Not only is fatigue rampant among EMS workers, but it is also linked to increased injuries, medical errors and risky behaviors that can put responders and patients in danger, a new study finds.
Researchers from the University of Pittsburgh and colleagues surveyed more than 500 EMS workers nationwide about their sleep quality, including sleep duration and use of sleep medication, and their level of physical and mental fatigue. The researchers also asked about work-related injuries, medical errors or adverse events, and risky behaviors that could compromise safety.
About 55 percent of respondents reported poor sleep quality or severe fatigue while at work; 18 percent reported being injured in the previous three months; 41 percent reported a medical error or adverse event; and 90 percent reported that their safety or that of their patients was compromised during the prior three months.
The study found that fatigued EMS workers were nearly twice as likely to be injured as their well-rested peers. The odds of medical errors or adverse events were 2.2 times greater among the fatigued, while the odds of safety-compromising behavior was 3.6 times greater. “The risk of negative outcomes for the EMS worker and patient is high and different from risks from within the hospital,” the researchers report. “For example, the EMS worker makes a decision to provide medication or other treatment within minutes or even seconds of establishing a general impression of patient and condition. These decisions are made in a fast-paced and uncertain environment where the patient and bystanders can be violent, create distractions, or disrupt care delivery.”
Most respondents reported working between six and 15 shifts per month. One-half reported regular shift lengths of 24 hours, while one-third said they regularly worked at more than one EMS agency.
Longer shifts (24 vs. 12 hours or less) were not associated with increased safety risks. The researchers say they might not have been able to detect an association between shift length and safety because workload can vary so much for an individual EMS worker due to factors such as call volume, emergency department crowding and driving distance to emergency departments. The study is in the January–March issue of Prehospital Emergency Care.
Driving While Drowsy Exceedingly Common
Almost 32 percent of U.S. drivers admitted that during the previous month, they had driven when they were so tired that they had trouble keeping their eyes open, according to a AAA Foundation for Traffic Safety 2011 safety culture survey. “Drivers have a tendency to underestimate the impact being tired has on their driving ability, which puts themselves and others at risk,” AAA Foundation President and CEO Peter Kissinger said in a news release.
Nearly 17 percent of fatal crashes and 13 percent of crashes resulting in hospitalization involved a drowsy driver from 1999 to 2008, the report states. Driving with someone else seems to help; vehicles that contained two or more people were almost half as likely to be involved in a drowsy-related crash. Men and drivers aged 16 to 24 were more likely than others to be involved in such a crash.
Workplace Safety Culture May Affect Injuries, Patient Outcomes
EMS workers who rate their workplace as having a poor safety culture are more likely to be injured on the job, to make medical errors or experience adverse events, and to report engaging in safety-compromising behaviors, a new study finds.
Researchers from the University of Pittsburgh and colleagues surveyed EMS workers from 21 agencies across the U.S. using the EMS Safety Attitudes Questionnaire, which asks about six key areas of workplace safety: safety climate, teamwork, perceptions of management, working conditions, stress recognition and job satisfaction. Safety outcomes were measured using the EMS Safety Inventory, a survey designed by EMS physician medical directors and investigators to identify provider injuries, patient care errors and safety-compromising behavior.
About 16 percent of respondents reported sustaining an injury in the previous three months; 40 percent reported an error or adverse event; and 89 percent reported safety-compromising behaviors. Those who sustained an injury, who reported an error or adverse event, or who engaged in unsafe behaviors scored lower on nearly all of the safety attitude domains.
“There are sometimes drastic differences in how workers perceive their workplace safety from one EMS agency to the next,” senior author P. Daniel Patterson, Ph.D., EMT-B, assistant professor of emergency medicine at the University of Pittsburgh School of Medicine, said in a university news release. “What we have found is that perceptions about safety may be reality.”
Prior studies in hospitals and in other non-health care high-risk occupations have linked safety culture scores to injuries and accidents, but this is the first time such a connection has been found in the EMS setting, Patterson said.
The study is in the January–March issue of Prehospital Emergency Care.
Big Increase in TBIs Among Youth Athletes
Youth treated for sports and recreation-related traumatic brain injuries (TBIs) at U.S. emergency departments rose by 62 percent from 2001 to 2009, or from about 153,000 to about 248,000 annually, according to the Oct. 7, 2011, Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report. Top causes were bike riding, football and playground mishaps, basketball and soccer. CDC experts believe much of the increase occurred because of better recognition of the consequences of TBIs, rather than more injuries.
