The Sleep Health and Fatigue Education Program for the Administrators of Emergency Medical Services Agencies (CODE3)

A short education program focused on importance of sleep health and fatigue delivered to emergency medical services administrators (EMS Administrator Arm)

A short education program focused on importance of sleep health and fatigue delivered to emergency medical services administrators

• Sleep health and fatigue education program

Frontline EMS personnel employed at EMS agencies where EMS administrators are exposed to the Sleep Health and Fatigue Education Program

A short education program focused on importance of sleep health and fatigue delivered to emergency medical services administrators

• Sleep health and fatigue education program

A single question: "Did participant's EMS agency create a new or change an existing policy after watching the CODE3 Sleep & Fatigue in EMS Program? __Yes. __No."

Sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) among frontline EMS personnel. The PSQI solicits self-reported responses on 19 survey items that primarily use a Likert type response scale that are weighted using prescribed formulas and reference the prior month. Scores range from 0 - 21 with scores 6- 21 indicating poor sleep quality. A PSQI score decrease > = 3 points is considered clinically meaningful and associated with a reduction in signs and symptoms of poor sleep.

Sleep health as measured by the RU-SATED survey instrument (Regularity, Satisfaction, Alertness, Timing, Efficiency, and Duration). The survey solicits self-reported responses on a Likert type response scale to 6 items that reference the prior month. Six items, each scored 0-2. Response of 0 = Never/rarely; 1 = Sometimes; 2 = Usually/always. Total score = sum of six items. There are no universally established clinical cut points for the RU-SATED; however, higher scores suggest good sleep health.

Daytime sleepiness is measured with the Epworth Sleepiness Scale (ESS). The ESS solicits self-reported responses on a Likert type scale to 8 items. Items are scored using a prescribed algorithm with scores ranging from 0 - 24. Higher scores indicate greater daytime sleepiness. A score decrease of > = 2 points is considered clinically meaningful and associated with a reduction in signs and symptoms of daytime sleepiness.

Fatigue (mental and physical) is measured with the Chalder Fatigue Questionnaire (CFQ). The CFQ solicits self-reported responses on a Likert type response scale to 11 survey items. One approach to scoring includes: Less than usual = 0; No more than usual = 1; More than usual = 2; Much more than usual = 3. The more commonly used approach to scoring (bimodal approach) includes: Less than usual = 0; No more than usual = 0; More than usual = 1; Much more than usual = 1. Scores > = 4 suggest severe mental and physical fatigue.

Chronic fatigue (CF) is measured with the CF sub-scale survey instrument of the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Responses for the CF sub-scale are solicited for 5 items using a Likert response scale: 0 = strongly disagree to 6 = strongly agree. Scoring involves summing the 5 items, dividing by 30 and then multiplying by 100. Scores range from 0 to 100. Final scores 0 - 25 suggest Low CF; scores 26 - 50 suggest Low to Moderate CF; scores 51 - 75 suggest Moderate to High CF; scores 76 to 100 suggest High CF.

Acute fatigue (AF) is measured with the AF sub-scale survey instrument of the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Responses for the AF sub-scale are solicited for 5 items using a Likert response scale: 0 = strongly disagree to 6 = strongly agree. Scoring involves summing the 5 items, dividing by 30 and then multiplying by 100. Scores range from 0 to 100. Final scores 0 - 25 suggest Low AF; scores 26 - 50 suggest Low to Moderate AF; scores 51 - 75 suggest Moderate to High AF; scores 76 to 100 suggest High AF. Two items of the AF sub-scale are reverse scored/coded.

Intershift Recovery between shifts (IR) is measured with the IR sub-scale survey instrument of the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Responses for the IR sub-scale are solicited for 5 items using a Likert response scale: 0 = strongly disagree to 6 = strongly agree. Scoring involves summing the 5 items, dividing by 30 and then multiplying by 100. Scores range from 0 to 100. Final scores 0 - 25 suggest Low IR; scores 26 - 50 suggest Low to Moderate IR; scores 51 - 75 suggest Moderate to High IR; scores 76 to 100 suggest High IR. Three items of the IR sub-scale are reverse scored/coded.