The relationship between work scheduling, fatigue, and risk of injury and illness among Emergency Medical Services (EMS) workers is not well understood. Evidence in other settings suggests that work duration contributes to fatigue and increases the risk of accidents and occupational injuries. Rates of occupational injury are high. Extended shifts and overtime hours are common. Workers often report fatigue and poor sleep quality. Evidence is needed to inform policy-making and promote safety.
Shift schedules and occupational injury and illness reports were obtained for 14 EMS agencies over a three-year period. The cohort contained 966,082 shifts, 4,382 employees, and 950 total injuries. Analyses examined the association between shift length, weekly work hours, crewmember familiarity, and occupational injury and illness. An increased risk of occupational injury and illness was hypothesized for individual shifts >8 hours and ≥48 weekly work hours. The proposed mechanism for increased risk was on-shift fatigue. A systematic literature review was performed to better understand differences in prior estimates of fatigue in EMS by methodologic approach.
Risk of occupational injury and illness was increased for shifts >8 & ≤12 hours (RR 1.43; 95% CI 1.04-1.97), shifts >12 & ≤16 hours (RR 1.82; 95% CI 1.17-2.82), and shifts >16 and ≤24 hours (RR 2.29; 95% CI 1.52-3.46), compared to shifts ≤8 hours in duration. There was no increase in risk of occupational illness or injury with increasing weekly work hours. Crewmember familiarity was not associated with the outcome. Nightshift work was protective.
Shift length is associated with occupational injury and illness in this cohort. As shift length increases, the risk of workplace injury and illness increases. These findings are based on observational data and are not generalizable to all EMS agencies. Evidence should be used to justify comprehensive prospective study.
These projects are significant to public health. Calls for research were addressed from the National Occupational Research Agenda and the National EMS Advisory Council, government bodies who identified gaps in the knowledge of these issues. These data may serve as a foundation for future studies to inform decision-making at EMS agencies nationally and protect the health of the EMS workforce
