1
|
Ferris MJ, Wolkow AP, Bowles KA, Lalor A. A Guided Comparative Analysis of Fatigue Frameworks in Australasian Ambulance Services. PREHOSP EMERG CARE 2024:1-9. [PMID: 39047175 DOI: 10.1080/10903127.2024.2381055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Paramedics work in a complex, unpredictable environment, subject to many external stressors including critically unwell patients, dangerous driving conditions, and prolonged shift work. Paramedic fatigue from these and other occupational demands is well documented. Ambulance services attempt to safeguard paramedics from fatigue using internal policies or procedures - a type of Fatigue Risk Management Systems (FRMSs). This study reviews ambulance service fatigue frameworks to understand the current situation in fatigue management in paramedicine, and to identify fatigue monitoring tools, strategies, and other components of these frameworks that are designed to protect personnel. METHODS This study involved a qualitative document thematic content analysis. All eleven statutory ambulance services across Australia, New Zealand, and Papua New Guinea, represented by the Council of Ambulance Authorities, were contacted and invited to participate. Fatigue frameworks were collated and entered into NVivo where data extraction occurred through three a priori areas (fatigue, fatigue mitigation tools & fatigue management). RESULTS Nine of the eleven ambulance services provided fatigue documentation, with one declining to participate, and one did not respond to invitations. Through thematic analysis and abstraction, seven themes were identified: fatigue definition, consequences of fatigue, sources of fatigue, signs and symptoms of fatigue, fatigue-related incidents, fatigue monitoring tools, and fatigue mitigation. There was also poor alignment between provided frameworks and established FRMSs components. CONCLUSION Our findings provide an initial insight into existing ambulance service fatigue frameworks across Australia, New Zealand, and Papua New Guinea. The many inconsistencies in frameworks between ambulance services highlight an opportunity to develop a more consistent, collaborative approach that follows evidence-based FRMSs guidelines.
Collapse
Affiliation(s)
- Matthew J Ferris
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria
- Queensland Ambulance Service, Kedron, Queensland, Australia
| | - Alexander P Wolkow
- Paramedic Health and Wellbeing Research Unit, School of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria
- School of Psychological Sciences, Monash University, Clayton, Victoria
| | - Kelly-Ann Bowles
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria
- Paramedic Health and Wellbeing Research Unit, School of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria
| | - Aislinn Lalor
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria
| |
Collapse
|
2
|
Ippolito M, Einav S, Giarratano A, Cortegiani A. Effects of fatigue on anaesthetist well-being and patient safety: a narrative review. Br J Anaesth 2024; 133:111-117. [PMID: 38641516 DOI: 10.1016/j.bja.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
The elements that render anaesthesia a captivating profession can also foster stress and fatigue. Professionals considering anaesthesia as a career choice should have a comprehensive understanding of the negative consequences of fatigue and its implications for clinical performance and of the available preventive measures. Available evidence suggests that factors unrelated to patient characteristics or condition can affect clinical outcomes where anaesthetists are involved. Workload, nighttime work, and fatigue are persistent issues in anaesthesia and are perceived as presenting greater perioperative risks to patients. Fatigue seems to negatively affect both physical and mental health of anaesthetists. Existing evidence justifies specific interventions by institutions, stakeholders, and scientific societies to address the effects of anaesthetist fatigue. This narrative review summarises current knowledge regarding the effects of fatigue on anaesthetist well-being and patient safety, and discusses potential preventive solutions.
Collapse
Affiliation(s)
- Mariachiara Ippolito
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy
| | - Sharon Einav
- Maccabi Healthcare Services Regional Director Hod HaSharon, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Antonino Giarratano
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy.
| |
Collapse
|
3
|
Foxx F, Orpet H. The need for recovery: An investigation into short-term work-related fatigue in veterinary nurses. Vet Rec 2024; 194:e3898. [PMID: 38603590 DOI: 10.1002/vetr.3898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Veterinary nursing is physically and emotionally demanding, putting veterinary nurses at risk of acute work-related fatigue (AWRF). Despite the increased recognition of chronic occupational syndromes such as burnout and compassion fatigue in recent years, few studies have investigated how AWRF impacts individuals and the profession. METHODS An anonymous survey open to all UK-based registered veterinary nurses (RVNs) was distributed via email and social media. The survey investigated work patterns, hobbies, opinions about work and intentions to leave the veterinary profession. An English translation of the need for recovery (NFR) scale was used to quantify the AWRF. RESULTS The median NFR score from 387 responses was 81.8, indicating high levels of AWRF. Long shifts, sole-charge work and overtime were associated with higher scores, while having support at work and a better work-life balance were associated with lower scores. Higher scores were correlated with intentions to leave the profession. LIMITATIONS Although validated as a measure of AWRF, the unidimensional NFR scale oversimplifies the complexities of fatigue. A limited number of RVNs responded to the survey, reducing statistical power. CONCLUSION Although there is no single solution to staff turnover, the results from this survey suggest that addressing AWRF may improve retention of RVNs.
Collapse
Affiliation(s)
- Flora Foxx
- North Shore Veterinary Hospital, Artarmon, New South Wales, Australia
| | | |
Collapse
|
4
|
Wu JY, Li H, Shuai JK, He Y, Li PC. Evidence summary on the non-pharmacological management of sleep disorders in shift workers. Sleep Breath 2024; 28:909-918. [PMID: 37587356 PMCID: PMC11136795 DOI: 10.1007/s11325-023-02901-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This study aimed to evaluate, and integrate the relevant evidence on the non-pharmacological management of sleep disorders in shift workers to provide a reference for improving sleep of shift workers. METHODS According to the "6S" pyramid model of evidence, a comprehensive search was conducted in evidence-based databases, including BMJ-Best Practice, UpToDate, DynaMed, Cochrane Library, and Joanna Briggs Institute (JBI); clinical practice guideline websites, such as the Guidelines International Network; professional association websites, such as the World Sleep Society; and literature databases, including PubMed, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biology Medicine disc (CBM) from inception to November 30, 2022. Two researchers independently evaluated the literature in accordance with the evaluation standards; conducted the extraction, classification, and synthesis of the evidence; and evaluated its grade and recommendation grade. RESULTS A total of 18 studies were included, including 2 clinical decisions, 2 guidelines, 3 expert consensuses, and 11 systematic reviews. In total, 25 pieces of evidence were summarized from 6 aspects: sleep assessment, sleep scheduling, sleep hygiene, light therapy, workplace intervention, and other managements. CONCLUSION This study summarized the best evidence for the non-pharmacological management of sleep disorders in shift workers. Shift workers should reasonably arrange their sleep time and develop good sleep hygiene. Additionally, work organizations should jointly promote sleep to improve the sleep conditions of shift workers and promote their physical and mental health.
Collapse
Affiliation(s)
- Jin-Yu Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
| | - Hui Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
| | - Jun-Kun Shuai
- Department of Emergency Medicine, Affiliated Hospital of Chengdu University, No.82, North 2nd Section, 2nd Ring Road, Chengdu, 610081, Sichuan, China
| | - Yue He
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China
| | - Peng-Cheng Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China.
- West China School of Nursing, Sichuan University, No.37, Guoxue Alley, Chengdu, 610044, Sichuan, China.
| |
Collapse
|
5
|
Deng S, Wang Q, Fan J, Lu J, Liu W, Wang W, Yang Y, Ding F, Mei J, Ba L. Association of intra-shift nap duration with heart rate variability in medical night shift workers. J Sleep Res 2024; 33:e13935. [PMID: 37226542 DOI: 10.1111/jsr.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
Napping during night shifts effectively reduces disease risk and improves work performance, but few studies have investigated the association between napping and physiological changes, particularly in off-duty daily lives. Changes in the autonomic nervous system precede diseases like cardiovascular disease, diabetes, and obesity. Heart rate variability is a good indicator of autonomic nervous system. This study aimed to investigate the link between night shift nap durations and heart rate variability indices in the daily lives of medical workers. As indicators of chronic and long-term alterations, the circadian patterns of heart rate variability indices were evaluated. We recruited 146 medical workers with regular night shifts and divided them into four groups based on their self-reported nap durations. Heart rate variability circadian parameters (midline-estimating statistic of rhythm, amplitude, and acrophase) were obtained by obtaining 24-h electrocardiogram on a day without night shifts, plotting the data of the heart rate variability indices as a function of time, and fitting them into periodic cosine curves. Using clinical scales, depression, anxiety, stress, fatigue, and sleepiness were assessed. Linear regression analysis revealed a positive relationship between 61-120-min naps and 24-h, daytime, and night-time heart rate variability indices, and the parasympathetic activity oscillation amplitude (indexed by high-frequency power, the square root of the mean of the sum of squares of differences between adjacent normal intervals, standard deviation of short-term R-R-interval variability) within one circadian cycle. This study indicated that napping for 61-120 min during night shifts could benefit medical workers' health, providing physiological evidence to promote nap management.
Collapse
Affiliation(s)
- Saiyue Deng
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Quan Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jingjing Fan
- Cardiac Unit, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jiajia Lu
- Cardiac Unit, Wuhan No.1 Hospital, Wuhan, People's Republic of China
| | - Wenhua Liu
- Department of Clinical Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yuan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Fengfei Ding
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
- Department of Pharmacology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Junhua Mei
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, People's Republic of China
| | - Li Ba
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| |
Collapse
|
6
|
Gage CB, Powell JR, Bosson N, Crowe R, Guild K, Yeung M, Maclean D, Browne LR, Jarvis JL, Sholl JM, Lang ES, Panchal AR. Evidence-Based Guidelines for Prehospital Airway Management: Methods and Resources Document. PREHOSP EMERG CARE 2023; 28:561-567. [PMID: 38133520 DOI: 10.1080/10903127.2023.2281377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Emergency airway management is a common and critical task EMS clinicians perform in the prehospital setting. A new set of evidence-based guidelines (EBG) was developed to assist in prehospital airway management decision-making. We aim to describe the methods used to develop these EBGs. METHODS The EBG development process leveraged the four key questions from a prior systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) to develop 22 different population, intervention, comparison, and outcome (PICO) questions. Evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and tabulated into the summary of findings tables. The technical expert panel then used a rigorous systematic method to generate evidence to decision tables, including leveraging the PanelVoice function of GRADEpro. This process involved a review of the summary of findings tables, asynchronous member judging, and online facilitated panel discussions to generate final consensus-based recommendations. RESULTS The panel completed the described work product from September 2022 to April 2023. A total of 17 summary of findings tables and 16 evidence to decision tables were generated through this process. For these recommendations, the overall certainty in evidence was "very low" or "low," data for decisions on cost-effectiveness and equity were lacking, and feasibility was rated well across all categories. Based on the evidence, 16 "conditional recommendations" were made, with six PICO questions lacking sufficient evidence to generate recommendations. CONCLUSION The EBGs for prehospital airway management were developed by leveraging validated techniques, including the GRADE methodology and a rigorous systematic approach to consensus building to identify treatment recommendations. This process allowed the mitigation of many virtual and electronic communication confounders while managing several PICO questions to be evaluated consistently. Recognizing the increased need for rigorous evidence evaluation and recommendation development, this approach allows for transparency in the development processes and may inform future guideline development.
Collapse
Affiliation(s)
- Christopher B Gage
- National Registry of Emergency Medical Technicians, Columbus, Ohio
- The Ohio State University College of Public Health, Division of Epidemiology, Columbus, Ohio
| | - Jonathan R Powell
- National Registry of Emergency Medical Technicians, Columbus, Ohio
- The Ohio State University College of Public Health, Division of Epidemiology, Columbus, Ohio
| | - Nicole Bosson
- Los Angeles County EMS Agency, Santa Fe Springs, California
| | | | - Kyle Guild
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Matthew Yeung
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Davis Maclean
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | | | | | - Eddy S Lang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Ashish R Panchal
- National Registry of Emergency Medical Technicians, Columbus, Ohio
- The Ohio State University College of Public Health, Division of Epidemiology, Columbus, Ohio
- The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio
| |
Collapse
|
7
|
Marvin G, Schram B, Orr R, Canetti EFD. Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7055. [PMID: 37998287 PMCID: PMC10671419 DOI: 10.3390/ijerph20227055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Fatigue in emergency first responders (EFRs) is known to affect performance abilities and safety outcomes for both patients and EFRs. The primary aim of this review was to determine the main contributors to occupation-induced fatigue in EFRs and its subsequent impacts. Following the PRIMSA checklist, academic databases (Medline, Embase, CINAHL, and SPORTDiscus) were searched using key terms with results subjected to inclusion and exclusion criteria. Populations of interest were firefighters, paramedics, or emergency call centre personnel. Of the 5633 records identified, 43 studies, which reported on 186 unique measures from a total population of 6373 participants, informed the review. Synthesis revealed fatigue was caused by lack of sleep during the shift and consistent poor sleep quality which negatively impacted cognitive function, alertness, and physical and mental health while increasing safety-compromising behaviours and injuries. Both subjective and objective assessments of fatigue are necessary for effective risk management in EFRs. EFRs that are consistently fatigued are at a greater risk of poor physical and mental health, reduced cognitive function, and increased injuries. No studies reported on fatigue in emergency call centre personnel, highlighting a literature gap. Funding was provided by the Australian Capital Territory Emergency Services Agency. Preregistration was filed in OSF: osf.io/26f3s.
Collapse
Affiliation(s)
- Graham Marvin
- Tactical Research Unit, Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia
| | | | | | | |
Collapse
|
8
|
Richardsen C, Lubin J, Fadale M, Flamm A. Evaluation of a Team-Based Flight Risk Assessment Tool in Air Medical Transport. Air Med J 2023; 42:450-455. [PMID: 37996181 DOI: 10.1016/j.amj.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/05/2023] [Accepted: 07/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Fatigue is common in emergency medical services (EMS) and is exacerbated in air medical transport. There is no gold standard for recognizing high-risk factors contributing to fatigue. Current survey instruments designed to assess fatigue in EMS have limited evidence supporting their reliability and validity. The purpose of this study was to investigate the use of a team-based flight risk assessment tool (FRAT) as an instrument to improve safety and patient care for air medical transport. METHODS The FRAT factors professional experience, stressors, sleepiness, and work conditions at the beginning of each shift and generates a team-based score. The 1,919 FRAT scores from a single air/ground critical care transport program during 2021 were retrospectively analyzed against measurable operational outcomes and indicators of error, including first-pass intubation success, the presence of quality assurance flags on documentation, and the time spent on scene. RESULTS There were 281 occurrences of a FRAT score that warranted mitigation, and 259 reported mitigation strategies. There were no associations between FRAT score and intubation success, quality assurance flags, and scene time. CONCLUSION The team-based FRAT score triggered a mitigation activity on 281 occasions in 2021. There were no associations between the FRAT score and specific quality measures examined.
Collapse
Affiliation(s)
| | - Jeffrey Lubin
- Department of Emergency Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Michael Fadale
- Life Lion Critical Care Transport, Penn State Health, York, PA
| | - Avram Flamm
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA; Department of Emergency Medicine, WellSpan York Hospital, WellSpan Health, York, PA.
| |
Collapse
|
9
|
Patterson PD, Okerman TS, Roach DGL, Hilditch CJ, Weaver MD, Patterson CG, Sheffield MA, Di Salvatore JS, Bernstein H, Georges G, Andreozzi A, Willson CM, Jain D, Martin SE, Weiss LS. Are Short Duration Naps Better than Long Duration Naps for Mitigating Sleep Inertia? Brief Report of a Randomized Crossover Trial of Simulated Night Shift Work. PREHOSP EMERG CARE 2023; 27:807-814. [PMID: 37347968 DOI: 10.1080/10903127.2023.2227696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE We sought to test the effects of different duration naps on post-nap cognitive performance during simulated night shifts. METHODS We used a randomized laboratory-based crossover trial design with simulated 12-hr night shifts and each participant completing three conditions of 72 hrs each (Clinicaltrials.gov; registration # NCT04469803). The three conditions tested included no-nap, a 30-min nap opportunity, and a 2-hr nap opportunity. Naps occurred at 02:00 hrs. Cognitive performance was assessed with the Brief 3-min Psychomotor Vigilance Test (PVT-B). Four PVT-B measures include: reaction time (RT in milliseconds (ms)), lapses (RT > 355 ms), false starts (reactions before stimulus or RT <100 ms), and speed (1,000/RT). The PVT-B was performed at the start of the simulated night shift (19:00), end of shift (07:00), pre-nap (02:00), and at 0 mins, 10 mins, 20 mins, and 30 mins following the 30-min and 2-hr nap conditions. Simultaneously, participants reported subjective ratings of fatigue and other constructs. RESULTS Twenty-eight (15 female), mostly certified emergency medical technicians or paramedics, consented to participate. For all three conditions, looking within condition, PVT-B lapse performance at the end of the 12-hr simulated night shift (at 07:00) was poorer compared to shift start (p < 0.05). Performance on PVT-B speed, RT, and false starts were poorer at shift end than shift start for the no-nap and 30-min nap conditions (p < 0.05), but not for the 2-hr nap condition (p > 0.05). Compared to pre-nap measures, performance on the PVT-B assessed at 0 mins post-nap showed significant performance declines for lapses and speed for both the 30-min and 2-hr nap conditions (p < 0.05), but not at 10, 20, or 30 mins post-nap. After waking from the 2-hr on-shift nap opportunity (at 0 mins), participants rated sleepiness, difficulty with concentration, and alertness poorer than pre-nap (p < 0.05). Participants in the 30-min nap condition rated alertness poorer immediately after the nap (at 0 mins) compared to pre-nap (p < 0.05). CONCLUSIONS While sleep inertia was detectable immediately following short 30-min and long 2-hr nap opportunities during simulated night shift work, deficits in cognitive performance and subjective ratings quickly dissipated and were not detectable at 10-30 mins post-nap.
Collapse
Affiliation(s)
- P Daniel Patterson
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Department of Rehabilitation Sciences and Technology, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany S Okerman
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David G L Roach
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cassie J Hilditch
- Fatigue Countermeasures Laboratory, San José State University, San José, California
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Charity G Patterson
- School of Health and Rehabilitation Sciences Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark A Sheffield
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jillian S Di Salvatore
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Department of Rehabilitation Sciences and Technology, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Haley Bernstein
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George Georges
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - April Andreozzi
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cameron M Willson
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Disha Jain
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah E Martin
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leonard S Weiss
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Patterson PD, Okerman TS, Roach DGL, Weaver MD, Patterson CG, Martin SE, Okwiya N, Nong L, Eyiba C, Huff JR, Ruzicka A, Ruggieri J, McIlvaine Q, Weiss LS. Effect of Short versus Long Duration Naps on Blood Pressure during Simulated Night Shift Work: A Randomized Crossover Trial. PREHOSP EMERG CARE 2023; 27:815-824. [PMID: 37347964 DOI: 10.1080/10903127.2023.2227891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Blunting of the sleep-related dip in blood pressure (BP) has been linked to numerous cardiovascular outcomes including myocardial infarction. Blunting of BP dipping occurs during night shift work and previous research suggest that a 60-min or longer on-shift nap is needed to restore normal/healthy BP dipping. We sought to determine the effect of different durations of napping on BP during and following simulated night shifts. We hypothesized that the greatest benefit in terms of restoration of normal BP dipping during night shift work would be observed during a longer duration nap versus a shorter nap opportunity. METHODS We used a randomized crossover laboratory-based study design. Participants consented to complete three separate 72-hr conditions that included a 12-hr simulated night shift. Nap conditions included a 30-min and 2-hr nap compared to a no-nap condition. Ambulatory BP monitoring was assessed hourly and every 10-30 mins during in-lab naps. Blunted BP dipping during in-lab naps was the primary outcome. Goal enrollment of 25 (35 with attrition) provided 80% power to detect a mean difference of 5 mmHg in BP between nap conditions. RESULTS Of the 58 screened, 28 were consented, and 26 completed all three 72-hr conditions. More than half (53.6%) were female. Mean age was 24.4 years (SD7.2). Most (85.7%) were certified as emergency medical technicians or paramedics. The mean percentage dip in systolic BP (SBP) and diastolic BP (DBP) did not differ between the 30-min and 2-hr nap conditions (p > 0.05), yet a greater proportion of participants experienced a 10-20% dip in SBP or DBP during the 2-hr nap versus the 30-min nap (p < 0.05). For every additional minute of total sleep during the 30-min nap, the percentage of SBP dip improved by 0.60%, and the percentage of DBP dip improved by 0.68% (p < 0.05). These improvements approximate to a 6% per minute relative advancement toward normal/healthy BP dipping. CONCLUSIONS Restoration of a normal/healthy dip in BP is achievable during short and long duration nap opportunities during simulated night shift work. Our findings support the hypothesis that BP dipping is more common during longer 2-hr versus shorter 30-min naps. TRIAL REGISTRATION ClinicalTrials.gov, NCT04469803. Registered on 9 July 2020.
Collapse
Affiliation(s)
- P Daniel Patterson
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany S Okerman
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David G L Roach
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Charity G Patterson
- School of Health and Rehabilitation Sciences, SHRS Data Center, and Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah E Martin
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas Okwiya
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lily Nong
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chinemeh Eyiba
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordan R Huff
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anna Ruzicka
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julia Ruggieri
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Quentin McIlvaine
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leonard S Weiss
- School of Medicine, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
11
|
Martin-Gill C, Brown KM, Cash RE, Haupt RM, Potts BT, Richards CT, Patterson PD. 2022 Systematic Review of Evidence-Based Guidelines for Prehospital Care. PREHOSP EMERG CARE 2023; 27:131-143. [PMID: 36369826 DOI: 10.1080/10903127.2022.2143603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Multiple national organizations and federal agencies have promoted the development, implementation, and evaluation of evidence-based guidelines (EBGs) for prehospital care. Previous efforts have identified opportunities to improve the quality of prehospital guidelines and highlighted the value of high-quality EBGs to inform initial certification and continued competency activities for EMS personnel. OBJECTIVES We aimed to perform a systematic review of prehospital guidelines published from January 2018 to April 2021, evaluate guideline quality, and identify top-scoring guidelines to facilitate dissemination and educational activities for EMS personnel. METHODS We searched the literature in Ovid Medline and EMBASE from January 2018 to April 2021, excluding guidelines identified in a prior systematic review. Publications were retained if they were relevant to prehospital care, based on organized reviews of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised to identify if they met the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored across the six domains of the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS We identified 75 guidelines addressing a variety of clinical and operational aspects of EMS medicine. About half (n = 39, 52%) addressed time/life-critical conditions and 33 (44%) contained recommendations relevant to non-clinical/operational topics. Fewer than half (n = 35, 47%) were based on systematic reviews of the literature. Nearly one-third (n = 24, 32%) met all NAM criteria for clinical practice guidelines. Only 27 (38%) guidelines scored an average of >75% across AGREE II domains, with content relevant to guideline implementation most commonly missing. CONCLUSIONS This interval systematic review of prehospital EBGs identified many new guidelines relevant to prehospital care; more than all guidelines reported in a prior systematic review. Our review reveals important gaps in the quality of guideline development and the content in their publications, evidenced by the low proportion of guidelines meeting NAM criteria and the scores across AGREE II domains. Efforts to increase guideline dissemination, implementation, and related education may be best focused around the highest quality guidelines identified in this review.
Collapse
Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel M Haupt
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Benjamin T Potts
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
12
|
Powell JR, Browne LR, Guild K, Shah MI, Crowe RP, Lindbeck G, Braithwaite S, Lang ES, Panchal AR. Evidence-Based Guidelines for Prehospital Pain Management: Literature and Methods. PREHOSP EMERG CARE 2023; 27:154-161. [PMID: 34928783 DOI: 10.1080/10903127.2021.2018074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Emergency Medical Services (EMS) clinicians commonly encounter patients with acute pain. A new set of evidence-based guidelines (EBG) was developed to assist in the prehospital management of pain. Our objective was to describe the methods used to develop these evidence-based guidelines for prehospital pain management. METHODS The EBG development process was supported by a previous systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) covering nine different population, intervention, comparison, and outcome (PICO) questions. A technical expert panel (TEP) was formed and added an additional pediatric-specific PICO question. Identified evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and tabulated into Summary of Findings tables. The TEP then utilized a rigorous systematic method, including the PanelVoice function, for recommendation development which was applied to generate Evidence to Decision Tables (EtD). This process involved review of the Summary of Findings tables, asynchronous member judging, and facilitated panel discussion to generate final consensus-based recommendations. RESULTS The work product described above was completed by the TEP panel from September 2020 to April 2021. For these recommendations, the overall certainty of evidence was very low or low, data for decisions on cost effectiveness and equity were lacking, and feasibility was rated well across all categories. Based on the evidence, one strong and seven conditional recommendations were made, with two PICO questions lacking sufficient evidence to generate a recommendation. CONCLUSION We describe a protocol that leveraged established EBG development techniques, the GRADE framework in conjunction with a previous AHRQ systematic review to develop treatment recommendations for prehospital pain management. This process allowed for mitigation of many confounders due to the use of virtual and electronic communication. Our approach may inform future guideline development and increase transparency in the prehospital recommendations development processes.
Collapse
Affiliation(s)
- Jonathan R Powell
- National Registry of Emergency Medical Technicians, Columbus, Ohio.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Lorin R Browne
- Medical College of Wisconsin, Milwaukee County EMS, Milwaukee, Wisconsin
| | - Kyle Guild
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Manish I Shah
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - George Lindbeck
- Office of Emergency Medical Services, Virginia Department of Health, and the Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sabina Braithwaite
- Missouri Department of Health and Senior Services, and the Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Eddy S Lang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Ashish R Panchal
- National Registry of Emergency Medical Technicians, Columbus, Ohio.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.,Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | |
Collapse
|
13
|
Martin-Gill C, Panchal AR, Cash RE, Richards CT, Brown KM, Patterson PD. Recommendations for Improving the Quality of Prehospital Evidence-Based Guidelines. PREHOSP EMERG CARE 2023; 27:121-130. [PMID: 36369888 DOI: 10.1080/10903127.2022.2142992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Evidence-based guidelines that provide recommendations for clinical care or operations are increasingly being published to inform the EMS community. The quality of evidence evaluation and methodological rigor undertaken to develop and publish these recommendations vary. This can negatively affect dissemination, education, and implementation efforts. Guideline developers and end users could be better informed by efforts across medical specialties to improve the quality of guidelines, including the use of specific criteria that have been identified within the highest quality guidelines. In this special contribution, we aim to describe the current state of published guidelines available to the EMS community informed by two recent systematic reviews of existing prehospital evidenced based guidelines (EBGs). We further aim to provide a description of key elements of EBGs, methods that can be used to assess their quality, and concrete recommendations for guideline developers to improve the quality of evidence evaluation, guideline development, and reporting. Finally, we outline six key recommendations for improving prehospital EBGs, informed by systematic reviews of prehospital guidelines performed by the Prehospital Guidelines Consortium.
Collapse
Affiliation(s)
- Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen M Brown
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
14
|
Patterson PD, Martin SE, Brassil BN, Hsiao WH, Weaver MD, Okerman TS, Seitz SN, Patterson CG, Robinson K. The Emergency Medical Services Sleep Health Study: A cluster-randomized trial. Sleep Health 2023; 9:64-76. [PMID: 36372657 DOI: 10.1016/j.sleh.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Greater than half of emergency medical services (EMS) clinician shift workers report poor sleep, fatigue, and inadequate recovery between shifts. We hypothesized that EMS clinicians randomized to receive tailored sleep health education would have improved sleep quality and less fatigue compared to wait-list controls after 3 months. METHODS We used a cluster-randomized, 2-arm, wait-list control study design (clinicaltrials.gov identifier: NCT04218279). Recruitment of EMS agencies (clusters) was nationwide. Our study was powered at 88% to detect a 0.4 standard deviation difference in sleep quality with 20 agencies per arm and a minimum of 10 individuals per agency. The primary outcome was measured using the Pittsburgh Sleep Quality Index (PSQI) at 3-month follow-up. Our intervention was accessible in an online, asynchronous format and comprised of 10 brief education modules that address fatigue mitigation topics prescribed by the American College of Occupational Environmental Medicine. RESULTS In total, 36 EMS agencies and 678 individuals enrolled. Attrition at 3 months did not differ by study group (Intervention = 17.4% vs. Wait-list control = 18.2%; p = .37). Intention-to-treat analyses detected no differences in PSQI and fatigue scores at 3 months. Per protocol analyses showed the greater the number of education modules viewed, the greater the improvement in sleep quality and the greater the reduction in fatigue (p < .05). CONCLUSIONS While intention-to-treat analyses revealed no differences in sleep quality or fatigue at 3 months, per protocol findings identified select groups of EMS clinician shift workers who may benefit from sleep health education. Our findings may inform fatigue risk management programs.
Collapse
Affiliation(s)
- P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, Pennsylvania, USA.
| | - Sarah E Martin
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Bridget N Brassil
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Wei-Hsin Hsiao
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, Massachusetts, USA; Harvard Medical School, Division of Sleep Medicine, Boston, Massachusetts, USA
| | - Tiffany S Okerman
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Staci N Seitz
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Charity G Patterson
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Department of Physical Therapy, Pittsburgh, Pennsylvania, USA
| | - Kathy Robinson
- National Association of State EMS Officials (NASEMSO), Falls Church, Virginia, USA
| |
Collapse
|
15
|
D King G, Pan E, Millin MG. Wilderness First Responder Medical Clearance - A Scoping Review with Recommendations. PREHOSP EMERG CARE 2023; 28:50-75. [PMID: 36595615 DOI: 10.1080/10903127.2022.2162650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Due to environmental extremes, as well as the nature of the work itself, wilderness first responders are at risk of incurring medical events in the line of duty. There currently do not exist standardized and scientifically supported methods to screen for a wilderness first responder's risk of incurring a medical event. METHODS We performed multiple scoping reviews using PubMed and CINAHL. The reviews covered six medical screening criteria based on previous recommendations from the National Fire Protection Association (NFPA) and the US Forest Service, and we grouped our reviews into two categories: articles that addressed objective screening criteria, and articles that addressed subjective findings with the first responder. RESULTS Of the objective criteria, our reviews identified 21 articles addressing the ability to screen for risk of incurring a medical event by evaluation of a first responder's heart rate, 12 by blood pressure assessment, and 56 by assessment of body temperature. Of the subjective criteria we identified 19 articles focused on self-assessment, 34 articles on the use of standardized tools to assess for fatigue and sleepiness, and two articles on assessment of a first responder's urine to determine level of dehydration. We also identified seven additional articles through a hand search. Overall, there were 151 articles identified in our scoping reviews. These articles were largely of low quality, consisting mostly of case series without comparison groups. CONCLUSION There is a dearth of high-quality research into the medical assessment of first responders. We recommend that this paper, and measures discussed within it, be used as a starting point in the development of an evidence-based assessment protocol for wilderness first responders. We also recommend the development of a national database of medical events incurred by wilderness first responders to facilitate higher-quality research of screening protocols in this community.
Collapse
Affiliation(s)
- Gregory D King
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Maryland and Mid-Atlantic Wilderness Rescue Squad, Inc./Austere Medical Professionals, Dayton, Maryland, USA
| | - Erik Pan
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Maryland and Mid-Atlantic Wilderness Rescue Squad, Inc./Austere Medical Professionals, Dayton, Maryland, USA
| | - Michael G Millin
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Maryland and Mid-Atlantic Wilderness Rescue Squad, Inc./Austere Medical Professionals, Dayton, Maryland, USA
| |
Collapse
|
16
|
Allison P, Tiesman HM, Wong IS, Bernzweig D, James L, James SM, Navarro KM, Patterson PD. Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research. Am J Ind Med 2022; 65:878-897. [PMID: 35711032 PMCID: PMC9851314 DOI: 10.1002/ajim.23407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
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.
Collapse
Affiliation(s)
- Penelope Allison
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Hope M. Tiesman
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Imelda S. Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David Bernzweig
- Ohio Association of Professional Fire Fighters, Columbus, Ohio, USA
| | - Lois James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Stephen M. James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Kathleen M. Navarro
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
17
|
Work schedule and seasonal influences on sleep and fatigue in helicopter and fixed-wing aircraft operations in extreme environments. Sci Rep 2022; 12:8263. [PMID: 35585079 PMCID: PMC9117332 DOI: 10.1038/s41598-022-08996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Sleep and fatigue were investigated in aviation search and rescue, firefighting, emergency medical services and offshore transfer operations in 210 participants, for 21 days each, across 17 datasets in seven countries. Sleep data were collected using wrist-worn actigraphs and sleep diaries. Sustained attention was assessed using a 5-min Psychomotor Vigilance Task (PVT). Duty information was provided from corporate IT systems. Despite the number of 24 h operations, most work occurred during daytime hours, and most sleep occurred at night. There were seasonal changes in work and sleep patterns, with naps used to augment total sleep time. The proportion of sleep occurring during duty varied from zero to 30%. Differences in PVT response times were trivial to small. Legislation that defines flight, duty time and minimum rest limits assume that sleep is not obtained during duty periods, apart from some napping under Fatigue Risk Management Systems (FRMS). However, especially in cases where the aviation service requires waiting for tasks (e.g. search and rescue, emergency medical response), this assumption may not always hold. FRMS should accommodate different modes of working that safely facilitate sleep during duty time where appropriate.
Collapse
|
18
|
Hruska B, Anderson L, Barduhn MS. Multilevel analysis of sleep quality and anger in emergency medical service workers. Sleep Health 2022; 8:303-310. [PMID: 35450834 DOI: 10.1016/j.sleh.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Poor sleep quality characterizes the emergency medical service (EMS) profession. Anger is particularly affected by sleep disturbance and may be related to sleep quality at both between- and within-person levels, yet this has never been examined. The current study performed a multilevel analysis of the relationship between sleep quality and anger among EMS workers. DESIGN Ecological momentary assessment PARTICIPANTS: Seventy-nine EMS workers employed at an emergency medical service provider in Central New York. MEASUREMENTS Participants completed 8 daily assessments that inquired about sleep quality and anger. RESULTS EMS workers who typically experienced poorer sleep quality reported greater anger levels; for instance, workers who routinely experienced poor sleep quality reported anger levels that were 18%-35% higher compared to workers receiving fair sleep quality. Regardless of their typical sleep quality, days when workers experienced poorer sleep than usual was characterized by higher levels of anger: on a day when a worker experienced poorer sleep quality than usual for them, their anger levels were 5% higher on that day regardless of their typical sleep quality. CONCLUSIONS EMS workers regularly experiencing poor sleep quality experience more anger. However, even workers who typically have better sleep quality experience anger elevations following poor sleep. These findings suggest that interventions targeting both between- and within-person factors impacting sleep may be important for addressing sleep quality's influence on anger in the EMS profession.
Collapse
Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA.
| | - Lauren Anderson
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| | | |
Collapse
|
19
|
Barth J, Greene JA, Goldstein J, Sibley A. Adverse Health Effects Related to Shift Work Patterns and Work Schedule Tolerance in Emergency Medical Services Personnel: A Scoping Review. Cureus 2022; 14:e23730. [PMID: 35509733 PMCID: PMC9060748 DOI: 10.7759/cureus.23730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
|
20
|
Basner M, Smith MG, McCauley P, Van Dongen HPA. Seasonal night-work with extended hours and transmeridian travel: An analysis of global fatigue-related sleigh crash risk. Sleep Health 2021; 8:3-6. [PMID: 34920975 DOI: 10.1016/j.sleh.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael G Smith
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Peter McCauley
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| |
Collapse
|
21
|
Gurubhagavatula I, Barger LK, Barnes CM, Basner M, Boivin DB, Dawson D, Drake CL, Flynn-Evans EE, Mysliwiec V, Patterson PD, Reid KJ, Samuels C, Shattuck NL, Kazmi U, Carandang G, Heald JL, Van Dongen HP. Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society. J Clin Sleep Med 2021; 17:2283-2306. [PMID: 34666885 PMCID: PMC8636361 DOI: 10.5664/jcsm.9512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022]
Abstract
CITATION Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.
Collapse
Affiliation(s)
- Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Christopher M. Barnes
- Department of Management and Organization, Foster School of Business, University of Washington, Seattle, WA, USA
| | - Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane B. Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Drew Dawson
- Appleton Institute, Central Queensland University, Wayville, SA, Australia
| | | | - Erin E. Flynn-Evans
- Fatigue Countermeasures Laboratory, NASA Ames Research Center, Moffett Field, CA, USA
| | - Vincent Mysliwiec
- STRONG STAR ORU, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn J. Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Division of Sleep Medicine, Northwestern University, Chicago, IL, USA
| | - Charles Samuels
- Centre for Sleep and Human Performance, Calgary, Alberta, Canada
| | - Nita Lewis Shattuck
- Operations Research Department, Naval Postgraduate School, Monterey, CA, USA
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, IL, USA
| | | | | | - Hans P.A. Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| |
Collapse
|
22
|
Renkiewicz GK, Hubble MW. Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services Personnel. PREHOSP EMERG CARE 2021; 26:652-663. [PMID: 34128453 DOI: 10.1080/10903127.2021.1943578] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Compassion fatigue (CF) is defined as the acute or gradual loss of benevolence that occurs after exposure to critical incident stress. Colloquially referred to as the "cost of caring," CF can affect an individual's future response to stressful situations and is unhealthy for caregivers.Objective: To identify the prevalence and predictors of CF in EMS professionals.Methods: This was a cross-sectional survey of EMS personnel using one-stage area sampling. Nine EMS agencies recruited based on location and geographic region provided data on service area and call mix. Respondents were surveyed in-person during monthly training. The survey evaluated the relationship between CF and psychosocial factors using the Professional Quality of Life Scale (ProQOL). Parametric and non-parametric tests were used where appropriate for the univariate analysis. Those factors significant in the univariate analysis were included in the multivariable analysis. A logistic regression was conducted to determine predictors of CF while controlling for potential confounders.Results: A total of 686 EMS personnel completed the survey. Altogether, 48% had CF, of which 50.8% were male and 14% were minorities. Compared to those without CF, more than 4 times as many respondents with CF (n = 28[8.6%] v. 7[2.0%]) self-reported as currently in counseling and over a third (n = 109[33.1%]) had considered suicide. Irrespective of the presence of CF, one in two knew another EMS professional who had completed suicide. African-American EMS professionals were 3 times more likely to have CF (OR:3.1;p = 0.009). Mean scores on the ProQOL CF subscale were 10 points higher in those with CF compared to those without (27.1[±4.34] v. 17.04[±2.9]). EMS personnel were 48% more likely to have CF if they knew an EMS provider who completed suicide (p = 0.047). Additionally, those with concomitant traumatic stress syndromes, such as vicarious trauma and burnout, were 4.61 and 3.35 times more likely to have CF, respectively.Conclusions: CF is a considerable concern for EMS professionals and there are several modifiable factors that may reduce the prevalence of this cumulative stress syndrome. Additional research should focus on causal factors and mitigation strategies, as well as the individual and agency impact of CF on the prehospital work environment.
Collapse
|
23
|
Gurubhagavatula I, Barger LK, Barnes CM, Basner M, Boivin DB, Dawson D, Drake CL, Flynn-Evans EE, Mysliwiec V, Patterson PD, Reid KJ, Samuels C, Shattuck NL, Kazmi U, Carandang G, Heald JL, Van Dongen HPA. Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society. Sleep 2021; 44:6312566. [PMID: 34373924 DOI: 10.1093/sleep/zsab161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
Risks associated with fatigue that accumulates during work shifts have historically been managed through working time arrangements that specify fixed maximum durations of work shifts and minimum durations of time off. By themselves, such arrangements are not sufficient to curb risks to performance, safety, and health caused by misalignment between work schedules and the biological regulation of waking alertness and sleep. Science-based approaches for determining shift duration and mitigating associated risks, while addressing operational needs, require: (1) a recognition of the factors contributing to fatigue and fatigue-related risks; (2) an understanding of evidence-based countermeasures that may reduce fatigue and/or fatigue-related risks; and (3) an informed approach to selecting workplace-specific strategies for managing work hours. We propose a series of guiding principles to assist stakeholders with designing a shift duration decision-making process that effectively balances the need to meet operational demands with the need to manage fatigue-related risks.
Collapse
Affiliation(s)
- Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Christopher M Barnes
- Department of Management and Organization, Foster School of Business, University of Washington, Seattle, WA, USA
| | - Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane B Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Drew Dawson
- Appleton Institute, Central Queensland University, Wayville, SA, Australia
| | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, NASA Ames Research Center, Moffett Field, CA, USA
| | - Vincent Mysliwiec
- STRONG STAR ORU, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn J Reid
- Center for Circadian and Sleep Medicine, Department of Neurology, Division of Sleep Medicine, Northwestern University, Chicago, IL, USA
| | - Charles Samuels
- Centre for Sleep and Human Performance, Calgary, Alberta, Canada
| | - Nita Lewis Shattuck
- Operations Research Department, Naval Postgraduate School, Monterey, CA, USA
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, IL, USA
| | | | | | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| |
Collapse
|
24
|
Lundholm KR, Honn KA, Skeiky L, Muck RA, Van Dongen HPA. Trait Interindividual Differences in the Magnitude of Subjective Sleepiness from Sleep Inertia. Clocks Sleep 2021; 3:298-311. [PMID: 34204864 PMCID: PMC8293243 DOI: 10.3390/clockssleep3020019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/06/2023] Open
Abstract
In shift work settings and on-call operations, workers may be at risk of sleep inertia when called to action immediately after awakening from sleep. However, individuals may differ substantially in their susceptibility to sleep inertia. We investigated this using data from a laboratory study in which 20 healthy young adults were each exposed to 36 h of total sleep deprivation, preceded by a baseline sleep period and followed by a recovery sleep period, on three separate occasions. In the week prior to each laboratory session and on the corresponding baseline night in the laboratory, participants either extended their sleep period to 12 h/day or restricted it to 6 h/day. During periods of wakefulness in the laboratory, starting right after scheduled awakening, participants completed neurobehavioral tests every 2 h. Testing included the Karolinska Sleepiness Scale to measure subjective sleepiness, for which the data were analyzed with nonlinear mixed-effects regression to quantify sleep inertia. This revealed considerable interindividual differences in the magnitude of sleep inertia, which were highly stable within individuals after both baseline and recovery sleep periods, regardless of study condition. Our results demonstrate that interindividual differences in subjective sleepiness due to sleep inertia are substantial and constitute a trait.
Collapse
Affiliation(s)
| | | | | | | | - Hans P. A. Van Dongen
- Sleep and Performance Research Center & Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA; (K.R.L.); (K.A.H.); (L.S.); (R.A.M.)
| |
Collapse
|
25
|
Patterson PD, Liszka MK, Mcilvaine QS, Nong L, Weaver MD, Turner RL, Platt TE, Opitz SE, Guyette FX, Martin-Gill C, Weiss LS, Buysse DJ, Callaway CW. Does the evidence support brief (≤30-mins), moderate (31-60-mins), or long duration naps (61+ mins) on the night shift? A systematic review. Sleep Med Rev 2021; 59:101509. [PMID: 34116386 DOI: 10.1016/j.smrv.2021.101509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022]
Abstract
We performed a systematic review of four databases to determine if the evidence supports a short or long duration nap during night shifts to mitigate fatigue, and/or improve health, safety, or performance for emergency services and public safety personnel (PROSPERO CRD42020156780). We focused on experimental research and evaluated the quality of evidence with the grading of recommendations, assessment, development, and evaluation (GRADE) framework. We used the Cochrane Collaboration's risk of bias tool to assess bias and reported findings using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Our search yielded n = 10,345 records and n = 44 were reviewed in full-text. Inter-rater agreement during screening was substantial (Kappa = 0.66). We retained n = 11 publications, reporting on n = 7 experimental studies with a cumulative sample size of n = 140. We identified wide variation in study design, napping interventions (i.e., timing, placement, and duration), and outcomes. We identified mixed findings comparing brief, moderate, and long duration naps on outcomes of interest. All seven studies presented serious risk of bias and the quality of evidence was rated as low. Based on the best available evidence, decisions regarding nap duration during night shift work should be based on time (post-nap) and outcome.
Collapse
Affiliation(s)
- P Daniel Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA.
| | - Mary K Liszka
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Quentin S Mcilvaine
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Lily Nong
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Matthew D Weaver
- Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Boston, MA, 02115, USA; Harvard Medical School, Division of Sleep Medicine, Boston, MA, 02115, USA
| | - Rose L Turner
- University of Pittsburgh, Health Sciences Library System, Pittsburgh, PA, 15261, USA
| | - Thomas E Platt
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA
| | - Samantha E Opitz
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Francis X Guyette
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Christian Martin-Gill
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Leonard S Weiss
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Daniel J Buysse
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15261, USA
| | - Clifton W Callaway
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| |
Collapse
|
26
|
Patterson PD, Martin-Gill C, Buysse DJ. Commentary on Dawson et al.: Fatigue risk management in emergency services personnel. Sleep Med Rev 2021; 57:101484. [PMID: 33865012 DOI: 10.1016/j.smrv.2021.101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Paul D Patterson
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA; University of Pittsburgh, School of Health and Rehabilitation Sciences, Division of Community Health Services, Emergency Medicine Program, Pittsburgh, PA, 15261, USA.
| | - Christian Martin-Gill
- University of Pittsburgh, School of Medicine, Department of Emergency Medicine, Pittsburgh, PA, 15261, USA
| | - Daniel J Buysse
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15261, USA
| |
Collapse
|
27
|
Thompson BJ. Fatigue and the Female Nurse: A Narrative Review of the Current State of Research and Future Directions. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:53-61. [PMID: 33786531 PMCID: PMC8006794 DOI: 10.1089/whr.2020.0107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
Background: The female nurse exhibits a multitude of personal and environmental characteristics that renders this population especially prone to fatigue. The consequences of fatigue in nurses are widespread and impactful at the personal, organizational, and societal levels. These include high injury rates and burnout in the nurse and poor patient and organizational outcomes. Objective: This article discusses the implications of fatigue in female nurses, including the impacts of fatigue across multiple entities (e.g., worker, patient, organization). It also reviews the current state of the research, including recent work on nurse fatigue and work schedule characteristics, and key areas for future work that would help empirically establish approaches to counter the detrimental and widespread effects of fatigue. Method: A narrative literature review was conducted resulting from an analysis of the literature limited to peer-reviewed studies. Results: A confluence of factors combines to elevate the prevalence and risk of fatigue in the female nurse. Numerous measures have established that performance-based fatigue results from nursing work schedules in nurses. Data also demonstrate that fatigue accumulates across successive shifts. Recent evidence supports the use of objective fatigue measures, including psychomotor reaction time and muscle function-related variables. Current gaps in the literature are delineated in the text. Conclusions: Strategic and well-designed research studies, as well as recent technological advances in fatigue tracking tools have the potential to help workers, administrators, and organizations develop fatigue management programs that could reduce the heavy burdens of fatigue on a multitude of health, safety, and economical outcomes.
Collapse
Affiliation(s)
- Brennan J Thompson
- Kinesiology and Health Science Department, Utah State University, Logan, Utah, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, Utah, USA
| |
Collapse
|
28
|
Patterson PD, Weiss LS, Weaver MD, Salcido DD, Opitz SE, Okerman TS, Smida TT, Martin SE, Guyette FX, Martin-Gill C, Callaway CW. Napping on the night shift and its impact on blood pressure and heart rate variability among emergency medical services workers: study protocol for a randomized crossover trial. Trials 2021; 22:212. [PMID: 33726840 PMCID: PMC7962082 DOI: 10.1186/s13063-021-05161-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/27/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is an emerging body of evidence that links exposure to shift work to cardiovascular disease (CVD). The risk of coronary events, such as myocardial infarction, is greater among night shift workers compared to day workers. There is reason to believe that repeated exposure to shift work, especially night shift work, creates alterations in normal circadian patterns of blood pressure (BP) and heart rate variability (HRV) and that these alterations contribute to increased risk of CVD. Recent data suggest that allowing shift workers to nap during night shifts may help to normalize BP and HRV patterns and, over time, reduce the risk of CVD. The risk of CVD related to shift work is elevated for emergency medical services (EMS) shift workers due in part to long-duration shifts, frequent use of night shifts, and a high prevalence of multiple jobs. METHODS We will use a randomized crossover trial study design with three study conditions. The targeted population is comprised of EMS clinician shift workers, and our goal enrollment is 35 total participants with an estimated 10 of the 35 enrolled not completing the study protocol or classified as lost to attrition. All three conditions will involve continuous monitoring over 72 h and will begin with a 36-h at-home period, followed by 24 total hours in the lab (including a 12-h simulated night shift), ending with 12 h at home. The key difference between the three conditions is the intra-shift nap. Condition 1 will involve a simulated 12-h night shift with total sleep deprivation. Condition 2 will involve a simulated 12-h night shift and a 30-min nap opportunity. Condition 3 will involve a simulated 12-h night shift with a 2-h nap opportunity. Our primary outcomes of interest include blunted BP dipping and reduced HRV as measured by the standard deviation of the inter-beat intervals of normal sinus beats. Non-dipping status will be defined as sleep hours BP dip of less than 10%. DISCUSSION Our study will address two indicators of cardiovascular health and determine if shorter or longer duration naps during night shifts have a clinically meaningful impact. TRIAL REGISTRATION ClinicalTrials.gov NCT04469803 . Registered on 9 July 2020.
Collapse
Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
- Division of Community Health Services, Emergency Medicine Program, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA 15261 USA
| | - Leonard S. Weiss
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115 USA
- Harvard Medical School, Division of Sleep Medicine, Boston, MA 02115 USA
| | - David D. Salcido
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Samantha E. Opitz
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Tiffany S. Okerman
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
- Division of Community Health Services, Emergency Medicine Program, University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA 15261 USA
| | - Tanner T. Smida
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Sarah E. Martin
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Francis X. Guyette
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| | - Clifton W. Callaway
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Ave., Iroquois Building, Suite 400A, Pittsburgh, PA 15261 USA
| |
Collapse
|
29
|
Richards CT, Fishe JN, Cash RE, Rivard MK, Brown KM, Martin-Gill C, Panchal AR. Priorities for Prehospital Evidence-Based Guideline Development: A Modified Delphi Analysis. PREHOSP EMERG CARE 2021; 26:286-304. [PMID: 33625309 DOI: 10.1080/10903127.2021.1894276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Few areas of prehospital care are supported by evidence-based guidelines (EBGs). We aimed to identify gaps in clinical and operational prehospital EBGs to prioritize future EBG development and research funding. Methods: Using modified Delphi methodology, we sought consensus among experts in prehospital care and EBG development. Five rounds of surveys were administered between October 2019 and February 2020. Round 1 asked participants to list the top three gaps in prehospital clinical guidelines and top three gaps in operational guidelines that should be prioritized for guideline development and research funding. Based on responses, 3 reviewers performed thematic analysis to develop a list of prehospital EBG gaps, with participant feedback in Round 2. In Round 3, participants rated each gap's importance using a 5-point Likert scale, and participants' responses were averaged. In Round 4, participants rank-ordered 10 gaps with the highest mean scores identified in Round 3. In Round 5, participants indicated their agreement with sets of the highest ranked gaps. Results: Of 23 invited participants, 14 completed all 5 rounds. In Rounds 1 and 2, participants submitted 65 clinical and 58 operational gaps, and thematic analysis identified 23 unique clinical gaps and 28 unique operational gaps. The final prioritized list of clinical EBG gaps was: 1) airway management in adult and pediatric patients, 2) care of the pediatric patient, and 3) management of prehospital behavioral health emergencies, with 79% of participants agreeing. The final prioritized list of operational EBG gaps was: 1) define and measure the impact of EMS care on patient outcomes, 2) practitioner wellness, and 3) practitioner safety in the out-of-hospital environment, with 86% of participants agreeing. Conclusions: This modified Delphi study identifies gaps in prehospital EBGs that, if prioritized for development and research funding, would be expected to have the greatest impact on prehospital clinical care and operations.
Collapse
|
30
|
Magnavita N, Soave PM, Ricciardi W, Antonelli M. Occupational Stress and Mental Health among Anesthetists during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218245. [PMID: 33171618 PMCID: PMC7664621 DOI: 10.3390/ijerph17218245] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
Anesthetist-intensivists who treat patients with coronavirus disease 19 (COVID-19) are exposed to significant biological and psychosocial risks. Our study investigated the occupational and health conditions of anesthesiologists in a COVID-19 hub hospital in Latium, Italy. Ninety out of a total of 155 eligible workers (59%; male 48%) participated in the cross-sectional survey. Occupational stress was assessed with the Effort Reward Imbalance (ERI) questionnaire, organizational justice with the Colquitt Scale, insomnia with the Sleep Condition Indicator (SCI), and mental health with the Goldberg Anxiety and Depression Scale (GADS). A considerable percentage of workers (71.1%) reported high work-related stress, with an imbalance between high effort and low rewards. The level of perceived organizational justice was modest. Physical activity and meditation—the behaviors most commonly adopted to increase resilience—decreased. Workers also reported insomnia (36.7%), anxiety (27.8%), and depression (51.1%). The effort made for work was significantly correlated with the presence of depressive symptoms (r = 0.396). Anesthetists need to be in good health in order to ensure optimal care for COVID-19 patients. Their state of health can be improved by providing an increase in individual resources with interventions for better work organization.
Collapse
Affiliation(s)
- Nicola Magnavita
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Woman/Child & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence: ; Tel.: +39-3473300367
| | - Paolo Maurizio Soave
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Walter Ricciardi
- Department of Woman/Child & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Massimo Antonelli
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| |
Collapse
|
31
|
|
32
|
Patterson PD, Weaver MD, Guyette FX, Martin‐Gill C. Should public safety shift workers be allowed to nap while on duty? Am J Ind Med 2020; 63:843-850. [PMID: 32761915 PMCID: PMC7540594 DOI: 10.1002/ajim.23164] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
Fatigue and sleep deficiency among public safety personnel are threats to wellness, public and personal safety, and workforce retention. Napping strategies may reduce work-related fatigue, improve safety and health, yet in some public safety organizations it is discouraged or prohibited. Our aim with this commentary is to define intra-shift napping, summarize arguments for and against it, and to outline potential applications of this important fatigue mitigation strategy supported by evidence. We focus our discussion on emergency medical services (EMS); a key component of the public safety system, which is comprised of police, fire, and EMS. The personnel who work in EMS stand to benefit from intra-shift napping due to frequent use of extended duration shifts, a high prevalence of personnel working multiple jobs, and evidence showing that greater than half of EMS personnel report severe fatigue, poor sleep quality, inadequate inter-shift recovery, and excessive daytime sleepiness. The benefits of intra-shift napping include decreased sleepiness and fatigue, improved recovery between shifts, decreased anxiety, and reduced feelings of burnout. Intra-shift napping also mitigates alterations in clinician blood pressure associated with disturbed sleep and shift work. The negative consequences of napping include negative public perception, acute performance deficits stemming from sleep inertia, and the potential costs associated with reduced performance. While there are valid arguments against intra-shift napping, we believe that the available scientific evidence favors it as a key component of fatigue mitigation and workplace wellness. We further believe that these arguments extend beyond EMS to all sectors of public safety.
Collapse
Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
- Division of Community Health Services, Emergency Medicine Program, School of Health and Rehabilitation Sciences University of Pittsburgh Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders Brigham and Women's Hospital Boston Massachusetts
- Division of Sleep Medicine Harvard Medical School Boston Massachusetts
| | - Francis X. Guyette
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
| | - Christian Martin‐Gill
- Department of Emergency Medicine, School of Medicine University of Pittsburgh Pittsburgh Pennsylvania
| |
Collapse
|
33
|
Donnelly EA, Bradford P, Davis M, Hedges C, Socha D, Morassutti P, Pichika SC. What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes. J Am Coll Emerg Physicians Open 2020; 1:460-473. [PMID: 33000071 PMCID: PMC7493488 DOI: 10.1002/emp2.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes. METHODS A cross-sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post-traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non-responder survey was conducted to asses for demographic differences in those who did and did not complete the survey. RESULTS This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes. CONCLUSION These findings illustrate that a host of different stressors may influence safety-related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.
Collapse
Affiliation(s)
| | - Paul Bradford
- Department of Emergency Medicine Windsor Regional Hospital Southwest Ontario Regional Base Hospital Program University of Western Ontario London Ontario Canada
| | - Matthew Davis
- Division of Emergency Medicine Southwest Ontario Regional Base Hospital Program University of Western Ontario London Ontario Canada
| | | | - Doug Socha
- Hastings-Quinte Paramedic Services Belleville Ontario Canada
| | - Peter Morassutti
- Southwest Ontario Regional Base Hospital Program-Windsor Site Windsor Ontario Canada
| | | |
Collapse
|
34
|
Friedman NMG, Dingler BJ, Gorstein LN, Epstein JA. Implementation of a Mental Health Task Force in a collegiate-based emergency medical services organization. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:460-464. [PMID: 30946625 DOI: 10.1080/07448481.2019.1583654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/25/2018] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
Objective: A Mental Health Task Force (MHTF) was implemented in 2016 by a collegiate-based emergency medical services (CBEMS) organization to (1) improve mental health emergency response and to (2) address concerns for the mental health of CBEMS providers. Participants: Skidmore College EMS is a Basic Life Support First Response service staffed by volunteer undergraduate students. Methods: In coordination with faculty and staff, students in the MHTF developed trainings, peer support structures, community events, policies, and informational resources. Results: Sixteen students joined the MHTF within 1 year. Over 35 Skidmore College EMS members received training on mental health emergency response, peer-support, and self-care. Debriefing programs, mindfulness-based events, shift-length limitations, and access to informational resources promoted the mental health of Skidmore College EMS members. Conclusions: Implementing an MHTF is an innovative, student-led approach to coupling education on emergency response with programming that supports the mental health of CBEMS providers.
Collapse
Affiliation(s)
- Nicholas M G Friedman
- Skidmore College Emergency Medical Services, Skidmore College, Saratoga Springs, New York, USA
- National Collegiate Emergency Medical Services Foundation, West Sand Lake, New York, USA
| | - Brittany J Dingler
- Skidmore College Emergency Medical Services, Skidmore College, Saratoga Springs, New York, USA
- National Collegiate Emergency Medical Services Foundation, West Sand Lake, New York, USA
- Physician Assistant Program, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA
| | - Lauren N Gorstein
- Skidmore College Emergency Medical Services, Skidmore College, Saratoga Springs, New York, USA
- Department of Sociology, Skidmore College, Saratoga Springs, New York, USA
| | - Jesse A Epstein
- Skidmore College Emergency Medical Services, Skidmore College, Saratoga Springs, New York, USA
| |
Collapse
|
35
|
Khan WAA, Conduit R, Kennedy GA, Abdullah Alslamah A, Ahmad Alsuwayeh M, Jackson ML. Sleep and Mental Health among Paramedics from Australia and Saudi Arabia: A Comparison Study. Clocks Sleep 2020; 2:246-257. [PMID: 33089203 PMCID: PMC7445850 DOI: 10.3390/clockssleep2020019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Paramedics face many challenges while on duty, one of which is working different types of shifts. Shift work has been linked to a number of health issues such as insomnia, depression, and anxiety. Besides shift work, Saudi paramedics, a group that has not been investigated for sleep or mental health issues previously, may be facing more demands than Australian paramedics due to lower numbers of paramedics in comparison to the general population. The aim of this study was to investigate the prevalence of sleep and mental health disorders among paramedics in Saudi Arabia and Australia. Paramedics were invited to complete a survey to assess stress, post-traumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift work disorder, obstructive sleep apnoea, fatigue, and general health. A total of 104 males Saudi paramedics (M age = 32.5 ± 6.1 years) and 83 males paramedics from Australia (M age = 44.1 ± 12.1 years) responded to the survey. Significantly higher rates of depression, PTSD, insomnia, and fatigue, along with significantly poorer physical functioning were observed among Saudi paramedics in comparison with Australian paramedics. However, Australian paramedics reported significantly poorer sleep quality and general health in comparison to Saudi paramedics. After removing the effect of driving and working durations, outcomes were no longer significant. The higher burden of depression and PTSD among Saudi paramedics may be explained by longer hours spent driving and longer work durations reported by this group. Taking into consideration the outcomes reported in this study, more investigations are needed to study their possible effects on paramedics' cognition, performance, and safety.
Collapse
Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, P.O. Box 715, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
| | - Gerard A Kennedy
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Psychology, Federation University Australia, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC 3084, Australia;
| | - Ahmed Abdullah Alslamah
- General Supervisor of Emergency Medical Services Affairs, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Mohammad Ahmad Alsuwayeh
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Melinda L Jackson
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| |
Collapse
|
36
|
Impact of shift work on blood pressure among emergency medical services clinicians and related shift workers: A systematic review and meta-analysis. Sleep Health 2020; 6:387-398. [DOI: 10.1016/j.sleh.2020.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/21/2020] [Accepted: 03/11/2020] [Indexed: 01/29/2023]
|
37
|
Turner S, Lang ES, Brown K, Franke J, Workun-Hill M, Jackson C, Roberts L, Leyton C, Bulger EM, Censullo EM, Martin-Gill C. Systematic Review of Evidence-Based Guidelines for Prehospital Care. PREHOSP EMERG CARE 2020; 25:221-234. [PMID: 32286899 DOI: 10.1080/10903127.2020.1754978] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Introduction: Multiple national organizations have identified a need to incorporate more evidence-based medicine in emergency medical services (EMS) through the creation of evidence-based guidelines (EBGs). Tools like the Appraisal of Guidelines for Research and Evaluation (AGREE) II and criteria outlined by the National Academy of Medicine (NAM) have established concrete recommendations for the development of high-quality guidelines. While many guidelines have been created that address topics within EMS medicine, neither the quantity nor quality of prehospital EBGs have been previously reported. Objectives: To perform a systematic review to identify existing EBGs related to prehospital care and evaluate the quality of these guidelines using the AGREE II tool and criteria for clinical guidelines described by the NAM. Methods: We performed a systematic search of the literature in MEDLINE, EMBASE, PubMED, Trip, and guidelines.gov, through September 2018. Guideline topics were categorized based on the 2019 Core Content of EMS Medicine. Two independent reviewers screened titles for relevance and then abstracts for essential guideline features. Included guidelines were appraised with the AGREE II tool across 6 domains by 3 independent reviewers and scores averaged. Two additional reviewers determined if each guideline reported the key elements of clinical practice guidelines recommended by the NAM via consensus. Results: We identified 71 guidelines, of which 89% addressed clinical aspects of EMS medicine. Only 9 guidelines scored >75% across AGREE II domains and most (63%) scored between 50 and 75%. Domain 4 (Clarity of Presentation) had the highest (79.7%) and domain 5 (Applicability) had the lowest average score across EMS guidelines. Only 38% of EMS guidelines included a reporting of all criteria identified by the NAM for clinical practice guidelines, with elements of a systematic review of the literature most commonly missing. Conclusions: EBGs exist addressing a variety of topics in EMS medicine. This systematic review and appraisal of EMS guidelines identified a wide range in the quality of these guidelines and variable reporting of key elements of clinical guidelines. Future guideline developers should consider established methodological and reporting recommendations to improve the quality of EMS guidelines.
Collapse
|
38
|
Crowe RP, Fernandez AR, Pepe PE, Cash RE, Rivard MK, Wronski R, Anderson SE, Hogan TH, Andridge RR, Panchal AR, Ferketich AK. The association of job demands and resources with burnout among emergency medical services professionals. J Am Coll Emerg Physicians Open 2020; 1:6-16. [PMID: 33000008 PMCID: PMC7493511 DOI: 10.1002/emp2.12014] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Although burnout has been linked to negative workplace-level effects, prior studies have primarily focused on individuals rather than job-related characteristics. This study sought to evaluate variation in burnout between agencies and to quantify the relationship between burnout and job-related demands/resources among emergency medical services (EMS) professionals. METHODS An electronic questionnaire was sent to all licensed, practicing EMS professionals in South Carolina. Work-related burnout was measured using the Copenhagen Burnout Inventory. Multivariable generalized estimating equations were used to estimate odds ratios (ORs) for specific job demands and resources while adjusting for confounding variables. Composite scores were used to simultaneously assess the relationship between burnout and job-related demands and resources. RESULTS Among 1271 EMS professionals working at 248 EMS agencies, the median agency-level burnout was 35% (interquartile range [IQR]: 13% to 50%). Job-related demands, including time pressure, were associated with increased burnout. Traditional job-related resources, including pay and benefits, were associated with reduced burnout. Less tangible job resources, including autonomy, clinical performance feedback, social support, and adequate training demonstrated strong associations with reduced burnout. EMS professionals facing high job demands and low job resources demonstrated nearly a 10-fold increase in odds of burnout compared with those exposed to low demands and high resources (adjusted OR [aOR]: 9.50, 95% confidence interval [CI]: 6.39-14.10). High job resources attenuated the impact of high job demands. CONCLUSION The proportion of EMS professionals experiencing burnout varied substantially across EMS agencies. Job resources, including those reflective of organizational culture, were associated with reduced burnout. Collectively, these findings suggest an opportunity to address burnout at the EMS agency level.
Collapse
Affiliation(s)
| | - Antonio R. Fernandez
- ESO IncAustinTexasUSA
- Department of Emergency MedicineSchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Paul E. Pepe
- Metropolitan EMS Medical Directors Global CoalitionFort LauderdaleFloridaUSA
| | - Rebecca E. Cash
- The National Registry of EMTsColumbusOhioUSA
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Madison K. Rivard
- The National Registry of EMTsColumbusOhioUSA
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Robert Wronski
- South Carolina Department of Health and Environmental ControlBureau of EMSColumbiaSouth CarolinaUSA
| | | | - Tory H. Hogan
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | | | - Ashish R. Panchal
- The National Registry of EMTsColumbusOhioUSA
- Wexner Medical CenterThe Ohio State UniversityColumbusOhioUSA
| | - Amy K. Ferketich
- College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
39
|
Berastegui P, Jaspar M, Ghuysen A, Nyssen AS. Fatigue-related risk perception among emergency physicians working extended shifts. APPLIED ERGONOMICS 2020; 82:102914. [PMID: 31422293 DOI: 10.1016/j.apergo.2019.102914] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/07/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
There is a growing body of studies indicating that extended shift duration has an adverse effect on fatigue, consequently leading to reduced work performance and higher risk of accident. Following modern fatigue risk management systems (FRMS), acceptable performance could be maintained by the mobilization of appropriate mitigation strategies. However, the effective deployment of such strategies assume that workers are able to assess their own level of fatigue-related impairments. In this study, we sought to determine whether emergency physicians' subjective feelings of sleepiness could provide accurate knowledge of actual fatigue-related impairments while working extended shifts. We conducted a prospective observational study with a within-subjects repeated measures component. We collected sleep logs, sleepiness ratings and reaction times on a Psychomotor Vigilance Task (PVT) at different time points during shifts. Our results show that the PVT is sensitive to sleep loss and fatigue, with a 10% increase in mean reaction time across the shift. Subjective sleepiness, however, showed no significant association with time since awakening and was not a significant predictor of PVT performance. Our results are consistent with experimental studies showing that individuals tend to underestimate fatigue-related impairments when sleep deprived or functioning under adverse circadian phase. The discrepancy between subjective sleepiness and actual fatigue-related impairments may give workers the illusion of being in control and hinder the deployment of mitigation strategies. Further research is needed to determine the relative weight of circadian phase shifting and cumulative sleep deprivation in the decline of self-knowledge in extended shifts.
Collapse
Affiliation(s)
| | - Mathieu Jaspar
- Cognitive Ergonomics Laboratory, University of Liège, Belgium
| | | | | |
Collapse
|
40
|
Abstract
OBJECTIVES Extant research has established an empirical relationship between fatigue and safety-related outcomes. It is not clear if these findings are relevant to Canadian paramedicine. The purpose of this study was to determine if fatigue and shiftwork variables were related to safety outcomes in Canadian paramedics. METHODS A survey was conducted with ten paramedic services in Ontario with a 40.5% response rate (n = 717). Respondents reported levels of fatigue, safety outcomes (injury, safety compromising behaviours, and medical errors/adverse events), work patterns (types of shifts, hours worked weekly) and demographic characteristics. Univariate and logistic regression analyses were used to assess for significant differences. RESULTS In this sample, 55% of paramedics reported being fatigued at work. Fatigued paramedics were over twice as likely to report injuries, three times as likely to report safety compromising behaviors, and 1.5 times more likely to report errors/adverse outcomes. When controlling for fatigue, shift length variables did not consistently influence safety outcomes. CONCLUSION These results create preliminary evidence of a relationship between fatigue and safety outcomes in Canadian paramedicine. While more research is needed, these findings point to the influence fatigue has on safety outcomes and provide an indication that fatigue mitigation efforts may be worthwhile.
Collapse
|
41
|
Does evidence support “banking/extending sleep” by shift workers to mitigate fatigue, and/or to improve health, safety, or performance? A systematic review. Sleep Health 2019; 5:359-369. [DOI: 10.1016/j.sleh.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 02/21/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022]
|
42
|
Patterson PD, Weaver MD, Markosyan MA, Moore CG, Guyette FX, Doman JM, Sequeira DJ, Werman HA, Swanson D, Hostler D, Lynch J, Templin MA, Rozario NL, Russo L, Hines L, Swecker K, Runyon MS, Buysse DJ. Impact of shift duration on alertness among air-medical emergency care clinician shift workers. Am J Ind Med 2019; 62:325-336. [PMID: 30734328 DOI: 10.1002/ajim.22956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Greater than half of Emergency Medical Services (EMS) shift workers report fatigue at work and most work long duration shifts. We sought to compare the alertness level of EMS shift workers by shift duration. METHODS We used a multi-site, 14-day prospective observational cohort study design of EMS clinician shift workers at four air-medical EMS organizations. The primary outcome was behavioral alertness as measured by psychomotor vigilance tests (PVT) at the start and end of shifts. We stratified shifts by duration (< 24 h and 24 h), night versus day, and examined the impact of intra-shift napping on PVT performance. RESULTS One hundred and twelve individuals participated. The distribution of shifts <24 h and 24 h with complete data were 54% and 46%, respectively. We detected no differences in PVT performance measures stratified by shift duration (P > 0.05). Performance for selected PVT measures (lapses and false starts) was worse on night shifts compared to day shifts (P < 0.05). Performance also worsened with decreasing time between waking from a nap and the end of shift PVT assessment. CONCLUSIONS Deficits in performance in the air-medical setting may be greatest during night shifts and proximal to waking from an intra-shift nap. Future research should examine alertness and performance throughout air-medical shifts, as well as investigate the timing and duration of intra-shift naps on outcomes.
Collapse
Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
- Division of Community Health Services; University of Pittsburgh, School of Health and Rehabilitation Sciences; Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Harvard Medical School, Division of Sleep Medicine, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology; Brigham and Women's Hospital; Boston Massachusetts
| | - Mark A. Markosyan
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
- Division of Community Health Services; University of Pittsburgh, School of Health and Rehabilitation Sciences; Pittsburgh Pennsylvania
| | - Charity G. Moore
- Department of Physical Therapy; University of Pittsburgh; School of Health and Rehabilitation Sciences; Pittsburgh Pennsylvania
| | - Frank X. Guyette
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| | - Jack M. Doman
- Department of Psychiatry, University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| | - Denisse J. Sequeira
- Department of Emergency Medicine; University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| | | | - Doug Swanson
- Carolinas HealthCare System; Charlotte North Carolina
| | - David Hostler
- Department of Exercise and Nutrition Sciences; The State University of New York; University at Buffalo; Buffalo New York
| | - Joshua Lynch
- MercyFlight of Western New York; Buffalo New York
- Department of Emergency Medicine; Jacobs School of Medicine and Biomedical Sciences; The State University of New York; University at Buffalo; Buffalo New York
| | | | | | - Lindsey Russo
- Department of Exercise and Nutrition Sciences; The State University of New York; University at Buffalo; Buffalo New York
| | | | | | | | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh; School of Medicine; Pittsburgh Pennsylvania
| |
Collapse
|
43
|
Thompson BJ. Does work-induced fatigue accumulate across three compressed 12 hour shifts in hospital nurses and aides? PLoS One 2019; 14:e0211715. [PMID: 30730927 PMCID: PMC6366767 DOI: 10.1371/journal.pone.0211715] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/19/2019] [Indexed: 11/19/2022] Open
Abstract
Fatigue-related impairments in the nursing workforce contribute to a multitude of health, safety, and economic consequences at the individual, organizational and societal levels. Long and compressed work schedules are commonly worked in the healthcare industry, but more research is needed to understand the cumulative effects of multiple work shifts on physiology-based performance outcomes in nurses. The purpose of this study was to compare the effects of a single nursing work shift versus three compressed (one every 24 hours) 12 hour shifts on performance-based fatigue in nurses and aides. Twenty-six fulltime hospital working nurses and aides (age = 36.1 ± 13.3 years) reported to the lab for testing before, immediately after working a single 12 hour shift, and after working three 12 hour shifts in a 72 hour period. Outcome measures included vigilance-based reaction time, lapses of attention, and muscle function assessments (lower and upper body muscle strength, explosive strength and vertical jump performance). All variables except hand grip strength showed a significant decline following the three work shifts. The psychomotor vigilance reaction time and lapses of attention variables also generally showed a significant decline from the end of shift one to the end of shift three, indicting an accumulation of fatigue in these metrics with increasing number of shifts worked. Muscle function variables responded early in the duty cycle, showing a significant decline after a single work shift, but did no further decline by the end of the third shift. These findings use objective measures to substantiate that fatigue impairments occur from working a single 12 hour shift, and in several instances, increase further with more successive work shifts. Caution should be employed by personnel and administrators with work schedules involving multiple compressed 12 hour shifts. Fatigue management strategies may be used to improve risks and consequences from fatigue-related mishaps, and this study reports several variables that appear sensitive to identifying and tracking fatigue in this population.
Collapse
Affiliation(s)
- Brennan J. Thompson
- Department of Kinesiology and Health Science, Utah State University, Logan, Utah, United States of America
- Movement Research Suite, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, Utah, United States of America
| |
Collapse
|
44
|
Patterson PD, Moore CG, Guyette FX, Doman JM, Weaver MD, Sequeira DJ, Werman HA, Swanson D, Hostler D, Lynch J, Russo L, Hines L, Swecker K, Kroemer AJ, Runyon MS, Buysse DJ. Real-Time Fatigue Mitigation with Air-Medical Personnel: The SleepTrackTXT2 Randomized Trial. PREHOSP EMERG CARE 2018; 23:465-478. [PMID: 30285519 DOI: 10.1080/10903127.2018.1532476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: The aims of this study were: 1) to determine the short-term impact of the SleepTrackTXT2 intervention on air-medical clinician fatigue during work shifts and 2) determine the longer-term impact on sleep quality over 120 days. Methods: We used a multi-site randomized controlled trial study design with a targeted enrollment of 100 (ClinicalTrials.gov NCT02783027). The intervention was behavioral (non-pharmacological) and participation was scheduled for 120 days. Participation was voluntary. All consented participants answered baseline as well as follow-up surveys. All participants answered text message queries, which assessed self-rated fatigue, sleepiness, concentration, recovery, and hours of sleep. Intervention participants received additional text messages with recommendations for behaviors that can mitigate fatigue. Intervention participants received weekly text messages that promoted sleep. Our analysis was guided by the intent-to-treat principle. For the long-term outcome of interest (sleep quality at 120 days), we used a two-sample t-test on the change in sleep quality to determine the intervention effect. Results: Eighty-three individuals were randomized and 2,828 shifts documented (median shifts per participant =37, IQR 23-49). Seventy-one percent of individuals randomized (n = 59) participated up to the 120-day study period and 52% (n = 43) completed the follow-up survey. Of the 69,530 text messages distributed, participants responded to 61,571 (88.6%). Mean sleep quality at 120 days did not differ from baseline for intervention (p > 0.05) or control group participants (p > 0.05), and did not differ between groups (p > 0.05). There was no change from baseline to 120 days in the proportion with poor sleep quality in either group. Intra-shift fatigue increased (worsened) over the course of 12-hour shifts for participants in both study arms. Fatigue at the end of 12-hour shifts was higher among control group participants than participants in the intervention group (p < 0.05). Pre-shift hours of sleep were often less than 7 hours and did not differ between the groups over time. Conclusions: The SleepTrackTXT2 behavioral intervention showed a positive short-term impact on self-rated fatigue during 12-hour shifts, but did not impact longer duration shifts or have a longer-term impact on sleep quality among air-medical EMS clinicians.
Collapse
|
45
|
Van Dongen HPA. Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services: A Significant Step Forward and a Model for Other High-Risk Industries. PREHOSP EMERG CARE 2018; 22:110-112. [PMID: 29324057 DOI: 10.1080/10903127.2017.1380098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Martin-Gill C, Higgins JS, Van Dongen HPA, Buysse DJ, Thackery RW, Kupas DF, Becker DS, Dean BE, Lindbeck GH, Guyette FX, Penner JH, Violanti JM, Lang ES, Patterson PD. Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services. PREHOSP EMERG CARE 2018; 22:102-109. [DOI: 10.1080/10903127.2017.1381791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
47
|
Myers JB, Wages RK, Rowe D, Nollette C, Touchstone M, Sinclair J, Mund EL, Eberly JM, Montes JD, Sherlock RJ, Barger LK, Drummond SPA, Gurubhagavatula I. What an Evidence-based Guideline for Fatigue Risk Management Means for Us: Statements From Stakeholders. PREHOSP EMERG CARE 2018; 22:113-118. [DOI: 10.1080/10903127.2017.1380100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|