What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes

Abstract

Objective The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes. Methods A cross‐sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post‐traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non‐responder survey was conducted to asses for demographic differences in those who did and did not complete the survey. Results This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes. Conclusion These findings illustrate that a host of different stressors may influence safety‐related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.

Emerging Concepts in the Paramedicine Literature to Inform the Revision of a pan-Canadian Competency Framework for Paramedics: A Restricted Review

“…Finally, we observed an encouraging and considerable increase in literature exploring health and wellbeing in paramedicine over the past decade. We identified a total of 60 reports exploring paramedic physical health [36,37], safety [38,39], mental health [40,41], violence against paramedics [42], mental health supports and interventions [43], and family and social supports [44]. However, we observed a continued lack of understanding related to spirituality, holistic self-care, empathy, compassion, and the impacts of and influences on paramedicine culture.…”

Work in stressful conditions in medical emergency system during the COVID-19 pandemic

“…Paramedics' injuries showed a significant association with fatigue and critical stress. Considering that medication errors were also significantly associated with fatigue [43] it should be noted that the safety of patients depends on the psychophysical condition of medical personnel, in particular with the increase in stress factors and fatigue [43].…”

“…The safety of the rescue team, the patient and other road users depends on the speed of the driver's reaction, which can be reduced by prolonged stress. Based on author's own observations, in recent years an increasing number of accidents involving ambulances and rescue motorcycles can be noticed [43]. Lifshitz et al [45] indicated that mistakes occurred in up to 12.76% of medication administrations in prehospital care.…”

Mental Disorder Symptoms among Paramedics in a Single Canadian Site

“…Related research has also suggested that exposure to potentially psychologically traumatic events [10][11][12][13][14][15][16]; symptoms consistent with chronic pain, [17] clinical insomnia [18] and alcohol use disorder [9]; suicidal ideation, planning, and attempts [19]; and a history of adverse childhood experiences [20] are prevalent among paramedics, again varying across demographic categories, including gender. The downstream consequences are potentially significant, and can include lost time from work [21], family hardship [22], reduced quality of life [23][24][25][26], and suicidality [7,27], all of which can contribute to burnout [6,28], workplace incivility [29,30], attrition [31] and potentially compromise patient care [32]. As a result, the situation has been characterized in research and policy as a 'crisis in Canada' [33,34].…”