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Fatigue, Poor Sleep Linked to EMS Safety, Work Quality

Sleep disorders (


Fatigue and poor sleep affect many emergency medical services (EMS)  workers, which appear linked to higher rates of injuries and medical errors, according to a study by researchers at University of Pittsburgh. The findings, with contributions from colleagues at Western Carolina University in Cullowhee, North Carolina and National Center for Human Factors Engineering in Healthcare in Washington, DC, appear online in the journal Prehospital Emergency Care (paid subscription required).

The team led by Daniel Patterson, a professor at Pittsburgh’s medical school, surveyed EMS workers nationwide, receiving 547 responses from 30 EMS agencies, a return rate of about 36 percent from the agencies contacted. The survey included a tested index of sleep quality, also developed at Pittsburgh, items measuring physical and mental fatigue adapted for EMS work, and questions on safety outcomes — worker injuries, medical errors or adverse events, and behaviors compromising safety, such as driving at excessive speeds.

The findings show EMS workers carrying aggressive work schedules. Most survey respondents reported working between six and 15 shifts per month, and half reported regular shift lengths of 24 hours. A third of the respondents were regularly working at more than one EMS agency.

The results indicate more than half (55%) of the respondents were classified as fatigued. Some four in 10 (41%) reported medical errors, and nearly two in 10 respondents (18%) said they were injured in the line of work. Nearly all respondents — nine in 10 (90%) — reported safety-compromising behavior on the job.

The findings suggest fatigue may affect the quality of EMS work, as well as the personal safety of the workers themselves. After controlling for extraneous variables, researchers found the odds of medical errors or adverse events were more than twice as high (2.2 times greater) among fatigued respondents than their non-fatigued peers. The researchers also found the odds of worker injury were nearly twice (1.9 times) as high, and chances of safety-compromising behavior were 3.6 times greater for fatigued compared to non-fatigued EMS workers.

The team reports as well the number of shifts worked monthly was associated with identified medical errors and adverse events. However, they did not find associations between number of shifts and personal injury or perceptions of compromised safety.

“Emergency medical technicians and paramedics work long hours in a demanding occupation with an unpredictable workload, which can easily lead to fatigue and poor sleep,” says Patterson. “Our study is one of the first to show that this may jeopardize patient and provider safety in the EMS setting.”

Read More: Insomnia Costs U.S. Employers Billions in Lost Productivity

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