Association Between Poor Sleep, Fatigue, and Safety Outcomes in Emergency Medical Services Providers

Abstract

Objective To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among Emergency Medical Services (EMS) workers. Methods We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AE), and safety compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes. Results We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95%CI 6.6, 7.2). Greater than half of respondents were classified as fatigued (55%, 95%CI 50.7, 59.3). Eighteen percent of respondents reported an injury (17.8%, 95%CI 13.5, 22.1), forty-one percent a medical error or AE (41.1%, 95%CI 36.8, 45.4), and 89% (95%CI 87, 92) safety compromising behaviors. After controlling for confounding, we identified 1.9 greater odds of injury (95%CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95%CI 1.4, 3.3), and 3.6 greater odds of safety compromising behavior (95%CI 1.5, 8.3) among fatigued respondents versus non-fatigued respondents. Conclusions In this sample of EMS workers, poor sleep quality and fatigue is common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.

Effects of Napping During Shift Work on Sleepiness and Performance in Emergency Medical Services Personnel and Similar Shift Workers: A Systematic Review and Meta-Analysis

“…Greater than half of Emergency Medical Services (EMS) personnel report fatigue and poor sleep quality (1)(2)(3). Naps improve alertness, vigilance, and cognitive performance in laboratory and field studies (4,5).…”

Effect of Fatigue Training on Safety, Fatigue, and Sleep in Emergency Medical Services Personnel and Other Shift Workers: A Systematic Review and Meta-Analysis

“…Educating and training Emergency Medical Services (EMS) personnel to mitigate fatigue and manage their sleep may lead to improved safety and worker health. The need for fatigue education and training is evidenced by the high proportion of EMS personnel that report high levels of work-related fatigue and poor sleep (8,9). …”

Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

“…Background studies mostly have assessed the effect of sleeplessness on the performance of physicians. [7][8][9][10] But the differences and effecting factors on the sleep quality between the specialties in medicine is not investigated. Emergency physician's sleep quality (who must passed all the nigh sleepless) compared to medical colleagues in other specialties are unknown.…”