisms of injury associated with the need for tube thoracostomy, and these interventions are often performed by enlisted medical personnel. Future efforts should be made to provide a correlation between chest interventions and pneumothorax management in prehospital thoracic trauma.

Biomechanical assessment of alternative hand trucks for transporting heavy loads up and down stairs.

Hand trucks are frequently used in delivery and moving occupations to move a variety of materials including appliances and beverages. Frequently these transport tasks involve ascending or descending stairs. This research assessed the efficacy of three commercially available alternative hand truck designs that could be used to deliver appliances. Nine experienced participants moved a 52.3 kg washing machine up and down a flight of stairs using a conventional two-wheeled hand truck, a multi-wheeled hand truck, and a two-speed powered hand truck. Electromyographic (EMG) data showed reduced right erector spinae, bilateral trapezius, and bilateral biceps 90th and 50th percentile normalized responses while ascending and descending the stairs when using the powered hand truck. The multi-wheel hand truck did not reduce EMG levels relative to the conventional hand truck. Participants, however, did express a potential concern regarding the ascent time with powered hand truck at the slower speed.

Evaluating the Efficacy of a New Alternating Pressure Air Mattress Aimed at Reducing Pressure Injuries During the Transport of Combat Casualties.

INTRODUCTION: The development of pressure ulcers during aeromedical transport of combat casualties is an issue that continues to exist, especially during long transport flights. This study investigated the potential for a new intervention, an air-inflated insulating mattress pad (IMP) that has a pump system designed to alternate the pressurization of air cells under the patient, thus temporally shifting the pressure concentration locations. MATERIALS AND METHODS: In a repeated measures design study, 12 participants experienced the following four simulated transport conditions, each for 90 minutes: (1) The North Atlantic Treaty Organization (NATO) litter by itself (control condition), (2) the NATO litter covered with the standard mattress pad (Warrior Evacuation Pad), (3) the NATO litter covered with the air-inflated mattress (IMP), and (4) the NATO litter, covered with the standard mattress pad that was covered by the insulating mattress pad. Peak pressure readings were obtained every 15 seconds under the head, torso, pelvis, legs, and heels. RESULTS: While both mattress pads significantly reduced the peak pressures relative to the litter-only condition, the new IMP with the alternating cell pressurizations, by itself or in combination with the standard mattress pad, further reduced the peak pressures under the regions with the localized highest pressures, namely the head, pelvis, and heels. Moreover, the IMP with alternating pressure introduced the most variability in the peak pressure readings, which reduces the peak pressure exposure periods for specific tissue locations. CONCLUSIONS: The IMP with alternating cell pressurizations could further reduce the likelihood of pressure injuries during aeromedical transport of combat casualties.

Musculoskeletal discomfort in veterinary healthcare professions.

BACKGROUND: Veterinarians appear to be at risk for work-related musculoskeletal discomfort (MSD), based on surveys conducted outside the US. OBJECTIVE: This study provides new information about MSD prevalence in veterinarians and veterinary technicians in the US. METHODS: Cross-sectional survey and observation. RESULTS: A survey of 56 veterinarians and 38 veterinary technicians in Ohio found 12-month prevalence of MSD exceeded 60% in the neck, low back, and legs/feet. More than 85% of participants reported that work activities exacerbated discomfort in at least one region. Less than one-third of participants reported symptom-related lost work time. Personal and work-related burnout scores were higher for veterinary technicians, compared with veterinarians. Nine percent of observed work activities performed by veterinarians and 43% performed by veterinary technicians were rated high or very high risk. CONCLUSIONS: High prevalence of MSD and low lost work time suggest many individuals are working in pain. Increased adoption of existing ergonomics solutions (equipment and process changes), in addition to further investigation of unmet needs, could improve working conditions and reduce musculoskeletal stress in veterinary health professions.

Exploring the relationships between computer task characteristics, mental workload, and computer users' biomechanical responses.

Previous biomechanics studies suggest that higher cognitive mental workload when performing office computer tasks may increase the risk of MSDs among office workers. Cognitive workload can be interpreted in terms of task factors (e.g. task complexity and time pressure) and mental workload factors which include mental demand and mental effort. A laboratory study was conducted to further explore how the task and mental workload factors affected computer users' biomechanical responses, specifically the muscle activation levels and sitting postures. Data were collected as 20 participants worked on computer tasks which varied in their levels of task complexity and time pressure. Visual analog scales were used for assessing mental workload factors. Results indicated that the level of mental effort reported, as opposed to the level of task complexity, was associated with changes in participants' biomechanical responses, but primarily occurred when the chair's backrest was not used. Practitioner summary: A study was conducted to investigate the association between computer users' cognitive workload and biomechanical responses when performing computer task. While task complexity was not directly associated with the changes in participants' biomechanical responses, higher reported mental effort was associated with increased biomechanical responses, but only when the participants did not use the backrest on the chair.

The effects of using a footrest during computer tasks varying in complexity and temporal demands: A postural and electromyographic analysis.

Prior research has found that office workers may not be fully utilizing their chair's back support. This may be due in part to cognitive demands or other psychological stressors. Not using the back support may increase the muscle tension and contribute to muscle fatigue and discomfort. Historically, footrests have been advocated to address anthropometric disparities in office settings. In this laboratory study, it was hypothesized that a footrest may facilitate the use of the backrest and mediate the biomechanical demands on the back and neck muscles, especially when cognitive workload is elevated. Twenty participants performed computer tasks, which varied in their complexity levels, both with and without an angled footrest. Using a footrest increased workers' use of a chair's backrest, increased pelvic rotation towards the backrest, and had a corresponding change in spine flexion. However, no changes were found in the sampled electromyographic activities due to the footrest.

Ergonomic considerations when slotting piece-pick operations in distribution centers.

Many warehouse slotting algorithms have overlooked worker ergonomics. This research aimed to develop ergonomics slotting guidelines based upon the back and shoulder postures and electromyographic (EMG) responses of the deltoid and erector spinae muscles when individual items are picked from, or full cases replenished to, different shelf heights In the first study of two studies, participants lifted small items representative of piece-pick tasks from seven shelf heights. In the second study, participants performed a simulated full case replenishment task in which they lifted boxes weighing between 2.7 and 10.9 kg from a cart into a flow rack. Shelf height significantly affected all postural and EMG variables and there was a trade-off between back and shoulder muscle activity across the varying shelf heights. Together, these studies were used to develop some general ergonomic slotting guidelines that could be implemented to reduce biomechanical load exposures experienced by distribution center workers.

An investigation of an ergonomics intervention to affect neck biomechanics and pain associated with smartphone use.

BACKGROUND: Neck discomfort and pronounced neck flexion have been associated with smartphone use. OBJECTIVE: Eye glasses with a 90 deg prism in each lens were investigated as a potential intervention to reduce awkward head and neck postures during activities involving viewing the device. METHODS: Sixteen smartphone users with neck pain and 9 asymptomatic users performed a texting task on a smartphone with and without the prism glasses, in sitting and standing postures in a laboratory setting. RESULTS: Cervical erector spinae and upper trapezius muscle activity, head posture and motion, performance, discomfort and other subjective perceptions were assessed. Prism glasses reduced neck extensor muscle activity, neck flexion, and head tilt compared to the direct view. In the symptomatic group, the intervention produced less neck and shoulder discomfort compared to the direct view. CONCLUSIONS: This intervention could offer an alternative way of interacting with a smartphone while texting in stationary postures, by reducing exposure to pronounced flexed neck and head posture commonly seen in users, and thereby could reduce neck discomfort associated with smartphone use.

The efficacy of a lifting strap as an ergonomic intervention for EMS providers: Does it make it easier to raise a supine patient to an upright sitting posture?

Patient handling related musculoskeletal injuries are prevalent among Emergency Medical Service (EMS) providers. The first step in many patient handling situations is where a supine patient on the floor is brought to a sitting position. This study investigated whether a strap, placed under the patient's torso and long enough that EMS providers can perform the patient raising task in a standing posture, reduced muscular effort. Fifteen participants raised a simulated patient, with the help of an assistant, using the strap method and a traditional method (grasping the shoulders) in an open area, a restricted space, and in a bathtub. Torso postures improved in all location conditions when using the strap. The muscle activation data showed mixed results. While EMG responses from the latissimus dorsi muscles were reduced, EMG activity of the erector spinae muscles increased when the strap was used. Perceived effort assessments supported the use of the strap.

Assessment of alternative methods for informal caregivers to perform patient repositioning tasks.

Manual patient handling tasks put formal and informal caregivers at risk of musculoskeletal injury. Intervention research to reduce risks to informal caregivers is limited. This study examined effects of slide sheet use when individual informal caregivers performed patient boosting and turning tasks. Three methods of slide sheet use and a baseline method (no slide sheet) were compared, to reposition a 70 kg individual. Muscle activity, ground reaction force, posture, and rating of perceived exertion were significantly affected by task method. Erector Spinae activity was reduced in boosting and turning away tasks with the slide sheet. Shoulder elevation, torso angle, and normalized vertical ground reaction force were also reduced with the slide sheet during boosting. The turn towards task was generally not improved with the slide sheet. Overall, using a slide sheet provided biomechanical benefits to individual caregivers performing two common patient handling tasks: boosting and turning patient away from caregiver.

A framework for studying risk factors for lower extremity musculoskeletal discomfort in nurses.

Lower extremity musculoskeletal discomfort (MSD) is prevalent, but understudied, in nurses. A comprehensive, theoretical, aetiological model of lower extremity work-related MSD in hospital in-patient staff nurses was developed through a review of the literature to provide a framework for aetiological and intervention research. The framework informed the design of a survey of 502 hospital staff nurses. Symptom prevalence ranged from 32% in hip/thigh to 59% in ankle/foot regions. Logistic regression modelling using survey data showed that different work and personal factors were associated with discomfort in different regions of the lower extremity. Individual factors (e.g. older age, higher BMI or having any foot condition), physical factors (e.g. higher frequency of patient handling), psychosocial factors (e.g. lower job satisfaction) were associated with discomfort in one or more parts of the lower extremity. Future research should target these factors for intervention, to attempt to reduce occurrence of lower extremity discomfort in nurses. Practitioner Summary: Practitioners may find useful the illustrated, theoretical aetiological model of factors that could influence the prevalence of lower extremity discomfort in nurses. The model could guide conversations with nurses and observational analyses of nursing work. The model and survey results may provide ideas for intervention exploration. Abbreviations: MSD: musculoskeletal discomfort; BMI: body mass index; MSK: musculoskeletal; ICU: intensive care unit; NLERF: nurses' lower extremity MSD risk factor; NASA-TLX: NASA-task load index.

Collaborating with radiographers to address their work-related musculoskeletal discomfort.

The prevalence of musculoskeletal (MSK) symptoms in radiographers is high, similar to other healthcare occupations that involve high levels of physical exertion (e.g. patient handling; grasping and moving equipment). Reports of interventions to reduce MSK discomfort in radiographers are limited. A participatory approach was used to investigate daily challenges, needs, and opportunities for developing interventions to address exposures to many of the risk factors that contribute to MSK symptoms in radiographers. In this paper, we present the expressed needs of experienced radiographers (including assistance with patient handling, security, supportive design of equipment and work spaces), along with their evaluations of several intervention concepts intended to address some of those needs. We also report results from tests of three prototype interventions stemming from this participatory process that demonstrate the potential for new engineering control concepts to reduce the physical effort associated with some of the most common tasks radiographers perform.

Developing Evidence-Based Design Guidelines for Medical/Surgical Hospital Patient Rooms That Meet the Needs of Staff, Patients, and Visitors.

OBJECTIVES: This research investigated medical/surgical (Med/Surg) patient room design to accommodate the needs of hospital staff, while at the same time accommodating the needs of patients and their visitors. BACKGROUND: Designing hospital patient rooms that provide a comfortable healing experience for patients, while at the same time meeting the needs of the hospital staff, is a challenging process. Prior research has shown that many hospital patient room designs adversely affect the ability of hospital staff to perform their tasks effectively, efficiently, and safely. METHOD: Twenty-seven design sessions were conducted in which 104 participants, representing 24 different occupations, worked in small mixed occupational groups to design an ideal single patient Med/Surg patient room to fit their collective needs using a full-scale mock-up. During analysis, the investigators reduced the resulting 27 room designs to 5 hybrid designs that were sequentially reviewed by patients and visitors and by staff to address design conflicts. RESULTS: This design process identified 51 desirable room design features that were incorporated into 66 evidence-based design guidelines for the different areas within the Med/Surg patient room including the entry way (16 guidelines), the patient clinical area (22 guidelines), the bathroom (17 guidelines), the family area (8 guidelines), and storage areas for patients and their visitors (3 guidelines). CONCLUSIONS: The guidelines developed through this study identified many opportunities for improving the design of hospital Med/Surg rooms to allow staff to be more effective, efficient, and safer, while at the same time addressing the design needs of patients and their visitors.

A biomechanical evaluation of potential ergonomic solutions for use by firefighter and EMS providers when lifting heavy patients in their homes.

Firefighters and EMS providers continue to be challenged when lifting heavy patients in their homes. This study investigated the biomechanical efficacy of four devices that could be used by two-person teams when lifting patients from the floor, from a reclining chair, or from a Simulated Inflatable Seat at chair height. Fourteen firefighter-paramedics, working in two-person teams, were instrumented with motion capture and electromyographic sensors. The Binder Lift™, the Simple Strap, and the Slip Preventer were used to lift patient actors, and were compared to current lifting methods. Postural data and the peak dynamic spine shear forces at the L5/S1 level were reduced when using the Simple Strap, the Binder Lift, and the Simulated Inflatable Seat. The Slip Preventer reduced spine flexion when the Binder Lift was not used. In summary, the tested devices can potentially reduce the biomechanical loads experienced by EMS providers as they lift and move patients.

Evaluating Home Healthcare Workers' Safety Hazard Detection Ability Using Virtual Simulation.

Home healthcare workers (HHWs) are routinely exposed to occupational safety hazards when servicing patients in their homes that put them at risk for injury. These hazards can be broadly classified as "electric, fire and burn," "environmental," or "slip, trip, and lift" hazards. To better train HHWs regarding their potential exposure to these hazards, a home healthcare virtual simulation training system (HH-VSTS) was developed. The HH-VSTS contains three training modules, corresponding to the aforementioned hazard categories, and an assessment module. In each training module, the trainee must navigate the virtual space, via a mouse click, and identify items or conditions that represent hazards. Once an item has been clicked on, the HH-VSTS asks the user if the item or condition is a hazard. For items or conditions that are hazards, additional text boxes present material to the user as to why the item constitutes a hazard and potential remediation approaches. Thus, it is important that hazards be identified and clicked on for the trainee to receive the educational component of the training system. This article evaluated the ability of 49 HHWs to find hazards in each of the three categories. In all modules, participants found the most salient hazards (e.g., clutter on stairs, unattended candles, biohazard stains) but struggled to find some of the less salient hazards. Several less salient hazards included the pet food bowls in the path of travel, the frayed electrical cord, oxygen tube leaking into a mattress, hot water that was too hot, and elevated room temperatures. Overall, this analysis found that most of the hazards within the training modules could be found by naïve HH-VSTS users. These data suggest the need for including hints that guide users toward hazards with which they are less familiar.

Quantifying the effectiveness of static and dynamic insoles in reducing the tibial shock experienced during walking.

Many individuals work in jobs that require them to spend much of their day walking. There is evidence to suggest that shoe insoles may reduce the lower extremity discomfort for these workers. This study compared the effects of static and dynamic shoe insoles on lower extremity forces when walking at different speeds. Tibial acceleration (a.k.a. tibial shock) was assessed bilaterally in 30 participants who walked in both athletic shoes and work boots without any additional insole, with additional static insoles, and with additional dynamic insoles. The participants walked a prescribed course at a "slow", "normal", and "fast" pace. With both shoe types, there were significant reductions in tibial shock values when insoles were used. With the work boots, the dynamic insole further reduced tibial shock relative to the static insole. The significant interactions show that the differences between insole conditions become greater with faster walking speeds.

The Effects of Load Stability and Visual Access During Asymmetric Lifting Tasks on Back and Upper Extremity Biomechanical Responses.

OBJECTIVE: To explore the change of muscular and biomechanical responses in different load stability and visual access conditions during an asymmetric lifting task. BACKGROUND: Previous studies found that lifting unstable loads resulted in changes to the biomechanical loads experienced by the spine and upper extremities. However, researchers have not extensively investigated behaviors when people lift potentially unstable loads. It was hypothesized that lifting a potentially unstable load can lead to changes in lifting behavior, which may be mitigated by visual access to the load. METHOD: Fourteen volunteers lifted either a stable load or a potentially unstable load that could move within the container during the lifting task. In half of the lifting conditions, the box was covered to restrict visual access when lifting. Spine kinematic and kinetic measures and surface electromyographic (EMG) signals from back, shoulder, and arm muscles were obtained. RESULTS: Lifts of the stable load were faster and generally had higher peak muscle activations than lifts of the potentially unstable load. Participants had less spine flexion when handling the potentially unstable load without visual access. CONCLUSION: When lifting and moving a potentially unstable load that could lead to a perturbation, people tended to lift the container more slowly comparing with lifting a stable load, which in turn reduced the peak muscle activities. APPLICATION: In industry, there are many work situations where workers need to lift or carry unstable loads that can shift during transport. Providing visual access to the load may help mitigate some of these effects.

A Grounded Theoretical Analysis of Room Elements Desired by Family Members and Visitors of Hospitalized Patients: Implications for Medical/Surgical Hospital Patient Room Design.

OBJECTIVE:: To identify family members' and visitors' needs with relation to the design of a hospital room. BACKGROUND:: There is a trend toward incorporating family zones in hospital patient rooms in order to improve patient satisfaction and encourage family caregivers to stay longer and overnight. METHOD:: A mixed-method study was employed. Interviews of patients and family caregivers were conducted to understand opportunities to improve hospital room designs based on recent experiences. Features intended to support short-term and overnight visitors were embedded in five full-scale simulated room design concepts. Small groups of family caregivers and patients toured two room design concepts and reacted real time to room features. A grounded theory approach was employed to identify emerging themes. RESULTS:: A theoretical design framework is developed for the needs of family members and visitors for a range of time periods. This framework is founded upon desires to help make the patient feel more comfortable. There are various levels of helping the patient feel more comfortable, including visiting, keeping company, providing support, providing assistance, and being a caregiver. Beyond this core need, family members and visitors must take care of their own needs in order to feel comfortable in the hospital room. Activities associated with these needs include sitting, relaxing, eating, working, tending to daily needs, and resting overnight. CONCLUSIONS:: Potential implications for architects, healthcare planners, and interior space designers are described. Design and renovation guidance for the hospital room environment in order to support the needs and expectations of families and visitors is provided.

Re-thinking floor mat design from an ergonomics perspective: Can a two-part mat system reduce biomechanical loads during normal mat handling tasks?

Floor mats are commonplace in commercial buildings, particularly in entry ways. These mats are routinely handled by delivery personnel as the mats are picked up for cleaning and clean mats are deployed. A new two-part mat design, which eliminates the need to move the rubber base during mat change operations, was hypothesized to reduce the physical demands on delivery personnel. Electromyographic data from back and shoulder muscles and spinal kinematics were obtained as 12 volunteers simulated mat selection, mat deployment, and mat pick-up tasks. Other factors considered in this study included mat size, pick-up method, and mat textile orientation during deployment. Results indicated that the two-part design reduced muscle activation levels across all tasks. Biomechanical benefits were also found when the mats were picked-up using a kick-fold as opposed to hand-fold method and when mats were deployed with the textile component rolled towards the inside of the roll.

Meeting Patient Expectations During Hospitalization: A Grounded Theoretical Analysis of Patient-Centered Room Elements.

OBJECTIVES: To identify patient needs and expectations that can be utilized to inform the design or renovation of medical-surgical patient rooms in a hospital. BACKGROUND: There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process. METHODS: Patients' and family caregivers' reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session. RESULTS: A theoretical design framework was generated, showing patients expect a hospital room that provides them with the core components of comfort to support healing, facilitates a strong sense of connection to people and the outside world, enables quick and independent access to the patient's things, and offers suitable levels of control to the patient throughout their hospital stay. CONCLUSIONS: The implications for assisting architects, healthcare planners, and interior space designers are described using this framework, as well as its potential for design guidance. In addition, the connection between patient-centered room elements and relevant survey questions in publicly reported patient satisfaction scores for hospitals is discussed.