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Poranen A, Kouvonen A, Nordquist H. Human errors in emergency medical services: a qualitative analysis of contributing factors. Scand J Trauma Resusc Emerg Med 2024; 32:78. [PMID: 39215372 PMCID: PMC11363522 DOI: 10.1186/s13049-024-01253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The dynamic and challenging work environment of the prehospital emergency care settings creates many challenges for paramedics. Previous studies have examined adverse events and patient safety activities, but studies focusing on paramedics' perspectives of factors contributing to human error are lacking. In this study, we investigated paramedics' opinions of the factors contributing to human errors. METHOD Data was collected through semi-structured individual interviews (n = 15) with paramedics and emergency medical field supervisors in Finland. The data was analyzed using inductive content analysis. Consolidated criteria for reporting qualitative research were used. RESULTS Contributing factors to human errors were divided into three main categories. The first main category, Changing work environment, consisted of two generic categories: The nature of the work and Factors linked to missions. The second main category, Organization of work, was divided into three generic categories: Inadequate care guidelines, Interaction challenges and Challenges related to technological systems. The third main category, Paramedics themselves, consisted of four generic categories: Issues that complicate cognitive processing, Individual strains and needs, Attitude problems and Impact of work experience. CONCLUSION Various factors contributing to human errors in emergency medical services (EMS) settings were identified. Although many of them were related to individual factors or to the paramedics themselves, system-level factors were also found to affect paramedics' work and may therefore negatively impact patient safety. The findings provide insights for organizations to use this knowledge proactively to develop their procedures and to improve patient safety.
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Affiliation(s)
- Anna Poranen
- Faculty of Medicine, University of Helsinki, Helsinki, 00014, Finland.
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, 00014, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BA, Northern Ireland
| | - Hilla Nordquist
- Faculty of Medicine, University of Helsinki, Helsinki, 00014, Finland
- Faculty of Social Sciences, University of Helsinki, Helsinki, 00014, Finland
- South-Eastern Finland University of Applied Sciences, Kotka, 48220, Finland
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Weetman S, Roche M, Leckie T, Samuels T, Hodgson L. Feasibility of application-based psychomotor vigilance testing to assess fatigue in doctors working night shifts and correlation with smartwatch assessed shift intensity. Occup Environ Med 2024; 81:252-257. [PMID: 38658047 DOI: 10.1136/oemed-2023-109311] [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: 11/16/2023] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To assess: (1) the feasibility of novel data collection methods (wearable technology and an application-based psychomotor vigilance test (PVT)), (2) the impact of night shift working on fatigue, both objective and perceived, for doctors working night shifts in acute hospital specialties and (3) the effects of shift intensity and naps obtained on participant fatigue. METHODS We adopted an innovative, multimodal approach to data collection allowing assessment of objective and perceived measures of fatigue, in addition to markers of shift intensity. This comprised 5 min PVT for objective quantification of fatigue (via the validated, smartphone-based NASA PVT+ application), wearable electronic devices (Fitbit Versa2) for assessment of shift intensity (step counts and active minutes) and questionnaires to elicit perceptions of fatigue and shift intensity. RESULTS Data was collected from 25 participants for a total of 145 night shifts. Objective fatigue (assessed by PVT performance) was significantly increased post night shift, with a PVT mean reaction time 257 ms pre shift versus 283 ms post shift (p<0.0001). However, differences in PVT pre and post shift were not affected by night shift intensity, nor breaks or naps taken on shift. Differences in psychomotor performance between doctors working in different specialties were also observed. CONCLUSIONS The data collection methods used were found to be feasible with good participant engagement. Findings support existing evidence that night shift working in healthcare workers is associated with fatigue, with psychomotor impairment observed post shift. Lower shift intensity and napping did not appear to mitigate this effect.
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Affiliation(s)
- Stefan Weetman
- Anaesthetics and Intensive Care, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Matthew Roche
- Anaesthetics and Intensive Care, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Todd Leckie
- Anaesthetics and Intensive Care, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Theophilus Samuels
- Anaesthetics and Intensive Care, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Luke Hodgson
- Respiratory Medicine and Intensive Care, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Miller B, Lenz TJ. The Effect of Coronavirus Disease 2019 on Adverse Events in Health Care: A Retrospective Study in Ground and Helicopter Emergency Medical Services. Air Med J 2024; 43:221-225. [PMID: 38821702 DOI: 10.1016/j.amj.2023.11.015] [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: 09/30/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has proven to be a significant hardship for the entire world. Health care systems and their workers have been stretched to their limits. Research regarding whether this increased strain has affected patient safety has not been sufficient, especially in emergency medical services. The aim of this study was to determine if there has been an increased rate of adverse events in ground and helicopter emergency medical services since the onset of the COVID-19 pandemic. METHODS A 2-year retrospective review was performed at a Midwest regional critical care transport service. The rate of adverse events for 1-year periods before and after March 13, 2020, was the primary outcome. All adverse events that generated a quality improvement incident report form (QIRF) were included, except those generated for non-clinical-related incidents. Additionally, a smaller time frame between May 1st and August 31st of both years was included containing all flagged adverse events from peer reviewers; not all of these generated a QIRF. RESULTS In the time period between March 13, 2019, and March 12, 2020, 5 of 3,154 (0.16%) calls generated a QIRF versus 21 of 3,185 (0.66%) calls between March 13, 2020, and March 12, 2021. There was a significant relationship showing an adverse event was more likely to happen after the onset of COVID-19 compared with before (χ21 [N = 6,339] = 8.643, P ≤ .001). Additionally, from May 1st to August 31st, the total adverse event rates were 16.86% (143/848 calls) and 24.46% (387/1,582 calls) for 2019 and 2020, respectively. Similarly, statistical significance existed for adverse events occurring after onset of the pandemic versus before (χ21 [N = 2,430] = 18.253, P ≤ .001). CONCLUSION A higher rate of adverse events for the year after the onset of COVID-19 existed. Additional studies looking at the causes of adverse events and patient outcomes should be undertaken to further understand this increase.
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Affiliation(s)
- Blake Miller
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy J Lenz
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
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Liu Z, Luo L, Dai H, Zhang B, Ma L, Xiang T. An important issue of burnout among pre-hospital emergency medical personnel in Chengdu: a cross-sectional study. BMC Emerg Med 2024; 24:69. [PMID: 38649815 PMCID: PMC11036575 DOI: 10.1186/s12873-024-00984-1] [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: 11/12/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE This survey aims to comprehensively understand occupational burnout among pre-hospital emergency medical personnel and explore associated risk factors. METHODS A cross-sectional online survey using a census method was conducted between 15 July, 2023, and ends on 14 August, 2023, in Chengdu, SiChuan province, China. The questionnaire included general demographic information, the Maslach Burnout Inventory-General Survey (MBI-GS) with 15 items, and the Fatigue Scale-14 (FS-14) with 14 items. Univariate analysis was conducted on all variables, followed by multivariate logistic regression models to examine the associations between occupational burnout and the risk factors. RESULTS A total of 2,299 participants,99.57% completed the survey effectively The participants were from 166 medical institutions in Chengdu, comprising 1,420 nurses (61.50%) and 889 clinical doctors (38.50%). A total of 33.36% participants experienced burnout, predominantly mild (30.27%), followed by moderate (2.78%) and severe (0.3%). Physicians, higher fatigue scores, age, work experience appeared to be related to burnout. Logistic regression models revealed that individuals aged over 50 were less prone to experience burnout compared to medical staff aged 18-30 (OR: 0.269, 95% CI: 0.115-0.627, p = 0.002). Physicians were more prone to experience burnout compared to nursing staff (OR: 0.690, 95% CI: 0.531-0.898, p = 0.006). Those with 0-5 years of experience were more prone to experience burnout compared to those with 6-10 years or over 15 years of experience (OR: 0.734, 95% CI: 0.547-0.986, p = 0.040; OR: 0.559, 95% CI: 0.339-0.924, p = 0.023). Additionally, for each 1-point increase in the fatigue score, the likelihood of burnout in medical staff increased by 1.367 times (OR: 1.367, 95% CI: 1.323-1.412, p < 0.0001). CONCLUSION Pre-hospital emergency medical personnel demonstrate a notable prevalence of mild job burnout. These results provide a groundwork for future focus on the various stages of job burnout within pre-hospital emergency staff, alerting hospital and departmental managers to promptly address the mental well-being of their personnel and intervene as needed.
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Affiliation(s)
- ZhiJiang Liu
- Chengdu medical emergency center, 610041, Chengdu, China
| | - Li Luo
- Department of emergency, The Third People's Hospital of Chengdu, 610031, Chengdu, China
| | - Hang Dai
- Department of emergency, The Third People's Hospital of Chengdu, 610031, Chengdu, China
| | - Bihua Zhang
- College of medicine, southwest jiaotong university, 610036, Chengdu, China
| | - Lin Ma
- Chengdu medical emergency center, 610041, Chengdu, China
| | - Tao Xiang
- Department of emergency, The Third People's Hospital of Chengdu, 610031, Chengdu, China.
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Elsässer A, Dreher A, Pietrowsky R, Flake F, Loerbroks A. Psychosocial working conditions, perceived patient safety and their association in emergency medical services workers in Germany - a cross-sectional study. BMC Emerg Med 2024; 24:62. [PMID: 38616266 PMCID: PMC11017549 DOI: 10.1186/s12873-024-00983-2] [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: 01/22/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Emergency medical service (EMS) workers face challenging working conditions that are characterized by high stress and a susceptibility to making errors. The objectives of the present study were (a) to characterize the psychosocial working conditions of EMS workers, (b) to describe the perceived quality of patient care they provide and patient safety, and (c) to investigate for the first time among EMS workers associations of psychosocial working conditions with the quality of patient care and patient safety. METHODS For this cross-sectional study, we carried out an online survey among 393 EMS workers who were members of a professional organization. Working conditions were measured by the Demand-Control-SupportQuestionnaire (DCSQ) and seven self-devised items covering key stressors. Participants reported how often they perceived work stress to affect the patient care they provided and we inquired to what extent they are concerned to have made a major medical error in the last three months. Additionally, we used parts of the Emergency Medical Services - Safety Inventory (EMS-SI) to assess various specific errors and adverse events. We ran descriptive analyses (objective a and b) and multivariable logistic regression (objective c). RESULTS The most common stressors identified were communication problems (reported by 76.3%), legal insecurity (69.5%), and switching of colleagues (48.9%) or workplaces (44.5%). Overall, 74.0% reported at least one negative safety outcome based on the EMS-SI. Concerns to have made an important error and the perception that patient care is impaired by work stress and were also frequent (17.8% and 12.7%, respectively). Most psychosocial working conditions were associated with the perception that patient care is impaired due to work stress. CONCLUSIONS Work stress in EMS staff is pronounced and negative safety outcomes or potential errors are perceived to occur frequently. Poor psychosocial working conditions were only consistently associated with perceived impairment of patient care due to work stress. It seems necessary to reduce communication problems and to optimize working processes especially at interfaces between emergency services and other institutions. Legal insecurity could be reduced by clarifying and defining responsibilities. Communication and familiarity between team colleagues could be fostered by more consistent composition of squads.
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Affiliation(s)
- Antonia Elsässer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Annegret Dreher
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Frank Flake
- German Association of Emergency Medical Services (Deutscher Berufsverband Rettungsdienst e. V.), Lübeck, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Peris-Ramos HC, Míguez MC, Rodriguez-Besteiro S, David-Fernandez S, Clemente-Suárez VJ. Gender-Based Differences in Psychological, Nutritional, Physical Activity, and Oral Health Factors Associated with Stress in Teachers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:385. [PMID: 38673298 PMCID: PMC11050169 DOI: 10.3390/ijerph21040385] [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: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
The aim of this study was to analyze gender differences in stress-related factors among active teachers. A cross-sectional study was conducted to examine gender disparities in psychological, nutritional, physical activity, and oral health factors and how these habits correlate with stress and burnout in their work environment. The sample comprised 1037 teachers from Spain, Colombia, and Chile, consisting of 40.1% men and 59.9% women, with an average age of 41 years and teaching experience of 11.8 ± 9.2 and 12.2 ± 8.7 years, respectively. They were evaluated using a compilation of questionnaires with the objective of analyzing gender differences in habits that are associated with stress levels in teachers. The findings revealed that men had significantly higher levels of depersonalization and personal accomplishment, whereas women exhibited higher levels of perceived stress and conscientiousness. Regarding nutritional habits, results were more positive for women, and men exhibited healthier functional habits by engaging in more weekly sports. Regarding oral health habits, women had better oral hygiene practices, brushing their teeth more frequently. However, women showed a higher tendency to smoke than their male counterparts. We conclude that there are notable gender differences that can provide insights for developing strategies to enhance the overall well-being of teachers.
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Affiliation(s)
- Helia Carmen Peris-Ramos
- Clinical Odontology Department, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (H.C.P.-R.); (S.D.-F.)
| | - María Carreira Míguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (M.C.M.); (S.R.-B.)
| | - Stephanie Rodriguez-Besteiro
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (M.C.M.); (S.R.-B.)
| | - Susana David-Fernandez
- Clinical Odontology Department, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (H.C.P.-R.); (S.D.-F.)
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (M.C.M.); (S.R.-B.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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Diaz E, Abad-Tortosa D, Ghezal M, Davin J, Lopez-Castroman J. Role of stressful life events and personality traits on the prevalence of wish to die among French physicians. Front Public Health 2024; 12:1244605. [PMID: 38322123 PMCID: PMC10844508 DOI: 10.3389/fpubh.2024.1244605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Background Suicide rates are higher among physicians than in the general population. We aimed to investigate the role of stressful life events (related or not to work conditions) and personality traits on wish to die, a proxy measure of suicidal ideation. Methods This cross-sectional study took place in France from March 2018 to September 2018. Physicians completed an online questionnaire. A multiple logistic regression model estimated factors associated with wish to die. Moderated moderation models were used to assess the effect of personality traits on the relationship between stressful events and wish to die. Results 1,020 physicians completed the questionnaire. Most (75%) had endorsed a work-related stressful event and one in six (15.9%) endorsed a wish to die the year before. Wish to die was associated with burnout (OR = 2.65, 95%CI = 1.82-3.88) and work-related stressful events (OR = 2.18, 95%CI = 1.24-3.85) including interpersonal conflicts, harassment and work-overload. Emotional stability was the only personality trait associated with wish to die in the logistic regression (OR = 0.69, 95%CI = 0.59-0.82). In moderation models, we observed a significant interaction involving three personality traits-emotional stability, extraversion, and agreeableness-along with gender, influencing the impact of stressful events on the wish to die. Limitations Our study is limited by the impossibility to control for risk factors associated with suicide like psychiatric comorbidities. Conclusion Work-related stressful events significantly contribute to the manifestation of a wish to die among physicians. The impact of stressful events on the wish to die is moderated by factors such as gender and personality traits, including emotional stability and extraversion. These results are overall consistent with prior studies concerning the risk of burnout and suicide among physicians.
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Affiliation(s)
- Emmanuel Diaz
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Diana Abad-Tortosa
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Maha Ghezal
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Josephine Davin
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Nîmes University Hospital (CHU), Nîmes, France
- IGF, CNRS-INSERM, University of Montpellier, Montpellier, France
- CIBERSAM, Madrid, Spain
- Department of Signal Theory and Communication, Universidad Carlos III, Madrid, Spain
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Biondi FN. Adopting Stimulus Detection Tasks for Cognitive Workload Assessment: Some Considerations. HUMAN FACTORS 2024:187208241228049. [PMID: 38247319 DOI: 10.1177/00187208241228049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVE This article tackles the issue of correct data interpretation when using stimulus detection tasks for determining the operator's workload. BACKGROUND Stimulus detection tasks are a relative simple and inexpensive means of measuring the operator's state. While stimulus detection tasks may be better geared to measure conditions of high workload, adopting this approach for the assessment of low workload may be more problematic. METHOD This mini-review details the use of common stimulus detection tasks and their contributions to the Human Factors practice. It also borrows from the conceptual framework of the inverted-U shape model to discuss the issue of data interpretation. RESULTS The evidence being discussed here highlights a clear limitation of stimulus detection task paradigms. CONCLUSION There is an inherent risk in using a unidimensional tool like stimulus detection tasks as the primary source of information for determining the operator's psychophysiological state. APPLICATION Two recommendations are put forward to Human Factors researchers and practitioners dealing with the interpretation conundrum of dealing with stimulus detection tasks.
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Billings JM, Jahnke SA, Haddock CK. Daily variation in sleepiness among firefighters while working the 24/48 and 48/96 shift schedules. SAFETY SCIENCE 2024; 169:10.1016/j.ssci.2023.106335. [PMID: 39205677 PMCID: PMC11350525 DOI: 10.1016/j.ssci.2023.106335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Objective To assess the daily relationship between prior-night total sleep time (TST) and next-day, afternoon sleep propensity among firefighters operating from two popular fire department shift schedules. Methods Dataset included 22 firefighters (24/48 shift schedule) and 20 firefighters (48/96 shift schedule). Daily TST was assessed using actigraphy and daily sleep propensity was assessed using the Epworth Sleepiness Scale (ESS), completed every afternoon. Results Separate one-way repeated measures ANOVA indicated statistically significant differences among daily sleep propensity within each shift schedule. Separate Pearson product moment correlations indicated moderate relationships between prior-night TST and next-day, afternoon sleep propensity. Conclusion When firefighters slept less, sleep propensity the following day increased. Least TSTs occurred on nights prior to commuting suggesting firefighters likely begin shifts without sufficient sleep and drive home without sufficient sleep, then experience greatest sleep propensity.
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Affiliation(s)
- Joel M. Billings
- Department of Security and Emergency Services, Embry-Riddle Aeronautical University, Daytona Beach, FL, United States
| | - Sara A. Jahnke
- Center for Fire, Rescue & EMS Health Research, NDRI–USA, Leawood, KS, United States
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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.
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Affiliation(s)
- Graham Marvin
- Tactical Research Unit, Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia
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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.
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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.
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Heuer C, Howard I, Stassen W. Trigger tool-based description of adverse events in helicopter emergency medical services in Qatar. BMJ Open Qual 2023; 12:e002263. [PMID: 37963672 PMCID: PMC10649605 DOI: 10.1136/bmjoq-2023-002263] [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: 01/13/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Adverse events (AEs) in helicopter emergency medical services (HEMS) remain poorly reported, despite the potential for harm to occur. The trigger tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their proximal causes (PCs) in Qatar HEMS. METHODS Using the Pittsburgh Adverse Event Tool to identify AEs in HEMS, we retrospectively analysed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for triggers, AEs and harm per 100 patient encounters, plotted measures on statistical process control charts, and conducted a multivariate analysis to report harm associations. RESULTS We identified 883 triggers in 536 patients, with a rate of 1.1 triggers per patient encounter, where 81.2% had documentation errors (n=436). An AE and harm rate of 27.7% and 3.5%, respectively, was realised. The leading PC was actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the intervention and medication triggers (n=16), where deviation from standard of care was common (37.9%; n=11). Age and diagnosis-adjusted odds were significant in the patient condition (6.50; 95% CI 1.71 to 24.67; p=0.01) and interventional (11.85; 95% CI 1.36 to 102.92; p=0.03) trigger groupings, while age and diagnosis had no effect on harm. CONCLUSION The TT methodology is a robust, reliable and valid means of AE detection in the HEMS domain. While an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and documentation errors should also be addressed in future research.
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Affiliation(s)
- Calvin Heuer
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Ian Howard
- Clinical Services, Hamad Medical Corporation Ambulance Service, Doha, Qatar
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Schnell J, Thielmann B, Schumann H, Böckelmann I. Effect of Work-Related Behavior and Experience Patterns on Sleep Quality in Emergency Medical Service Personnel. J Occup Environ Med 2023; 65:976-986. [PMID: 37621036 DOI: 10.1097/jom.0000000000002951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE The aim of this study was to examine the influence of work-related behavior and experience patterns on sleep quality in emergency medical service personnel. METHODS From the total sample of 508 emergency medical service workers who took part in the Germany-wide online survey, 368 respondents completed the questionnaires on sleep characteristics (Pittsburgh Sleep Quality Index [PSQI]) and work-related behavior and experience pattern. Three hundred sixty-seven of the 368 participants also finished the Regensburg Insomnia Scale. RESULTS Based on their work-related behavior and experience pattern results, individuals were categorized into one of the four following patterns: two risk patterns (A, B) and two healthy behavior and experience patterns (G, S). Participants that were classified into risk-pattern A and B (33.85%) scored significantly higher in both PSQI and Regensburg Insomnia Scale overall score and all PSQI components implicating a poorer sleep quality. A total of 78.5% of the individuals with pattern A and B were considered bad sleepers whereas only 43.4% of individuals with pattern G and S were scored as bad sleepers. CONCLUSIONS Work-related behavior and experience patterns showed a strong association to sleep characteristics and may therefore be used to identify appropriate preventative measures.
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Affiliation(s)
- Julia Schnell
- From the Otto-von-Guericke-University, Institute of Occupational Medicine, Medical Faculty, Magdeburg, Germany
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14
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Maguire BJ, Al Amiry A, O’Neill BJ. Occupational Injuries and Illnesses among Paramedicine Clinicians: Analyses of US Department of Labor Data (2010 - 2020). Prehosp Disaster Med 2023; 38:581-588. [PMID: 37559197 PMCID: PMC10548021 DOI: 10.1017/s1049023x23006118] [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: 04/09/2023] [Revised: 05/06/2023] [Accepted: 05/14/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Paramedicine clinicians (PCs) in the United States (US) respond to 40 million calls for assistance every year. Their fatality rates are high and their rates of nonfatal injuries are higher than other emergency services personnel, and much higher than the average rate for all US workers. The objectives of this paper are to: describe current occupational injuries among PCs; determine changes in risks over time; and calculate differences in risks compared to other occupational groups. METHODS This retrospective open cohort study of nonfatal injuries among PCs used 2010 through 2020 data from the US Department of Labor (DOL), Bureau of Labor Statistics; some data were unavailable for some years. The rates and relative risks (RRs) of injuries were calculated and compared against those of registered nurses (RNs), fire fighters (FFs), and all US workers. RESULTS The annual average number of injuries was: 4,234 over-exertion and bodily reaction (eg, motion-related injuries); 3,935 sprains, strains, and tears; 2,000 back injuries; 580 transportation-related injuries; and over 400 violence-related injuries. In this cohort, women had an injury rate that was 50% higher than for men. In 2020, the overall rate of injuries among PCs was more than four-times higher, and the rate of back injuries more than seven-times higher than the national average for all US workers. The rate of violence-related injury was approximately six-times higher for PCs compared to all US workers, seven-times higher than the rate for FFs, and 60% higher than for RNs. The clinicians had a rate of transportation injuries that was 3.6-times higher than the national average for all workers and 2.3-times higher than for FFs. Their overall rate of cases varied between 290 per 10,000 workers in 2018 and 546 per 10,000 workers in 2022. CONCLUSIONS Paramedicine clinicians are a critical component of the health, disaster, emergency services, and public health infrastructures, but they have risks that are different than other professionals.This analysis provides greater insight into the injuries and risks for these clinicians. The findings reveal the critical need for support for Emergency Medical Services (EMS)-specific research to develop evidence-based risk-reduction interventions. These risk-reduction efforts will require an enhanced data system that accurately and reliably tracks and identifies injuries and illnesses among PCs.
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Affiliation(s)
- Brian J. Maguire
- Leidos Inc., Reston, VirginiaUSA
- Central Queensland University - School of Medical and Applied Sciences, Queensland, Australia
| | - Ala’a Al Amiry
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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15
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Duffee B, Willis DB. Paramedic perspectives of job stress: Qualitative analysis of high-stress, high-stakes emergency medical situations. Soc Sci Med 2023; 333:116177. [PMID: 37595422 DOI: 10.1016/j.socscimed.2023.116177] [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: 03/02/2023] [Revised: 05/24/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023]
Abstract
The time from when an ambulance paramedic receives the 911 alarm notification until they have determined the differential diagnosis of a patient is highly stressful. During this time, there is a high demand placed on the paramedic, and they have a low level of control. Recent advances in prehospital care that place more responsibility on paramedics have exacerbated this high-stress phenomenon. Twenty paramedics from across the United States were interviewed and evaluated using descriptive phenomenology to better understand one of the most stressful moments of high-stakes decision-making that paramedics regularly face. Using descriptive phenomenology, we identified six categories in the paramedics' interview responses: pressure, overwhelm, emotional extremes (with sub-categories of adrenaline rush and time-dilation), dissociation, multi-tasking, and disconnect. This analysis of the paramedic's lived experience of this high-stress, high-stakes phenomenon provides insight into how paramedics experience the unique stress of this phenomenon. This understanding is key to elucidating the effects of this acute stress that may impact the judgment and, ultimately, the care performed by the paramedic. Both early- and late-career paramedics from thirteen different states in all regions of the United States were interviewed. Further qualitative data from paramedics from a diverse range of regions and backgrounds are essential to identify ways in which to ameliorate the negative effects of acute stress experienced by paramedics. Addressing such issues will reduce turnover and burnout among paramedics.
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Affiliation(s)
- Bram Duffee
- Institute for Social Innovation Research Fellow, Fielding Graduate University, 2020 De La Vina Street, Santa Barbara, CA, 93105, USA.
| | - David Blake Willis
- Professor of Anthropology and Education Faculty, School of Leadership Studies, Fielding Graduate University, 2020 De La Vina Street, Santa Barbara, CA, 93105, USA
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Klinefelter Z, Hirsh EL, Britt TW, George CL, Sulzbach M, Fowler LA. Shift Happens: Emergency Physician Perspectives on Fatigue and Shift Work. Clocks Sleep 2023; 5:234-248. [PMID: 37092431 PMCID: PMC10123702 DOI: 10.3390/clockssleep5020019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023] Open
Abstract
Research has shown that shiftworkers experience poor sleep and high levels of fatigue. Although considerable research has been performed on fatigue within many shift-work occupations, very little has been done with emergency physicians (EPs). This qualitative study was conducted with the goal of gaining insight into EPs' perceptions of fatigue at work. Twenty EPs from an academic medical center participated in virtual interviews, with nine open-ended questions asked in a semi-structured interview format. Twelve common topics with four main themes emerged from the interviews. Three of these common themes included sources of fatigue (including both work- and home-related sources), consequences of fatigue (including impacts on individuals and performance), and prevention and mitigation strategies to cope with fatigue. The fourth main theme was the belief in the inevitability of fatigue due to high cognitive load, emotionally taxing work experiences, work unpredictability, and the 24/7 shift-work nature of emergency medicine. EPs' experiences with fatigue are consistent with but extend those of other types of shiftworkers. Our findings suggest that EPs tend to incorporate the inevitability of fatigue at work into their identity as EPs and experience a sense of learned helplessness as a result, suggesting areas for future interventions.
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Affiliation(s)
| | | | - Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | | | - Margaret Sulzbach
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29605, USA
| | - Lauren A. Fowler
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Charlotte, NC 28203, USA
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17
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Raposa ME, Mullin G, Murray RM, Shepler LJ, Castro KC, Fisher AB, Gallogly VH, Davis AL, Resick CJ, Lee J, Allen JA, Taylor JA. Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based Emergency Medical Services Responders: A Tale of Two Samples (The RAPID Study I). J Occup Environ Med 2023; 65:e184-e194. [PMID: 36730580 PMCID: PMC10090321 DOI: 10.1097/jom.0000000000002745] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to examine the COVID-19 pandemic's impact on fire service safety culture, behavior and morale, levers of well-being, and well-being outcomes. METHODS Two samples (Stress and Violence against fire-based EMS Responders [SAVER], consisting of 3 metropolitan departments, and Fire service Organizational Culture of Safety [FOCUS], a geographically stratified random sample of 17 departments) were assessed monthly from May to October 2020. Fire department-specific and pooled scores were calculated. Linear regression was used to model trends. RESULTS We observed concerningly low and decreasing scores on management commitment to safety, leadership communication, supervisor sensegiving, and decision-making. We observed increasing and concerning scores for burnout, intent to leave the profession, and percentage at high risk for anxiety and depression. CONCLUSIONS Our findings suggest that organizational attributes remained generally stable but low during the pandemic and impacted well-being outcomes, job satisfaction, and engagement. Improving safety culture can address the mental health burden of this work.
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18
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Cavanagh N, Blanchard IE, Weiss D, Tavares W. Looking back to inform the future: a review of published paramedicine research. BMC Health Serv Res 2023; 23:108. [PMID: 36732779 PMCID: PMC9893690 DOI: 10.1186/s12913-022-08893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. METHODS We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. RESULTS The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. CONCLUSIONS Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.
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Affiliation(s)
- N Cavanagh
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - I E Blanchard
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
| | - D Weiss
- Alberta Health Services, Emergency Medical Services, Edmonton, Alberta, Canada
| | - W Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto, Toronto, Ontario, Canada
- York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario, Canada
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19
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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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20
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Harris R, Drummond SPA, Meadley B, Rajaratnam SMW, Williams B, Smith K, Bowles KA, Nguyen E, Dobbie ML, Wolkow AP. Mental health risk factors for shift work disorder in paramedics: A longitudinal study. Sleep Health 2023; 9:49-55. [PMID: 36400678 DOI: 10.1016/j.sleh.2022.09.009] [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: 10/24/2021] [Revised: 06/06/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Depression and anxiety are prominent in paramedics, as is the prevalence of shift work disorder (SWD), a circadian sleep condition comorbid with mental health disorders. However, the role of mental health risk factors for SWD is largely unknown. This study investigated whether mental health levels in recruit paramedics before shift work predicted greater risk of SWD at 6-months into their career and explored whether shift and sleep factors mediated this relationship. DESIGN A longitudinal study. SETTING Victoria, Australia. PARTICIPANTS Recruit paramedics were assessed at baseline (n = 101; ie, pre-shift work) and after 6-months (n = 93) of shift and emergency work. MEASUREMENTS At both time points, participants completed self-reported measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), and SWD (SWD-Screening Questionnaire). Participants also filled a sleep and work diary for 14-days at each timepoint. RESULTS After 6-months of emergency work 21.5% of paramedics had a high SWD risk. Logistic regression models showed baseline depression predicted 1.24-times greater odds for SWD at 6-months. Through Lavaan path analysis we found shift and sleep variables did not mediate the relationship between baseline mental health and SWD risk. Baseline depression was associated with increased sleepiness levels following paramedics' major sleep periods at 6-months. Pre-existing depression levels also predicted greater perceived nightshift workload. CONCLUSIONS Our results highlight depression symptoms before emergency work are a risk factor for SWD within 6-months of work. Depression represents a modifiable risk factor amenable to early interventions to reduce paramedics' risk of SWD.
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Affiliation(s)
- Rachael Harris
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Ben Meadley
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia
| | - Brett Williams
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Karen Smith
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kelly-Ann Bowles
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Elle Nguyen
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | | | - Alexander P Wolkow
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia.
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21
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Nicholson TP, Blazer EC, Hymes AS, Ginley MK. A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic. Int J Ment Health Addict 2023:1-22. [PMID: 36619000 PMCID: PMC9810250 DOI: 10.1007/s11469-022-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.
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Affiliation(s)
- Thalia P. Nicholson
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
| | - Erin C. Blazer
- Department of Counseling, Carson Newman, 1646 Russell Avenue, Jefferson City, TN 37760 USA
| | - Aaron S. Hymes
- Department of Counseling, Milligan University, P.O. Box 22, Milligan, TN 37682 USA
| | - Meredith K. Ginley
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
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Chen YH, Chou YH, Yang TY, Jong GP. The Effects of Frequent Coffee Drinking on Female-Dominated Healthcare Workers Experiencing Musculoskeletal Pain and a Lack of Sleep. J Pers Med 2022; 13:25. [PMID: 36675686 PMCID: PMC9866007 DOI: 10.3390/jpm13010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
Previous research has demonstrated that chronic diseases can occur due to musculoskeletal (MS) pain and poor sleep. It is also worth noting that the caffeine in coffee can reduce overall sleep duration, efficiency, and quality. Thus, the present study examines the effects of frequent coffee drinking (two cups per day) on individuals experiencing MS pain and a lack of sleep during the COVID-19 period. This observational and cross-sectional study recruited 1615 individuals who completed the self-reported (Nordic musculoskeletal) questionnaire. Long-term, frequent coffee drinking and a sleep duration of less than 6 h per day were significantly associated with neck and shoulder pain among healthy individuals. The mediation model demonstrated that the shorter sleep duration and drinking multiple cups of coffee per day had a two-way relationship that worsened such pain over the long term. Specifically, individuals who experienced such pain frequently drank multiple cups of coffee per day, which, in turn, shortened their sleep durations. In summary, long-term coffee drinking creates a vicious cycle between MS pain and sleep duration. Therefore, the amount of coffee should be fewer than two cups per day for individuals who sleep less than 6 h per day or suffer from MS pain, especially neck and shoulder pain.
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Affiliation(s)
- Yong-Hsin Chen
- Department of Public Health, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Occupational Safety and Health, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Tsung-Yuan Yang
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
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Caricati L, De vito M, Panari C. The role of group identification, self‐ and collective efficacy on secondary traumatic stress and general health in a sample of emergency medical service volunteers. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1111/jasp.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Caricati
- Department of Humanities, Social Sciences and Cultural Industries University of Parma Parma Italy
| | - Martina De vito
- Department of Humanities, Social Sciences and Cultural Industries University of Parma Parma Italy
| | - Chiara Panari
- Department of Economics and Management University of Parma Parma Italy
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Mansouri T, Ghanatios G, Hatzinger L, Barich R, Dampha E, Temple JL, Clemency BM, Hostler D. Eating Patterns among Emergency Medical Service Providers in the United States: A Qualitative Interview Study. Nutrients 2022; 14:nu14224884. [PMID: 36432571 PMCID: PMC9696925 DOI: 10.3390/nu14224884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Emergency medical service (EMS) providers experience demanding work conditions in addition to shift work, which increases risk for nutrition related chronic disease such as metabolic syndrome, diabetes, obesity, and cardiovascular disease. The high stress, emergent, and unpredictable nature of EMS may interfere with healthy eating patterns on and off shift, however little is known about how these conditions impact dietary patterns among EMS providers. This study aimed to understand factors impacting dietary patterns through semi-structured interviews with 40 EMS providers throughout the United States. Interviews were conducted virtually via Zoom video conference. Inductive coding was used to identify themes throughout the interviews. Salient factors mentioned in the interviews included hunger, fatigue, stress, coworker influence, ambulance posting, geographical location, agency policy, and culture. Factors were grouped into 4 domains: physiological factors, psychosocial factors, physical environment, and organizational environment, represented by an adapted version of the social ecological model of health behaviors to include factors influencing eating patterns specific to EMS, which may contribute to overall health. Various barriers to healthy eating exist within EMS, and future studies should explore interventions at each level of our proposed model to improve conditions and reduce nutrition related disease risk in this essential population.
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Affiliation(s)
- Tegan Mansouri
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Correspondence: ; Tel.: +1-716-829-2941; Fax: +1-716-829-2428
| | - George Ghanatios
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Lori Hatzinger
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA 90007, USA
| | - Rachel Barich
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Foods and Nutrition, University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada
| | - Ebriama Dampha
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Jennifer L. Temple
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Brian M. Clemency
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY 14203, USA
| | - David Hostler
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY 14203, USA
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25
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Postpandemic Stress Disorder among Health Care Personnel: A Cross-Sectional Study (Silesia, Poland). Behav Neurol 2022; 2022:1816537. [DOI: 10.1155/2022/1816537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/16/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Postpandemic stress disorder (PPSD) is an unofficial term that refers to posttraumatic stress disorder (PTSD), a mental disorder resulting from increased stress, anxiety, and trauma associated with unpleasant life experiences. Many scientific studies indicate that symptoms of increased stress, job burnout, anxiety, and depressive disorders are associated with medical personnel performing their professional duties around COVID-19 patients. Objective. The purpose of this study was to assess the prevalence of symptoms that may indicate the presence of PPSD symptoms—depression, anxiety, and stress—in medical personnel. Material and Methods. The survey included 300 people, representatives of medical personnel. The group was divided into two sections. The first section numbered 150 and consisted of personnel in direct contact with COVID-19 patients (FR); the second group also consisted of 150 medical professionals, who but no longer directly involved in helping with COVID-19 cases (SR). The survey was conducted by indirect survey method using CAWI (computer-assisted web interview). The survey used a questionnaire technique. A proprietary tool enriched with standardized psychometric scales: BDI, GAD-7, FCV-19S, and PSS-10 was used. Kruskal-Wallis and Mann–Whitney
statistical tests were used in the statistical processing of the data. The probability level was 0.05. Results. Statistical inference made it clear that mental health problems that may indicate trauma are mainly present in the FR group. These symptoms decreased slightly in comparison between periods 2020 and 2021 (
). Conclusions. The COVID-19 pandemic significantly increased the prevalence of depression, anxiety, and stress among first responders. To ensure the psychological well-being of first responders, early assessment and care of mild depression, anxiety, and stress should be promoted to prevent the development of moderate and severe forms.
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Poranen A, Kouvonen A, Nordquist H. Perceived human factors from the perspective of paramedics – a qualitative interview study. BMC Emerg Med 2022; 22:178. [DOI: 10.1186/s12873-022-00738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The work environment in prehospital emergency medical care setting is dynamic and complex and includes many stressors. However, little is known about the perceived human factors from the perspective of paramedics. In this study, we investigated, from the perspective of paramedics, what are the human factors, and how are they linked to prehospital emergency medical care?
Methods
Data were collected through semi-structured interviews (n = 15) with Finnish paramedics. The material was analyzed using inductive content analysis.
Results
Three main categories of human factors were identified. The first main category consisted of factors related to work which were divided into two generic categories: “Challenging organizational work environment” and “Changing external work environment.” The second main category comprised factors related to paramedics themselves and were divided into three generic categories: “Issues linked to personality,” “Personal experiences”, and “Factors resulting from personal features.” The third main category described that paramedics have difficulties in understanding and describing human factors.
Conclusion
This study revealed numerous factors that can affect paramedics’ work in the EMS setting. Increased knowledge about human factors in the EMS setting provides organizations with the opportunity to develop procedures that can support paramedics’ cognitive and physical work. Human factors in different situations can be addressed to improve occupational and patient safety.
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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.
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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
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Taylor JA, Murray RM, Davis AL, Brandt-Rauf S, Allen JA, Borse R, Pellechia D, Picone D. Model Policies to Protect U.S. Fire-Based EMS Responders From Workplace Stress and Violence. New Solut 2022; 32:119-131. [PMID: 35322702 PMCID: PMC9280702 DOI: 10.1177/10482911221085728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The stress and violence to fire-based emergency medical service responders (SAVER) Systems-Level Checklist is an organizational-level intervention to address stress and violence in emergency medical service (EMS), focused on the development of policy and training. Fire and EMS leadership, first responders, dispatchers, and labor union representatives participated in the SAVER Model Policy Collaborative to develop model policies that resulted from the most feasible checklist items. ThinkLets technology was employed to achieve consensus on the model policies, and an Action SWOT analysis was then conducted to assess facilitators and barriers to policy implementation. The resultant model policies are a systems-level workplace violence intervention for the U.S. fire and rescue service that is ready for implementation. Expected improvements to organizational outcomes such as burnout, job engagement, and job satisfaction are anticipated, as are decreasing assaults and injuries. The SAVER Model Policies have the potential to inform national standards and regulations on workplace violence in EMS.
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Affiliation(s)
- Jennifer A. Taylor
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Regan M. Murray
- Health, Human Performance and Recreation, University of Arkansas College of Education and Health Professions, Fayetteville, AR, USA
| | - Andrea L. Davis
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | - Sherry Brandt-Rauf
- Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, PA, USA
| | | | | | | | - David Picone
- San Diego Fire-Rescue Department, San Diego, CA, USA
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Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care. Healthcare (Basel) 2022; 10:healthcare10081395. [PMID: 35893217 PMCID: PMC9394272 DOI: 10.3390/healthcare10081395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 12/20/2022] Open
Abstract
Background: During the recent pandemic, Healthcare Professionals (HCPs) presented a significant prevalence of psychological health problems and sleep disturbances. The aim of this study was to assess the impact of COVID-19 on HCPs’ sleep and mental stress with a separate analysis for primary care HCPs. Methods: A cross-sectional observational study with an online anonymized, self-reported questionnaire was conducted in May 2020 (1st wave) and repeated in December 2020 (2nd wave). Patient health questionnaire-4 (PHQ-4), dimensions of anger reactions-5 (DAR-5) scale, 3-item UCLA loneliness scale (LS) and sleep condition indicator (SCI) were used. Results: Overall, 574 participants were included from the 1st wave, 514 from the 2nd and 469 were followed during both. Anxiety and depression were significantly higher during the 2nd wave vs. the 1st (32.8% vs. 12.7%, p < 0.001 and 37.7% vs. 15.8%, p < 0.001). During the 2nd wave, HCPs scored significantly higher in DAR-5 (9.23 ± 3.82 vs. 7.3 ± 3.3, p < 0.001) and LS (5.88 ± 1.90 vs. 4.9 ± 1.9, p < 0.001) with worse sleep quality SCI (23.7 ± 6.6 vs. 25.4 ± 3.2, p < 0.001). This was more evident in primary care HCPs. Significant correlations were found between SCI and PHQ4, DAR5 and LS. Conclusion: There is a need to support HCPs’ mental health and sleep, especially in those working in primary care.
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An R, Li C, Ai S, Wu Y, Luo X, Li X, Xu Y, He C. Effect of shift work on fatigue, reaction time and accuracy of nurses in the department of neurology: A cross-sectional observational study. J Nurs Manag 2022; 30:2074-2083. [PMID: 35510385 DOI: 10.1111/jonm.13665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023]
Abstract
AIMS The purpose of our study was mainly to explore the effect of different shift work on cognitive and executive performance in a real clinical environment among nurses from China. BACKGROUND Working in shifts can disrupt circadian rhythm, resulting in reduced sleep duration, which can have a detrimental effect on cognitive function. To provide continuous service for patient care, shift work is often a special requirement for nurses. The Stroop test can be used to measure selective attention and reaction time during executive function. However, there have been limited studies about the effect of shift work on the cognitive performance of nurses by Stroop tests. Additionally, no study has been conducted in nurses working in shifts from China. METHODS Registered nurses in general ward, Department of Neurology, from West China Hospital of Sichuan University, were eligible and consecutively included if they were simultaneously responsible for the day, evening and night shifts on the shift work schedule. A fatigue questionnaire and Stroop tests were performed for each subject separately before and after three working shifts (morning, evening and night shift) to measure changes in fatigue, reaction time and accuracy. RESULTS Eighteen registered nurses (4 males and 14 females) were included in our study, with a median age of 25 years old. The fatigue degree was significantly increased after day and evening shifts (p=0.015 and <0.001, respectively). Compared with those in the preshifts, the reaction time in the neutral task and incongruent task was significantly quicker after the day shift (p=0.001, p<0.001) and night shift (p=0.008, 0.019). In contrast, the reaction time after the evening shift was mildly increased, although without significance. There was no significant difference in accuracy among the three different working shifts. In addition, there was a negative correlation between the fatigue score and reaction time on the incongruent task in the Stroop test before the day shift (r=-0.542, p=0.020). The fatigue score in the postday shift was found to be inversely related to working hours in the daytime (r=-0.500, p=0.034). CONCLUSIONS Our study showed that increased fatigue was found in nurses after day and evening shifts, and shift work can affect the reaction time after the evening shift. However, there was no significant difference in accuracy and a high level of attention could be maintained among the three working shifts, suggesting a highly developed sense of responsibility in our nurses. IMPLICATIONS FOR NURSING MANAGEMENT In addition to focusing on the common adverse effects of evening or night shifts on nurses, fatigue in the day shift should be paid special attention to by the leadership in the nursing management. Also, nurse managers can implement specific strategies to reduce fatigue after the day shift by shortening the working hours in the daytime appropriately, setting rest periods in the day shift or dividing nurses into morning and afternoon shifts.
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Affiliation(s)
- Ran An
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University; Key Laboratory of Rehabilitation Medicine in Sichuan Province
| | - Cheng Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University; Key Laboratory of Rehabilitation Medicine in Sichuan Province
| | - Shaolong Ai
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University; Key Laboratory of Rehabilitation Medicine in Sichuan Province
| | - Yuan Wu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University; Key Laboratory of Rehabilitation Medicine in Sichuan Province
| | - Xi Luo
- Department of Neurology, West China Hospital, Sichuan University
| | - Xin Li
- Department of Neurology, West China Hospital, Sichuan University
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University; Key Laboratory of Rehabilitation Medicine in Sichuan Province
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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.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA.
| | - Lauren Anderson
- Department of Public Health, Syracuse University, Syracuse, NY, USA
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Billings JM. Firefighter sleep: a pilot study of the agreement between actigraphy and self-reported sleep measures. J Clin Sleep Med 2022; 18:109-117. [PMID: 34314350 PMCID: PMC8807900 DOI: 10.5664/jcsm.9566] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES The aim of this study is to determine the extent of agreement between self-reported measurements of total sleep time (TST) and actigraphy in the fire and emergency services occupation. METHODS Twenty-four firefighters participated in an 18-day study. Four measurements were used to assess TST: Pittsburgh Sleep Quality Index, a newly developed habitual Extended Sleep Survey, a newly developed daily Emergency Services Sleep Diary (ESSD), and actigraphy. The Extended Sleep Survey and ESSD were constructed to address the specific job-related characteristics of fire and emergency services that other measurements cannot achieve (eg, multiple sleep episode in a single night). RESULTS The Pittsburgh Sleep Quality Index TST is least accurate compared to actigraphy. The Extended Sleep Survey TST shows improvement over Pittsburgh Sleep Quality Index TST, but was statistically different from actigraphy TST. No difference in mean TST was found between ESSD TST and actigraphy TST. Furthermore, ESSD TST and actigraphy TST correlated strongly together. CONCLUSIONS Without modification, traditional self-reported measures may not be appropriate in the fire and emergency service occupation. This study suggests that the ESSD may serve as a useful alternative to actigraphy to measure TST. CITATION Billings JM. Firefighter sleep: a pilot study of the agreement between actigraphy and self-reported sleep measures. J Clin Sleep Med. 2022;18(1):109-117.
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Affiliation(s)
- Joel M. Billings
- Address correspondence to: Joel M. Billings, PhD, Department of Security and Emergency Services, Embry-Riddle Aeronautical University, 1 Aerospace Boulevard, Daytona Beach, Florida 32114;
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Song B, Wang B, Qian J, Zhang Y. Procrastinate at work, sleep badly at night: How job autonomy matters. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2021. [DOI: 10.1111/apps.12363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Baihe Song
- Department of Management The Hong Kong University of Science and Technology Hong Kong
| | - Bin Wang
- School of Management Shanghai University Shanghai China
| | - Jing Qian
- Business School Beijing Normal University Beijing China
| | - Yue Zhang
- School of Management Shanghai University Shanghai China
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Zahraie MA, Alaedini F, Payandemehr P, Saadat S, Sotoodehnia M, Bahreini M. The influence of shift work on the psychomotor capabilities of emergency medicine residents. J Am Coll Emerg Physicians Open 2021; 2:e12601. [PMID: 34927141 PMCID: PMC8649006 DOI: 10.1002/emp2.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Shift work affects health status of healthcare providers and patients. We assessed the effect of shift work on psychomotor activities of emergency medicine residents of 3 university hospitals. METHODS The participants were enrolled to perform selected psychomotor tests via the Vienna test system (VTS) after written consent. They passed 4 episodes of test performance before and after 2 consecutive day and night clinical shifts of 12 hours. The status of general health, circadian rhythm, sleepiness, smoking habits, and the scores of the cognition test (COG), the determination test (DT), and the visual pursuit test of emergency medicine residents were compared before and after morning and night shifts. RESULTS Overall, 23 residents (34.8% were male) performed tests. The mean (SD) age was 35.7 + 8.5 years. The mean general health and circadian scores before and after day/night shifts were not different. The Stanford sleepiness scale showed higher scores after night shifts. In the cognition test, the sum of correct rejections was higher after day shifts. Moreover, in the DT results, correct responses were more prevalent, the omitted responses were fewer accompanied by better median reaction time after day shifts. The sum of correct rejections of the COG test showed difference in terms of improved results in night tests compared to day-shift tests. The mean reaction time of the DT showed significant difference with shorter reaction time in night-shift tests. The visual pursuit test results were not different between day and night shifts. CONCLUSIONS Sleepiness was higher after night shifts. The results of selected psychomotor tests showed that the psychomotor function of the residents was not delayed or worse after night shifts in comparison to the day shifts.
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Affiliation(s)
| | - Farshid Alaedini
- Research Center for Health Management in Mass GatheringRed Crescent Society of IranTehranIran
| | - Pooya Payandemehr
- Department of Emergency MedicineSina Hospital, Tehran University of Medical SciencesTehranIran
| | | | - Mehran Sotoodehnia
- Department of Emergency MedicineSina Hospital, Tehran University of Medical SciencesTehranIran
| | - Maryam Bahreini
- Department of Emergency MedicineTehran University of Medical SciencesTehranIran
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Galli O, Jones CW, Larson O, Basner M, Dinges DF. Predictors of interindividual differences in vulnerability to neurobehavioral consequences of chronic partial sleep restriction. Sleep 2021; 45:6433368. [PMID: 34897501 DOI: 10.1093/sleep/zsab278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Interindividual differences in the neurobehavioral response to sleep loss are largely unexplained and phenotypic in nature. Numerous factors have been examined as predictors of differential response to sleep loss, but none have yielded a comprehensive view of the phenomenon. The present study examines the impact of baseline factors, habitual sleep-wake patterns, and homeostatic response to sleep loss on accrued deficits in psychomotor vigilance during chronic partial sleep restriction (SR), in a total of 306 healthy adults that participated in one of three independent laboratory studies. Findings indicate no significant impact of personality, academic intelligence, subjective reports of chronotype, sleepiness and fatigue, performance on working memory, and demographic factors such as sex, ethnicity, and body mass index, on neurobehavioral vulnerability to the negative effects of sleep loss. Only superior baseline performance on the psychomotor vigilance test and ability to sustain wakefulness on the maintenance of wakefulness test were associated with relative resilience to decrements in vigilant attention during SR. Interindividual differences in vulnerability to the effects of sleep loss were not accounted for by prior sleep history, habitual sleep patterns outside of the laboratory, baseline sleep architecture, or homeostatic sleep response during chronic partial SR. A recent theoretical model proposed that sleep-wake modulation may be influenced by competing internal and external demands which may promote wakefulness despite homeostatic and circadian signals for sleep under the right circumstances. Further research is warranted to examine the possibility of interindividual differences in the ability to prioritize external demands for wakefulness in the face of mounting pressure to sleep.
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Affiliation(s)
- Olga Galli
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher W Jones
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia Larson
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychology, University of Pennsylvania, Philadelphia, PA, 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
| | - David F Dinges
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Oderinde KO, Akanni OO, Olashore A. Knowledge of the coronavirus disease 2019 (COVID-19) and sleep problems among a selected sample of psychiatric hospital staff in Nigeria: a cross-sectional study. Pan Afr Med J 2021; 40:39. [PMID: 34795820 PMCID: PMC8571927 DOI: 10.11604/pamj.2021.40.39.25357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/03/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction as the coronavirus disease 2019 (COVID-19) spreads, sleep problems are expected to increase among healthcare workers. Therefore, we aimed to assess the knowledge of COVID-19, sleep problem and identify sociodemographic factors associated with sleep problems among healthcare workers in a Nigerian neuropsychiatric hospital. Methods a cross-sectional study was conducted among 200 healthcare workers in a neuropsychiatric hospital using self-administered questionnaires to assess knowledge of COVID-19, sleep problem, social support, and sociodemographic factors that affect sleep. Chi-square test and Spearman's correlation were applied to assess the association between sociodemographic factors and sleep problems. Results about 23.9% of the healthcare workers reported having a sleep problem. However, there was no association of sleep problems with any sociodemographic factors except age (r=0.26) and social support (r=-0.18). Conclusion the study offered insight into the occurrence of sleep problems among healthcare workers and suggested a guide for planning interventions targeted at improving the psychological well-being of healthcare workers in the face of current global pandemics.
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Affiliation(s)
| | | | - Anthony Olashore
- Department of Psychiatry, University of Botswana, Gaborone, Botswana
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Maglalang DD, Katigbak C, Gómez MAL, Sorensen G, Hopcia K, Hashimoto DM, Pandey S, Takeuchi DT, Sabbath EL. Workplace Discrimination and Short Sleep Among Healthcare Workers: The Buffering Effect of People-Oriented Culture. J Occup Environ Med 2021; 63:857-864. [PMID: 34597282 PMCID: PMC8486916 DOI: 10.1097/jom.0000000000002246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Examine the association of discrimination and short sleep and the buffering effect of people-oriented culture in the workplace among nurses and patient care associates. METHODS Used a mixed-methods design from the 2018 Boston Hospital Workers Health Study (N = 845) and semi-structured interviews among nurse directors (N = 16). RESULTS We found that people-oriented culture reduced the odds of short sleep and slightly attenuated the association of discrimination and short sleep. People-oriented culture did not buffer the effects of discrimination on short sleep. Qualitative findings showed that discrimination occurred between co-workers in relation to their job titles and existing support in the workplace does not address discrimination. CONCLUSIONS Healthcare industries need to implement specific programs and services aimed at addressing discrimination which can potentially improve health outcomes among workers.
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Affiliation(s)
- Dale Dagar Maglalang
- Stanford Prevention Research Center, Stanford University, School of Medicine, Stanford, California, USA
| | - Carina Katigbak
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - María Andrée López Gómez
- Department of Sociology, Memorial University of Newfoundland, St. Johns, Newfoundland and Labrador, Canada
| | - Glorian Sorensen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karen Hopcia
- Workplace Health and Wellbeing, Partners HealthCare System, Boston, Massachusetts, USA
| | - Dean M. Hashimoto
- Workplace Health and Wellbeing, Partners HealthCare System, Boston, Massachusetts, USA
- Boston College Law School, Newton Centre, Massachusetts, USA
| | - Shanta Pandey
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - David T. Takeuchi
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Erika L. Sabbath
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
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Riyapan S, Chantanakomes J, Somboonkul B, Shin SD, Chiang WC. Effect of Nighttime on Prehospital Care and Outcomes of Road Traffic Injuries in Asia: A Cross-Sectional Study of Data from the Pan-Asian Trauma Outcomes Study (PATOS). PREHOSP EMERG CARE 2021; 26:573-581. [PMID: 34464227 DOI: 10.1080/10903127.2021.1974990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Emergency response to a road traffic injury (RTI) plays a crucial role in patient survival, and the quality of the emergency response should be consistent regardless of the time of day. The aim of this study was to investigate prehospital care and survival outcomes compared between emergency response to RTI during the day and emergency response to RTI at night in Asia.Method: This cross-sectional study used data from the Pan-Asian Trauma Outcome Study (PATOS) that was conducted during 2015-2018. We included RTI patients who were transported to the emergency department (ED) by ground ambulance. That group was then categorized according to the time that the ambulance arrived on-scene. On-scene arrival during 8:00 am to 7:59 pm was defined as the daytime group, and arrival during 8:00 pm to 7:59 am was defined as the nighttime group. Multiple logistic regression was employed to identify factors associated with nighttime prehospital interventions and survival outcomes after adjustment for age, alcohol consumption, and injury severity score (ISS).Results: The final analysis included 20,105 RTI patients. Of those, 12,043 (60%) accidents occurred during the daytime, and 8,062 (40%) occurred at night. RTI patients at night were younger (mean age: 35.7 ± 17.3 vs. 39.5 ± 20.7; p < 0.001), had more alcohol consumption (15.0% vs. 4.2%; p < 0.001), and had more severe injuries (mean ISS: 6.5 ± 7.5 vs. 5.8 ± 7.0; p < 0.001) compared to the daytime group. The nighttime group had increased prehospital immobilization (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.14-1.31) and more prehospital intravenous (IV) access (aOR 1.36, 95%CI: 1.22-1.51). There was no significant difference in either basic or advanced airway management between the daytime and nighttime groups. The nighttime group had decreased survival in the ED (aOR: 0.80, 95%CI: 0.65-0.98); however, nighttime on-scene arrival did not impact survival to discharge (aOR: 1.10, 95%CI: 0.91-1.33).Conclusion: In the PATOS community, RTI patients that sustained their injuries at night received significantly more prehospital immobilization and IV access, and they had significantly decreased survival in the ED. The results of this study can be used to develop and enhance strategies to improve the care and outcomes of nighttime RTI in Asia.
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Cash RE, Anderson SE, Lancaster KE, Lu B, Rivard MK, Camargo CA, Panchal AR. Associations between sleep, stress, and cardiovascular health in emergency medical services personnel. J Am Coll Emerg Physicians Open 2021; 2:e12516. [PMID: 34322683 PMCID: PMC8295241 DOI: 10.1002/emp2.12516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Our objective was to quantify the associations between sleep duration and perceived and chronic stress with ideal cardiovascular health (CVH) among emergency medical services (EMS) personnel from county-based EMS agencies. METHODS We conducted a cross-sectional survey of cardiovascular disease (CVD)-free EMS personnel from 4 US EMS agencies. The questionnaire consisted of the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Chronic Burden Scale, and the CVH components (smoking, body mass index, physical activity, diet, blood glucose, blood pressure, cholesterol, each scored 0-2 points). The components were summed and ideal CVH considered 11-14 points. Mixed effects logistic regression models with a random intercept for agency were used to estimate the odds of ideal CVH for good sleep quality (PSQI < 5 points), recommended sleep duration (7 to < 9h), low perceived stress (PSS < 26 points), and low chronic stress (0 recent stressful events). RESULTS We received 379 responses (response rate = 32%). There was low prevalence of good sleep quality (23%) and recommended sleep duration (25%), but 95% reported low perceived stress, and 33% had low chronic stress. Ideal CVH was reported by 30%. No significant associations between ideal CVH and sleep quality, perceived stress, or chronic stress were found. There was a nearly 2-fold increase in the odds of ideal CVH with recommended sleep duration (odds ratio: 1.83, 95% confidence interval: 1.08-3.10). CONCLUSION In this sample of EMS personnel, only recommended sleep duration was associated with ideal CVH. Future longitudinal studies are needed to understand the relationship between sleep, stress, and CVD in this understudied occupational group.
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Affiliation(s)
- Rebecca E. Cash
- National Registry of Emergency Medical TechniciansColumbusOhioUSA
- Division of EpidemiologyThe Ohio State University College of Public HealthColumbusOhioUSA
| | - Sarah E. Anderson
- Division of EpidemiologyThe Ohio State University College of Public HealthColumbusOhioUSA
| | - Kathryn E. Lancaster
- Division of EpidemiologyThe Ohio State University College of Public HealthColumbusOhioUSA
| | - Bo Lu
- Division of BiostatisticsThe Ohio State University College of Public HealthColumbusOhioUSA
| | - Madison K. Rivard
- National Registry of Emergency Medical TechniciansColumbusOhioUSA
- Division of Health Behavior and Health PromotionThe Ohio State University College of Public HealthColumbusOhioUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ashish R. Panchal
- National Registry of Emergency Medical TechniciansColumbusOhioUSA
- Division of EpidemiologyThe Ohio State University College of Public HealthColumbusOhioUSA
- Department of Emergency MedicineThe Ohio State University Wexner Medical CenterColumbusOhioUSA
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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.
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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
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Supporting the Mental Health and Well-Being of First Responders from Career to Retirement: A Scoping Review. Prehosp Disaster Med 2021; 36:475-480. [PMID: 33928892 DOI: 10.1017/s1049023x21000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION First responders are at greater risk of mental ill health and compromised well-being compared to the general population. It is important to identify strategies that will be effective in supporting mental health, both during and after the first responder's career. METHODS A scoping review was conducted using the PubMed database (1966 to October 1, 2020) and the Google Scholar database (October 1, 2020) using relevant search terms, truncation symbols, and Boolean combination functions. The reference lists of all relevant publications were also reviewed to identify further publications. RESULTS A total of 172 publications were retrieved by the combined search strategies. Of these, 56 met the inclusion criteria and informed the results of this overview paper. These publications identified that strategies supporting first responder mental health and well-being need to break down stigma and build resilience. Normalizing conversations around mental health is integral for increasing help-seeking behaviors, both during a first responder's career and in retirement. Organizations should consider the implementation of both pre-retirement and post-retirement support strategies to improve mental health and well-being. CONCLUSION Strategies for supporting mental health and well-being need to be implemented early in the first responder career and reinforced throughout and into retirement. They should utilize holistic approaches which encourage "reaching in" rather than placing an onus on first responders to "reach out" when they are in crisis.
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Bouillon-Minois JB, Trousselard M, Pereira B, Schmidt J, Clinchamps M, Thivel D, Ugbolue UC, Moustafa F, Occelli C, Vallet G, Dutheil F. Protocol of the Study on Emergency Health Care Workers' Responses Evaluated by Karasek Questionnaire: The SEEK-Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4068. [PMID: 33921527 PMCID: PMC8069162 DOI: 10.3390/ijerph18084068] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stress is a significant public health concern that can be self-evaluated using the job control demands model from Karasek. Emergency health care workers are particularly exposed to stress because of the intrinsic characteristics associated with the job (i.e., life-threatening emergencies, overcrowding, lack of bed spaces). However, these attributes have never been studied using the Karasek model. METHODS An observational, prospective, multicentric study in French Emergency Departments will be conducted using a cohort of emergency health care workers. Four questionnaires before a control day and after a nightshift will be assessed every 5 years in the same emergency departments. Also, the Karasek questionnaire, a sociodemographic questionnaire, the Maslach Burnout Inventory scale, the Hospital Anxiety, Depression Scale, and a food intake questionnaire will be evaluated. Salivary biomarkers (cortisol, immunoglobulin A, lysozyme) will be collected from every emergency health care worker who consents to participating in the study. CONCLUSION This study will provide a point of care for the emergency health care workers' stress situation every 5 years. Ethics: This protocol was registered in Clinical Trials under the identification NCT02401607 after the French Ethics Committee's approval.
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Affiliation(s)
- Jean-Baptiste Bouillon-Minois
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (J.S.); (F.M.)
- LaPSCo, Université Clermont Auvergne, CNRS, 63000 Clermont-Ferrand, France; (G.V.); (F.D.)
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute, BP73, 91223 Brétigny-sur-Orge, France;
- APEMAC/EPSAM, EA 4360, Ile du Saulcy, BP 30309, 57006 Metz, France
| | - Bruno Pereira
- Clinical Research and Innovation Direction, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - Jeannot Schmidt
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (J.S.); (F.M.)
| | - Maelys Clinchamps
- Occupational and Environmental Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Ukadike Chris Ugbolue
- Institute for Clinical Exercise & Health Science, University of the West of Scotland, Glasgow G720LH, UK;
- Department of Biomedical Engineering, University of Strathclyde, Glasgow G1 1XQ, UK
| | - Farès Moustafa
- Emergency Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (J.S.); (F.M.)
| | - Céline Occelli
- Emergency Department, CHU Nice, 06000 Nice, France;
- Emergency Department, Université Côte d’Azur, 06000 Nice, France
| | - Guillaume Vallet
- LaPSCo, Université Clermont Auvergne, CNRS, 63000 Clermont-Ferrand, France; (G.V.); (F.D.)
| | - Frédéric Dutheil
- LaPSCo, Université Clermont Auvergne, CNRS, 63000 Clermont-Ferrand, France; (G.V.); (F.D.)
- Occupational and Environmental Medicine, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France;
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Afshari A, Borzou SR, Shamsaei F, Mohammadi E, Tapak L. Perceived occupational stressors among emergency medical service providers: a qualitative study. BMC Emerg Med 2021; 21:35. [PMID: 33757433 PMCID: PMC7988920 DOI: 10.1186/s12873-021-00430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/12/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Emergency medical services (EMS) providers are at continuous exposure to occupational stressors which negatively affect their health and professional practice. This study explored perceived occupational stressors among EMS providers. Methods This qualitative study was conducted from December 2019 to April 2020 using conventional content analysis. Sixteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. Semi-structured interviews (with length of 45–60 min) were held for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach. Findings Data analysis resulted in the development of two themes, namely critical conditions of EMS provision, and personal and professional conflicts. The six categories of these two themes were complexity of patients’ clinical conditions, interruption of EMS provision, health hazards, interpersonal problems, interprofessional interactions, and legal conflicts. Conclusion Besides the stress associated with emergency patient care, EMS providers face many different occupational stressors. EMS managers can use the findings of the present study to develop strategies for reducing occupational stress among EMS providers and thereby, improve their health and care quality.
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Affiliation(s)
- Ali Afshari
- Nursing and Midwifery School, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Reza Borzou
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Farshid Shamsaei
- Maternal and Child Care Research Center,Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health, Modeling of Noncommunicable diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Sedlár M. Work-related factors, cognitive skills, unsafe behavior and safety incident involvement among emergency medical services crew members: relationships and indirect effects. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:1281-1290. [PMID: 33557717 DOI: 10.1080/10803548.2021.1888018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives. This study examines relationships between work-related factors - stress and fatigue, cognitive skills - situation awareness and cognitive flexibility, unsafe behavior and safety incident involvement among emergency medical services (EMS) crew members, and whether cognitive skills and unsafe behavior together indirectly affect the relationship between work-related factors and safety incident involvement. Methods. A sample of 131 EMS crew members working in ground ambulances (physicians, paramedics, ambulance drivers) completed self-report questionnaires. Results. The correlation analysis showed significant positive interrelationships between work-related factors, unsafe behavior and safety incident involvement, and that cognitive skills were significantly negatively related to these variables. The multiple indirect effects analysis revealed significant indirect effects of both work-related factors on safety incident involvement through situation awareness and unsafe behavior, but not through cognitive flexibility. Conclusion. In terms of reducing the number of EMS provider and patient safety incidents, the findings suggest the importance of reducing stress and fatigue in EMS crew members, improving their cognitive skills, in particular situation awareness, and supporting their safety compliance behavior.
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Affiliation(s)
- Martin Sedlár
- Institute of Experimental Psychology, Centre of Social and Psychological Sciences, Slovak Academy of Sciences, Slovakia
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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.
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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
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Rogers H, Chalil Madathil K, Joseph A, McNeese N, Holmstedt C, Holden R, McElligott JT. Task, usability, and error analyses of ambulance-based telemedicine for stroke care. ACTA ACUST UNITED AC 2021. [DOI: 10.1080/24725579.2021.1883775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hunter Rogers
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Kapil Chalil Madathil
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Anjali Joseph
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Nathan McNeese
- College of Engineering, Computing and Applied Sciences, Departments of Civil and Industrial Engineering, Clemson University, Clemson, SC, USA
| | - Christine Holmstedt
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Richard Holden
- School of Medicine, Indiana University, Bloomington, IN, USA
| | - James T. McElligott
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Abbas A, Al-Otaibi T, Gheith OA, Nagib AM, Farid MM, Walaa M. Sleep Quality Among Healthcare Workers During the COVID-19 Pandemic and Its Impact on Medical Errors: Kuwait Experience. Turk Thorac J 2021; 22:142-148. [PMID: 33871338 PMCID: PMC8051301 DOI: 10.5152/turkthoracj.2021.20245] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Millions of people suffer from sleep disturbances. In addition, the coronavirus disease 2019 (COVID-19) pandemic created several new challenges-particularly for frontline healthcare workers (HCWs). This study assessed the sleep quality (SQ) among HCWs. MATERIAL AND METHODS A cross-sectional study was conducted using an English-language online survey. The participants were invited via a web link sent using social network platforms. It included sociodemographic- and profession-related characteristics. COVID-19-associated risks were assessed (e.g., being on the front line, doing swabs, satisfaction about protective equipment, and management protocols). Assessment of SQ was done using the Pittsburgh Sleep Quality Index (PSQI) and various medical errors were recorded. RESULTS A total of 217 HCWs completed the survey with mean (±standard deviation) age of 35.8 (±7.3) years; 56.2% were male, 18.43% had comorbidities, and 61.75% experienced sleep difficulties before the COVID-19 crisis. This work reports a 78.8% prevalence of poor SQ, with the mean (standard deviation) global PSQI score of 9.36 (±4.4). HCWs with poor sleep experienced more positive comorbid profile (23.64% versus 6.52%, p=0.01). Working on the front lines of COVID-19 was associated with poor sleep (69.59% versus 47.83%, p=0.006). Among the participants, 77.42% performed medical errors, particularly not checking for drug allergies (17.97%), dispensing medication with incomplete instructions (20.74%), providing incorrect doses or overdosing (14.75%), incorrectly explaining the use of medication (9.22%), and prescribing a drug to the wrong patient (10.14%). CONCLUSION This nationwide survey reported high prevalence of poor SQ among HCWs during the COVID-19 pandemic. Being an HCW on the front lines of COVID-19 and doing swabs with a positive comorbidity was associated with poor sleep.
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Affiliation(s)
- Ahmad Abbas
- Department of Chest Diseases, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
| | - Torki Al-Otaibi
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
| | - Osama Ashry Gheith
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
- Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ayman Maher Nagib
- Department of Nephrology, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah area, Kuwait
- Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud M. Farid
- National Blood Transfusion Services, Egypt & Health Care Management Consultant, Technical Office, MOH, Kuwait
| | - Mohammad Walaa
- Department of Chest Diseases, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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VITALE E. "Anxiety, Depression and Insomnia Conditions in Italian Nurses
during the First and the Second Waves of the Covid-19 Pandemic". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.1.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"Background: To assess the levels of anxiety, depression and insomnia among
Italian nurses directly involved in the care of patients with Covid-19,
considering the first and the second wave of the pandemic.
Methods: An online questionnaire was administered on some pages of the
nursing social networks and addressed precisely to nurses directly involved
in the care of patients affected by Covid-19 in two different periods of the
pandemic: during the first wave (March2020 - May 2020) and during the
second wave (October 2020 - November 2020).
Results: A total of 592 nurses agreed to participate in the study: 291 nurses
during the first wave and 301 during the second wave. No significant
differences were recorded among the two groups based on anxiety disorder
(p=.364). A significant difference between the two groups were recorded
considering the depression and the insomnia condition, too (p <.001;
p<.001). Additionally, no significant differences were recorded between the
two waves, both for the anxiety, depression and insomnia disorders. In fact,
there were only sex-related differences for each wave, but between the two
waves the condition among nurses did not vary significantly.
Conclusion: Further psychological support should be implemented and
nurses encouraged in their care of patients suffered from Covid-19."
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Affiliation(s)
- Elsa VITALE
- Registered Nurse at the Department of Mental Health, ASL Bari, Italy. Contract professor for the basic and specialist degree course in nursing at the University of Bari
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Bartlett D, Hansen S, Cruickshank T, Rankin T, Zaenker P, Mazzucchelli G, Gaston M, Du Plooy D, Minhaj Z, Errey W, Rumble T, Hay T, Miles A, Mills B. Effects of sleepiness on clinical decision making among paramedic students: a simulated night shift study. Emerg Med J 2021; 39:45-51. [PMID: 33593812 DOI: 10.1136/emermed-2019-209211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/04/2021] [Accepted: 01/17/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Paramedics are at the forefront of emergency healthcare. Quick and careful decision making is required to effectively care for their patients; however, excessive sleepiness has the potential to impact on clinical decision making. Studies investigating the effects of night shift work on sleepiness, cognitive function and clinical performance in the prehospital setting are limited. Here, we aimed to determine the extent to which sleepiness is experienced over the course of a simulation-based 13-hour night shift and how this impacts on clinical performance and reaction time. METHODS Twenty-four second year paramedic students undertook a 13-hour night shift simulation study in August 2017. The study consisted of 10 real-to-life clinical scenarios. Sleepiness, perceived workload and motivation were self-reported, and clinical performance graded for each scenario. Reaction time, visual attention and task switching were also evaluated following each block of two scenarios. RESULTS The accuracy of participants' clinical decision making declined significantly over the 13-hour night shift simulation. This was accompanied by an increase in sleepiness and a steady decline in motivation. Participants performed significantly better on the cognitive flexibility task across the duration of the simulated night shift and no changes were observed on the reaction time task. Perceived workload varied across the course of the night. CONCLUSION Overall, increased sleepiness and decreased clinical decision making were noted towards the end of the 13-hour simulated night shift. It is unclear the extent to which these results are reflective of practising paramedics who have endured several years of night shift work, however, this could have serious implications for patient outcomes and warrants further investigation.
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Affiliation(s)
- Danielle Bartlett
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia .,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sara Hansen
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Travis Cruickshank
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Timothy Rankin
- Centre for Sleep Science, Faculty of Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Pauline Zaenker
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Gavin Mazzucchelli
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Matthew Gaston
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dirk Du Plooy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Zahed Minhaj
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - William Errey
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Tyron Rumble
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Taylor Hay
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Alecka Miles
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Brennen Mills
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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50
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O’connor P, O’malley R, Oglesby AM, Lambe K, Lydon S. Measurement and monitoring patient safety in prehospital care: a systematic review. Int J Qual Health Care 2021; 33:mzab013. [PMID: 33459774 PMCID: PMC10517741 DOI: 10.1093/intqhc/mzab013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prehospital care is potentially hazardous with the possibility for patients to experience an adverse event. However, as compared to secondary care, little is known about how patient safety is managed in prehospital care settings. OBJECTIVES The objectives of this systematic review were to identify and classify the methods of measuring and monitoring patient safety that have been used in prehospital care using the five dimensions of the Measuring and Monitoring Safety (MMS) framework and use this classification to identify where there are safety 'blind spots' and make recommendations for how these deficits could be addressed. METHODS Searches were conducted in January 2020, with no limit on publication year, using Medline, PsycInfo, CINAHL, Web of Science and Academic Search. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies concerned with measuring and monitoring safety in prehospital care were included. Two researchers independently extracted data from studies and applied a quality appraisal tool (the Quality Assessment Tool for Studies with Diverse Designs). RESULTS A total of 5301 studies were screened, with 52 included in the review. A total of 73% (38/52) of the studies assessed past harm, 25% (13/52) the reliability of safety critical processes, 1.9% (1/52) sensitivity to operations, 38.5% (20/52) anticipation and preparedness and 5.8% (3/52) integration and learning. A total of 67 methods for measuring and monitoring safety were used across the included studies. Of these methods, 38.8% (26/67) were surveys, 29.9% (20/67) were patient records reviews, 14.9% (10/67) were incident reporting systems, 11.9% (8/67) were interviews or focus groups and 4.5% (3/67) were checklists. CONCLUSIONS There is no single method of measuring and monitoring safety in prehospital care. Arguably, most safety monitoring systems have evolved, rather than been designed. This leads to safety blind spots in which information is lacking, as well as to redundancy and duplication of effort. It is suggested that the findings from this systematic review, informed by the MMS framework, can provide a structure for critically thinking about how safety is being measured and monitored in prehospital care. This will support the design of a safety surveillance system that provides a comprehensive understanding of what is being done well, where improvements should be made and whether safety interventions have had the desired effect.
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Affiliation(s)
- Paul O’connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Roisin O’malley
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Anne-Marie Oglesby
- Health Protection and Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1, Ireland
| | - Kathryn Lambe
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, County Galway, Ireland
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