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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.
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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
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Patterson PD, Moore CG, Guyette FX, Doman JM, Sequeira D, Werman HA, Swanson D, Hostler D, Lynch J, Russo L, Hines L, Swecker K, Runyon MS, Buysse DJ. Fatigue mitigation with SleepTrackTXT2 in air medical emergency care systems: study protocol for a randomized controlled trial. Trials 2017; 18:254. [PMID: 28583143 PMCID: PMC5460424 DOI: 10.1186/s13063-017-1999-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 05/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Most air medical Emergency Medical Services (EMS) clinicians work extended duration shifts, and more than 50% report inadequate sleep, poor sleep quality, and/or poor recovery between shifts. The SleepTrackTXT pilot trial (ClinicalTrials.gov, NCT02063737) showed that use of mobile phone text messages could impact EMS clinician self-reported fatigue and sleepiness during long duration shifts. The purpose of the SleepTrackTXT2 trial is to leverage lessons learned from the first SleepTrackTXT study and test an enhanced intervention targeting air medical EMS clinicians. Methods/design We will conduct a multi-site randomized trial with a sample of adult EMS clinicians recruited from four air medical EMS systems located in the midwest, northeastern, and southern USA. Participants will be allocated to one of two possible arms for a 4-month (120-day) study period. The intervention arm will involve text-message assessments of sleepiness, fatigue, and difficulty concentrating at the beginning, every 4 hours during, and at the end of scheduled shifts. Participants reporting high levels of sleepiness, fatigue, or difficulty with concentration will receive one of nine randomly selected intervention messages to promote behavior change during shift work to improve alertness. Intervention participants will receive a text-message report on Friday of each week that shows their sleep debt over the previous 7 days followed by a text message to promote paying back sleep debt recovery when feasible. Participants in the control group receive text messages that only include assessments. Both arms will receive text-message assessments of perceived recovery since last shift, sleepiness, fatigue, or difficulty with concentration at noon (1200 hours) on days between scheduled shifts (off-duty days). We have two aims for this study: (1) to determine the short-term impact of the enhanced SleepTrackTXT2 intervention on air medical clinician fatigue reported in real time during and at the end of shift work, and (2) to determine the long-term impact of the SleepTrackTXT2 intervention on sleep quality and sleep health indicators including hours of sleep and recovery between shift work. Discussion The SleepTrackTXT2 trial may provide evidence of real-world effectiveness that would support widespread expansion of fatigue mitigation interventions in emergency care clinician shift workers. The trial may specifically support use of real-time assessments and interventions delivered via mobile technology such as text messaging. Trial registration ClinicalTrials.gov, NCT02783027. Registered on 23 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1999-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Avenue, Iroquois Bldg, Suite 400A, Pittsburgh, PA, 15260, USA.
| | | | - Frank X Guyette
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Avenue, Iroquois Bldg, Suite 400A, Pittsburgh, PA, 15260, USA
| | - Jack M Doman
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Denisse Sequeira
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, 3600 Forbes Avenue, Iroquois Bldg, Suite 400A, Pittsburgh, PA, 15260, USA
| | | | - Doug Swanson
- MedCenter Air, Department of Emergency Medicine, Carolinas HealthCare System, Charlotte, NC, USA
| | - David Hostler
- Department of Exercise and Nutrition Sciences, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Joshua Lynch
- MercyFlight of Western New York, Buffalo, NY, USA.,Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lindsey Russo
- Department of Exercise and Nutrition Sciences, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | | | | | - Michael S Runyon
- Department of Emergency Medicine, Carolinas HealthCare System, Charlotte, NC, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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Slanger TE, Gross JV, Pinger A, Morfeld P, Bellinger M, Duhme A, Reichardt Ortega RA, Costa G, Driscoll TR, Foster RG, Fritschi L, Sallinen M, Liira J, Erren TC. Person-directed, non-pharmacological interventions for sleepiness at work and sleep disturbances caused by shift work. Cochrane Database Syst Rev 2016; 2016:CD010641. [PMID: 27549931 PMCID: PMC8406755 DOI: 10.1002/14651858.cd010641.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Shift work is often associated with sleepiness and sleep disorders. Person-directed, non-pharmacological interventions may positively influence the impact of shift work on sleep, thereby improving workers' well-being, safety, and health. OBJECTIVES To assess the effects of person-directed, non-pharmacological interventions for reducing sleepiness at work and improving the length and quality of sleep between shifts for shift workers. SEARCH METHODS We searched CENTRAL, MEDLINE Ovid, Embase, Web of Knowledge, ProQuest, PsycINFO, OpenGrey, and OSH-UPDATE from inception to August 2015. We also screened reference lists and conference proceedings and searched the World Health Organization (WHO) Trial register. We contacted experts to obtain unpublished data. SELECTION CRITERIA Randomised controlled trials (RCTs) (including cross-over designs) that investigated the effect of any person-directed, non-pharmacological intervention on sleepiness on-shift or sleep length and sleep quality off-shift in shift workers who also work nights. DATA COLLECTION AND ANALYSIS At least two authors screened titles and abstracts for relevant studies, extracted data, and assessed risk of bias. We contacted authors to obtain missing information. We conducted meta-analyses when pooling of studies was possible. MAIN RESULTS We included 17 relevant trials (with 556 review-relevant participants) which we categorised into three types of interventions: (1) various exposures to bright light (n = 10); (2) various opportunities for napping (n = 4); and (3) other interventions, such as physical exercise or sleep education (n = 3). In most instances, the studies were too heterogeneous to pool. Most of the comparisons yielded low to very low quality evidence. Only one comparison provided moderate quality evidence. Overall, the included studies' results were inconclusive. We present the results regarding sleepiness below. Bright light Combining two comparable studies (with 184 participants altogether) that investigated the effect of bright light during the night on sleepiness during a shift, revealed a mean reduction 0.83 score points of sleepiness (measured via the Stanford Sleepiness Scale (SSS) (95% confidence interval (CI) -1.3 to -0.36, very low quality evidence). Another trial did not find a significant difference in overall sleepiness on another sleepiness scale (16 participants, low quality evidence).Bright light during the night plus sunglasses at dawn did not significantly influence sleepiness compared to normal light (1 study, 17 participants, assessment via reaction time, very low quality evidence).Bright light during the day shift did not significantly reduce sleepiness during the day compared to normal light (1 trial, 61 participants, subjective assessment, low quality evidence) or compared to normal light plus placebo capsule (1 trial, 12 participants, assessment via reaction time, very low quality evidence). Napping during the night shiftA meta-analysis on a single nap opportunity and the effect on the mean reaction time as a surrogate for sleepiness, resulted in a 11.87 ms reduction (95% CI 31.94 to -8.2, very low quality evidence). Two other studies also reported statistically non-significant decreases in reaction time (1 study seven participants; 1 study 49 participants, very low quality evidence).A two-nap opportunity resulted in a statistically non-significant increase of sleepiness (subjective assessment) in one study (mean difference (MD) 2.32, 95% CI -24.74 to 29.38, 1 study, 15 participants, low quality evidence). Other interventionsPhysical exercise and sleep education interventions showed promise, but sufficient data to draw conclusions are lacking. AUTHORS' CONCLUSIONS Given the methodological diversity of the included studies, in terms of interventions, settings, and assessment tools, their limited reporting and the very low to low quality of the evidence they present, it is not possible to determine whether shift workers' sleepiness can be reduced or if their sleep length or quality can be improved with these interventions.We need better and adequately powered RCTs of the effect of bright light, and naps, either on their own or together and other non-pharmacological interventions that also consider shift workers' chronobiology on the investigated sleep parameters.
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Affiliation(s)
- Tracy E Slanger
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
| | - J. Valérie Gross
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
| | - Andreas Pinger
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
| | - Peter Morfeld
- Evonik Technology & Infrastructure GmbHInstitute for Occupational Epidemiology and Risk Assessment (IERA)Rellinghauser Str. 1‐11EssenGermany45128
| | - Miriam Bellinger
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
| | - Anna‐Lena Duhme
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
| | - Rosalinde Amancay Reichardt Ortega
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
| | - Giovanni Costa
- University of MilanDepartment of Clinical Sciences and Community HealthVia S. Barnaba 8MilanItaly20122
| | - Tim R Driscoll
- The University of SydneySchool of Public HealthEdward Ford Building (A27)SydneyNew South WalesAustralia2006
| | - Russell G Foster
- University of OxfordNuffield Department of Clinical Neurosciences; Circadian and Visual NeuroscienceLevel 6, West Wing, The John Radcliffe HospitalHeadley WayOxfordUKOX3 9DU
| | - Lin Fritschi
- Curtin UniversitySchool of Public Health35 Stirling HighwayPerthWest AustraliaAustralia6152
| | - Mikael Sallinen
- Finnish Institute of Occupational HealthCentre of Expertise for the Development of Work and Organizations / Working Hours, Alertness, and Professional Traffic teamTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Juha Liira
- Finnish Institute of Occupational HealthResearch and Development in Occupational Health ServicesTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Thomas C Erren
- University of CologneInstitute and Policlinic for Occupational Medicine, Environmental Medicine and Preventive ResearchKerpener Str. 62CologneGermany50937
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Patterson PD, Buysse DJ, Weaver MD, Doman JM, Moore CG, Suffoletto BP, McManigle KL, Callaway CW, Yealy DM. Real-time fatigue reduction in emergency care clinicians: The SleepTrackTXT randomized trial. Am J Ind Med 2015; 58:1098-113. [PMID: 26305869 DOI: 10.1002/ajim.22503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND We assessed performance characteristics and impact of a mobile phone text-message intervention for reducing intra-shift fatigue among emergency clinician shift workers. METHODS We used a randomized controlled trial of 100 participants. All participants received text-message assessments at the start, every 4 hr during, and at end of scheduled shifts over a 90-day period. Text-message queries measured self-rated sleepiness, fatigue, and difficulty with concentration. Additional text-messages were sent to intervention participants to promote alertness. A performance measure of interest was compliance with answering text-messages. RESULTS Ninety-nine participants documented 2,621 shifts and responded to 36,073 of 40,947 text-messages (88% compliance rate). Intervention participants reported lower mean fatigue and sleepiness at 4 hr, 8 hr, and at the end of 12 hr shifts compared to controls (P < 0.05). Intervention participants reported better sleep quality at 90-days compared to baseline (P = 0.01). CONCLUSIONS We showed feasibility and short-term efficacy of a text-message based assessment and intervention tool.
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Affiliation(s)
- P. Daniel Patterson
- Department of Emergency Medicine; Carolinas HealthCare System Medical Center; Charlotte North Carolina
| | - Daniel J. Buysse
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Matthew D. Weaver
- Harvard Medical School, Department of Medicine; Division of Sleep Medicine
| | - Jack M. Doman
- Department of Psychiatry; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Charity G. Moore
- Dickson Advance Analytics Group; Carolinas HealthCare System Medical Center; Charlotte North Carolina
| | - Brian P. Suffoletto
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
| | - Kyle L. McManigle
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
| | - Clifton W. Callaway
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
| | - Donald M. Yealy
- Department of Emergency Medicine; University of Pittsburgh School of Medicines; Pittsburgh Pennsylvania
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Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occup Environ Med 2015; 72:798-804. [PMID: 26371071 DOI: 10.1136/oemed-2015-102966] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/06/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors. METHODS We obtained 3 years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity. RESULTS The cohort contained 966,082 shifts, 4382 employees and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 h in duration (RR 0.70; 95% CI 0.51 to 0.96) compared with shifts >8 and ≤12 h. Relative to shifts >8 and ≤12 h, risk of injury was 60% greater (RR 1.60; 95% CI 1.22 to 2.10) for employees that worked shifts >16 and ≤24 h. CONCLUSIONS Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.
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Affiliation(s)
- Matthew D Weaver
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - P Daniel Patterson
- Department of Emergency Medicine, Carolinas HealthCare System Medical Center, Charlotte, North Carolina, USA
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Charity G Moore
- Dickson Advance Analytics Group, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
| | - Thomas J Songer
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Patterson PD, Klapec SE, Weaver MD, Guyette FX, Platt TE, Buysse DJ. Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report. PREHOSP EMERG CARE 2015; 20:132-6. [PMID: 25978152 DOI: 10.3109/10903127.2015.1025158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. We describe a case of a 26-year-old male paramedic who switched shift schedules during the midpoint of a randomized trial that addressed fatigue in EMS workers (clinicaltrials.gov identifier: NCT02063737). The participant (case) began the study working full-time with a critical care, advanced life support EMS system that utilized 24-hour shifts. He then transitioned to an EMS system that deploys workers on 8-hour shifts. Per protocol for the randomized trial, the participant completed a battery of sleep health and fatigue surveys at baseline and at the end of 90 days of study. He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.
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Patterson PD, Buysse DJ, Weaver MD, Callaway CW, Yealy DM. Recovery between Work Shifts among Emergency Medical Services Clinicians. PREHOSP EMERG CARE 2015; 19:365-75. [DOI: 10.3109/10903127.2014.995847] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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