Work-related musculoskeletal disorders and injuries among emergency medical technicians and paramedics: A comprehensive narrative review

The nature of work-related musculoskeletal disorders of the neck and upper limbs is reviewed using both scientific data and the consensus view of experts, union bodies and government agencies across the European Union. Work-related musculoskeletal disorders describe a wide range of inflammatory and degenerative diseases and disorders. These conditions result in pain and functional impairment and may affect, besides others, the neck, shoulders, elbows, forearms, wrists and hands. They are work-related when the work activities and work conditions significantly contribute to their development or exacerbation but are not necessarily the sole determinant of causation. The classification and the need for standardised diagnostic methods for assessment of neck and upper limb musculoskeletal disorders are reviewed. These disorders are a significant problem within the European Union with respect to ill health, productivity and associated costs. The pathomechanisms of musculoskeletal disorders affecting tendons, ligaments, nerves, muscle, circulation and pain perception are reviewed and conceptual models for the pathogenesis of musculoskeletal disorders affecting the neck and upper limbs are presented. The epidemiological evidence on the work-relatedness of these disorders is discussed. A relationship between the performance of work and the occurrence of neck and upper limb musculoskeletal disorders is evident. Intervention strategies in the workplace for the reduction of both exposure and effect should focus upon factors within the work organisation as well as actively involving the individual worker. The current knowledge is sufficient to enable informed decisions to be made on future research needs and prevention strategies at the societal, organisational and individual level.

Emergency medical services personnel treat 22 million patients a year, yet little is known of their risk of injury and fatality.

Work-related musculoskeletal disorders (MSDs) have accounted for a significant proportion of work injuries and workers' compensation claims in industrialized nations since the late 1980s. Despite epidemiological evidence for the role of repetition and force in the onset and progression of work-related MSDs, complete understanding of these important occupational health problems requires further elucidation of pathophysiological mechanisms of the tissue response, particularly in the early stage of these disorders. Results from several clinical and experimental studies indicate that tissue microtraumas occur as a consequence of performing repetitive and/or forceful tasks, and that this mechanical tissue injury leads to local and perhaps even systemic inflammation, followed by fibrotic and structural tissue changes. Here we review work linking inflammation and the development of work-related MSDs. We also propose a conceptual framework suggesting the potential roles that inflammation may play in these disorders, and how inflammation may contribute to pain, motor dysfunction, and to puzzling psychological symptoms that are often characteristic of patients with work-related MSDs.