Abstract
BACKGROUND: Manual handling injuries, particularly musculoskeletal disorders (MSDs), are a leading occupational health concern for Emergency Medical Technicians (EMTs) globally, including Taiwan. Lower back injuries are prevalent, often resulting from labor-intensive patient-handling techniques. Despite their critical role, limited training, cultural barriers, and underreporting exacerbate these risks, necessitating targeted interventions. METHODS: This study analyzed manual handling practices among Taiwanese EMTs, focusing on injury prevalence, reporting behavior, training adequacy, and the use of ergonomic equipment. A structured questionnaire was employed. The Health Belief Model (HBM) and Transtheoretical Model (TTM) were applied to examine behavioral factors influencing safe handling practices, including perceived risks, benefits, and barriers. RESULTS: The findings revealed a high prevalence of MSDs, with lower back injuries being the most common. Injuries occurred, on average, after 5.3 years of service, aligning with international data. Training was identified as insufficient, with Taiwanese EMTs receiving two hours compared to Victoria’s three-day programs. Behavioral analysis using HBM and TTM highlighted self-efficacy and perceived benefits as critical facilitators of safe practices, while perceived barriers and low susceptibility hindered adoption. Additionally, a lack of ergonomic tools and reliance on traditional methods increased injury risks. CONCLUSIONS: The study underscores the urgent need for policy reforms, expanded training programs, and ergonomic equipment adoption to mitigate manual handling injuries among EMTs in Taiwan. Promoting a culture of safety and improving injury reporting mechanisms are essential. These findings provide a foundation for evidence-based interventions to enhance EMT well-being and operational safety. TRIAL REGISTRATION: This project was approved by the Research Ethics Committee of the En Chu Kong Hospital under number ECKIRB1130507. The date of approval is June 12th, 2024. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-025-24200-2.