Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers.
OBJECTIVE
To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among emergency medical services (EMS) workers.


METHODS
We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AEs), and safety-compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes.


RESULTS
We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95% confidence interval [CI] 6.6, 7.2). More than half of the respondents were classified as fatigued (55%, 95% CI 50.7, 59.3). Eighteen percent of the respondents reported an injury (17.8%, 95% CI 13.5, 22.1), 41% reported a medical error or AE (41.1%, 95% CI 36.8, 45.4), and 90% reported a safety-compromising behavior (89.6%, 95% CI 87, 92). After controlling for confounding, we identified 1.9 greater odds of injury (95% CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95% CI 1.4, 3.3), and 3.6 greater odds of safety-compromising behavior (95% CI 1.5, 8.3) among fatigued respondents versus nonfatigued respondents.


CONCLUSIONS
In this sample of EMS workers, poor sleep quality and fatigue are common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. pattersond@upmc.edu
P Daniel
PD
Patterson
Matthew D
MD
Weaver
Rachel C
RC
Frank
Charles W
CW
Warner
Christian
C
Martin-Gill
Francis X
FX
Guyette
Rollin J
RJ
Fairbanks
Michael W
MW
Hubble
Thomas J
TJ
Songer
Clifton W
CW
Callaway
Sheryl F
SF
Kelsey
David
D
Hostler
D000062:Accidents, Occupational / Q000523:psychology / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000523:psychology; D005222:Mental Fatigue / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D016272:Occupational Health; D011594:Psychometrics; D018570:Risk Assessment / Q000379:methods; D012890:Sleep; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000209:etiology; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult