Ambulance paramedics are members of a discipline that forms a unique part of the emergency services. As pre-hospital providers they are constantly and increasing faced with heavy workloads that are physically, mentally and emotionally tiring. Fatigue and sleep disturbance are factors which can compromise the effectiveness of these workers, and as a result not only hamper patient safety but can have detrimental consequences on the paramedics' health and overall well-being. The objective of this study was to investigate the impact shift work on physical fatigue, sleep and psychological factors among paramedics in Australia. Methods A convenience sample of paramedics was asked to complete a number of self-reporting standardised questionnaires: The Epworth Sleepiness Scale (ESS) (8-items), Berlin Questionnaire (BQ) (10-items), Pittsburgh Sleep Quality Index (PSQI) (19-items) and the Beck Depression Inventory (BDI) (21-items). Ethics approval was granted. Results The study recruited 60 participants, the majority of which were male 77% (n=46), > 45 years of age 31% (n=19), and having worked shift work between 5-10 years 35% (n=21). Nine out of ten (92%, n=55) of paramedics reported having experienced fatigue in the last 6 months, with 88% (n=53) believing it had affected their performance at work. The ESS reported 30% (n=18) of people had excessive daytime sleepiness, and 10% (n=6) being dangerously sleepy. Statistical significance was observed in the ESS items 'chance of dozing while sitting and talking to someone' (p<0.05), and 'whilst stopped in traffic for a few minutes' (p<0.05) between males and females. Almost half (48%, n=29) of paramedics answered yes to having nodded off or fallen asleep whilst driving. The PSQI found 68% (n=41) of participants suffered poor quality sleep, while 21 % (n=13) of respondents were at high risk for sleep apnoea (BQ). Depression was found to be mild among 27% (n=16) and moderate among 10% (n=6) of respondents. Conclusions Shift work affects health and well-being both physiologically and psychologically, which translates from work into home. Further research using a larger sample size is warranted to prevent the issues of patient safety, work-related fatigue and the cumulative effects of shift work in paramedic employees.
Frank Archer BMedSci(Hons), MBBS, MEd, MPH, FRACGP, FIMC(RCSEd), FAFPHM, FASMF
Frank is currently the director of the Monash University Centre for Ambulance and Paramedic Studies. He was previously the State Ambulance Medical Director for Victoria in the Department of Human Services - a position he had held for the previous 20 years. He also has a concurrent appointment as one of the four Medical Directors for the Metropolitan Ambulance Service in Melbourne.
Frank's first contact with the ambulance service was when he was employed as an Ambulance Officer during his long vacations whilst a medical student. He presented his first paper at the First Seminar on the Management of Road Traffic Casualties conducted by the Royal Australasian College of Surgeons in 1999. The title of his paper was, "Care Before Casualty - Current Shortcomings".
Following his graduation and hospital residencies, Frank combined clinical practice as a general practitioner with (initially) a four year period teaching anatomy to medical students at Monash University and later in a range of appointments within the Ambulance Service. Frank commenced a formal appointment as the "Ambulance Service Medical Officer" in 1976, combining responsibilities primarily for the development of the Mobile Intensive Care Ambulance program in Victoria, within both the Department of Human Services and the Metropolitan Ambulance Service, whilst based at the Ambulance Officers' Training Centre. These concurrent appointments continued until his appointment at Monash University in May 1999.
During these ambulance appointments, Frank has been a member of many teams which have led a series of innovations in ambulance policy, research and development, clinical practice education and operations, many of which have been benchmarks for interstate programs and have attracted international attention.
Frank has post graduate clinical fellowships in general practice, immediate medical care and public health medicine. He is also a member of a number of national and international committees in the area of prehospital care.
Brett Williams BAVEd, Grad Cert ICP, Grad Dip EmergHlth, MHlthSc, PhD (Candidate) MACAP, NAEMSE.
Brett Williams is a senior lecturer at Monash University (Department of Community Emergency Health & Paramedic Practice) with over 15 years experience in paramedic education. He has been heavily involved in the ideological transition of paramedic education from vocational origins to the higher education sector and has developed curriculum for both undergraduate and postgraduate students in face-to-face and e-learning modes.
Brett is currently undertaking his PhD. Brett's research and teaching interests are focused on the paradigm of student-centred learning, alternative learning opportunities, innovative teaching strategies and interprofessional education.
JEPHC PUBLICATIONS EducationQualitative analysis of undergraduate paramedic students' perceptions of using case-based learning in an online learning environment
Using creative and contemporary teaching strategies to promote emancipation, empowerment and achievement in undergraduate paramedic students - a personal reflection The Implementation of Case-Based Learning - Shaping the Pedagogy in Ambulance Education Opinion "Developmental Disability Medicine: Is it time for its inclusion into the paramedic curriculum?" an interview with Dr Jane Tracy
Removal of Invasive Devices from Deceased Persons: Forensic implications for Paramedics - A Victorian Perspective. an Interview with Professor Stephen Cordner Book Reviews "eACLS" American College of Emergency Physicians & National Safety Council. February 2004. Conference Reports OLT-2005 "Beyond Delivery" Conference 27 September 2005, QUT, Brisbane The Australian College of Ambulance Professionals 2004 National Conference at Alice Springs September 9-11
Sarah is currently enrolled as an Honours student in Emergency Health (Paramedics) at the Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.
Archer, Frank; Williams, Brett; Sofianopoulos, Sarah; and Thompson, Bruce
"The exploration of physical fatigue, sleep and depression in paramedics: a pilot study,"
Journal of Emergency Primary Health Care:
1, Article 3.
Available at: http://ro.ecu.edu.au/jephc/vol9/iss1/3