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This month we take a look at the human body and, in particular, the spine. The spine is an important part of the human body and has several functions which we will look at through this blog and, as such, is a vital part of the body to be looked after by its owner!


Location of the spine


It is possible that everyone knows the location of the spine. Just for the avoidance of doubt, the spine is located in the centre of the back and reaches from the base of the skull right down the bum.


Main functions of the spine


The human spine has 3 distinct functions:


1. Protect the spinal cord, nerve roots and several of the body’s vital organs.

2. Provide structural support and balance to maintain an upright posture.

3. Enable flexible movement.


Make-up of the spine


The spine is made of several sections as follows:

Cervical

Thoracic

Lumber

Sacral

Caudal.


Cervical Vertebrae

Diagram of the spine

The cervical vertebrae are located in the neck area of the spine. There are 7 vertebrae in this area. They are abbreviated down to C1 through C7 from top to bottom. The role of the cervical vertebrae is to protect the brain stem, support the skull and allow for a wide range of head movements.


If we take a look at the individual vertebra we will see that they are all shaped slightly differently. Vertebra C1 is called the Atlas and is shaped like a ring, supporting the skull. Vertebra C2 is circular in shape, with a blunt tooth type structure which projects upwards to the Atlas, and is known as the Axis. Together the Atlas and Axis allow the skull the full range of movements. Vertebrae C3 through C7 are similar in design, box-shaped with small spinous processes extending from the back of the vertebrae. Spinous processes are finger-like projections; they provide the point of attachment for the ligaments and muscles of the spine.


Thoracic Vertebrae


Beneath vertebrae C7 there are 12 vertebrae collectively known as the thoracic vertebrae. When they are abbreviated by medical staff they are referred to as T1 through T12 from top of the section to the base. Vertebra T1 is the smallest of the thoracic vertebrae with the bottom vertebra T12 being the largest. The thoracic vertebrae are larger than the cervical vertebrae and have longer spinous processes protruding from the back of them.


The thoracic vertebrae are connected to the rib cage which provides strength and stability for the spine, also making this section of the spine one of the strongest and most protected. Not only that, but the rib cage joining on to the spine assists the spine in protecting many of the vital organs contained within this area. Movement in this section is limited due to its restrictions of the rib cage.


Lumber Vertebrae


The lumber vertebrae are the largest of the spinal bones. In this section of the spine you will find 5 vertebrae known collectively as the lumber spine. They are abbreviated by medical staff to L1 through L5 from the top to the bottom. The lumber vertebrae carry most of the body’s weight. They allow a lot of movement but much less than that of the cervical spine. Lumber facet joints enable the lumber area to have significant flexion and extension movement but limit rotation.


What is Flexion and Extension Movements?


Flexion is the bending of a particular joint so that the bones forming the joint are pulled closer together. A visual example of this would be when the elbow bends, it reduces the angle of the ulna and radius bones in the arm.


Extension is the opposite movement to flexion in that it is a straightening movement that increases the angle between body parts.


Sacral Vertebrae


This is the 4th section of the spine vertebrae which is located behind the pelvis. There are 5 bones in this section of the spine and are abbreviated to S1 through S5. The bones are fused together in a triangular shape forming the sacrum. The sacrum fits between the 2 hip bones, connecting the spine securely to the pelvis. The fifth lumber vertebra moves in line with the sacrum.


Caudal Vertebrae


This is the final section of the spine, consisting of 4 bones which are fused together to form the Coccyx.


The spine in its entirety contains 33 of the 206 bones in a human body, that equates to almost 13% of the body’s bones. The other important thing to remember about the spine is that it holds the spinal cord through the middle of it, helping to send your nervous system around your body. Some people want to include the skull and the pelvis into the spine; this is however an incorrect thing to do. However these extra body parts do interrelate with the spinal cord and help to impact balance.


Spine curves


The spine is considered by many people to be straight, this is in fact not the case. The spine, if you look at it from the front, will indeed appear straight, however from the side the spine has 4 distinct curves in it. One of the curves in the spine, around the lumber vertebrae is an important curve as it helps to maintain a person’s centre of gravity. A person’s centre of gravity moves with each load and lift a person takes on before returning to normal. If this particular bend didn’t exist, we as human beings would simply fall over!


The curves in the spine are described as either kyphotic or lordotic. What do these words mean and which section of the spine will we find them in?


Kyphotic:


Found in: Thoracic and sacral sections of the spine.


Means: it is a convex curve in the spine. The convexity of the curve is towards the back of the spine.


Lordotic


Found in: Cervical and lumber sections of the spine.


Means: it is a concave curve in the spine, with the concavity towards the back of the spine.


In the diagram that we provided earlier the back of the spine is towards the labels of the spine sections. If you feel your own back, you are able to feel the spinous processes that are protruding from the back of the vertebrae.


Intervertebral Discs


Intervertebral discsBetween each of the vertebrae there is a cushion, also known as a disc, spinal disc or intervertebral disc. The purpose of the discs is to absorb the stresses the body endures through movement and also to prevent the vertebrae from grinding against each other, therefore preventing the sound of crepitus (2 bones make this sound when grinding against each other!). These objects are the largest structures in the human body without a vascular supply going to them. Each disc will absorb the nutrients  that it needs through the process of Osmosis. Each disc is

made of 2 key parts:



Illustration from Anatomy & Physiology, Connexions Web site.                                                                                Annulus Fibrosus and

http://cnx.org/content/col11496/1.6/, Jun 19, 2013.                                                                                                 Nucleus Pulposus.


Annulus Fibrosus


The Annulus Fibrosis is a tough tyre-like structure that encases a gel-like centre, the Nucleus Pulposus. The Annulus Fibrosus enhances the spine’s ability to rotate and also helps to resist the compressive stress. It has a layered structure which consists of water and sturdy elastic collagen fibres. The fibres are orientated at different angles horizontally similar to that of a tyre. Collagen consists of fibrous bundles made of protein that are held together by proteoglycan gel.


Nucleus Pulposus


The Nucleus Pulposus is found in the centre of each of the Annulus Fibrosus, and is a gel-like elastic substance. Together with the Annulus Fibrosus, the Nucleus Pulposus distributes stress and weight from vertebra to vertebra. Structurally the Nucleus Pulposus is similar in make-up to that of the Annulus Fibrosus in that it contains, water, collagen and proteoglycans. However the concentration varies between the 2 things, especially as the Nucleus Pulposus has more water in it.


Why is it important to look after your spine?


Your spine, as we have looked at, already does an amazing job of looking after your organs, providing support and flexible movements as well as maintaining an upright posture. In life you are given just the one spine and that will see you through the entirety of your life, or at least that is the plan. The sad thing is however that poor manual handling and lifting practices can cause injury. In the workplace over 8.8 million working days are lost due to musculoskeletal disorders, over 40% of these account for back injury.


Safe moving and handling


Manual handling includes:


Pulling,

Pushing,

Lifting,

Carrying,

Moving,

Putting Down,

Using Mechanical aids e.g. trucks and trolleys.


In the workplace, there is legislation in place. This piece of legislation is called The Manual Handling Operations Regulations 1992. Within this piece of legislation, it says that the employer should identify manual handling risks and, where practical, avoid manual handling risks. If avoidance is not possible the employer should take a risk assessment on the task needing to be done.


A good risk assessment that could be used is the TILE assessment, which we will look at now.


The TILE assessment stands for:


Task

Individual

Load

Environment.


Let’s explore these areas:


Task


You will need to look carefully at the task to be done, things that could be considered include:


Does it involve handling away from the body?

Are there movements such as bending, stretching, or twisting?

Is the movement over a long distance or is it repetitive?


The employer will need to consider whether the task can:


Be completed by using machinery, or handling aids,

The task layout be improved,

The movement of the body be modified,

The work routine be improved,

The task be completed in a team.


Individual


Once the task has been analysed the individual capability will need to be considered as follows:


Is the person completing the lift fit and healthy?

Have they been given training and information? Are they competent to do the task?

Is suitable supervision provided?

Are there any unusual circumstances that would cause a risk to certain employees e.g. is she pregnant?


The employer making the risk assessment could consider:


Pre-employment medical,

Provision for training and information,

Ensuring the employee is competent in safe handling techniques,

Providing supervision.


Load


The load is a really important aspect of the assessment to be carried out. The person who is going to lift it should consider:


How heavy is the load?

Is it equally balanced?

Is it stable?

Does it have sharp edges?

Will the contents shift?


If the load really does have to be lifted and moved, then control measures that could be considered are:


Make the load lighter by splitting it,

Make the load smaller,

Provide handles to make it easier to grasp,

Make the load more stable.


Environment


In everyday living we have to consider the environment, and in a moving safely lift this is no exception, you will have to consider the following:


Is there enough space to carry out the task?

Is the floor even or slippery?

Is there good lighting?


In order to maintain safety, you could consider the following things:


Can the workplace layout be improved?

Can you improve the floor condition?

Can we keep the lift to one level?

Can you improve the environmental conditions?

Do we have a good housekeeping process in place?


Of course, there are other things that should be taken into account as well the TILE assessment and these things include:


Is movement hindered by work equipment?

Is movement being hindered by any Personal Protection Equipment (PPE)?

Issues that arise from employees identifying a lack of training or communication.


How to lift and move safely


There is a very easy, simple 6-step process to move safely this is:


Step 1: Stop and think.

Step 2: Position your feet.

Step 3: Bend your knees.

Step 4: Get a firm grip and keep the back slightly flexed.

Step 5: Raise with the legs.

Step 6: Keep the load close to your body.


Below image has been used with thanks to https://www.theimagen.eu


How to lift safely diagram


Want to know more about looking after your spine and how to safely move and handle objects? Why not attend one of our courses? For more information visit the Moving and Handling section of our website by clicking here.



The Spine and Safe Moving and Handling

Posted by Steve at 12:45 on Tuesday 15th January 2019.

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Emergency Services’ Telephone Numbers

Posted by Steve at 12:45 on Friday 15th February 2019.


This month we thought we would have a look at the emergency telephone numbers that are used in the United Kingdom and abroad.


Do you know what telephone number to call when you need emergency assistance around the world?


The number used will vary depending on the country; below is a list of numbers that may be useful:


The UK   - 999


Australia  - 000

Barbados  - 911

The Bahamas  - 911 or 919

Brazil (Police)   - 190

Brazil (Ambulance) - 192

Brazil (Fire)  - 193

China (Police)   - 110

China (Ambulance) - 120

China (Fire)  - 119

European Union  - 112

Hong Kong  - 999

India   - 112

Japan (Police)  - 110

Japan (other services)  -  119

New Zealand   - 111

USA and Canada - 911


So that’s made it much more clearer, hasn’t it? Well technically no it hasn’t as there are so many different emergency numbers for the same purpose, and not only that but the list also shows that there are countries who even have different numbers for each of the different services!


So why 999?


999 was the world’s first automated telephone to contact the emergency services. The first call originated in 1936. The idea of the emergency service contact number goes back even further than this, as in 1935 5 women died during a fire in Wimpole Street, London. Neighbours of the women had dialled ‘0’ to get in touch with the emergency services, which connected them to the switchboard, sadly, what these callers found was that the switchboard was jammed full of other calls that were not an emergency. This method of contacting the emergency services had been recommended since 1927.


During the 1920s and 30s police stations were being overrun with visitors alerting them of emergencies as well as having to field calls from the telephone which was a new invention at the time. The other way, during these decades, to contact the emergency services was to ask the operator for Whitehall 1-2-1-2, which was the Information Room set up at the Metropolitan Police Headquarters on Victoria Embankment.


Following on, from the 5 women’s deaths in Wimpole Street the General Post Office, that ran the telephone network, suggested a 3-digit telephone number that could be dialled to trigger a special signal and flashing light at the exchange. This would then signal to the operators to give their attention into this call. In order to find the new emergency number in the dark or smoke it was suggested to use an end number so that it could be easily found by touch.


Many combinations were suggested, ‘111’, was ruled out immediately as it could be triggered by faulty equipment or lines getting crossed. ‘222’ was also ruled out as it would have connected to the Abbey Local Exchange as in those days the number represented the first three letters ‘ABB’. They also looked at using ‘1’ and decided against this as it could be accidentally triggered, and ‘000’ wasn’t used as the first ‘0’ would have connected to the switchboard.


999 was then deemed to be the most reasonable choice of number. The service came into effect on July 1st 1937 and covered a 12-mile radius from London’s Oxford Circus. Several people claimed to have made the first 999 call, however one newspaper claims the first 999 call was made by Mrs Beard of Hampstead, on July 8th 1937. She was reporting a burglar that her husband was chasing, and he was promptly caught.


It is believed that during the first full week of 999, a total of 1,336 calls were made. In the November the Information Room was able to take over the control of the calls, and the system started to get rolled out around the UK, in particular Glasgow, in 1938.


By 1967, 400,000 calls were made to the Police in London, with over a million for all services across the UK.


What happens when you call 999?


When you call 999, the operator will ask which service you require. Here we take a look at the ambulance. Your call will be connected to an Emergency Operations Centre. The person on the other end of the line, known as a call handler, will then ask you a series of questions. It is important to note that these questions will not slow down the ambulance to reach you but will allow the call handler to fully assess the needs of the casualty.


You will need to ensure that you have the following information available for the call handler:


The address of the emergency including postcode:

This is possibly the most important information you can provide to the call handler, as it will help the ambulance to reach the emergency as quickly as possible. Should you be in a rural, countryside location, if you can provide the grid reference that will be a big help. If you are totally unsure you should look for telephone boxes, members of the public who you could ask for your location, motorway marker boards if these are safe for you to view or street signs. All of these things can assist you in providing location information to the call handler.


The telephone number you are calling from:

This is helpful for the call handler should the call get disconnected and they need to call you back to continue getting information from you to help them assess the casualty.


What has happened:

If you are able to, you should provide the call handler with as much information as you can as to the circumstances around the emergency, the state of the casualty’s health and what you are doing in order to support the casualty.


Once you have handed this information to the call handler, they are able to release an ambulance, the call handler will then ask you further questions. These questions will help the call handler to provide you with first aid advice that can help you to look after the casualty until the ambulance staff arrive to take over.


The questions they may ask include:


The casualty’s age, gender and medical history,

Whether the casualty is conscious and breathing or otherwise,

Is the casualty bleeding?

Does the casualty have any chest pain?

Details of the casualty’s injury and how it has happened,

What part of the body is injured?

Is there any serious bleeding?


Depending on the cause of the injury, you may be asked if the attacker is still on scene, so that the crew can be advised, and if necessary held back until the Police are able to attend and assist. Another relevant question may be is there anyone trapped inside a vehicle, this will then help the call handler to arrange other assistance that their crew may need, e.g. the Fire Service.

While you are at the scene of the emergency it is important that you remain as calm as you possibly can and listen carefully to the questions being asked of you, so that you are then able to provide the call handler with the information they require. While you are waiting for the ambulance the call handler will provide you with information you need to be able to assist the casualty, if you are in the street it is important that you stay with the casualty. Should you have put the telephone down and ended the call, you should call the emergency Operations Centre back should the casualty change, or you change location. If you are calling from home or work, it is advisable that you open windows or doors so that you can signal to the ambulance crew, or you could send someone to wait in a visible place for them to guide them into where you and the casualty are waiting. It is always a good idea to lock away animals and pets for the safety of the crew.


Other things you can do to assist the medical staff are to have written down the casualty’s doctor’s details and any information on medication they take, even better collect their medication up and show this to the paramedics on their arrival. Be aware of any allergies the casualty has and ensure that you have told the call handler so they can pass this on to the ambulance crew, you can also reinforce this with the crew when they arrive.


Always try to stay calm, this is harder to achieve than it is to say but it is important so that you are able to take heed of the advice the call handler has given you and then carry it out.


Do NOT hang up the telephone, stay on the line, unless you are told otherwise by the call handler. The ambulance will be sent as soon as you have passed on the location to the call handler.


999 or 112 in the UK?


Where does this question come from, I hear you ask, and the answer to that is simple. In the UK confusion reigns as to the right number to use for the emergency services. The main reason for the confusion is, as far as I can tell, the advent of social media, although I have been made aware of a video on YouTube which backs up the myth that 112 is better than 999.


Firstly, I would ask how the telephone number that is universally known in the UK as the emergency number became inferior to a number of which not everyone is aware. 112 as discussed earlier is the European Union telephone that is live in all current 28-member states of the EU, (Brexit is not discussed further in this article!).


Secondly, we look at social media, sadly in today’s world, if it’s on social media it must be true and vice versa. This is not the case. You can write anything on social media whether there is evidence behind it or not. The myth on social media is that the telephone call will send more information to the call handler and handles the call in a different way if you use 112 over 999. This is in fact incorrect. Another myth is that a mobile phone’s SIM card is specially preprogrammed to dial 112 in an emergency; this is in fact true however it is important to note that the SIM card is also preprogrammed for 999 and some 911 as well.


The video on YouTube, which could be where some of the myth and incorrect detail of 112 comes from, is entitled, ‘Help me’ The secrets of using 112 on a mobile phone in an emergency or accident. I have taken the decision not to link to this video as it contains incorrect and therefore confusing information, but as of Monday the video has received 236,087 views!


The Truth:


In truth, 999 and 112 are the SAME in the United Kingdom! Yes, you read that correctly, the 2 numbers are exactly the same in the United Kingdom. You can use either one and you will get the same service, with the same location information sent to the call handler as each other. Most people will dial 999 as this is the number that we have been brought up with in the UK since we were knee high to a grasshopper and it will continue to be for many years to come having celebrated its 80th birthday in 2017.


REMEMBER: Should your mobile telephone not have a signal BUT has battery, you will be able to contact the emergency services by calling either 999 or 112 as your mobile will recognise both of these as an emergency.


What has changed to 999


During this article we want to look at 2 major evolutions of the emergency number 999 over its 80 years.


The first of these is the opportunity to be able to text 999 and get an emergency response.


The EmergencySMS service was introduced in September 2009, and was developed by:


Action on Hearing Loss,

British Telecom (BT),

Cable and Wireless,

The Department of Communities and Local Government,

OFCOM,

The UK Emergency Services, and

All the UK mobile network operators.


The idea behind this service is that if you are unable to make voice calls, you can contact the EmergencySMS from your mobile phone. This is a service which is part of the usual 999 service but designed specifically for people with hearing loss or difficulty with speech.


The service should ONLY be used to send notification of an emergency, test texts should not be sent. An emergency is described as:


Someone’s life is at risk,

A crime is happening now,

Someone is injured or threatened,

There is a fire, or someone is trapped,

You need an ambulance urgently,

Someone is troubled on the cliffs, on the shoreline or is missing at sea.


In order to use the service, the person who may need to use it has to register by sending ‘register’ to 999, and then follow the instructions that are sent back to them. Once registered the user can then text 999 in an emergency but will need to ensure that they have included in their message, which service they require, where the problem is and what the emergency is. The emergency services’ operator will then ask for further information if required or will confirm that help is on the way. The assumption of help being on its way should not be made, and if a reply has not been received, usually after 2 minutes, the user should try to send another message usually after 3 minutes or find another way to summon help.


Another change to the emergency services, is the advent of Silent Solutions; this service has been available on the Emergency Operator line since 2001, although even today is relatively unknown. The idea is that if you are unable to speak or make a sound on an emergency call, due to a terrorist attack or domestic abuse for instance, you will be asked to dial 55 and then be put through to the Police. Although, you are being put through to the Police this can also result in a life being saved. You should remember that the Police are unable to attend to all silent calls and therefore this service seems the obvious answer as they now know you are genuinely trying to contact the 999 operator.


The usual protocol in the UK, is for the operator to ask you a series of questions when you dial 999 in doing so trying to identify if you meant to dial the number in the first place. If they have not had a reply to their first question, which is, Which service do you require? The operator will then ask you to either tap the handset, cough or make a noise, should you not do this the operator will divert your call to a message that encourages you then to dial 55.


One of the myths that goes along with this service is that the Police are able to track your location. The emergency services have an array of methods to track your location, but not because you use the 55 process.


Finally, please remember that you DO NOT NEED a mobile phone signal to contact 999, the mobile phone SIM card will recognise this as an emergency number, and when trying to find a signal, will look for your network first, should this be unsuccessful then it will look for the next available network signal to allow the mobile to connect to the emergency services’ operator!



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