Shorter Versus Longer Shift Durations to Mitigate Fatigue and Fatigue-Related Risks in Emergency Medical Services Personnel and Related Shift Workers: A Systematic Review

Abstract

The quality of existing evidence on the impact of shift duration on fatigue and fatigue-related risks is low or very low. Despite these limitations, this systematic review suggests that for outcomes considered critical or important to EMS personnel, shifts <24 hours in duration are more favorable than shifts ≥24 hours.

Impact of shift duration on alertness among air‐medical emergency care clinician shift workers

“…Our study is one of the largest prospective studies of air‐medical clinician alertness in relation to shift duration . We detected no differences in sleep behavior/patterns before and after shifts by shift duration.…”

“…Similar research on other healthcare shift worker populations (eg, resident physicians) has shown a progressive degeneration in performance and cognitive performance in relation to extended shift work . Several studies have investigated the relationship between shift duration and alertness of air‐medical clinicians . Braude et al investigated the impact of shiftwork cognitive performance in a small air‐medical system with 22 air‐medical participants .…”

“…Our findings provide valuable base rate information, as well as comparative data, for future research that may seek to replicate our protocol. From 1980 to 2016 only seven studies involving shift workers reported comparisons of outcomes stratified by 12 and 24‐h shift durations . The need for research comparing outcomes by 12‐h and 24‐h shifts is compelling, especially given that the majority of EMS shifts are 12 and 24 h in duration .…”

“…The 2018 Evidence Based Guidelines for Fatigue Risk Management in Emergency Medical Services (EMS) operations recommends shifts less than 24 h in duration . Because the current body of evidence germane to air‐medical clinicians and shift duration is limited and variable, the need for research that explores and explains differences in outcomes stratified by shift duration specific to air‐medical EMS operations is compelling …”

“…Despite these data, little is known about the impact of shift duration and fatigue on safety and performance related outcomes in the air‐medical EMS setting . One prior study of air‐medical clinicians evaluated cognitive performance and detected a decline in memory at the end of shifts compared to the beginning .…”