Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers

Prehosp Emerg Care. Jan-Mar 2012;16(1):86-97. doi: 10.3109/10903127.2011.616261. Epub 2011 Oct 24.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Occupational / psychology
  • Accidents, Occupational / statistics & numerical data
  • Adolescent
  • Adult
  • Chi-Square Distribution
  • Confidence Intervals
  • Cross-Sectional Studies
  • Emergency Medical Services*
  • Female
  • Health Status Indicators
  • Humans
  • Male
  • Medical Errors / prevention & control
  • Medical Errors / psychology
  • Mental Fatigue / epidemiology*
  • Mental Fatigue / etiology
  • Middle Aged
  • Occupational Exposure / adverse effects*
  • Occupational Health*
  • Psychometrics
  • Risk Assessment / methods
  • Sleep Wake Disorders / epidemiology*
  • Sleep Wake Disorders / etiology
  • Sleep*
  • Stress, Psychological / complications
  • Stress, Psychological / psychology
  • Surveys and Questionnaires
  • Young Adult