She sprained her lower back lifting cylinders. He twisted his ankle going down some stairs. She slipped on the floor and tore a ligament. He felt a chest pain lifting a hose. What is happening to those in the fire service?

Why have so many been affected by cumulative trauma disorders, repetitive strain disorders and upper-extremity musculoskeletal disorders? While such injuries can't be avoided entirely, ergonomically appropriate fire facility design, in conjunction with smarter work habits, can help limit them.

There now are ergonomic regulations or proposed standards in several states, including California, Connecticut, Maine, Minnesota, North Carolina, Oregon, Washington and Wisconsin. While some of these standards have been contested by the construction industry on the state level, OSHA is looking at the state of Washington's ergonomic rules as a possible model for a federal law.

The fire service also is beginning to pay closer attention to this issue, as evidenced by the IAFF/IAFC Joint Wellness Fitness Program Initiative, which addresses the prevention, recognition and reporting of ergonomics-related injuries. Departments even are beginning to use consultants to analyze job-related injuries so that risk factors can be engineered out of fire service facilities.

Design concepts and tools

According to Deborah Read, president of ErgoFit Consulting Inc., the goal of ergonomic design is to optimize human performance, considering the dimensions of human, tool and environment, as well as the force or exertion required to perform tasks.

The major areas evaluated are:

• Material handling (lift, carry, push, pull);
• Weights, distances, handholds, forces;
• Standing and seated workstations;
• Standing and seated exertions;
• Reach and step distances;
• Tool design and selection;
• Grip and hand strength;
• Awkward postures and physiological stress;
• Workflow;
• Noise and lighting; and
• Cognitive demand.

Various assessment tools can be used to evaluate these major areas. If an ergonomics expert is hired, he or she should start by identifying the problem you're trying to solve, which may be health- or safety-based and/or productivity-related. An action plan is then identified, and a risk/hazard analysis is undertaken. The analysis could include record reviews, surveys, and monitoring and recording activities. Solutions are developed and tested with the help of front-line personnel, in existing facilities or via computer modeling. At the end of the process, the changes are monitored to verify that the goals have been achieved. Any hazards that haven't been mitigated are then revisited.

Sound expensive? It doesn't have to be. Although the process can be as complicated and scientific as a department wants to make it, a basic in-house assessment can be conducted if personnel have the time and training. Washington's ergonomic risk factor checklist is an easy-to-use assessment tool that can be downloaded from www.lni.wa.gov. Such lists can be a starting point for the development of a more thorough plan for revamping both daily operations and facility design.

When designing or remodeling a facility, fire departments need to move beyond operational space needs, physical structure, environmental sustainability, and the look and feel of a station. Appropriate design also should consider ergonomic issues to ensure sustainability of one of our most important assets — our bodies. This is where an architect, in conjunction with department staff or an ergonomist, can help you avoid costly mistakes. If ergonomic discussions take place early in the design process, incorporating ergonomically appropriate design has little to no cost impact.

Simple, probing questions can be asked to start the process. What station activities are performed in training, emergency or non-emergency modes? Does the operation mode influence how spaces and equipment are used? What is the duration of each daily task or activity? A designer should have a clear understanding of the end users and their tasks. Are they male, female, paid, volunteer, young or graying rapidly? Do various operational specialties attract people of different stature?

Starting points

When considering ergonomic-friendly design, worker's compensation claims records can be a treasure trove of information. At a glance, problem areas begin to emerge. Most firefighters who have had an injury in a station will say that it happened while lifting or carrying something; by slipping, tripping or falling; or while in an awkward position. If the type of claim, location and description of the injury are given in the records, you already have a good start. If a department tracks ergonomic claims, identifying possible operating and design solutions becomes easier.

After records have been retrieved, injuries should be sorted into activities and locations. Generally, the apparatus, crew and administrative areas are reviewed. As operational needs are defined and the space needs of the facility are determined, an architect can then overlay the identified claims over the space requirements to identify areas of concern.

An existing fire station is one of the most informative teachers relative to facility design. A good place to start is by identifying “hassle factors,” those annoyances that produce physical or mental stress, and those tasks that often lead to pain and discomfort. If left unchecked, they can lead to work-related musculoskeletal disorders or acute injuries. So what generally annoys you about your facility? Can't sleep at night due to others' snoring? Can't hear a call while working out? Can't get at equipment and supplies because storage is packed so tight? Wet spots in the apparatus room due to inadequate drainage? Bay doors getting hit by drivers? All of these issues have ergonomic effects, but they can be remedied through good design and common sense.

After your records have been reviewed and hassle factors have been identified, an architect can determine how they can be designed out of your new or remodeled facility. Appropriate ergonomic design is a continual evaluation and learning process based on a clear methodology and a conscious intent to address changing needs. Identifying the operational needs and understanding the day-to-day tasks within each space is paramount to the design process.

Apparatus area

The apparatus bay and the associated support space are the anchor of most facilities, often comprising 30-60% of the entire square footage of a facility. This is a prime location for ergonomic claims to occur.

The largest potential safety hazard is the bay floor, where slips and falls can occur frequently if contractors fail to avoid perfectly smooth concrete finishes. Although few applied slip-resistant floor systems can withstand the wear and tear of apparatusr, a carefully specified and finished concrete floor can be quite effective in alleviating this problem. Of course, there's always a balance between slip resistance and maintenance.

Heavy lifting injuries are also common in the apparatus area as equipment is transported from point A to point B. A simple adjustable wheeled cart could allow firefighters to perform their jobs in a safer and more efficient manner. Using a cart during non-emergency operations decreases the number of times a firefighter must bend or squat, thereby decreasing the physical exertion and physiological stress to the back and leg muscles and to the intervertebral discs.

While a cart would be considered a tool and not a part of the facility design, an accompanying design response must also occur for it to be effective. Where will the cart be stored? Will double doors or oversized doors need to be incorporated to accommodate the cart's width? What's the appropriate height of the storage system used for supplies so transferring equipment to the cart doesn't require excessive bending or lifting above the shoulders? Is the storage area too cramped, causing people to twist and potentially injure themselves? Each design solution has to be carefully considered to achieve success.

Other wheeled systems that need to be designed into facilities include mobile hose racks, turnout gear storage racks and, in certain circumstances, removable wheeled davit arms to assist in raising and lowering equipment. The general idea is to design jobs so that people can avoid awkward postures (reach overhead, reach below knee, reach with extended arms, back bend, neck bend, wrist bend, squat, kneel) and perform work with less physical exertion.

Crew area

In many states the iconic fire pole or slide can no longer be used in new stations due to inherent safety concerns and code mandates.

This law posed a design problem for the firefighters of Mercer Island, Wash. Site constraints forced the sleeping rooms to be located on the second floor, and the increased fall potential from responding down a flight of stairs was of great concern. After several design committee discussions, the notion of a “response stair” was conceived. TCA Architecture Planning of Seattle identified average reach ranges, and the stair was narrowed so a firefighter could comfortably hold two handrails while descending the straight run of stairs. This ergonomic design has proved to be an effective solution to a specific problem.

Another common problem in designing crew areas is that the overall makeup of the fire service is changing — the “average” firefighter no longer exists. As a result, many departments are moving toward single sleeping rooms to accommodate mixed genders, health concerns and, of course, snoring!

In response to these changes, an architect may include a bank of wardrobe units in the individual sleeping rooms to accommodate each shift or locate units in gender-neutral locker areas. Departments should remember that these lockers are often firefighters' only personal space. Firefighters can be frustrated if lockers are too small or have no flexibility. Modular units with adjustable interiors allow individuals to accommodate their personal reach range and unique space needs.

Administrative area

Because they're used similarly to traditional office spaces, administrative areas need to handle shifts in activity, from heavy and awkward lifting toward high repetitive functions in sustained or awkward postures. The most frequent issues are reach ranges; eyestrain; back and leg discomfort; and neck, shoulder and wrist pain.

Understanding the variability of the user and activity durations will result in varying ergonomic design responses. Filling out reports, updating inspection records or reviewing plans all take different amounts of time. In addition, administrative areas in volunteer stations tend to be smaller with fewer tasks that require prolonged sitting than in career stations.

Often times, multiple people use the same workstations, chairs and equipment in a phenomenon known as “hot seating.” This transitory work environment calls for more flexibility than a traditional office because users will be changing throughout the day and night. As a result, built-in furniture is reduced or eliminated to improve user control of the environment.

Chairs should have adjustable height, depth, back angle, seat angle and lumbar support options. Keyboard trays should have height and tilt adjustments to allow users to keep their arms parallel to the floor when typing. Monitors should have tilt features to reduce glare, and the workstation design should allow a user's mousing elbow to be held close to the body. Generally, high-use items at workstations such as phones, paper work, binders and supplies should be within a 14- to 18-inch reach range.

Additionally, more stations are opting for natural ventilation systems, sound baffling and better lighting controls. Increasing controlled natural daylight, adding dimmers, providing indirect lighting and incorporating personal task lighting to illuminate paperwork substantially increases physical comfort. Just a few years ago, this type of flexibility meant a substantial increase in project costs, but market demand for such ergonomic features is driving costs down. There are several excellent sources for both new and retrofit equipment that ergonomically enhances work areas, such as www.details-worktools.com.

There's an ergonomic solution to every problem or activity if there's a clear definition of the task. By identifying user activities in all modes of operation early in the design phase, an architect can better understand the task and provide a low- or no-cost ergonomic solution.

By implementing ergonomic design concepts into a facility in conjunction with the development of smart work habits, a fire department can experience increased efficiency and productivity, reduced errors, increased worker comfort, reduced injury severity and incidence, and reduced insurance claims and lawsuits. Injuries equate to problems for everyone, and embracing an ergonomic design approach is a fitting task for us all.

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Brian J. Harris, AIA, is a principal of TCA Architecture Planning located in Seattle. He has been involved in the planning and design of over 75 fire, rescue and emergency facilities throughout the western United States. Over the last 40 years, TCA has planned more than 150 fire facilities.

Injuries Both Dangerous, Pricey

Ergonomic-related injuries involve muscles, tendons, ligaments and discs and are cumulative in nature. They include thoracic outlet syndrome, lower back strain, disc herniation, rotator cuff tear, lateral epicondylitis (tennis elbow), scalene syndrome, carpal tunnel syndrome, gatekeeper's thumb, tendinitis, bursitis, yenosynovitis, and many more. Poor ergonomic design also can contribute to acute injuries such as a trips, slips, falls and lacerations.

Fire service personnel are especially prone to back, shoulder, knee and ankle injuries due to the physical demands of emergency tasks. Strain on their bodies results from heavy, frequent and awkward lifting and working in awkward positions. Poorly designed work environment and equipment often can exacerbate these inherent job hazards.

According to an NFPA report of U.S. firefighter injuries in 2000, 18.6% of injuries occurred during “other on-duty activities,” putting that category second after fireground injuries. For non-fireground injuries, strains, sprains and muscular pain accounted for 56.1% of injuries. In 2001, similar non-fireground injuries showed a decrease of only 1.5%.

Injuries cost money, too. The Department of Labor and Industries says that in the past two years, the state of Washington has seen nearly $1.9 million in direct claim costs for firefighters. As large as that figure is, it doesn't include the indirect costs of overtime to cover the injured worker, lost time, decreased productivity, administration to manage claims, or the possible hiring and training of new firefighters.

Could the use of ergonomic equipment and the incorporation of ergonomic principles into the work environment reduce these injuries and costs? Many experts, such as Deborah Read, president of ErgoFit Consulting Inc., thinks so:

“As fire and emergency medical service agencies become increasingly diversified, both in task responsibilities and personnel, ignorance or avoidance of ergonomics relative to facility and equipment design simply is not safe or cost-effective.”