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Fatigue in EMS: Preview of an evidence-based guideline

Evidence-based recommendations to address fatigue in EMS was introduced to paramedic chiefs and EMS leaders at Pinnacle 2017


BOCA RATON, Fla. — EMS leaders and providers, acutely interested from their own experience as well as media reports about ambulance collisions caused by sleep deprivation, learned about the Fatigue in EMS project's recommendations after reviewing thousands of documents to answer seven research questions. 

Daniel Patterson, Ph.D., paramedic, gave Pinnacle EMS conference attendees background on the Fatigue in EMS project and how an expert panel is developing evidence-based guidelines.

The research team's process, supporting documentation and recommendations will be published in an upcoming issue of Prehospital Emergency Care. (Photo/CDC)
The research team's process, supporting documentation and recommendations will be published in an upcoming issue of Prehospital Emergency Care. (Photo/CDC)

Patterson, University of Pittsburgh assistant professor of emergency medicine, explained that the Fatigue in EMS project was stimulated by a National EMS Advisory Council call to action to develop evidence-based guidelines for fatigue risk management in EMS. The Fatigue in EMS project, which began in 2015, has three phases.

  • Phase 1: Develop an evidence-based guideline.
  • Phase 2: Test the impact of implementing recommendations from the guidelines.
  • Phase 3: Develop a biomathematical model tailored to EMS shift schedule.

The Fatigue in EMS project team, convened by the National Highway Traffic Safety Administration and National Association of State EMS Officials, has nearly completed Phase 1. The Pinnacle presentation to paramedic chiefs and EMS leaders is the beginning of information dissemination and education on an evidence-based guideline. The research team's process, supporting documentation and recommendations will be published in an upcoming issue of Prehospital Emergency Care.

The project team reviewed more than 38,000 studies across the seven PICO questions. A screening process was used to determine if the research was applicable and used to generate a recommendation to one or more of the outcomes of interest. 

Memorable quotes on Fatigue in EMS project

Here are memorable quotes from Patterson's presentation:

"The purpose of evidence-based guidelines is to help with decision making and optimal decision making."

"The process started with questions that everyone (on the research team) agrees are answerable."

"Don't focus solely on shift duration."

Fatigue in EMS expert panel recommendations

Patterson's team registered seven research questions in PROSPERO, an international database of prospectively registered systematic reviews. Use these PROSPERO links to read the questions and documentation related to the review of the evidence.

  • Question #1: The diagnostic question
  • Question #2: The intervention question regarding shift work and fatigue
  • Question #3: The intervention question regarding fatigue countermeasures
  • Question #4: The intervention question regarding sleep/rest strategies to mitigate fatigue
  • Question #5: The intervention question regarding fatigue education and training
  • Question #6: The intervention question that addresses use of statistical models to mitigate fatigue
  • Question #7: The intervention question regarding task load/workload and fatigue

Here are the top needs for EMS personnel, based on the expert panel's review of the evidence. The review of research has led to weak (which is a label based on the strength of evidence) recommendations in favor of these components of a fatigue guideline. EMS personnel need:

1. Education and training on fatigue.

2. An opportunity to nap on-duty.

3. Access to caffeine as a fatigue countermeasure.

4. To work shifts shorter than 24 hours. Patterson acknowledged that the question about shift length was among the most controversial considered by the research team. He also discussed the lack of research about shifts longer than 24 hours.

5. To measure and monitor fatigue in EMS personnel. The only strong recommendation issued by the expert panel is to use research validated instruments to measure and monitor fatigue.

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