title: An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers.
abstract: OBJECTIVE
  Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors.
  
  
  METHODS
  We obtained 3 years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity.
  
  
  RESULTS
  The cohort contained 966,082 shifts, 4382 employees and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 h in duration (RR 0.70; 95% CI 0.51 to 0.96) compared with shifts >8 and ≤12 h. Relative to shifts >8 and ≤12 h, risk of injury was 60% greater (RR 1.60; 95% CI 1.22 to 2.10) for employees that worked shifts >16 and ≤24 h.
  
  
  CONCLUSIONS
  Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Weaver
authors.affiliation: Department of Emergency Medicine, Carolinas HealthCare System Medical Center, Charlotte, North Carolina, USA.
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Patterson
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: Dickson Advance Analytics Group, Carolinas HealthCare System, Charlotte, North Carolina, USA.
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Department of Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Freiberg
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Songer
mesh_terms: D000062:Accidents, Occupational; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D005221:Fatigue / Q000150:complications; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D009784:Occupational Diseases / Q000209:etiology*; D060051:Occupational Injuries / Q000209:etiology*; D021641:Recognition, Psychology; D012307:Risk Factors; D012890:Sleep; D014940:Work Schedule Tolerance; D017132:Workplace