More than one-third of all injuries lasting over three days reported to the Health and Safety Executive (HSE) and Local Health Authorities are a result of manual handling.² In a survey in 2001/2002 it was found that over 1.1 million staff suffered musculoskeletal injury or disorder as a result of their work or previous work duties.² Epidemiological studies into ambulance staff and healthcare workers suggest that these groups represent a high risk area of musculoskeletal injury.^3,4 A recent survey of accident and incident data collated from six UK ambulance Trusts showed that between 30 and 51% of all recorded incidents resulting in injury were a result of the moving and handling of loads; the mean incidence rate was 178 per 1000 staff members.⁵ Where data were available it was noted the Emergency Medical Services had an increased prevalence of manual handling related incidents compared with patient transport services, with 90% of the cases from EMS personnel. Analysis of the incidents found three root causes: the use of the carry chair; the use of stretchers; and patient transfers (from bed to chair, floor to bed). These accident statistics represent a worrying picture for ambulance staff and highlight the need to introduce appropriate measures to reduce manual handling injury.

There are numerous pieces of key legislation that relate to manual handling policy and procedure. These are explained briefly below:

Health and Safety at Work etc Act [HSAWA] (1974) ⁶

The overall objective of this act was to:

‘make further provision for securing the health, safety and welfare of persons at work, for protecting others against risks to health or safety in connection with the activities of persons at work.’

The act established two bodies: The Health and Safety Commission and the HSE, to promote the objectives of the act and ensure the implementation of its provisions. This act set out a series of duties for employers, employees and designers, manufacturers and suppliers of equipment. HSAWA set out that the employer has an overall objective and responsibility to employees to:

‘ensure, so far is reasonably practicable, the health, safety and welfare at work of all of their employees.’

These responsibilities include:

• Provision and maintenance of plant and safe systems of work.
  
• Safety in the collection, use, storage and transport of loads and substances.
  
• Provision of information, instruction, training and supervision of employees.
  
• Maintaining a safe workplace, access and egress.
  
• Maintaining a safe and healthy working environment including providing adequate welfare facilities.

The HASAWA, whilst implementing duties for the employer also set out a series of duties for the employee which requires any employee to take reasonable care for their own and others health and safety in the workplace. This includes taking positive steps to ensure that hazards in the workplace are understood and to comply with policy and guidance. Any failure to comply with these duties can make the employer of the employee liable for prosecution.

Manual Handling Operations Regulations [MHOR] (1992 – a mended 2002)⁷

These regulations resulted from the 1990 ‘Manual Handling of Loads – European Directive⁸ which legally obliged each member of the European Community to introduce legislation which would harmonise standards. These regulations placed a duty upon employers to:

• So far as is reasonably practicable to avoid the need for employees to undertake any manual handling operations at work which involve a risk of their being injured.
  
• Assess any hazardous manual handling operations that cannot be avoided.
  
• Reduce the risk of injury from manual handling operations so far as is reasonably practicable.
  
• To regularly review any assessment if there is reason to believe the previous assessment is no longer valid or there has been a significant change in the operations to which it relates.

From HSE (1992) MHOR – Regulation 4.³

In addition the MHOR placed a duty upon the employee to ensure that they make full and proper use of any system of work provided for his/her use by his employer in compliance with regulation 4.

Management of Health and Safety at Work Regulations [MHSAW] (1999)

These regulations set out a range of responsibilities for the employer with a primary focus upon risk assessment in the workplace. MHSAW set out regulations that ensured that each employer must undertake a risk assessment of any activity or environment that an employee or non-employee may experience. In the occurrence of any risks being identified, these must be reduced and those affected informed of their presence. Reduction of risk may be through the avoidance of such tasks if practicable to do so, through the provision of equipment (i.e. hoists) or training to those undertaking the activity. Again the individual is also given a duty to ensure the health and safety of themselves and others in the workplace.

Lifting Operations and Lifting Equipment Regulations [LOLER] (1998)⁹

These regulations apply to the use of lifting equipment in all industries and work activities. The regulations aim to reduce risks to people’s health and safety from lifting equipment provided for use at work. In addition to the requirements of LOLER, lifting equipment is also subject to the requirements of the Provision and Use of Work Equipment Regulations 1998 (PUWER); see below. The regulations apply to any piece of equipment that is designed to lift or lower any load. LOLER requires that any equipment meets the following standards:

• Strong and stable enough for the particular use and marked to indicate safe working loads.
  
• Positioned and installed to minimise any risks.
  
• Used safely, i.e. the work is planned, organised and performed by competent people.
  
• Subject to ongoing thorough examination and, where appropriate, inspection by competent people.

Whilst these regulations do not directly apply to employees, all staff have a responsibility to ensure equipment meets the required standard under previous regulations such as HSAWA.²

Provision and Use of Work Equipment Regulations [PUWER] (1998)¹⁰

These regulations cover all equipment used at work including manual handling equipment. The act places a responsibility upon the employer to ensure that the correct equipment is available, is well maintained and used in situations where it is suitable. The regulations also state that the employer has a duty to ensure that staff are adequately trained in the use of any such equipment.

This is always a contentious area for prehospital care staff with many calls to areas in which a ‘no lift’ policy appears to exist. A duty of care exists under professional registration¹¹ and under the Human Rights Act¹² that contradicts the guidance of the earlier regulations and policy that suggest that manual handling tasks should only be undertaken if the risk is deemed low. The Human Rights Act⁸ states that no one should be subjected to inhuman or degrading treatment and has the right to liberty and security of person. This means that the patient has the right to refuse to be handled in a certain way and the practitioner has the right to refuse to endanger themselves with a manual handling procedure.

In a high profile legal case surrounding no lift policies the High Court Judge ruled that a blanket no lift policy may be unlawful.¹³ This case went on to highlight that under the Human Rights Act the refusal to undertake manual handling (in the event that mechanical aids cause great distress) could be considered an unlawful breach. This is an area in which there is no specific guidance other than to undertake a risk assessment and act accordingly in each individual case.

Risk assessment is the first step in the manual handling and risk management process. Assessment involves five steps as shown below:

• Identify the hazards.
  
• Identify who may be harmed and how.
  
• Evaluate the risks and decide upon precautions.
  
• Record the findings and implement them.
  
• Review the assessment and update accordingly.

From The HSE (2006) Five Steps to Risk Assessment.¹⁴