The MedEvac Foundation International has approved grant funding for Dr Daniel Patterson to investigate sleep-wake patterns and real-time fatigue reduction in EMS clinicians.

The medical transportation community requires that emergency care be available 24 hours a day. Shift work requires the prehospital emergency clinician to diverge from normal circadian sleep cycles and be alert when the pressure to sleep is greatest. While recent data suggest a link between sleep, fatigue, and safety in the EMS setting, the data are limited to cross-sectional designs and subject to recall and measurement bias. The proposed study will provide detailed prospective observational data to address questions regarding the relationships between shift duration, sleep/wake cycles, and behavioral alertness.

The overarching goal of the study is to address the Foundation’s research priority of “educational techniques and technologies aimed at improving patient care, critical decision making, safety, or other areas pertinent to transport medicine.” Patterson, along with several colleagues, intends to accomplish this goal by performing a multi-site study of air-medical EMS clinicians. The Foundation Board has approved Phase 1 of the study, which will involve a prospective observational study of sleep/wake cycles, shift work duration, intershift recovery, fatigue, and behavioral alertness (ie, psychomotor vigilance). The analysis of Phase 1 data will focus on differences between 12-hour versus 24-hour shifts.

This study will have a significant impact on the transportation community. First, the debate on shift duration (shorter versus longer shifts) is ongoing and unresolved. Many EMS systems use extended shift periods in light of low patient volume and resource limitations. Other systems use shifts of shorter duration. The relationships between shift duration, sleep, fatigue, and performance are complex and the data to support a prescribed shorter or longer shift schedule are limited.

“The Foundation is excited to support this study, which I believe is vital to not only better work place environments, the safety of our industry’s professionals, and of every patient-in-need, but it will help improve the level of patient care to an optimal level,” says Rick Sherlock, MedEvac Foundation International president and CEO, in a release.

Patterson and colleagues also proposed a Phase 2 for their study. Phase 2 will be considered for funding upon completion and presentation of Phase 1. Phase 2 would involve an experimental study design, and test novel fatigue risk management intervention that uses real-time assessment and intervention to improve alertness of EMS clinicians during shift work as well as their overall sleep health.