Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

Martin‐Gill, Christian; Higgins, Johanne; Dongen, Hans P A Van; Buysse, Daniel J.; Thackery, Ronald W; Kupas, Douglas F.; Becker, David W.; Dean, Bradley E; Lindbeck, George; Guyette, Francis X; Penner, Josef H; Lang, Eddy; Patterson, P. Daniel

doi:10.1080/10903127.2017.1381791

Cited by 15 publications

(9 citation statements)

References 26 publications

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“…Additionally, studies of worker age 70 and of long-term effects of replacement napping are lacking. 71 Finally, in the work setting, developing specific recommendations about naps is challenging 72,73 due to the enormous variation in the possible timing, duration and frequency of naps and the potential for sleep inertia after napping. 48 Napping in the context of teams creates another level of complexity, as the impact on team function of one or more team members napping at different times has not been addressed.…”

Section: Recommendations Regarding Intervention Approachesmentioning

confidence: 99%

Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce

Redeker

Caruso

Hashmi

et al. 2019

Journal of Clinical Sleep Medicine

114

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Study Objectives: The purpose of this review is to synthesize the published literature that addresses employer-initiated interventions to improve the sleep of workers and in turn improve health, productivity, absenteeism, and other outcomes that have been associated with sleep disorders or sleep deficiency. Methods: We conducted a systematic search and a selective narrative review of publications in PubMed from 1966 to December 2017. We extracted study characteristics, including the workers' professions, workplace settings and shift work, and workplace interventions focused on worker sleep. Because of the high degree of heterogeneity in design and outcomes, we conducted a narrative review. Results: We identified 219 publications. After restriction to publications with studies of workplace interventions that evaluated the outcomes of sleep duration or quality, we focused on 47 articles. An additional 13 articles were accepted in the pearling process. Most studies employed non-randomized or controlled pretest and posttest designs and self-reported measures of sleep. The most common workplace interventions were educational programs stressing sleep hygiene or fatigue management. Other interventions included timed napping before or after work, urging increased daytime activity levels, modifying workplace environmental characteristics such as lighting, and screening, and referral for sleep disorders treatment. Overall, most reports indicated that employer efforts to encourage improved sleep hygiene and healthier habits result in improvements in sleep duration, sleep quality, and self-reported sleepiness complaints. Conclusions: These studies suggest employer-sponsored efforts can improve sleep and sleep-related outcomes. The existing evidence, although weak, suggests efforts by employers to encourage better sleep habits and general fitness result in self-reported improvements in sleep-related outcomes, and may be associated with reduced absenteeism and better overall quality of life. Candidate workplace strategies to promote sleep health are provided.

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Section: Recommendations Regarding Intervention Approachesmentioning

confidence: 99%

Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce

Redeker

Caruso

Hashmi

et al. 2019

Journal of Clinical Sleep Medicine

114

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“…All of these elements should be part of a comprehensive fatigue risk management program. 10,76 See Table 1 for a list of pros versus cons associated with intra-shift napping.…”

Section: The Argument Against Intra-shift Nappingmentioning

confidence: 99%

Should public safety shift workers be allowed to nap while on duty?

Patterson

Weaver

Guyette

et al. 2020

American J Industrial Med

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Fatigue and sleep deficiency among public safety personnel are threats to wellness, public and personal safety, and workforce retention. Napping strategies may reduce work‐related fatigue, improve safety and health, yet in some public safety organizations it is discouraged or prohibited. Our aim with this commentary is to define intra‐shift napping, summarize arguments for and against it, and to outline potential applications of this important fatigue mitigation strategy supported by evidence. We focus our discussion on emergency medical services (EMS); a key component of the public safety system, which is comprised of police, fire, and EMS. The personnel who work in EMS stand to benefit from intra‐shift napping due to frequent use of extended duration shifts, a high prevalence of personnel working multiple jobs, and evidence showing that greater than half of EMS personnel report severe fatigue, poor sleep quality, inadequate inter‐shift recovery, and excessive daytime sleepiness. The benefits of intra‐shift napping include decreased sleepiness and fatigue, improved recovery between shifts, decreased anxiety, and reduced feelings of burnout. Intra‐shift napping also mitigates alterations in clinician blood pressure associated with disturbed sleep and shift work. The negative consequences of napping include negative public perception, acute performance deficits stemming from sleep inertia, and the potential costs associated with reduced performance. While there are valid arguments against intra‐shift napping, we believe that the available scientific evidence favors it as a key component of fatigue mitigation and workplace wellness. We further believe that these arguments extend beyond EMS to all sectors of public safety.

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“…Fatigue Risk Management Systems have been defined as “scientifically based, data-driven addition or alternative to prescriptive hours of work limitations which manages employee fatigue in a flexible manner appropriate to the level of risk exposure and the nature of the operation”20 ) . While a number of Fatigue Risk Management System guidelines have been developed for a range of industries20, 101,102,103,104,105,106,107,108,109,110,111 ) , a set of commonalities have emerged based on the core components of SMSs (i.e. safety management policies and procedures, risk management, safety assurance and safety promotion) (Fig.…”

Section: An Introduction To Fatigue Risk Management As a Long-term Sumentioning

confidence: 99%

Working Time Society consensus statements: A multi-level approach to managing occupational sleep-related fatigue

2019

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A substantial body of literature indicates that shift workers have a significantly higher risk of workplace accidents and injuries, compared to workers in regular daytime schedules. This can be attributed to work during nights which require workers to stay awake during normal sleeping hours and sleep during natural waking hours, leading to circadian desynchronization, sleep disruption and cognitive impairment. A fatigue-risk trajectory model developed by Dawson and McCulloch has been used to describe the series of events which may precede fatigue-related incidents. This includes insufficient sleep opportunities, impaired sleep, fatigue-behavioral symptoms, and fatigue-related errors. The purpose of this paper is to provide examples of control measures along each level of the fatigue-risk trajectory, which include: (i) work scheduling strategies to include breaks for adequate sleep opportunities; (ii) training and educational programs to help workers make best use of recovery times for quality sleep; (iii) fatigue-detection devices to alert workers and safety managers of fatigue-related behaviors and errors. A brief introduction to Fatigue-Risk Management systems is also included as a long-term sustainable strategy to maintain shift worker health and safety. The key statements in this paper represent a consensus among the Working Time Society regarding a multi-level approach to managing occupational sleep-related fatigue.

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Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

Abstract: Performance measures for fatigue risk management in the EMS setting will facilitate the implementation and evaluation of the EBG for Fatigue in EMS.

Cited by 15 publications

References 26 publications

Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce

Workplace Interventions to Promote Sleep Health and an Alert, Healthy Workforce

Should public safety shift workers be allowed to nap while on duty?

Working Time Society consensus statements: A multi-level approach to managing occupational sleep-related fatigue

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