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P. Daniel Patterson | November 28, 2017
Reports of fatigue-related ambulance crashes are on the rise. Previous research shows that greater than half of EMS personnel report fatigue while at work. Many in EMS are sleep deprived, which contributes to fatigue. Our colleagues in EMS seem to fail easily at obtaining the National Sleep Foundation’s recommended 7-9 hours of sleep per 24 hours. Fatigue and sleep deprivation have long been deemed “part of the job” in EMS operations. Programs to deal with fatigue in the EMS setting are sparse, and most administrators lack any guidance on how to mitigate fatigue in the workplace.
Most administrators lack any guidance on how to mitigate fatigue in the workplace.
Guidance Based on Evidence
In 2013, the National EMS Advisory Council (NEMSAC) recommended that the National Highway Traffic Safety Administration (NHTSA) and federal partners review the evidence and provide the EMS industry with guidance on fatigue mitigation. In 2015, NHTSA funded a project (The Fatigue in EMS Project) led by the National Association of State EMS Officials (NASEMSO) and academic partners at the University of Pittsburgh, Department of Emergency Medicine. As Principal Investigator of this effort, I led more than two-dozen investigators and staff in a coordinated effort to evaluate the evidence germane to fatigue mitigation in shift workers.
We began work on this project in 2015. In 2016, the project team reviewed more than 38,000 pieces of literature. A panel of experts was assembled and evaluated the evidence as part of a rigorous process to develop recommendations for fatigue mitigation tailored to the EMS environment. The expert panel was comprised of experts in sleep medicine, fatigue science, emergency medicine, risk administration and public safety. Their composition met the high standards of the Institute of Medicine for projects that aimed to develop evidence-based guidelines (EBGs).
By the summer of 2017, the panel reached consensus on five recommendations and a set of performance measures that EMS organizations should consider when developing their own fatigue risk management program. The results of this work will be published in a series of 15 journal articles and appear in special issue of Prehospital Emergency Care. The release date has not yet been set, but the publisher anticipates access to the articles online in late 2017. Visit the project’s website for more information (www.emsfatigue.org).
Significance of Fatigue Mitigation in EMS
It is true that many other industries or occupations have a mature understanding of fatigue and have developed rigorous fatigue risk management programs or systems. Surprisingly, none of these other industries developed their programs based a review and evaluation of the best available evidence with multiple systematic reviews and meta-analyses. The Fatigue in EMS Project is unique because it includes multiple systematic reviews and multiple meta-analyses for the specific purpose of developing guidelines for fatigue risk management. Administrators can view the findings of this work with confidence that the strategies recommended are informed by a synthesis of the best available evidence from all types of shift worker groups and occupations. The project team didn’t limit the evidence review to research involving only EMS personnel. Unfortunately, the body of literature focused only on EMS personnel and fatigue is very sparse. The team evaluated evidence from all types of shift worker groups who share the burden of shift work, fatigue, sleep deprivation, and need to mitigate the effects of fatigue to ensure safety.
Work performed on the Fatigue in EMS Project was supported with funding from the U.S. Department of Transportation, NHTSA to the NASEMSO: contract/grant number: DTNH2215R00029. The views contained in this article are those of the authors and not necessarily those of the NHTSA.
Dr. P. Daniel Patterson is a Assistant Professor of Emergency Medicine; EMSARN Primary Investigator. Patterson studies safety in emergency care settings with special emphasis on safety culture, fatigue, shift work, sleep health, teamwork, medical errors and adverse events, and clinician injury in the prehospital EMS setting. Collaborations have led to creation of reliable and valid safety measurement tools and establishing base rate data for key indicators of EMS safety. Patterson has led multi-disciplinary teams in evidence reviews and experimental studies testing novel interventions to improve safety. His research is informed by immersion in the EMS setting as a paramedic clinician.
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