Helping EMS responders be safer by being less tired

UB researchers played a key role in the development of new guidelines released in January for managing fatigue in emergency medical services (EMS) personnel.

John Violanti, a former New York State Police trooper who studies police stress and fatigue among public safety workers, helped draft the guidelines along with researchers from the University of Pittsburgh Medical Center.

Violanti, research professor of epidemiology and environmental health in the School of Public Health and Health Professions, is a co-author on the paper, “Evidence-based guidelines for fatigue risk management in Emergency Medical Services,” published in a special issue of the journal Prehospital Emergency Care.

In addition, David Hostler and Jennifer Temple were the lead authors on a supporting review on caffeine use and fatigue in shift workers — a review that found a lack of research on caffeine and its effects on EMS shift workers in particular. Theirs is one of six supporting reviews published in the special issue.

Hostler, chair of the Department of Exercise and Nutrition Sciences, has extensive experience in EMS research and was asked by P. Daniel Patterson, principal investigator and assistant professor of emergency medicine at the University of Pittsburgh, to participate in the project.

Temple, associate professor of exercise and nutrition sciences and director of the Nutrition and Health Research Laboratory at UB, is a nationally recognized expert on caffeine use.

The problem of overly tired EMS workers is widespread, and it’s problematic for a variety of reasons. EMS personnel who are fatigued are more likely to get injured on the job and make mistakes when caring for patients, researchers say.

EMS organization managers aren’t properly equipped to address workplace fatigue, in part because until now there haven’t been any guidelines for managing fatigue risk in the EMS setting, according to researchers.

Based on a review of evidence published between 1980 and 2016, the panel created five recommendations for fatigue-risk management in EMS operations. Its guidelines range from the obvious — that EMS personnel should work shifts shorter than 24 hours in duration — to the more novel, such as allowing EMS workers to nap while on duty to mitigate fatigue.

In addition, panel members recommend using fatigue/sleepiness survey instruments to measure and monitor fatigue in EMS workers. They also suggest emergency responders have access to caffeine to combat fatigue.

The guidelines also recommend training and education in mitigating fatigue and fatigue-related risks. For example, education in sleep health may help EMS workers identify undiagnosed sleep disorders, such as obstructive sleep apnea, that can affect their performance while on duty. Back-to-back shifts and overtime are common. In addition, half of EMS clinicians report mental and physical fatigue while at work, as well as poor sleep quality, according to Violanti.

“It can be dangerous when they are transporting persons to medical care facilities while they are too tired to drive,” says Violanti. “Additionally, their own physical health is at risk if they are not getting the proper sleep. We know that poor sleep and shift work are associated with heart disease and diabetes, for example.”

In their supporting review, published along with the new guidelines, Hostler, Temple and colleagues conducted a meta-analysis of nearly 1,400 studies that focus on caffeine as a countermeasure for fatigue in shift workers.

This included worker groups, such as pilots or drivers, whose jobs require intense concentration and attention to detail per shift, and which can have serious, possibly deadly, consequences when workers are inattentive or careless due to being overly tired.

In particular, researchers sought to identify studies that addressed patient safety and EMS personnel safety through interventions using caffeine as a countermeasure to fatigue and sleepiness.

“There are no studies that investigate caffeine use and its effects on EMS workers or on patient safety,” they write.

“The lack of direct evidence for caffeine use in EMS workers makes the case that we need studies in this area to identify proper dose and timing to improve both patient safety and EMS workers’ health and safety,” says Hostler.

They did find a handful of studies indicating caffeine can help combat fatigue and improve performance in shift workers. For example, studies showed that caffeine use can lead to faster reaction time while lessening a slowdown in reaction time at the end of a shift.

However, EMS workers were not a represented group in these studies; one study assessed personnel safety by simulating a night mission in pilots, while another employed a driving simulator.

Previous studies also showed caffeine reduces sleep duration and quality, which could have serious implications for emergency personnel and patients alike, Hostler and Temple note, adding that additional studies are needed in order to better understand how caffeine affects the safety of both EMS personnel and patients.