digital human modeling in ergonomics assessment of patient lifting by paramedics
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Excellence Through Innovative Research
www.wise.binghamton.edu
Digital Human Modeling for Ergonomics Assessment of Patient Lifting by Paramedics
Akiev Samson
Graduate Research AssociateDepartment of Systems Science and Industrial Engineering
Binghamton University (State University of New York) Binghamton, NY 13902
Feb 27th, 2009
2Binghamton University | February 2009www.wise.binghamton.edu
Agenda
• Ergonomics
• Work-Related Musculoskeletal Disorders (WMSDs)
• Patient Handling
• Paramedic Profession, Statistics
• Conventional Ergonomics vs Digital Human Modeling (DHM)
• Research Objectives and Outline
• Uniqueness and Significance
• Experiments
• Validation, Anthropometric Effect, Adjustment, Postural Effect
• Results
• Recommendations
• Conclusions and Future Work
3Binghamton University | February 2009www.wise.binghamton.edu
Ergonomics
Ergonomics
4Binghamton University | February 2009www.wise.binghamton.edu
Work-Related Musculoskeletal Disorders (WMSDs)
WMSDs
ConstructionManufacturingMining Office Work
Repetitive Motion Injuries
Repetitive Strain Injuries
Cumulative Trauma Disorders
Occupational Cervicobrachial
Disorders
Overuse Syndrome
Regional Musculoskeletal
Disorders
Soft Tissue Orders
5Binghamton University | February 2009www.wise.binghamton.edu
Cost of WMSDs
2 Million Lost
Workdays
Highest Risk for
WRMSDs 1 in 5 Reported WRMSDs
Rate of Injuries
Twice the Working
Population
$1 in $3 Spent on WRSMDs
Healthcare Domain
“Increase in Ergonomic
Injuries, Worker Compensation
Claim..” Washington
State
Construction:
$1,000,000,000
Manufacturing:$500,000,000
Administrative: $200,000,000
Educational: $75,000,000
Healthcare: $340,000,000
50,000 Claims
45,000 Claims
20,000 Claims
8,000 Claims
36, 000 Claims
“Just for Washington State”
Center for Occupational and Environmental Medicine, 2003. Safety and Health Assessment and Research for Prevention (SHARP), 2005
6Binghamton University | February 2009www.wise.binghamton.edu
Motivation
Du, 2005
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Patient Handling in Healthcare
“Paramedics do not have the option of Time”
8Binghamton University | February 2009www.wise.binghamton.edu
Paramedic Profession
Occupational Fatalities
Back Injuries
Sickness
Ambulance Crashes
Shootings
Fire BreakoutPatient Lifting
Repetitive Bending
Awkward Bending Hazardous
Material
Treating the Diseased
Excessive Work
“More than half have some form of WMSD”
“Many devices and many injuries”
“Complex and challenging” “Lack of
documentation of data”
“Many EMTs were volunteers”
“Less emphasis on patient lifting
training”
9Binghamton University | February 2009www.wise.binghamton.edu
Paramedics: Statistics
Okada et al. (2005)
10Binghamton University | February 2009www.wise.binghamton.edu
Conventional Ergonomics vs DHM
• Postural
Angles
• 3DSSPP
LMM
• Muscle
Activity
• Electrodes
EMG
• Stress
Perception
• Survey
BORG’s
Scale
DHM TechnologyLower Back
Analysis
Static Strength Prediction
Metabolic Energy Expenditure
Fatigue Analysis
Animation
Digital Humans Never
Say ‘No’ !!
TSB SimulationReach Zone
Analysis
Vision Analysis Collision Detection
“Lumbar Motion Monitor”
“Electromyography”
11Binghamton University | February 2009www.wise.binghamton.edu
Research Objectives
• To demonstrate the effectiveness of DHM software for ergonomics assessment of paramedic patient handling
• To study the influence of anthropometry of paramedics on lower back stress
• To study the influence of postural variables on lower back stress during patient lifting
12Binghamton University | February 2009www.wise.binghamton.edu
Research Outline
Quantifying Lower Back Stress: Validation
Defining Team Roles through Anthropometry
Adjustment of Stretcher and GurneyPostural Variables
DHM Software
“Challenging Environment”
13Binghamton University | February 2009www.wise.binghamton.edu
Uniqueness and Significance
“Innovative Technology to Study
Healthcare Ergonomics”
“Implementation of a Cost Effective Solution
to Study Healthcare Ergonomics that will Benefit Healthcare Professionals in the
long term”
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Research Methodology
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Validation of DHM Software as a Tool to Study Patient Lifting
16Binghamton University | February 2009www.wise.binghamton.edu
Validation
Replication of Images from Previous Research
10 Male Paramedics
Variable Anthropometry
48 Kilogram Patient
Average Postural Angles
Difference in Back Stress between Teams
Lavender et al. (2000a, 2000b)
17Binghamton University | February 2009www.wise.binghamton.edu
Results: Validation
Bed Stretcher
Bed-side
Paramedic:
Standing
Stretcher- Side
Paramedic
Patient
Bedside
Paramedic:
Kneeling
Stretcher- Side
Paramedic
Stretcher Bed
Patient
Follower
Leader
Patient
Backboard
Follower
Leader
Stairs
Patient
Backboard
Follower
Leader
Stairs
Patient
Stairchair
Follower
Leader
Stairs
Patient
Stairchair
Gurney Side
Paramedic
Stretcher Side
Paramedic
Patient
Gurney
Stretcher
18Binghamton University | February 2009www.wise.binghamton.edu
Results: Validation (Contd.)
“Paramedics will experience > 3400 N at least once during a complete transfer task”
48 Kg Patient
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Effect of Anthropometry
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Methodology for Simulating Postures
Get Anthropometries
Identify Grip Points
Identify Dimensions which are (can be) Fixed
Height of Stretcher Height
of Gurney
Distance between Grips (Stretcher, Backboard &
Stairchair)
Height of Bed
A
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A
Distance between Hands (Gripping a
Bed Sheet)
Identify Dimensions
(angles) which can be Varied
Wrist Angles
Trunk Flexion
Shoulder Abduction
Position Body with Respect to Grip Points
Validate Postures
Analyze
Repeat for Other Digital
Humans
Paramedic Height
Patient Weight5th 50th 95th 5th 50th 95th
Methodology for Simulating Postures (Contd.)
22Binghamton University | February 2009www.wise.binghamton.edu
Results: Effect of Anthropometry – Paramedic Height
“
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Influence of Stretcher and Gurney Height Adjustment on Lower Back Stress for
Paramedics with Different Heights
24Binghamton University | February 2009www.wise.binghamton.edu
Methodology for Simulating Tasks
Paramedic Height
Paramedic Weight
Patient Weight
Stretcher and Gurney Height
5th 50th 95th
5th 50th 95th
5th 50th 95th
53 cm
72.5 cm
92 cm
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Results: Stretcher Side Paramedic
3750 N
2870 N
3200 N
4900 N
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Main Effects: Stretcher Side Paramedic
3000 N
4200 N
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Contour Plot: Stretcher Side Paramedic
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Results: Gurney Side Paramedic
5750 N
6050 N
6500 N
7600 N
5900 N
5550 N
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Contour Plot: Gurney Side Paramedic
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Stretcher vs Gurney Side
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Postural Variables
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Different Postural Variables
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Results: Trunk Flexion vs Shoulder Rotation
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Results: Trunk Flexion vs Shoulder Separation
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Results: Trunk Flexion vs Shoulder Elevation
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Results: Trunk Flexion vs Elbow Angle
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Summary of Results
• Team Role
• Leader in a safer role compared to follower
• Gurney Side role strenuous
• Standing safer than kneeling
• Anthropometry of Paramedic
• Shorter paramedics encounter lower back stress
• Could influence lower back stress of team member
• Height Adjustment is Crucial
• Degree of adjustment more for stretcher side than gurney side
• Postural Variables
• Stress trends at 0 , 10 , 20 and 30 , 40 and 50
38Binghamton University | February 2009www.wise.binghamton.edu
Proposed Solutions
Recruitment
• Ideal: Shorter Paramedics
• Not the Most Effective: Shortage of Paramedics
Pre-planning
• Less Strength: Less Strenuous Task
• Equal Strength: Alternate between Tasks
Equipment
• Handles as Close as Possible to Patient Body
• Use of DHM to Evaluate Equipment
“Effort from Upper Management to Invest in Patient Lifting Equipment”
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Limitations
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Conclusions and Future Work
Stryker, 2007
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