A Pocket Full of Kryptonite

Myth: I am Invincible! 

What we know: This column talks about research, but we're going to go out on a limb and with no research to back us up, state that you are not the Man of Steel or Wonder Woman. You cannot fly, and you don't ride around in an invisible plane. But if this bold statement won't convince you, maybe some scientific evidence will.

To determine how vulnerable EMS providers really are, we're going to take a look at some data from the Longitudinal EMT Attributes and Demographic Study (LEADS), which we've mentioned before. We asked a national sample of EMS providers to report on some common health problems. Specifically, we asked if they had experienced any hearing, sleeping or back problems within the past 12 months. We also asked EMS providers to report how many days of work they missed due to an on-the-job injury.

Let's look at Figure 1. This graph describes the overall prevalence of specific health problems among all EMS providers in this study. Prevalence is just a fancy way of saying you're looking at the percentage of people who report a given condition at a given point in time. Interestingly, it seems more than 25% of EMS providers report having sleeping problems and back problems. Also, 15% of providers missed at least one day of work in the past year because of an on-the-job injury.

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Figure 1. Prevalence of Health Problems among EMS Providers

Figure 2 presents the same type of information, but broken down by certification level—EMT-basic and paramedic. Shockingly, it appears as though many more paramedics report having health problems. In fact, one in five paramedics were injured in the past year to the point that they had to take at least one day off work. When was the last time you heard of Superman calling in because he had a sore back?

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Figure 2. Comparison of Health Problems among EMT-Bs & Paramedics

It appears that fewer EMT-basics have missed work due to an injury. Does that mean that EMT-Bs are more closely related to the Man of Steel? Don't get too excited, EMT-B friends; we'll talk about this phenomenon in a second.

What we don't know: We're going to repeat the same phrase you've heard before: The data we report comes from a national sample of EMS providers, and to truly understand how injuries affect your service, you're going to have to step up to the plate and investigate further yourself. That said, we want to focus on two specific things we can learn from this analysis of health problems.

We mention that EMT-Bs appear to report fewer injuries leading to time off from work. Why do you think that is? Do you really believe that just being an EMT-B makes it less likely you'll get hurt or that just having a paramedic license makes you more vulnerable to serious injury? Probably not. These results present us with the opportunity to discuss the difficulties of interpreting research—specifically, understanding the concept of confounding.

Stay with us for a minute as we use another real-world example. Did you know that ice cream is associated with drownings? That's right: As ice cream sales increase, so to do the number of drownings. All you ice cream lovers out there, be careful.

Hold on. Are we really to believe that because I love vanilla ice cream cones with chocolate sprinkles, my chances of drowning are higher? Of course not. Just apply some logic: Ice cream sales increase during the … summer, and more people are inclined to go swimming during the … summer. Are you getting the picture? Another factor is involved—summer—and that illustrates the concept of confounding. It's just a coincidence that more ice cream is sold in the summer, when more people go swimming.

To those who read research willy-nilly, confounding can really trip you up. It would've been easy to say that your level of certification puts you at different risks for injury. You smell that? Take another whiff. Yep, we smell confounding.

Besides certification level, what are some other explanations for this difference? Well, it's not summer or ice cream. Could it be that in general paramedics have been working longer, lifting patients longer and have more wear and tear on their bodies?1 Many other possible explanations might exist, and we challenge you to try and figure out what they are.

Let's go back to the myth. It looks like it will be rejected. However, we always tell you one study is never enough to draw definitive conclusions. Don't take our word for it: Several papers indicate just how dangerous EMS is. The highest risk of on-duty fatality for EMS professionals is associated with vehicle crashes.2, 3, 4, 5 One study indicated that 90% of EMS providers had experienced a violent situation while at work, and 84% believed that their personal safety was at risk due to workplace violence.6 Grange et al reported that during a 31-day period, EMS professionals reported violent behavior on 8.5% of all calls.7 Schwartz et al estimated the prevalence of the following health problems among EMS providers: stress (27.2%), back injury (25.4%), extremity injury (23.7%), assault (20.3%), ear problems (6.0%) and eye (3.4%) problems.8 And Maguire et al estimated that 34 out of every 100 full time EMS providers per year had some occupational injury.9

Verdict: Rejected. There you have it: You're not invincible. So the next time you respond to a suicide attempt, let the cops go in first. They may not be Superman or Wonder Woman, but at least they have bulletproof vests. Be careful out there; we don't want you to end up as just another statistic.