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Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 646-650
Comparing the frequency of occupational injuries among medical emergency staff and nurses of Intensive Care Units in Hamadan

1 School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Pediatric Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
3 Department of Pediatric Nursing, School of Nahavand Paramedical, Hamadan University of Medical Sciences, Hamadan, Iran
4 Student in Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
5 Hamadan University of Medical Sciences, Hamadan, Iran
6 School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
7 Research Center for Maternal and Child Care, Hamadan University of Medical Sciences, Hamadan, Iran

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Date of Web Publication21-Aug-2017


Background: The occupational injury can lead to partial disability or sick leave of nursing staff and prehospital emergency services for a certain period of time. This study aimed to compare the frequency of occupational hazards emergency medical and nursing staff of Intensive Care Units (ICUs) in Hamadan. Materials and Methods: In this cross-sectional study, a standard questionnaire was distributed to all emergency personnel, doctors, and nurses of ICU in Hamadan. The collected data analyzed by SPSS version 16 to compare occupational injuries that inferential statistics, Chi-square test, and Fisher's exact test were used. Results: Out of 340 questionnaires distributed among the emergency medicine personnel and nurses, 147 questionnaires were returned. The most frequent occupational injuries (84.5%) by aged 20–30 years, Also the highest frequency of injury in the area of emergency medicine personnel spine (66%) and nurses' legs (72.3%). Its difference between the areas affected by the type of job and the relationship between job and the risk factors causing significant damage was compared between nurses and emergency medicine personnel (P > 0.001). Conclusion: To prevent damage to the occupational and medical personnel because of the sensitivity of musculoskeletal injuries, recommended strategies for the prevention of occupational injuries to be included in training programs for health personnel.

Keywords: Medical personnel, occupational injuries, partial disability

How to cite this article:
Afshari A, Khalili A, Dehghani M, Beiramijam M, Lotf MD, Noodeh FA, Oshvandi K. Comparing the frequency of occupational injuries among medical emergency staff and nurses of Intensive Care Units in Hamadan. Ann Trop Med Public Health 2017;10:646-50

How to cite this URL:
Afshari A, Khalili A, Dehghani M, Beiramijam M, Lotf MD, Noodeh FA, Oshvandi K. Comparing the frequency of occupational injuries among medical emergency staff and nurses of Intensive Care Units in Hamadan. Ann Trop Med Public Health [serial online] 2017 [cited 2021 Mar 8];10:646-50. Available from:

   Introduction Top

Occupational injuries among health-care workers around the globe, especially injury or musculoskeletal injuries constitute the leading cause of disability.[1] The causes of occupational injuries are generally divided into three categories: human factors that can be created for a person in an accident and given time to work; environmental factors include factors such as physical workplace lighting, sound, and temperature; and organizational factors that include management policies, clear objectives, personnel problems, responsibility, employment relationship, problems housekeeping, and rules and regulations included.[2] In Iran, the most important job injuries, musculoskeletal disorders, and work-related injury are different.[3] Risk factors of musculoskeletal injuries include applying excessive force, awkward postures, contact stress, individual factors, psychosocial factors, and lack of mobility. The risk factors associated with poor posture can be a deviation of the wrist, spine curvature, and rotation of mention. The risk factors associated with individual factors include poor physical fitness, excessive weight, poor nutrition, lifestyle, and the risk factors associated with psychosocial factors such as stress, job insecurity, and lack of support from colleagues involved.[4] The highest risk factors include workplace musculoskeletal injuries, heavy lifting, working by hand, repetitive movements, and working hard.[5],[6] The emergency medical service (EMS) providers are among people who are constantly exposed to occupational hazards, musculoskeletal injuries, and subsequent physical and mental disabilities.[7] The system of prehospital EMSs among the first lines of treatment in the health system of each country shall be considered. The system in terms of emergency services saves millions of people worldwide.[8] Today, due to population increases, increased public awareness of EMSs as well as increased road traffic accidents than in past years, the number of dispatch ambulances for emergency missions has significantly increased.[9] According to the abovementioned risk and education of personnel about saving lives and many have passed courses as well as the government spent huge cost to educate this group, their safety is of paramount importance and sensitivity.[10] Although emergency medical technicians have a range of job duties, the greatest and most repetitive are act of lifting and handling of patients of the hospital's emergency scene.[11] Patient handling equipment and transport facilities currently existing in the system of medical emergencies because of the design and performance, for carrying and lifting patients, need medical emergency technicians and physical strength. Physical force used to transfer injured patients had to maintain the rules of proper body mechanics and movement principles and standards, and in case of noncompliance with safety rules in handling patients, emergency medical technicians will face irreparable harm.[12] Statistics and Research Agency work showed that the injuries suffered by emergency medical technicians more than the average in other occupation injuries.[13] On the other hand, nurses in the Intensive Care Unit (ICU) due to the characteristics of the relevant section as well as the high workload of care for critically ill patients are a risk of occupational hazards of working in this sector. Nurses working in this ward are more involved with direct nursing care for these patients and since most of these patients are dependent on the ventilator or that they are losing consciousness, nurses alone are responsible for all cares and procedures. The patient does not have any work to do, so the nurses were particularly at risk of occupational injuries and musculoskeletal injuries. This complication was responsible for the absence of work and withdrawal from the service among many of the operational personnels in the field of emergency medical services. This damage has also reduced job motivation, job change, and disability in some of personnel.[14] Considering the importance of the issue mentioned above, this study aimed to compare the frequency of occupational injuries among emergency medical and nursing staff working in ICUs in Hamadan.

   Materials and Methods Top

This study was a cross-sectional descriptive study. The study population included all emergency personnel, doctors, and nurses working in ICUs of teaching hospitals in Hamadan. By census sampling method and includes all health-care workers and nurses working in ICUs of Hamadan (Besat, Farshchian, Ekbatan, and Shahid Beheshti hospitals) who were willing to participate in this study. Inclusion criteria included having at least 1 years' experience in the unit, lack of chronic diseases, and musculoskeletal injuries due to lack of factors outside of the workplace. Exclusion criteria included having a physical disability, the following year relevant work experience in the sector, and employment to another job or employment in the same job in other medical centers. The instrument used in this study included demographic information including age and gender checklists, education, work history, medical history of working hours and a standard Norodic questionnaire that used in similar researches.[15] To determine the symptoms of musculoskeletal disorders, Norodic questionnaire was used. The questionnaire consists of two parts: general and specific. Norodic questionnaire assess the body's motor system in 9 areas including: The neck, shoulders, elbows, wrists/hands, waist, hips/thighs, knees, and ankles/legs, and using questions, history of pain in these areas is analyzed. This questionnaire can be used in epidemiologic surveys in musculoskeletal disorders, but it cannot be used for clinical diagnosis.[16] In an Iranian study in 2015 by Mokhtarinia et al. as localization, validity, and reproducibility Nordic Musculoskeletal Questionnaire, intercorrelation coefficient, and standard error of measurement (SEM) Persian version questionnaire developed by Nordic at an acceptable level (intraclass correlation coefficient >0.70, SEM = 0.56–1.76), respectively. The kappa coefficient ranges between 0.78 and 1, respectively.[17] After approval of the project, the researcher referred to the Emergency Medical System and the hospitals with the introduction of the letter from the research deputy and after coordinating with the honored directors, researcher referred to Emergency Medical Centers and Intensive Care Units in various shifts. Staffs who were willing to participate gave written consent and questionnaires were distributed. To avoid biasness, participant was asked to answer the questionnaire at the right time so that fatigue and excitement are excluded. After data collection to analysis, descriptive and inferential statistical methods were used. The analysis of demographic data and descriptive statistics (such as the relative frequency and average) was used to compare occupational injuries, and inferential statistics, Chi-square test, and Fisher's exact test by software SPSS version 16 were used. The Research Council and the Human Research Ethics Committee of Hamadan University of Medical Sciences approved the study protocol and its ethical considerations (code number: P/16/35/9/19/47). To begin the study, the researcher explained the study process to the medical emergency staffs and nurses and they signed a written informed consent. They were also assured about data confidentiality, safeness of the study, and their right of not to participate.


A total of 147 participants (94 nurses and 53 medical emergency technician), 60 (40.8%) were males and 87 (59.2%) were females. Fifty-two (35.4%) patients were in the age group of 20-30 years and 76 patients (51.7%) were in the age group of 31-40 years. Nearly 57.1% had between 4 and 10 years of work experience. Most skeletal problems related to the spine and leg, respectively, with the total of 102 cases (69.4%) and 92 patients (62.6%) and skeletal problems related to hip and shoulder lowest number of 18 (12.2%) and 25 patients (17%). Of 53 emergency personnel, 8 (15.1%) had no skeletal problems, 17 cases (32.1%) had skeletal problems, 19 cases (35.8%) two skeletal problems, 5 (9.4%) three skeletal problems, and 4 (7.5%) had experienced four or more than four skeletal problems; of 94 nurses, 5 (5.3%) had no skeletal problems, 24 (25.5%) had skeletal problems, 19 cases (20.2%) two skeletal problems, 20 (21.3%) three skeletal problems, and 26 (27.7%) had experienced four or more than four skeletal problems. Thus, according to the Chi-square test, nurses experience more skeletal problems compared to medical emergency personnel. The distribution of the number of injuries in the emergency medical personnel group was the equal in the three age groups, but in the nurses' group, individuals aged between 40 and 31, based on the Fisher exact test, had a significantly greater number of injuries than two other age groups.

According to [Table 1], Fisher's exact test showed that there is a significant relationship between these injured areas and the type of occupation, So that in all body's affected areas, the injured people are more in the nursing group.
Table 1: The relationship between the type of job and the participants in the injured area

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According [Table 2] Using Fisher's exact test showed that the type of job and type of damage are independent of each other if the highest type of injury in both groups was the type strain and the lowest type of injury in both groups was the type of scratches.
Table 2: The relationship between occupation and type of damage in subjects

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   Discussion Top

Of the 147 people who completed the questionnaire, 13 (8.8%) had no skeletal problems, 41 cases (27.9%) had one skeletal problem, 38 (25.9%) cases had two skeletal problems, and 55 cases (37.4%) had experienced three and more than three skeletal problems. These findings are consistent with Salem et al,[18] Choobineh et al.,[19] Maguire and Smith,[5] and Shafizadeh [8]et al studies. Comparing the type of occupation and the number of injured areas in the studied units showed that nurses had more skeletal musculoskeletal problems than emergency medical personnel. These findings are consistent with Heick et al and Pompeii et al studies. Data evaluated by Emergency Medical Technicians showed that there is a significant relationship between gender and the number resumes. These findings are consistent with Shafizadeh [8] and Mohseni et al[20] studies but do not match with Kooranian et al[21] and Mahmoudi et al[22] and this discrepancy could be due to the studied samples that were in the general wards. No significant relationship was found between age and the number of accidents if individuals in the age group of 3140 years, more accidents compared to other groups such as the results of Shafizadeh [8] Mohseni et al.,[20] and Pompeii et al.[10] while the studies of Mirzaee et al.[23] and Salem et al.[18] did not match. The cause of the discrepancy is mainly due to the procedure, and samples in their studies were due to the fact that public sector nurses were used and had a history of <1 year at work.

In people injured in all areas surveyed, the highest rates were in nurses while injuries to neck and spine in both groups had the same distribution. The studies by Choobineh et al.,[19] Salem et al.,[18] Aghilinejad et al.,[9] and Heick et al.[15] reported that more nurses in emergency medicine had spine and the back injuries that was consistent with the findings of Aghilinejad et al.[9] and Maguire and Smith.[5] Also, according to the consistent of the findings of the present study with the results of Nakhhaei et al.[12] in 2006, we can say due to the shortage of nurses and nurse assistance in the intensive care units, on the other hand, much workload is associated with the care of critically patients, Nurses in this units are standing in the most of the time of shift work and are on the bedside of the patients, and most of the areas involved are the legs and the spine system.

The relationship between occupation and type of injury showed a significant relationship between the types of injury in the two groups such as ICU doctors and nursing emergency personnel was observed. Similar results were reported by Salem et al.[18] and Mahmoudi et al.[22] but inconsistent with the study by Choobineh et al.[19] The results showed most important risk factors in the ICU nurses, heavy workload, and emergency medicine personnel lift and carry patients. This is consistent with the findings of Fisher and Wintermeyer [11] in 2012 corresponded to 77% of the personnel working in emergency medicine in this study, carrying and lifting patients and patients with risk factors for that. The findings of this study, Smith and DeJoy,[14] in 2012 that showed the most consistent risk factor for nurses' workload is high.

   Conclusion Top

The nature of nursing work as well as prehospital care due to direct contact with some activities such as carrying and lifting patients, abnormal working conditions, sudden bending, and twisting put people at risk of musculoskeletal injuries.[21],[22],[23] On the other hand, in these professions there are tasks such as changing the patient's condition, carrying the patient and equipment, performing time-based procedures, etc. These tasks are constantly and repeatedly carried out in most of their work shifts, resulting in injuries to Musculoskeletal system. Moreover, who do these things constantly, most shifts are frequent, will lead to musculoskeletal injuries. Therefore, it is necessary to use the methods of preventing such problems as teaching body mechanics, changes ergonomic work environment, and proper education about body position while doing work. Ways to prevent injury and damage from jobs on the job training and the frequency of the program is training nurses and medical emergency.


This study is based on the approved projects with the code 9.1947/35 in the School of Nursing and Midwifery, Hamadan. This is respected by all authorities and emergency medical personnel and hospitals Holloway's ambition for cooperation as well as Deputy of Hamadan University of Medical Sciences for financial support appreciated.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

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David G, Woods V, Li G, Buckle P. The development of the Quick Exposure Check (QEC) for assessing exposure to risk factors for work-related musculoskeletal disorders. Appl Ergon 2008;39:57-69.  Back to cited text no. 2
Amini M, Hasanzadeh H. CTD from the standpoint of ergonomics and occupational medicine. Tehran: Hayan Publisher; 2003.  Back to cited text no. 3
Smith DR, Wei N, Kang L, Wang RS. Musculoskeletal disorders among professional nurses in mainland China. J Prof Nurs 2004;20:390-5.  Back to cited text no. 4
Maguire BJ, Smith S. Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehosp Disaster Med 2013;28:376-82.  Back to cited text no. 5
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Shafizadeh KR. Prevalence of musculoskeletal disorders among paramedics working in a large hospital in Ahwaz, Southwestern Iran in 2010. Int J Occup Environ Med 2011;2:157-65.  Back to cited text no. 8
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Afshari A, Khalili A, Afshari R, Setvati Bassir M.R, Alazmani Noodeh F. The effect of using of Ergonomics Knowledge in Preventing Occupational Hazards of Medical Emergency Personnel, and Nurses Working in Intensive Care Units in Teaching Hospitals of Hamedan. RJPBCS 2017;8:195-99.  Back to cited text no. 16
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Correspondence Address:
Khodayar Oshvandi
Research Center for Maternal and Child Care, Hamadan University of Medical Sciences, Hamadan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_182_17

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