Date of Award

1-1-2002

Degree Type

Thesis

Degree Name

Master of Health Science

Faculty

Faculty of Communications, Health and Science

First Advisor

Nicole McLeod

Second Advisor

Jacques Oosthuizen

Abstract

The study of fatigue in the health and transport sectors has predominantly been focused on night shift or day shift operations. This study has been applied to the hours of operation of Ambulance Officers who perform both night and day shifts, while also being required for on-call. The Officer on-call is on stand-by between shifts, to be available to respond for duties from the completion of one shift until the commencement of the next, usually a ten-hour shift. Studies of a similar focus have not been identified so a comparison of these specific findings has not been possible. However trends in sleep debt, peaks in the drive for sleep and recognition of fatigue are consistent with findings of other studies. The initial impetus for the study, to compare the degree of fatigue between air and road long distance transports, provided no significant output. The data collected did however provide clear identification of the various precipitators of fatigue in the Ambulance Officers workplace. To adequately address the hazard of fatigue, the introduction of integrated systems that address sleep deprivation and circadian cycles are required to aid in managing fatigue. The identification and control of fatigue in the workplace is to the benefit of both the employer and the employee. The study consists of fourteen Ambulance Officers utilising both road and helicopter transport mechanisms to undertake transfers to major medical facilities. The Officers were required to answer questionnaires at the completion of each shift to record the precipitators and indicators of fatigue. Findings indicate there is no significant difference between the levels of fatigue induced by air or road transport. The influences of the time of day and the degree of sleep deprivation are however indicative of fatigue in the individual. Day shifts accounted for 70% of data collected with results of fatigue as more prevalent in the 1501-1800 hours period, coinciding with a trough in performance and alertness. Their adherence to non-performance indicators suggests an unwillingness to identify anomalies in their performance or an inability to self-determine a level of fatigue. Performance of duty during "on-call periods" induces sleep deprivation that may develop into a sleep debt if the restorative sleep is not obtained. Individuals generally function for 16-hollrs and sleep for 8-hours, to replenish the organism. When this ratio is redistributed the individual develops a sleep debt and left unaddressed develops into fatigue. Performance of long distance transports and reliance on on-call officers removes their ability to address their sleep debt. The introduction of rescheduling of transports and fatigue breaks reduces the influence of fatigue in the Ambulance Officers workplace. The magnitude of fatigue is only evident when the consequences are realised. Officers performing transfers on empty expressways can wander on the lanes with only a fright to remember the experience. However a patient, of the belief that they are safe when in an Ambulance, will have more to remember if the expressway has a car in the other lane. Fatigue is evident in the Ambulance Officers workplace and remedies to address it, which incorporate a Safety Management System, have been outlined in the recommendations of the study.

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