Patterson P Daniel, Klapec Sharon E, Weaver Matthew D, Guyette Francis X, Platt Thomas E, Buysse Daniel J
Prehosp Emerg Care. 2016;20(1):132-6. doi: 10.3109/10903127.2015.1025158. Epub 2015 May 15.
Emergency medical services (EMS) clinicians often work 24-hour shifts. There is a growing body of literature, with an elevated level of concern among EMS leaders that longer shifts contribute to fatigued workers and negative safety outcomes. However, many questions remain about shift length, fatigue, and outcomes. We describe a case of a 26-year-old male paramedic who switched shift schedules during the midpoint of a randomized trial that addressed fatigue in EMS workers (clinicaltrials.gov identifier: NCT02063737). The participant (case) began the study working full-time with a critical care, advanced life support EMS system that utilized 24-hour shifts. He then transitioned to an EMS system that deploys workers on 8-hour shifts. Per protocol for the randomized trial, the participant completed a battery of sleep health and fatigue surveys at baseline and at the end of 90 days of study. He also reported perceived fatigue, sleepiness, and difficulty with concentration at the beginning, every 4 hours during, and at the end of scheduled shifts, for a total of ten 24-hour shifts and twenty-four 8-hour shifts. We discuss differences in measures taken before and after switching shift schedules, and highlight differences in fatigue, sleepiness, and difficulty with concentration taken at the end of all 34 scheduled shifts stratified by shift duration (24 hours versus 8 hours). Findings from this case report present a unique opportunity to 1) observe and analyze a phenomenon that has not been investigated in great detail in the EMS setting; and 2) address an issue of significance to employers and EMS clinicians alike.
紧急医疗服务（EMS）临床医生通常要值24小时的班。越来越多的文献表明，EMS领导者越来越担心长时间轮班会导致员工疲劳和负面安全结果。然而，关于轮班时长、疲劳和结果仍有许多问题。我们描述了一个案例，一名26岁的男性护理人员在一项针对EMS工作人员疲劳问题的随机试验（clinicaltrials.gov标识符：NCT02063737）进行到一半时更换了轮班时间表。该参与者（案例）开始研究时在一个提供重症监护、高级生命支持的EMS系统全职工作，该系统采用24小时轮班制。然后他转到了一个采用8小时轮班制的EMS系统。按照随机试验的方案，该参与者在基线和研究90天结束时完成了一系列睡眠健康和疲劳调查。他还报告了在预定轮班开始时、轮班期间每4小时以及轮班结束时的疲劳感、困倦感和注意力不集中情况，总共进行了10个24小时轮班和24个8小时轮班。我们讨论了更换轮班时间表前后所采取措施的差异，并强调了按轮班时长（24小时与8小时）分层的所有34个预定轮班结束时在疲劳、困倦和注意力不集中方面的差异。本病例报告的结果提供了一个独特的机会，一是观察和分析在EMS环境中尚未得到详细研究的现象；二是解决对雇主和EMS临床医生都具有重要意义的问题。
