Project Overview January 11, Project web site:
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1 Project Overview January 11, 2018 Project web site:
2 An Amazing Partnership to Improve Safety in EMS! National Highway Traffic Safety Administration (NHTSA) Office of Behavioral Safety Research Office of Emergency Medical Services National Association of State EMS Officials (NASEMSO) University of Pittsburgh (Pitt) P. Daniel Patterson, PhD, NRP, Principal Investigator Institutes for Behavior Resources, Inc. (IBR) Contract Number DTNH2215C00029
3 Population of Interest EMS personnel or similar worker groups, defined as shift workers whose job activity requires multiple episodes of intense concentration and attention to detail per shift, with serious adverse consequences potentially resulting from a lapse in concentration. Do Not Circulate Without Permission of P.D. Patterson
4 November 2015 November 2017 The Fatigue in EMS Project PHASE 1 PHASE 2 PHASE 3 Develop Evidence- Based Guideline (EBG) for fa2gue risk management in EMS Test the impact of one or more evidencebased recommenda2ons in an experimental study Develop a biomathema2cal model tailored to EMS shim scheduling and make freely available
5 EMS is setting the bar: There is no equivalent effort from any other high risk industry/occupation to improve worker fatigue.
6 Phase 1 Methodology Paper Published Spring 2017 Patterson et al., 2017 PMID Do Not Circulate Without Permission of P.D. Patterson
7 Ques%on # Research Ques%ons That Guided Systema%c Reviews 1 Are there reliable and valid instruments for measuring fa2gue among EMS personnel? 2 In EMS personnel, do shim-scheduling interven2ons mi2gate fa2gue, mi2gate fa2gue-related risks, and/or improve sleep? 3 In EMS personnel, does the worker s use of fa2gue countermeasures mi2gate fa2gue, mi2gate fa2gue-related risks, and/or improve sleep? 4 In EMS personnel, does the use of sleep or rest strategies and/or interven2ons mi2gate fa2gue, mi2gate fa2gue-related risks, and/or improve sleep? 5 In EMS personnel, does fa2gue training and educa2on mi2gate fa2gue, mi2gate fa2gue-related risks, and/or improve sleep? 6 In EMS personnel, does implementa2on of model-based fa2gue risk management mi2gate fa2gue, mi2gate fa2gue-related risks, and/or improve sleep? 7 In EMS personnel, do task load interven2ons mi2gate fa2gue, mi2gate fa2guerelated risks, and/or improve sleep? Do Not Circulate Without Permission of P.D. Patterson
8 Phase 1 Methods Research Ques%on Literature Screened / Reviewed 1 1, , , , , , ,394 TOTAL 38,972 Do Not Circulate Without Permission of P.D. Patterson
9 Results of Phase 1 Five recommendations 1. Recommend use of reliable/valid instruments 2. Recommend shifts <24-hours in duration 3. Recommend access to caffeine 4. Recommend allowing naps during shifts 5. Recommend education/training in sleep/fatigue 15 total peer-reviewed papers Do Not Circulate Without Permission of P.D. Patterson
10 Evidence Based Guidelines for Fatigue Risk Management in Emergency Medical Services: /
11 ALL Fatigue Study Related Materials AVAILABLE NOW!! showaxaarticles?journalcode=ipec20
12 Adoption & Evaluation 1. Recommend use of reliable/valid instruments Goal: Assess fatigue/sleepiness of EMS personnel with reliable/valid survey instrument(s) quarterly (4 out of 4 quarters annually). Performance Measure: Demonstrated use of reliable/ valid fatigue and/or sleepiness survey instruments to measure and monitor fatigue in EMS personnel on at least a quarterly basis. See Pa\erson et al. at h\p://tandfonline.com/doi/full/ /
13 Adoption & Evaluation 2. Recommend shifts <24-hours in duration Goal: 100% of shifts are less than 24 hrs in duration. Performance Measure: Percent of all shifts that are less than 24 hrs in duration. See Patterson et al. at
14 Adoption & Evaluation 3. Recommend access to caffeine Goal: 100% of shifts with access to caffeine. Performance Measure: Percent of all shifts where EMS personnel have access to caffeine. See Temple et al. at
15 Adoption & Evaluation 4. Recommend allowing naps during shifts Goal: EMS personnel are provided with access to, and permission to take a nap while on duty in 100% of extended shifts (i.e., 12 hours) and shifts taking place overnight. Performance Measure: Percent of all shifts where EMS personnel are provided with access to and permission to take a nap on duty. See Martin-Gill et al. at
16 Adoption & Evaluation 5. Recommend education/training in sleep/fatigue Goal: 1) 100% of EMS personnel have received fatigue education and training as part of new employee orientation/ training; and 2) 100% of EMS personnel have received fatigue education and training within the previous two years. Performance Measure: Percent of EMS personnel who have: 1) received education and training to mitigate fatigue and fatigue-related risks during new employee orientation/training; and 2) received education and training to mitigate fatigue and fatigue-related risks within the previous two years. See Barger et al.at
17 Summary Five recommendations based on the best available evidence Tremendous flexibility with implementing recommendations
18 November 2017 December 2018* The Fatigue in EMS Project PHASE 1 PHASE 2 PHASE 3 Develop Evidence- Based Guideline (EBG) for fa2gue risk management in EMS Test the impact of one or more evidencebased recommenda2ons in an experimental study Develop a biomathema2cal model tailored to EMS shim scheduling and make freely available Do Not Circulate Without Permission of P.D. Patterson
19 Contract Timeline for Aim 1 and 2 November 17 to May 18 develop and pilot test the intervention and recruit EMS agencies May 18 enroll EMS agencies and start data collection Nov/Dec 18 complete data collection* Do Not Circulate Without Permission of P.D. Patterson
20 *Possible Impact Phase 2 Deadline To avoid overburdening the public with federally sponsored data collections, the Paperwork Reduction Act (PRA) of 1995 requires that U.S. federal government agencies obtain Office of Management and Budget (OMB) approval before requesting or collecting most types of information from the public. Study likely to be delayed beyond 2018.
21 Study Population Recruit & enroll diverse EMS operations All ground-based operations Include fire-based EMS operations Moderate sized (minimum of employees) Nationwide recruitment Representation in all major Census regions Goal enrollment n=30 total EMS operations Do Not Circulate Without Permission of P.D. Patterson
22 Phase 2-The Proposed Intervention Take 10 for Sleep Health 10 modules Online delivery method Each module no longer than 10-minutes Topics covered: Circadian rhythms, Sleep Health, Sleep Timing and Sleep Hygiene, Dangers of Fatigue, Strategic use of naps, Strategic use of caffeine, Strategic use of exercise, Negative effects of sleep deprivation, and more. Do Not Circulate Without Permission of P.D. Patterson
23 Our desired Longer Term Outcomes Goals for the EBG Project overall: Fewer EMS personnel that report fatigue while at work. Fewer EMS personnel classified with poor sleep quality. Fewer fatigue-related negative safety and performance outcomes (e.g., ambulance crashes). Increased number of EMS organizations that have formal fatigue risk management programs with strategies that are informed by the evidence. Do Not Circulate Without Permission of P.D. Patterson
24 Phase 3 Fatigue Modeling Tool for EMS Similar Models Used Everyday in Aviation, Rail, Maritime, Trucking. Source: Aviation: Rail: Trucking:
25 Expert Panel Expert Panel Name Area of Exper%se Ins%tu%on Hans Van Dongen, PhD Sleep Medicine / Fa2gue Washington State University John Violan2, PhD Fa2gue Expert University of Buffalo Daniel Buysse, MD Sleep Medicine Physician University of Pi\sburgh Douglas Kupas, MD Emergency Medicine / EMS Geisinger Health System Frank Guye\e, MD Emergency Medicine / EMS / Air-Medical The guideline development group should be multi-disciplinary and balanced, comprising a variety of methodological experts and clinicians, and populations expected to be affected by the guidelines. (IOM, 2011) University of Pi\sburgh Joe Penner EMS Administra2on Mecklenburg County EMS Ron Thackery, JD EMS / Risk Administra2on AMR David Becker, MA, EMT-P Fire / EMS Columbia Southern University / IAFC Bradley Dean, MA, NRP Field Provider / Clinician Rowan County EMS George Lindbeck, MD State EMS Medical Director Virginia State Office of EMS / Univ. of Virginia Dennis Eisnach Consumer Representa2ve None / Re2red
26 Research / Project Team Name Ins%tu%on Daniel Pa\erson, PhD, NRP University of Pi\sburgh, Department of Emergency Medicine J. Steve Higgins, PhD NHTSA Anthony Fabio, PhD Eddy Lang, MDCM Patricia Weiss, MLIS Laura Barger, PhD Ma\hew D. Weaver, PhD Chris2an Mar2n-Gill, MD Michael Runyon, MD Jon Studnek, PhD, NRP Allison Infinger, MSPH Charity Moore, PhD Denisse Sequeira, BS David Hostler, PhD, NRP Jennifer Templin, PhD Kathy Robinson, RN University of Pi\sburgh, Graduate School of Public Health University of Calgary, Emergency Medicine University of Pi\sburgh, Health Sciences Library Harvard Medical School, Division of Sleep Medicine Harvard Medical School, Division of Sleep Medicine University of Pi\sburgh, Department of Emergency Medicine Carolinas HealthCare System, Department of Emergency Medicine Mecklenburg EMS Mecklenburg EMS University of Pi\sburgh University of Pi\sburgh, Department of Emergency Medicine University of Buffalo, Department of Exercise & Nutri2on Sciences University of Buffalo, Department of Exercise & Nutri2on Sciences NASEMSO
27 Summary Evidence Based Guidelines for Fatigue Risk Management in Emergency Medical Services: / All Published Materials (Supplement): journalcode=ipec20 Project Website: Contact: NASEMSO Project Manager Kathy Robinson, RN, EMT-P Ph , Ext E:
National Highway Traffic Safety Administration. Developing Fatigue Risk Management Guidelines in EMS
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