An Assessment of the Relationship between Emergency Medical Services Work-life Characteristics, Sleepiness, and the Report of Adverse Events.

摘要

Literature examining sleepiness among the Emergency Medical Service (EMS) workforce, is limited. Because of the risks associated with sleepiness identified in other populations, and the importance of EMS with respect to public health and safety, there is a critical need to better understand how sleepiness and shift work may affect the EMS professional. Accordingly, the aims of this dissertation were to 1) quantify clinically significant excessive daytime sleepiness and identify related demographic and work-life factors, 2) quantify error-related events in EMS and assess the relationship between shift length, sleepiness and error-related events, 3) quantify occupational injuries or illnesses and assess the relationship between shift length, sleepiness and occupational injuries or illnesses, and finally 4) quantify negative impacts on personal and professional relationships among EMS professionals and examine the relationship between shift length, sleepiness, and negatively-affected personal and professional relationships. It was hypothesized that there was a positive association between EMS work-life characteristics, clinically-significant sleepiness, and the report of adverse events.;In order to complete the aims described above, the Longitudinal Emergency Medical Technicians Attributes and Demographics Study (LEADS) Sleep and Shift Work Survey, which included the Epworth Sleepiness Scale, was created and analyzed. Participants were selected for this study based on prior responses to LEADS. Specifically, in an attempt to survey only those whose main job was as an EMS professional, exclusion criteria dictated that individuals who reported on a previous LEADS from 2005-2007 that they were a volunteer were excluded. All non-volunteers during the same time period who indicated that they had been absent from work in the last 12 months due to a work related injury or illness were included in the sample (n=442). A simple random sample of non-volunteers who had not missed work due to a work-related injury or illness from 2005-2007 were also included for recruitment (n=1,463).;The final response rate for the survey was 67.2%. Results from this study indicate that 38% of the study population could be classified with clinically significant excessive daytime sleepiness. Moreover, extended shift length was associated with clinically significant excessive daytime sleepiness (OR: 1.79; 95% CI: 1.20-2.65; p-value = 0.004). After accounting for confounding and effect modification, sleepiness and extended shift length were associated with three outcome variables of interest: error-related events, occupational injury or illness, and negative impacts on relationships with family and friends (p-value 0.05). However, while sleepiness was significantly associated with negative impacts on relationships with co-workers (p-value 0.05), extended shift length was not.;These findings are important because they revealed that a large proportion of nationally-certified EMS professionals could be classified with clinically significant excessive daytime sleepiness and extended shift length was significantly associated with clinically significant excessive daytime sleepiness in a multiple logistic regression model. It is also important for leaders in the field of EMS to take note that, in this study, sleepiness and extended shift length were related to adverse events among EMS professionals.