Adverse Health Effects Related to Shift Work Patterns and Work Schedule Tolerance in Emergency Medical Services Personnel: A Scoping Review

Abstract

Paramedicine as a profession is continually evolving in clinical practice, responsibilities, and workload. Changes over time in both population demographics and distribution have altered the demand for, and availability of, prehospital emergency medical services (EMS). These factors may also affect scheduling policies in many EMS organizations. However, there is little evidence that suggests optimal shift scheduling patterns to reduce adverse health events such as increased stress or fatigue in prehospital emergency health care providers. Our objective was to describe associations between variations in shift scheduling patterns and EMS provider health outcomes, such as fatigue, stress, sleep quality, and general mental and physiological health. We also sought to identify knowledge gaps. We performed searches of PubMed, CINAHL, Embase, and Cochrane databases for primary studies, systematic reviews, and meta-analyses published between January 2000 and December 2020. Studies reporting measurable health care outcomes in prehospital personnel with defined shift schedule patterns in land-based ambulance systems were included. Our search strategy yielded 188 studies, of which 11 met eligibility criteria (eight cross-sectional surveys, one single case report, one retrospective cohort study, one prospective cohort study, and one systematic review), with one additional study found through reference list screening, leaving 12 studies for review. All publications contained a description of shift schedule characteristics and shared similar outcomes of interest, although there was variation in comparators and assessment of outcomes. Most studies showed high rates of fatigue, stress, mental health concerns, and negative general health outcomes in paramedic shift worker populations. The case study reported improved fatigue, alertness, and sleep quality levels following a switch from a 24-hour shift pattern to an eight-hour shift. We did not complete an in-depth risk of bias assessment for any of the studies. Melnyk evidence ratings varied from IV to VI, indicating a low quality of evidence evaluating the impacts of shift schedule patterns in paramedics, with the retrospective cohort study design, ranked as IV, systematic review as a V, and prospective cohort study, case report and surveys ranked as VI. The low quality and quantity of evidence indicate the need for further research to definitively assess relationships between specific schedule patterns and health outcomes.

Keywords: emergency medical services; fatigue; health; paramedicine; shift work; shift work tolerance; sleep; stress; work schedule.

Figure 1. PRISMA-ScR flow diagram

PRISMA-ScR: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews

Figure 2. Survey/tool used in studies grouped by shift pattern type

Figure created by the authors of this study. PSQI: Pittsburgh Sleep Quality Index; ESS: Epworth Sleepiness Scale; CFS: Chronic Fatigue Scale; CFQ: Chalder Fatigue Questionnaire; OFER: Occupational Fatigue Exhaustion Recovery scale; ISI: Insomnia Severity Index; BQOSA: Berlin questionnaire-obstructive sleep apnea; FSS: Fatigue Severity Scale; PSQI-PTSD: Pittsburgh Sleep Quality Index-posttraumatic stress disorder; KSS: Karolinska Sleepiness Scale; SPFC: Samn-Parelli Fatigue Checklist; PSD: Pittsburgh Sleep Diary; SFAB: Sleep Fatigue Alertness Behavior Survey; UNS: Ullanlinna Narcolepsy Scale; DASS: Depression Anxiety Stress Scales; PSS: Perceived Stress Scale; BDI: Beck Depression Inventory; STAI: State-Trait Anxiety Inventory; PANAS: Positive Affect and Negative Affect Scale; SOS: Sources of Occupational Stress Survey; SSI: Standard Shiftwork Index; SWD: Shiftwork Disorder Screening Questionnaire; SAS: Schedule Attitudes Survey; AEMS: American Emergency Medical Services Survey; H/O: Horne and Ostberg questionnaire for chronotype; IPAQ: International Physical Activity Questionnaire; GHQ: General Health Questionnaire; BMI: body mass index; BSA: BodyMedia SenseWear Armband; CCHS: Canadian Community Health Survey; BAQ: Bruxism Assessment Questionnaire