b"O P E R A T I O N SM U S C U L O S K E L E T A LBEST PRACTICES RECOMMENDATIONSThe following are best practices recommendations for reducing musculoskeletal disorders during EMS incidents, on-duty physical training, apparatus design and handling large-diameter hose. EMS INCIDENTS POWERED STRETCHERS AND LOADERSOne out of four EMS workers will suffer a career-ending back injury in the field within their first four years, primarily due to lifting (Sanders, 2011). Some of these injuries occur while the patient is being loaded onto the stretcher, while others are due to lifting the stretcher and loading the patient into the ambulance. Powered stretchers and loaders significantly reduce the physical back and shoulder strain placed on fire and EMS personnel during repetitive lifting and lowering of the stretcher, and repetitive loading and unloading of patients during EMS incidents and transports. Patients, EMS equipment and stretchers are heavy. Powered stretchers assist fire and EMS personnel with lifting and lowering a gurney through a battery-powered hydraulic system, which raises and lowers the stretcher with the push of a button. Powered loaders improve personnel and patient safety by allowing loading and unloading into the ambulance without manually lifting and supporting the weight of the stretcher and patient during the process. Powered stretchers and loaders make transfers and transports not only safer, but easier for both first responders and the patient. STRETCHER STATISTICSUsing powered stretchers may decrease compression forces on spinal discs by approximately 50% and shear forces by approximately 46% compared with manual stretchers (Fredericks, 2013). One study done in Canada compared injury rates of two different organizations during EMS incidents. One organization used powered stretchers and loaders while the other used manual stretchers. One year after introducing powered stretchers, occupational injuries dropped 78%. Meanwhile, injuries increased 37% over the same period when using manual stretchers (Armstrong, 2017). An analysis of costs and benefits revealed that investing in powered stretcher and load systems would yield a return on investment within the operational lifespan of the system. This return would be achieved through decreased expenses related to workers' compensation claims. (Armstrong, 2017). 44"