The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers

The association between the use of shift schedule evaluation tool with ergonomics recommendations and occupational injuries: A 4-year prospective cohort study among healthcare workers

OBJECTIVE

This study aimed to find out whether utilizing a shift schedule evaluation tool with ergonomics recommendations for working hours has favorable effects on the incidence of occupational injuries.

METHODS

This 4-year prospective cohort study (2015-2018) consisted of a dynamic cohort of healthcare shift workers (N=29 237) from ten hospital districts and six cities in Finland. Working hour characteristics and occupational injuries were measured with daily registry data. Multilevel generalized linear model was used for the analyses, and the estimates were controlled for hierarchical structure of the data and confounders.

RESULTS

Ward heads of the cities used the shift schedule evaluation tool 3.2 times more often than ward heads of the hospital districts. Overall incidence of workplace and commuting injuries did not differ between users and non-users of the evaluation tool. The incidence of dislocations, sprains, and strains was lower in the users than non-users [adjusted odds ratio (OR) 0.88, 95% confidence interval (CI) 0.78-0.99]. Approximately 13% of this association was mediated by increase in realized shift wishes and 10% by increase in single days off. In subgroup analyses, the incidence of workplace injury (OR 0.83, 95% CI 0.69-0.99), and among types of injuries, the incidence of dislocations, sprains, and strains (OR 0.69, 95% CI 0.55-0.85) and falling, slipping, tripping, or overturning (OR 0.75, 95% CI 0.58-0.99) were lower in users than non-users among employees of the cities, but no association was found among employees of the hospital districts.

CONCLUSION

The use of ergonomics recommendations for working hours is associated with a reduced risk of occupational injuries.

Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research

BACKGROUND

The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers.

METHODS

We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue.

RESULTS

Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs.

CONCLUSIONS

In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.

Emergency medical services professional behaviors with violent encounters: A prospective study using standardized simulated scenarios

Introduction

To evaluate emergency medical services (EMS) professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics.

Methods

EMS professionals of a large county‐based system participated in 1 of 4 standardized patient care scenarios. Each 8‐minute scenario included escalated threats of violence such that EMS personnel should escape the scene for safety. Trained evaluators recorded EMS professionals' performance using standardized data elements. Outcomes included EMS personnel escape and verbal de‐escalation attempts. Descriptive statistics and univariable odds ratios (OR) with 95% confidence intervals (95% CI) are reported.

Results

There were 270 EMS professionals evaluated as individual members of 2‐person crews. Overall, 54% escaped the unsafe scene and 54% made an adequate de‐escalation attempt; 20% did not make an adequate de‐escalation attempt nor escape the unsafe scene. Paramedics demonstrated lower odds of escaping compared to emergency medical technicians (OR: 0.40; 95% CI: 0.17–0.94), yet greater odds of adequate de‐escalation (OR: 3.17, 95% CI: 1.38–7.31). EMS professionals with more than 20 years of experience (OR: 0.32, 95% CI: 0.13–0.79, ref:2 years or less) and those with military experience (OR: 0.37; 95% CI: 0.17–0.81) demonstrated reduced odds of escaping. Crisis intervention team (CIT) training was associated with reduced odds of escape (OR: 0.38; 95% CI: 0.21–0.69), but increased odds of adequate de‐escalation (OR: 2.19; 95% CI: 1.19–4.04).

Conclusions

Nearly half of EMS professionals did not remove themselves from a simulated patient care scenario with an escalating threat of physical violence. EMS‐specific training for de‐escalation as a first‐line technique, recognizing imminent violence, and leaving a dangerous environment is needed.

Workplace violence against healthcare workers in Emergency Departments. A case-control study

BACKGROUND AND AIM

Assessment and management of workplace violence (WPV) towards healthcare workers (HCWs) employed in Emergency Departments (EDs) represents a challenge for healthcare organizations worldwide. To date there is a lack of scientific data about the impact of work-shifts on the occurrence of WPV against ED HCWs. The purpose of this study was to investigate the relationship between work shift schedules and WPV against registered nurses (RNs) working on non-traditional shifts, including nights and 12-hour shifts.

METHODS

The authors conducted a cross-sectional nested case-control analysis of data regarding the episodes of WPV perpetrated by patients or their relatives against RNs employed in three EDs, in the period between January -December 2017.

RESULTS

The one-year incidence of WPV was 29,30 per 100 Full Time Equivalent (FTE) positions. Cumulative nightshifts were significant for 3 or more nightshifts compared to working less than 3 nightshifts during the 7 days before the episodes of WPV; additionally, RNs working 9 or more night-shifts showed higher risk of experiencing WPV compared to RNs working less than 4 night-shifts in the previous 28 days.

CONCLUSION

In the present study shift work and WPV occurrence against ED RNs resulted interconnected; improvement interventions aimed at preventing the WPV should consider the characteristics of work shift schedules with the purposes of: 1) limiting the night shifts up to two per week and up eight per month; 2) adopting constant forward-rotating shift schedules. (www.actabiomedica.it).

Can Workplace Rest Breaks Prevent Work-Related Injuries Related to Long Working Hours?

OBJECTIVE

This study examined the relationship between long working hours, rest breaks, and work-related injuries.

METHODS

A total of 25,439 employees were examined from the 4th Korean Working Conditions Survey. Rest breaks were divided into two groups and working hours were divided into four groups. Multiple logistic regression was conducted to estimate the relationship between long working hours, rest breaks, and work-related injuries.

RESULTS

Work-related injuries were significantly associated with long working hours. Stratified by rest breaks, the risk of work-related injuries increased with increasing working hours in a dose-response pattern among those with insufficient rest breaks, while the risk was not significant among those with sufficient rest breaks.

CONCLUSION

It is important to provide sufficient rest breaks to prevent work-related injuries among workers with long working hours.

Assessing and preventing low back pain in nurses. Implications for practice management

Background and aims:

The prevention of low back pain (LBP) among nurses employed in hospital departments represents a special concern for healthcare organizations globally. A growing literature evidences the need of workplace policy development related to organizational issues as strategic contribution to minimize the occurrence of LBP in healthcare sector. The purposes of this study were: 1) to analyze the relationship between shiftwork and acute LBP among female shift nurses; 2) to detect preventive interventions targeted on organizational issues.

Methods:

The authors conducted a cross-sectional nested case-control analysis of data concerning acute LBP and staffing data for 671 nurses employed in the Departments of General Practice and Elderly Care Medicine. The statistical analysis consisted of a logistic regression to calculate incidence odds ratios with 95% confidence intervals. Chi-square test and t-test were used to examine the relationship between categorical and continuous data, respectively.

Results:

The occurrence of acute LBP resulted significantly related to nightshift, extended shifts, obesity; the adoption of forward rotating schedules was found a protective factor in moderating the occupational risk of acute LBP in shift nurses.

Conclusions:

In this study the authors observed an association between shiftwork and acute LBP; improvement interventions should be aimed at: 1) moderating organizational risks linked with shiftwork schedules; 2) promoting healthy lifestyles. These interventions are suggested as a strategic way to effectively manage the phenomenon among female rotating shift nurses. (www.actabiomedica.it)

Needlestick and Sharp Injuries Among Registered Nurses: A Case-Control Study

Objectives

The prevention of needlestick and sharp injuries (NSSIs) among registered nurses (RNs) employed in hospital wards represents an important issue. Accidental contact with blood, consequent to NSSIs, is the most frequent form of exposure to blood-borne pathogens that can be transmitted by accidental exposure.

Aims

This study investigates the relationship occurring between consecutive workdays, night-shifts, cumulative hours, forward-rotating shift schedules (morning-afternoon-night), and occupational NSSIs frequency.

Methods

The author conducted a cross-sectional nested case-control analysis from staffing data concerning 765 RNs and NSSIs occurred during a period of 48 months.

Results

NSSIs were more frequent among RNs working 3 or more night-shifts compared to RNs working less than 3 night-shift in the 7 days prior occurrence of NSSI; moreover, NSSIs were more frequent among RNs working 9 or more night-shifts compared to RNs working less than 4 night-shifts in the 28 days prior to NSSIs occurrence. Constant forward-rotating shift schedules showed a protective effect in preventing NSSIs compared to irregular forward-rotating shift schedules in the last 28 days (odds ratio = 0.45; 95% confidence interval = 0.22-0.91; P < 0.05).

Conclusions

In this study, the author observed an association between NSSIs and shift-work schedules, including night-shifts. These findings support the need for organizational interventions targeted on implementing forward-rotating shift-work schedules and minimizing night-shifts as part of the overall NSSIs prevention efforts in healthcare facilities.

The nature and burden of occupational injury among first responder occupations: A retrospective cohort study in Australian workers

INTRODUCTION

Workers in first responder (FR) occupations are at heightened risk for workplace injury given their exposure to physical/psychological hazards. This study sought to (1) characterise the occupational risk of injury; (2) determine factors associated with injury; and (3) characterise the burden of injury-related disability in police, ambulance officers, fire/emergency workers, compared with other occupations.

METHODS

A retrospective cohort of 2,439,624 claims occurring between July 2003 and June 2012 was extracted from the Australian National Dataset for Compensation-Based Statistics. Cases aged 16-75 years working 1-100 pre-injury hours per week were included. Regression models estimated risk of making a workers' compensation (WC) claim by age, gender, occupation and injury type. Injury burden was calculated using count and time loss, and statistically compared between groups.

RESULTS

The risk of making a WC claim among FR occupations was more than 3 times higher than other occupations. Risk of claiming was highest among female FRs and those aged 35-44 years. Ambulance officers had the greatest risk of upper-body MSK injuries and fire and emergency workers the greatest risk of lower-body MSK injuries. The risk of mental health conditions was elevated for all FR occupations but highest among police officers. The total burden of injury (expressed as working weeks lost per 1000 workers) differed significantly between groups and was highest amongst police.

DISCUSSION AND CONCLUSIONS

First responders record significantly higher rates of occupational injury claims than other occupations. Using a national population based dataset, this study demonstrates that not only are first responders exposed to significantly higher rates of occupational injury than all other occupations combined, but they experience differential injury patterns depending on their occupation. This suggests that among FR occupations injury prevention efforts should reflect these differences and be targeted to occupation-specific patterns of injury.

A qualitative assessment of safe work practices in logging in the southern United States

BACKGROUND

The logging industry is recognized as one of the most dangerous professions in the U.S., but little is known about safety management practices on remote logging sites.

METHODS

A total of six focus group sessions were held among logging supervisors and front line crew members in Arkansas, Louisiana, and Texas (N = 27 participants).

RESULTS

Participants perceived that logging was a dangerous profession, but its risks had been mitigated in several ways, most notably through mechanization of timber harvesting. Log trucking-related incidents were widely identified as the primary source of risk for injury and death on logging work sites. Human error, in general, and being out of the machinery on the work site were highlighted as additional sources of risk.

CONCLUSIONS

Participants indicated high levels of personal motivation to work in a safe manner but tended to underestimate workplace hazards and expressed widely varying levels of co-worker trust. Am. J. Ind. Med. 60:58-68, 2017. © 2016 Wiley Periodicals, Inc.

Physician staffed helicopter emergency medical service case identification - a before and after study in children

BACKGROUND

Severely injured children may have better outcomes when transported directly to a Paediatric Trauma Centre (PTC). A case identification system using the crew of a physician staffed helicopter emergency medical service (P-HEMS) that identified severely injured children for P-HEMS dispatch was previously associated with high rates of direct transfer. It was theorised that discontinuation of this system may have resulted in deterioration of system performance.

METHODS

Severe paediatric trauma cases were identified from a state based trauma registry over two time periods. In Period A the P-HEMS case identification system operated in parallel with a paramedic dispatcher (Rapid Launch Trauma Co-ordinator-RLTC) operating from a central control room (n = 71). In Period B the paramedic dispatcher operated in isolation (n = 126). Case identification and direct transfer rates were compared as was time to arrival at the PTC.

RESULTS

After cessation of the P-HEMS system the rate of case identification fell from 62 to 31 % (P < 0.001), identification of fatal cases fell from 100 to 47 % (P < 0.001), the rate of direct transfer to a PTC fell from 66 to 53 % (P = 0.076) and the time to arrival in a PTC increased from a median 69 (interquartile range 52 - 104) mins to 97 (interquartile range 56 - 305) mins (P = 0.003). When analysing the rate of direct transfer to a PTC as a function of team composition, after adjusting for age and injury severity scores, there was no change in the rate between the physician and paramedic groups across the two time periods (relative risk 0.92, 95 % CI: 0.44 to 1.41).

DISCUSSION

The parallel identification system improves case identification rates and decreases time to arrival at the PTC, whilst requiring RLTC authorisation preserves the safety and efficiency benefits of centralised dispatch. The model could be extended to adult patients with similar benefits.

CONCLUSIONS

A case identification system relying solely on RLTC paramedics resulted in a significantly lower case identification rate and increased prehospital time with a non-significant fall in direct transfer rate to the PTC. The elimination of the P-HEMS input from the tasking system resulted in worse performance indicators and has the potential for poorer outcomes.