For many years research has evidenced that people working shifts can experience, among other things, poor sleep quality, occupational fatigue, irritability, and poor recovery between shifts. When focusing on shift work in health care, there are specific concerns about the potential impact of shift work on clinicians, not just in relation to patient safety, but also with reference to the practitioners' own safety. Interestingly, emergency medical services (EMS) staff demonstrate comparatively high rates of injury at work (Patterson et al, 2012). Despite the growing body of evidence of the impact of shift work on health within other professions, there is limited research on the impact of shift work involving EMS clinicians.
This study examines intershift recovery among EMS workers focusing on key variables such as age, years of experience, body mass index (BMI) and the length of shift. Despite being undertaken in the USA where there are differences in shift patterns and, on occasion, length of shift when compared to the UK, this study produces interesting findings which could be considered when designing UK-based research in similar fields of inquiry.
This paper is based on results from two cross-sectional surveys involving EMS shift workers. The first group included a convenience sample of 355 EMS workers attending a conference who completed the Sleep, Fatigue and Alertness Behaviour (SFAB) paper-based survey; the second group of 100 EMS personnel, also attending a conference, completed the baseline online assessment used in the SleepTrackTXT randomised clinical trial. Clearly specific detail of these surveys is beyond the remit of this brief review, but there were similar components in each survey including use of the Pittsburgh Sleep Quality Index; the Epworth Sleepiness Scale; the Chalder Fatigue Questionnaire; the Schedule Attitudes Survey; and the Occupational Fatigue, Exhaustion, Recovery (OFER) scale.
Of the final sample (n=450: 99 SleepTrax; 351 SFAB), 39% were paramedics and 37% were EMT-basics, with the remainder recruited from nursing, medicine and other healthcare professions. In total, 61% were male and the mean years of service was 15.8 (SD +/- 10.9).
Overall, the authors emphasise, unsurprisingly perhaps, that repondents who are generally satisfied with their scheduling and shift patterns demonstrate greater recovery between shifts. The mean intershift recovery (rated on the OFER scale) among the respondents varied according to a variety of factors including their general health status, age, length of the shift, and the different clinical settings. For example, the mean intershift recovery for respondents with self-reported excellent health status was more than 15 points higher on the OFER scale than those reporting fair/poor general health (p<0.05).
Other factors that were associated with lower scores on intershift recovery were poor sleep quality (p<0.0001); excessive daytime drowsiness (p<0.05); and severe mental and/or physical fatigue while at work (p<0.0001).
Notable trends were identified when examining the impact of the length of shift, with respondents showing best adaptation to intershift recovery when working longer than 12-hour shifts; followed by those who were working ≤12 hours; and the least effective recovery was reflected by those working 12-hour shifts. The reviewer has assumed that when the researchers are referring to shifts longer than 12 hours, this does not include people scheduled to work for a 12-hour shift who get a late callout and are subsequently late off duty—however, this is not actually specified in the paper.
Some of the limitations identified by the authors include failing to identify the length of time respondents were given between shifts; and not assessing the actual workload during shifts. They recommend that these factors should be considered in future research studies.
Certainly there are many factors that should be considered when examining the effects of shift work on ambulance clinicians' wellbeing and safety, and how these correlate to patient care delivery and patient safety. With growing pressure being exerted on paramedics to work longer before they can retire, there is some urgency for further research to identify shift patterns which are not only acceptable to staff, but which also provide realistic and effective intershift recovery times contributing to achievement of optimal health status for paramedics and other staff working for ambulance services.