Patterson P Daniel, Higgins J Stephen, Van Dongen Hans P A, Buysse Daniel J, Thackery Ronald W, Kupas Douglas F, Becker David S, Dean Bradley E, Lindbeck George H, Guyette Francis X, Penner Josef H, Violanti John M, Lang Eddy S, Martin-Gill Christian
Prehosp Emerg Care. 2018 Feb 15;22(sup1):89-101. doi: 10.1080/10903127.2017.1376137. Epub 2018 Jan 11.
Administrators of Emergency Medical Services (EMS) operations lack guidance on how to mitigate workplace fatigue, which affects greater than half of all EMS personnel. The primary objective of the Fatigue in EMS Project was to create an evidence-based guideline for fatigue risk management tailored to EMS operations.
Systematic searches were conducted from 1980 to September 2016 and guided by seven research questions framed in the Population, Intervention, Comparison, Outcome (PICO) framework. Teams of investigators applied inclusion criteria, which included limiting the retained literature to EMS personnel or similar shift worker groups. The expert panel reviewed summaries of the evidence based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The panel evaluated the quality of evidence for each PICO question separately, considered the balance between benefits and harms, considered the values and preferences of the targeted population, and evaluated the resource requirements/needs. The GRADE Evidence-to-Decision (EtD) Framework was used to prepare draft recommendations based on the evidence, and the Content Validity Index (CVI) was used to quantify the panel's agreement on the relevance and clarity of each recommendation. CVI scores for relevance and clarity were measured separately on a 1-4 scale to indicate consensus/agreement among panel members and conclusion of recommendation development.
The EtD framework was applied to all 7 PICO questions, and the panel created 5 recommendations. PICO1: The panel recommends using fatigue/sleepiness survey instruments to measure and monitor fatigue in EMS personnel. PICO2: The panel recommends that EMS personnel work shifts shorter than 24 hours in duration. PICO3: The panel recommends that EMS personnel have access to caffeine as a fatigue countermeasure. PICO4: The panel recommends that, EMS personnel have the opportunity to nap while on duty to mitigate fatigue. PICO5: The panel recommends that EMS personnel receive education and training to mitigate fatigue and fatigue-related risks. The panel referenced insufficient evidence as the reason for making no recommendation linked to 2 PICO questions.
Based on a review of the evidence, the panel developed a guideline with 5 recommendations for fatigue risk management in EMS operations.
紧急医疗服务（EMS）运营管理人员缺乏关于如何减轻工作场所疲劳的指导，而这影响着超过半数的EMS人员。EMS项目中疲劳研究的主要目标是制定一项针对EMS运营的基于证据的疲劳风险管理指南。
从1980年至2016年9月进行了系统检索，并以人群、干预措施、对照、结局（PICO）框架下提出的七个研究问题为指导。研究团队应用纳入标准，包括将保留文献限制为EMS人员或类似轮班工人群体。专家小组根据推荐分级、评估、制定与评价（GRADE）方法审查了证据总结。该小组分别评估了每个PICO问题的证据质量，考虑了利弊平衡，考虑了目标人群的价值观和偏好，并评估了资源需求。GRADE证据到决策（EtD）框架用于根据证据制定建议草案，内容效度指数（CVI）用于量化小组对每项建议的相关性和清晰度的一致性。相关性和清晰度的CVI分数分别在1-4的量表上进行测量，以表明小组成员之间的共识/一致性以及建议制定的结论。
EtD框架应用于所有7个PICO问题，小组制定了5项建议。PICO1：小组建议使用疲劳/嗜睡调查工具来测量和监测EMS人员的疲劳情况。PICO2：小组建议EMS人员的轮班时长应短于24小时。PICO3：小组建议EMS人员可使用咖啡因作为抗疲劳措施。PICO4：小组建议EMS人员在值班时有机会小睡以减轻疲劳。PICO5：小组建议EMS人员接受教育和培训以减轻疲劳及与疲劳相关的风险。小组以证据不足为由，未针对2个PICO问题提出建议。
基于对证据的审查，小组制定了一项指南，其中包含5项针对EMS运营中疲劳风险管理的建议。
