Emergency Medical Services: When Fatigue Becomes The Norm.

BACKROUND: Emergency Medical Services (EMS) routinely work at the very limit of their capacity due to growing emergency rooms visits and residents’ shortage. In this context, EMS workers are regularly asked to work more than 10 hours a day, on varying shifts and with short recuperation breaks. Two approaches can be used to reduce fatigue-related risk: reducing the likelihood a fatigued operator is working (i.e. fatigue reduction), or reducing the likelihood a fatigued operator will make an error (i.e. fatigue proofing). In Emergency Medical Services, formal risk control mainly focuses on reduction strategies such as reducing work hours while proofing strategies develops as an implicit element of the safety system. OBJECTIVE: Our purpose is to identify individual proofing and reduction strategies used by emergency residents and to investigate how they relate to fatigue, performance and patient safety indicators. METHODS: First, we conducted 4 focus-group sessions with a total of 25 EMS residents to elicit perceived consequences of fatigue and strategies used to cope with them. Focus group results were used to design a questionnaire assessing how often EMS residents personally used any of the strategies reported during sessions. Second, we administered the questionnaire to a larger sample and conducted a prospective observational study with a repeated within-subjects component. A total of 35 EMS residents participated in the study for a total of 200 shifts analyzed. We gathered sleep diaries, subjective sleepiness, reaction time, self-reported medical errors and performance ratings at different time point during both day and night shift using an android-based application. Sleep time and activity levels were confirmed using wrist actigraphy. DISCUSSION: We will discuss what can be drawn from our results in terms of individual and collective resilience processes with a focus on the potential for implementation of more formal processes at a system level.