title: Mobile phone text messaging intervention to improve alertness and reduce sleepiness and fatigue during shiftwork among emergency medicine clinicians: study protocol for the SleepTrackTXT pilot randomized controlled trial.
abstract: BACKGROUND
  Mental and physical fatigue while at work is common among emergency medical services (EMS) shift workers. Extended shifts (for example 24 hours) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management. Text message-based interventions are a potentially high-impact, low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue.
  
  
  METHODS
  We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website. Participants will be allocated to one of two possible arms for a 90-day study period. The intervention arm will involve text message assessments of sleepiness, fatigue, and difficulty with concentration at the beginning, during, and end of scheduled shifts. Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork. Control subjects will receive assessment only text messages. We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention. We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers. Additional aims include testing whether a theory-based behavioral intervention, delivered by text message, changes 'alertness behaviors'.
  
  
  CONCLUSIONS
  The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms: 1) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers; or 2) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management services.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02063737, Registered on 10 January 2014.
authors: Department of Emergency Medicine, School of Medicine, University of Pittsburgh, 3600 Forbes Avenue, Iroquois Bldg, Suite 400A, Pittsburgh, PA, USA. pattersond@upmc.edu.
authors: Paul Daniel
authors: PD
authors: Patterson
authors: Charity G
authors: CG
authors: Moore
authors: Matthew D
authors: MD
authors: Weaver
authors: Daniel J
authors: DJ
authors: Buysse
authors: Brian P
authors: BP
authors: Suffoletto
authors: Clifton W
authors: CW
authors: Callaway
authors: Donald M
authors: DM
authors: Yealy
mesh_terms: D000328:Adult; D040421:Cell Phone; D004634:Emergency Medical Technicians / Q000458:organization & administration; D004635:Emergency Medicine / Q000458:organization & administration; D016529:Emergency Nursing / Q000458:organization & administration; D005221:Fatigue / Q000517:prevention & control*; D006801:Humans; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D010865:Pilot Projects; D017010:Reminder Systems; D012107:Research Design; D016037:Single-Blind Method; D012890:Sleep; D020178:Sleep Disorders, Circadian Rhythm / Q000517:prevention & control*; D012894:Sleep Stages; D060145:Text Messaging; D014851:Wakefulness