Operations

Fatigue in EMS: Report from the National EMS Safety Summit

Daniel Patterson, PhD, NRP, is an assistant professor for the Department of Emergency Medicine at the University of Pittsburg. While at the National EMS Safety Summit in Denver, Colo., he delivered a must-attend presentation on Evidence-Based Strategies for Fatigue Risk Management in EMS.

Noting that fatigue can have devastating effects on the EMS provider and become a serious risk management issue for an EMS service, Patterson pointed out how fatigue can adversely affect the provider’s ability to work, as well as the safety and health of patients under the fatigued worker’s care. He showed several ambulance cab videos that showed fatigued drivers dozing off and crashing.

Fatigue = Overwhelming tiredness

Patterson cited the definition of fatigue as “unpleasant symptoms incorporating feelings of tiredness to exhaustion, creating mental and physical conditions that interfere with the ability to function in a normal capacity.”1

He then presented compelling statistics:

  • 50% of EMS personnel report they do not achieve 7–8 hours of sleep as recommended, and therefore have poor sleep quality.
  • 50% do not get the 16 hours of “recovery” required in between shifts

There is presently no clear standard for how we manage this threat in EMS. However, the National Highway Traffic Safety Administration (NHTSA) has important research underway that will present evidence-based guidelines for fatigue management, which Patterson believes may present significant results and recommendations that could impact and improve EMS delivery, and—equally important—positively affect the health and well-being of emergency responders who are shift workers.

The PICO (Population, Intervention, Comparisons and Outcomes) questions being addressed in this important study:

  1. Are there reliable and valid instruments for measuring fatigue among EMS providers?
  2. In EMS, do shift-scheduling interventions mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?
  3. Does the worker’s use of fatigue countermeasures mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?
  4. Does the use of sleep or rest strategies and/or interventions mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?
  5. Does fatigue training and education mitigate fatigue-related risks, and/or improve sleep?
  6. Does implementation of model-based fatigue risk management mitigate fatigue, fatigue-related risks, and/or improve sleep?
  7. In EMS, do task load interventions mitigate fatigue mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?

Each PICO will produce a document and report that will be presented on the NHTSA website, with follow-up presentations in peer-reviewed journals, in JEMS and at EMS Today 2017 in Salt Lake City.

Patterson, a seasoned Pennsylvania paramedic provider at two EMS systems (one of which is a high-performance system), enthusiastically concluded his presentation stating: “I can’t wait to find out what we find out!”

Go to www.emsfatigue.org to participate in this important research by providing comments or questions on Federal Docket NHTSA-2015-0121.

Reference

1. Ream E, Richardson A. Fatigue: a concept analysis. Int J of Nurs Stud. 1996;33:519–529.