Differences in Paramedic Fatigue before and after Changing from a 24-hour to an 8-hour Shift Schedule: A Case Report

Abstract

Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. We describe a case of a 26-year-old male paramedic who switched shift schedules during the midpoint of a randomized trial that addressed fatigue in EMS workers (clinicaltrials.gov identifier: NCT02063737). The participant (case) began the study working full-time with a critical care, advanced life support EMS system that utilized 24-hour shifts. He then transitioned to an EMS system that deploys workers on 8-hour shifts. Per protocol for the randomized trial, the participant completed a battery of sleep health and fatigue surveys at baseline and at the end of 90 days of study. He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.

Keywords: fatigue; shiftwork; sleep.

Conflict of interest statement

Conflict of Interests: The authors report no competing interests or conflicts of interests. This study was supported with resources internal to the Department of Emergency Medicine, University of Pittsburgh School of Medicine, the Pittsburgh Emergency Medicine Foundation (www.PEMF.net), and Dr. Patterson’s career development award/KL2 training grant from the National Center Research Resources and the National Institutes of Health (NIH/NCATS Grant no: KL2 TR000146 (Dr. Reis PI). The conclusions, views, opinions, and content in this paper should not be interpreted as reflecting the opinions of the NIH or PEMF.

Figures

Figure 1

Differences in Fatigue, Sleepiness, and Difficulty with Concentration (Mean STD) between 24-hour and 8-hour shifts