Which muscles would I need to train for ambulance work?

Question

TL;DR Version:

Which muscle groups would I use when

1. lifting an object from the floor with a straight back
2. holding an object at chest height for an extended period of time whilst climbing stairs

...and how would I best train them?

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In a few months I'll have to do the standard lifting assessment for patient transport work in the UK. I'm only very slight myself so I'm looking to improve my lifting capabilities in the intervening months, unfortunately I don't have access to a gym so am very limited in the equipment I have access to.

The assessment is in two parts and I'd like advice as to whether I'm working the right muscle groups:

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Floor Lift - Lifting a 12.5 stone (80kg) dummy on a scoop stretcher up to say waist height and walking with it. This is done with a crew member at each end.

I'm a bit concerned with this one as 80kg is 160% of my own weight, however with the equipment I'm sure it'll be manageable as even if I have the head end I should only be taking over a little over half the weight, correct?

^{*with better manual handling technique than that!}

Anyway for this I've been assuming that as I'm starting in a squatted position then lifting up with bent knees I'll need to work on my thigh muscles. To this end I've been doing squats, is there anything else I could be doing? Would I need to work on my lower legs too?

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Stair Carry - The same dummy is placed into a carry chair (essentially a chair with rear wheels and grips), we lift it up (again two person lift) then go up and down 3 flights of stairs without lowering the chair

I've been working on the basis that the lift for this is similar to the floor lift above (if you're at the feet end) so any advice you could give for the previous lift would probably suffice for that. However when lifting from the head end or when in the carrying position at the feet we are advised to tuck our elbows into our sides and keep your arms in a bicep curl position. Hopefully I can find a picture to illustrate all this more clearly.

Therefore in addition to the squats to train my thighs and my above question about the lower legs, I think I have to put some effort into my arms too in order to keep the chair up (once it's off the floor and you're climbing, all the effort is in your arms rather than your legs). For general upper body strength I've been planning to do pushups and reading back it sounds like bicep curls could be a good idea too.

Is there anything else that you think would help, or any assumptions that I've made and you can point out are completely wrong? I'd be very grateful for any help you can give me!

Answer 1

You already have some good answers so I'll just add to keep in mind specificity of exercise.

Specificity of exercise means that if you want to get better at cycling, you should cycle. If you want to be able to run fast, you should train for speed etc. And if you want to be able to squat, lift, and carry you should train specifically to squat, lift, and carry working your way up until you are able to lift the desired amount without strain.

Keeping specificity of exercise in mind, part of your training should actually be to practice the floor lift and stair carry with graduating weights (ideally with a stretcher, a carry chair and your lifting partner). Also look at all the different components to each task as you have described: squatting, lifting, carrying, walking forwards and backwards, climbing up and down stairs forwards and backwards, pushing, pulling, gripping etc.

Focus on building core muscle strength with planks, side planks, bird dog, bridges etc. so that you can stabilize your spine when you lift and carry. Work your trunk muscles in functional and diagonal patterns with exercises like chops with resistance bands and rotational movements using a staggered stance for stability with pushing and pulling movements.

I'm assuming that you are looking towards working in patient transport. Given your "slight" frame and ever increasing patient sizes :), make sure that you develop enough strength, endurance and flexibility to handle the tasks without straining to avoid potential injuries. Good luck.

Answer 2

Just like spot weight reduction, there is no such thing as spot strength building. From what you describe, the two most beneficial exercises are deadlifts (http://stronglifts.com/how-to-deadlift-with-proper-technique/) and farmer walks (http://www.t-nation.com/readArticle.do?id=4959113). Both will build the off-the-ground power you need, the grip strength required and endurance under stress. I would recommend an overall strength building program, utilizing natural lifting using various forms of weights (sand bags, blocks, slush pipes, etc.) to get your body use to unbalanced lifts. Everything should be focused on core and grip strength. You don't need a gym, and I would recommend working out in the environment that your work will be carried out in (farmer walk on steps, deadlift outside where the ground is uneven). Good luck.

Answer 3

You'll be squatting, lifting things from the floor (akin to deadlifting), pulling on things (akin to chin-ups), and pushing on things (akin to a bench or overhead press). Sounds like you need a general strength program.

Buy Starting Strength and follow its advice. It includes these exercises in an efficient program with excellent descriptions. You'll get strong all over, which just happens to be the same strength you need for the situations you describe.

Modifying the SS program to add farmer's walks or weekly conditioning work such as sprints or 20-rep squats might be a good idea.

Answer 4

As has been mentioned, deadlifts and farmers walks will be key. What you'd also want to focus on is grip strength. Sliding straps under someone to get them onto the stretcher would benefit from grip work, so getting yourself a gripper could help, doing towel pull ups and chin ups and doing deadlifts with sand bags would help you deal with some of the unpredictability of ambulance work.

As far as not having access to equipment - I can't think of a scenario in which getting adjustable dumbbells wouldn't be an option, so I'd suggest getting some (I would personally go for spinlock dumbbells if I didn't have access to a gym) and some plates.

Depending on where you are, there might be an outdoor park with monkey bars allowing you to do bodyweight exercises. If you can do chin ups with your own bodyweight, you'll quite likely be able to lift your own weight where your arms are concerned.

Answer 5

I ran ambulances for a period, and also spent 3 years working primary ambulance response in an Air Force ER.

The other answers are good but kind of need to be all combined, since for first responder type of ambulance work, the correct answer is that you need an overall body weightlifting and conditioning program.

During a normal year, and depending on where you live (Age of the city is one consideration, as for example many homes in Boston differ in shape/configuration than newer cities further west), you will be standing, walking, running. You will be hauling large, heavy oxygen tanks to install, portable medical units and treatment packs, stretchers, lifting patients from floors, beds, couches, cars, ponds, pools, etc. You may need to take down doors, be able to gain access to mangled car carriages, get into very tight spaces, things like this. You can run into an incredible variety of odd situations that you can't really prepare for, other than making sure you are both physically and mentally fit.

The above may differ if you live in a large, urban area as often ambulance response in these areas is secondary to a local fire department being the first responder. However, as you get more outlying/rural, or if you are attached to a fire department, then you may be the first response.

Since you don't have access to a gym, I would invest in a doorway pullup bar. Lots of pullups, chip ups (different hand positions), dead arm hangs, chair dips, abdominal and oblique work, lower back extensors, squats, duck/farmer walks, calf raises, lunges, and variants of all of the above. Add this to a sensible aerobic fitness regimen (If you are stuck in the field doing chest compressions, this is a very taxing exercise when properly done. You need to be able to last as long as possible, especially if you are part of a two man unit with no backup readily available).

It can be a very challenging job with little thanks, but it is very rewarding work.