title: Assessing management of musculoskeletal disorders in the ambulance service.
abstract: BACKGROUND
  Musculoskeletal disorders (MSDs) are the most common occupational illness in Great Britain affecting 1.1 million people a year. Paramedics, in particular, are known to have a high incidence of MSDs resulting, for many, in early retirement.
  
  
  OBJECTIVE
  To explore the management of MSDs at two ambulance services with respect to the implementation of policies and experience of staff.
  
  
  METHODS
  The data were collected at two ambulance services using document retrieval and semi-structured interviews. The first service used a functional-centred occupational health (OH) approach with patient participation. The second service used a more traditional medical model with the patient in a more passive role.
  
  
  RESULTS
  The first service reported their MSD management policies and procedures concurred with 28 of the 32 Faculty of Occupational Medicine guidelines (88%) in contrast to the second service, where only 17 (53%) concurred. For both services, the expected recovery pathways (management policies and procedures) had points of variance with the experienced recovery pathways. Both services had haphazard referral to OH resulting in limited referral for treatment in the first 4 weeks post-injury and no difference in median recovery times. These variances resulted in a convergence in the timing and type of treatment received by staff at both services.
  
  
  CONCLUSIONS
  Both ambulance services were found to have variance in the experienced recovery pathway in comparison to the expected pathway. It was concluded that without systematic monitoring and regular audit, there was likely to be a lack of compliance with the policy and procedures.
authors.affiliation: Department of Human Sciences, Loughborough University, Loughborough, Leicestershire, UK. S.M.Hignett@lboro.ac.uk
authors.forename: Sue
authors.initials: S
authors.lastname: Hignett
authors.forename: Paula
authors.initials: P
authors.lastname: Griffiths
authors.forename: Ian D
authors.initials: ID
authors.lastname: Murdey
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Lee
mesh_terms: D000488:Allied Health Personnel / Q000523:psychology; D000552:Ambulances; D001291:Attitude of Health Personnel; D004632:Emergency Medical Services; D004651:Employment; D006801:Humans; D009140:Musculoskeletal Diseases / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D009784:Occupational Diseases / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D009786:Occupational Health Services / Q000379:methods / Q000458:organization & administration; D010358:Patient Participation; D012017:Referral and Consultation