Moving Handling

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Moving Handling Risk Assessment in the NHS
Ambulance Service
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• Objectives
• To State-
• The Legislation around MHRA
• Ergonomic Dynamic Risk Assessment
• Principles of Biomechanics
• High Risk Unsafe Procedures

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Introduction
Prevention Is better than a CURE!
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Legislation
The Moving Handling Operation Regulation 1992 was
introduced under the provisions of the Health
Safety at Work Act 1974.

• Other Regulations
• European Directive 901269/EEC
• European Directive of May 1990

1992 Regulations (revised in 1998) comprise of 8
individual regulations, of which only regulations
2, 4 5 are most applicable.
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Regulation 2 (Definitions)

• '..any transporting or supporting of a load
• (including the lifting, putting down, pushing,
  pulling,
• carrying or moving thereof )
• by hand or by bodily force'.

..Load is anything which is moveable e.g.
inanimate objects, person or animal
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Regulation 4 (The Employer)
Highlights the responsibilities and imposes
duties on the employers.

• Must be seen too-
• Avoid
• Assess
• Reduce
• Review

..So far as reasonably practicable, AVOID the
need for his employees to undertake any Moving
Handling Operations at Work which involves a risk
of their being injured.
Where it is not reasonably practicable to avoid
the need for his employers to undertake any
Moving Handling at Work, the employer must-
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Regulation 5 (The Employee)
This Regulation imposes duties on the
employee, while at work -

• .shall make full and proper use of any system
  of work
• Provided for his use by his employer in
  compliance with
• Regulation 4.

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Ergonomics Dynamics
Regulation 4 requires the employers to make
suitable sufficient assessments of any
hazardous operation.

• The Ergonomic Approach, therefore looks at-
• the Nature of the TASK
• the INDIVIDUAL CAPABILITY
• the LOAD
• the working ENVIRONMENT

The above is also imposed onto the employees to
perform a dynamic assessment prior to performing
any Moving handling operation.
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Statistics
Number Of Major Injuries
1999/2000 per 100,000 staff
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Statistics
No of Staff requiring gt3 days sick
1999/2000 per 100,000 staff
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Statistics
Percentage of gt3 day injuries to employees by
kind of accident in the NHS 2001/2
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Statistics
Over the last 25 years - 1.5 Million working days
have been lost due to back pain costing the NHS
over 70 Million
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The Normal Spine
Made up of 33 vertebrae of which 24 are separated
by intervertebral discs of cartilage.
Cervical
Thoracic
Lumbar
Sacrum
Coccyx
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The Facet Joints
Located posterior to the vertebral body, enable
limited movement, also restricting
hyper-extension hyper-flexion
Two sets of facets Superior Articular
Inferior Articular facets
Each are surrounded by capsules of connective
tissue. Produce synovial fluid to nourish and
lubricate the joint
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The Intervertebral Discs
Lie between adjacent vertebrae in the spine. Each
disc forms a cartilaginous joint to allow slight
movement of the vertebrae, and acts as a ligament
to hold the vertebrae together.
The annulus fibrosus consists of several layers
of fibrocartilage. The strong annular fibers
contain the nucleus pulposus and distribute
pressure evenly across the disc. The nucleus
pulposus contains loose fibers suspended in a
mucoprotein gel the consistency of jelly.
The nucleus of the disc acts as a shock absorber,
absorbing the impact of the body's daily
activities and keeping the two vertebrae
separated.
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The Intervertebral Discs
24 of the 32 vertebrae are separated by the
intervertebral discs
The design of these discs are equipped to
accommodate the spine when it moves in several
directions. But how much compression are these
discs designed to handle???
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The Intervertebral Discs
If the spine becomes compressed, the pressure on
one or more of then discs is increased.
If the pressure becomes to great, the discs will
begin to bulge eventually, it may even burst
(herniated disc)
95 of herniated discs occur in the lumbar spine,
where the discs are subjected to high forces
levels of compression. The remaining occur in the
cervical region, though this area is under low
levels of compression, its range of movement is
far greater than the rest of the spine
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The Intervertebral Discs
The pain associated with either condition is
usually severe. The outer layer of the discs is
well supplied with nerves and as a result, pain
is often caused by mechanical distension or
stretching of the outer wall
In addition to this, the herniated disc will
often exert pressure on the nerves that branch of
the spine
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Back Pain
Faulty Body Mechanics
Poor Posture
Stressful Living
Common Causes
Working Habits
Poor physical Condition
Loss of Flexibility
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Introduction to the Principles of Biomechanics
The study of how we as humans move and the
effects that outside influences have on the
motion of our bodies.
The movement of the body is caused by the action
of the muscles, which when contracting produce a
force.

• 3 Principles to Biomechanics-
• Centre of Gravity
• Base of Support
• Avoid Tension short levers

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Principle 1 Centre of Gravity
This is the point where the total body mass is
concentrated.
With uniform boxes cylinders, the centre of
gravity will always be in the middle
The Human body alters its dimensions at will,
therefore the centre of gravity sometimes moves
outside the physical body.
In the upright position, the centre of gravity
lies within the pelvis.
The further the centre of gravity from the body,
the greater the effort required to keep the body
stable.
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Principle 1 Centre of Gravity
The lower our centre of gravity to the floor, the
more stable we are.
NOTE The more effort required to stay stable,
means that the muscles, ligaments tendons in
our backs are working at a greater effort
Higher risk of injury
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Principle 1 Centre of Gravity
When sitting the Centre of gravity will be
outside the physical body, and behind the feet,
making it difficult to stand.
Standing can be made easier by first moving
forward in the chair, bringing the patient closer
to their centre of gravity.
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Principle 1 Centre of Gravity
When lying, the centre of gravity will lie within
the pelvis.
An efficient use of body movement, would be to
use the pelvis to roll a client/patient, should
we wish to roll them.
When a person is sitting upright in bed, their
centre of gravity is far from the body making it
difficult to move them.
This is also a problem, if a person is slumped in
bed
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Principle 2 Using the Base of Support for
Stability
This consists of the feet and the area between
the shaded area.
The line of gravity, is the vertical direction
down to the floor from the centre of gravity.
To remain stable, it is necessary to keep the
line of gravity within the base of support
Humans are more stable when their feet are placed
slightly apart, and their knees are slightly bent
this widens the base of support and lowers the
centre of gravity
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Principle 3 Avoiding Tension by Keeping the
External Levers Short
As the centre of gravity moves forward, the line
of gravity falls outside the base, causing
instability.
To counterbalance this, internal muscles and
ligaments in the back are put under pressure, to
prevent us toppling over
To prevent this, external levers should be kept
as short as possible, knees bent and feet
slightly apart.
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Application of Biomechanics to Client Handling
Inanimate Objects

• From Sitting to Standing
• From Lying to Sitting
• From Floor to Sitting/Standing
• The Base Lift Technique

Refer to MHRA Handout
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Risk Assessment
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Guidelines for Safe Lifting Lowering of Loads
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Unsafe and/or High Risk Lifting Practices
Refer to MHRA Handout
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Summary

• Always adopt the Biomechanics of Manual Handling
• Always perform a risk assessment prior to
  undertaking a task
• Dont cut corners use the equipment available
  safely
• Always operate within the MHOR 1992 guidelines
  Trust Policies

• Manger Elk CPOs
• Pat Slides
• Use carry chair as indicated
• Use the Stretcher as indicated

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Any questions ?