Public Release: 

Pitt study suggests risk management approach to combat EMS fatigue

Guidelines aim to mitigate the effects of fatigue by addressing the impact of shift work.

University of Pittsburgh Schools of the Health Sciences

PITTSBURGH, Jan. 12, 2018 - Extended shift work has historically been linked to interrupted sleep patterns and risk of injury, and is a persistent problem for emergency medical services (EMS) personnel who are tasked with delivering acute care under significant pressure.

New guidelines, written by a team led by University of Pittsburgh School of Medicine scientists and published this week in the journal Prehospital Emergency Care, aim to mitigate the effects of fatigue by addressing the impact of shift work and scheduling.

"The problem of fatigued EMS personnel is widespread and not isolated to one type of EMS operation or category of EMS clinician. Administrators of EMS organizations are not sufficiently equipped to address fatigue in the workplace, in part because of the absence of guidelines for fatigue risk management in the EMS setting," said Daniel Patterson, Ph.D., lead author and assistant professor of emergency medicine at the Pitt School of Medicine

After review and analysis of more than 38,000 journal articles, conference presentations and other publications, Patterson and his colleagues gathered information on fatigue and shift work to develop the evidence-based guidelines for fatigue risk management and test the impact of the findings to create a biomathematical model for use by the EMS community to aid in shift-scheduling decisions.

The guidelines consist of five recommendations:

  • Use of fatigue/sleepiness surveys to measure and monitor EMS personnel fatigue.

  • Limit EMS shifts to less than 24 hours in duration.

  • Give EMS personnel access to caffeine to help stave off fatigue.

  • Allow EMS personnel the opportunity to nap while on duty.

  • Provide education and training in fatigue risk management to EMS personnel.

Patterson and his team expect the guidelines to have a wide impact on improving practice and policies to alleviate EMS personnel fatigue, whether when driving an ambulance or caring for patients.

"Operating the ambulance is only one aspect of EMS care," said Patterson. "Most of the work EMS clinicians do is actually patient care. Fatigue affects decision-making abilities and overall performance, and with the pressure of delivering acute care, one wrong decision can be detrimental."

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Additional study authors are Francis Guyette, M.D., Christian Martin-Gill, M.D., and Daniel Buysse, Ph.D., Pitt School of Medicine; Stephen J. Higgins, Ph.D., National Highway Traffic Safety Administration; Hans Van Dongen, Ph.D.; Washington State University; Ronald Thackery, American Medical Response, Inc.; Douglas Kupas, M.D., Geisinger Health System; David Becker, Columbia Southern University; Bradley Dean, Rowan County Emergency Medical Services; George Lindbeck, M.D., University of Virginia School of Medicine; Josef Penner, Mecklenburg County EMS; John Violanti, Ph.D., University at Buffalo; and Eddy Lang, M.D., University of Calgary.

The research was funded by the National Association of State EMS Officials and the National Highway Traffic Safety Administration.

About the University of Pittsburgh School of Medicine

As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.

Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.

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