5 recommendations for fatigue management in EMS personnel

Scientists from the University of Pittsburgh School of Medicine have developed a set of guidelines published in Prehospital Emergency Care to combat fatigue in emergency medical services (EMS) personnel in order to reduce medical errors and risk of injury. 

"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.

Researchers produced their guidelines for the aim of mitigating the effects of fatigue and identifying the impact of shift work and scheduling. A total of 38,000 articles were reviewed for data on fatigue and shift work to develop the recommendations.

The guidelines contain five recommendations:

• Use of fatigue and sleepiness surveys to measure EMS fatigue.
• Limit EMS shifts to less than 24 hours.
• Provide access to caffeine to prevent fatigue.
• Give EMS employees the opportunity to nap.
• Provide education and training on fatigue risk management to EMS employees.

Not all the data reviewed was given high marks for quality. The authors noted the accuracy of fatigue and sleepiness surveys has been questioned and there were concerns among the panel that workers could report high levels of fatigue to manipulate the surveys for their own benefit, limiting or eliminating work or, conversely, avoiding the loss of overtime work by reporting low levels of fatigue. The panel concluded that using the surveys, despite their limitations, would be more beneficial than ignoring them entirely.

The panel also labeled the recommendation to limit EMS shifts to 24 hours as “weak” and based on “very low” quality of evidence, noting that many EMS workers favor the longer shifts and cutting extended duration shifts may not be practical, cost-effective or safe for patients in some operations with low volume or in rural parts of the country.

Further recommendations were kept off the final list of guidelines due to weak evidence, including implementing “model-based fatigue risk management.”

One of the biggest obstacles in implementing these guidelines, the study concluded, may be convincing the workers themselves to change their habits. The authors noted EMS personnel “may judge themselves as invulnerable to fatigue” or dismiss fatigue as a sign of weakness. They also may not trust the motives of EMS administrators promoting the new standards.

“Faced with these and other barriers or threats, EMS administrators should clearly communicate their support for the evidence-based recommendations adopted,” Patterson and his coauthors wrote. “Increasing the awareness of fatigue as a threat should be a top priority, as limited awareness of the problem and solutions supported by evidence are commonly cited barriers to successful implementation of evidence-based guidelines.”