Association Between Poor Sleep, Fatigure, and Safety Outcomes in Emergency Medical Services Providers

Objective: To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among Emergency Medical Services (EMS) workers.\ud \ud 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 (AE), 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.\ud \ud 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%CI 5.5, 7.2). Greater than half of respondents were classified as fatigued (55%, 95%CI 50.7, 59.3). Seventeen percent of respondents reported an injury (17.8%, 95%CI 13.5, 22.1), forty-one percent a medical error or AE (41.1%, 95%CI 36.8, 45.4), and 89% (95%CI 87, 92) safety compromising behaviors. After controlling for confounding, we identified 1.9 greater odds of injury, 2.2 greater odds of medical error or AE, and 3.7 greater odds of safety compromising behavior among fatigued respondents versus non-fatigued respondents.\ud \ud Conclusions: In this sample of EMS workers, poor sleep quality and fatigue is common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.\ud Public Health Significance: Some level of EMS care covers every community in the U.S. Every minute of every day EMS workers transport 35 patients to hospital Emergency Departments (EDs). The health and safety of EMS workers may impact health and safety of the public – thereby making fatigue and sleep of EMS workers an issue of public health significance.\u