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5 evidence-based guidelines for fatigue management in EMS

Expert opinion and guidelines can frame this important EMS health and safety issue and guide future research and progress


Research into fatigue recommends that EMS personnel work shifts shorter than 24 hours in duration.

Photo/Federal Occupational Health

Regardless of the community, medical emergencies and calls that require an EMS response never confine themselves to an 8-5 schedule. While emergency response is needed 24 hours a day, humans are not designed to be awake and responding to calls for 24 hours at a time. Fatigue on the job has been found to be related to accidents, injuries and mistakes. Work is underway to find ways to mitigate these risks.

An expert panel of scientists, EMS leaders and EMS personnel just published a comprehensive set of evidence-based guidelines for fatigue management in the EMS community. Guideline development was funded by the U.S. Department of Transportation to the National Association of State EMS Officials.

After reviewing all the published data on the topic, the expert panel made five evidence-based recommendations:

  1. Recommend using fatigue/sleepiness survey instruments to measure and monitor fatigue in EMS personnel.
  2. Recommend that EMS personnel work shifts shorter than 24 hours in duration.
  3. Recommend that EMS personnel have access to caffeine to help stave off fatigue.
  4. Recommend that EMS personnel have the opportunity to nap while on duty to mitigate fatigue.
  5. Recommend that EMS personnel receive education and training to mitigate fatigue and fatigue-related risks.

While, on the surface, the recommendations appear rather simple and intuitive, the process used to develop them and the implications for current and future practice should not be understated.

A comprehensive review of the published literature from 1980 to 2016 for EMS workers and groups with similar work shifts was conducted to identify relevant scientific work in the area. Each article was reviewed by the panel for quality, benefit versus harm, value and preferences of the targeted populations, and resource needs.

An evidence-to-decision framework was used to draft evidence-based recommendations. The team then voted on consensus until the final recommendations were made.

Implementing fatigue-mitigation techniques

This landmark work goes beyond a list of recommendations. It summarizes and weighs the pros and cons that should be considered when implementing each recommendation.

For instance, while the panel recommended implementing shifts less than 24 hours, it also notes scenarios and instances where such implementation should be weighed against the logistical challenges, good of the community and good of the personnel.

In such instances, the recommendation is that other fatigue-mitigation techniques be encouraged. In online supplemental materials, the panel also provides a number of resources and tools to support the recommendations and implementation.

Having evidenced-based national guidelines supports both the decision makers and personnel in EMS organizations who are looking to mitigate the health risks associated with the job. While clearly not all recommendations will be universally adopted, having the start of an evidence base and expert opinion can frame the issue and be used to help move EMS organizations in decision making.

The guidelines also highlight where evidence is thin and needs more work. A number of areas for future research are introduced. These recommendations are important in that they provide a roadmap for progress in the EMS community and can be used as support for the justification of future work.

Ideally, this work will provide a foundation for addressing this sometimes underappreciated health issue among EMS personnel and shift workers. It can serve as a call to action from both the top down and the bottom up to begin considering ways to improve the environments and practices to reduce risk to patients, communities and EMS personnel themselves.

This article was originally posted Jan. 17, 2018. It has been updated.

Sara Jahnke, PhD, is the director and a senior scientist with the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes - USA. With over a decade of research experience on firefighter health, Dr. Jahnke has been the principal investigator on 10 national studies as well as dozens of studies as a co-investigator. Her work has focused on a range of health concerns, including the health of female firefighters, behavioral health, risk of injury, cancer, cardiovascular risk factors, and substance use, with funding from the Assistance to Firefighters Grant R&D Program, the National Institutes of Health and other foundations. Jahnke has more than 100 publications in the peer-reviewed medical literature. Awards include the 2019 Endowed Lecture at the annual conference of the American College of Epidemiology; the 2018 President’s Award for Excellence in Fire Service Research as well as the Excellence in Research, Safety, Health & Survival Award, both from the International Association of Fire Chiefs (IAFC); and the 2016 John Granito Award for Excellence in Firefighter Research from the International Journal of Fire Service Leadership and Management. Connect with Jahnke on LinkedIn, Twitter or via email.