Cash Rebecca E, Anderson Sarah E, Lancaster Kathryn E, Lu Bo, Rivard Madison K, Camargo Carlos A, Panchal Ashish R
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (REC, CAC).
National Registry of Emergency Medical Technicians, Columbus, OH (REC, MKR, ARP).
Prehosp Emerg Care. 2020 Sep-Oct;24(5):644-656. doi: 10.1080/10903127.2020.1758259. Epub 2020 May 7.
: Emergency medical services (EMS) personnel frequently encounter occupational factors that increase the risk of poor sleep and stress. The national prevalence of poor sleep and stress in EMS personnel is unclear, especially differences between personnel at the basic (BLS) versus advanced (ALS) life support levels. The objectives of this study were to: (1) estimate the prevalence of sleep and stress metrics in EMS personnel; and (2) compare these metrics between BLS and ALS-certified personnel. : This study was a survey of recertifying nationally-certified EMS personnel working in civilian settings. Respondents completed an electronic questionnaire assessing their sleep quality; workday, non-workday, and average sleep duration; sleep debt; perceived stress; and chronic stress. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (PR) comparing BLS (emergency medical technician) to ALS (advanced emergency medical technician and paramedic) for each metric. Models were adjusted for age, sex, minority status, education level, EMS agency type, service type, EMS role, and significant interactions. : A total of 17,913 (response rate = 19%) responses were received with 17,522 included in the analysis. Adjusted PRs were significantly higher for ALS-certified personnel compared to BLS-certified for poor sleep quality (PR: 1.23, 95% CI: 1.20-1.27) and short (<7 hours) or long (≥9 hours) workday sleep duration (PR: 1.17, 95% CI: 1.15-1.19). Significant interactions were found between certification level and sex (average sleep duration) or age category (sleep debt, perceived stress, and chronic stress). The highest prevalence of short or long average sleep duration was among ALS men. Sleep debt, perceived stress, and chronic stress differed by age group between certification levels with higher PRs for ALS regardless of age group. : There is a high prevalence of poor sleep and stress in EMS personnel, with evidence of the highest prevalence among ALS-certified personnel. Evidence of effect modification by age category and among BLS and ALS personnel suggests that interventions could target certain subgroups, such as older ALS personnel, to be most effective. Continued focus on sleep health and stress reduction is needed to improve the health and well-being of the EMS workforce.
紧急医疗服务（EMS）人员经常会遇到增加睡眠质量差和压力风险的职业因素。EMS人员中睡眠质量差和压力大的全国患病率尚不清楚，尤其是基础生命支持（BLS）与高级生命支持（ALS）水平人员之间的差异。本研究的目的是：（1）估计EMS人员中睡眠和压力指标的患病率；（2）比较BLS和获得ALS认证人员之间的这些指标。
本研究是对在民用环境中工作的重新认证的全国认证EMS人员进行的一项调查。受访者完成了一份电子问卷，评估他们的睡眠质量、工作日、非工作日和平均睡眠时间、睡眠债、感知压力和慢性压力。调查加权泊松回归模型用于估计比较BLS（急救医疗技术员）和ALS（高级急救医疗技术员和护理人员）各项指标的调整患病率比（PR）。模型针对年龄、性别、少数群体身份、教育水平、EMS机构类型、服务类型、EMS角色以及显著交互作用进行了调整。
共收到17913份回复（回复率 = 19%），其中17522份纳入分析。与获得BLS认证的人员相比，获得ALS认证的人员在睡眠质量差（PR：1.23，95%置信区间：1.20 - 1.27）以及工作日睡眠时间短（<7小时）或长（≥9小时）方面的调整PR显著更高。在认证水平与性别（平均睡眠时间）或年龄类别（睡眠债、感知压力和慢性压力）之间发现了显著的交互作用。平均睡眠时间短或长的患病率最高的是ALS男性。睡眠债、感知压力和慢性压力在不同年龄组的认证水平之间存在差异，无论年龄组如何，ALS的PR都更高。
EMS人员中睡眠质量差和压力大的患病率很高，有证据表明在获得ALS认证的人员中患病率最高。年龄类别以及BLS和ALS人员之间效应修正的证据表明，干预措施可以针对某些亚组，如年长的ALS人员，以达到最有效的效果。需要持续关注睡眠健康和减轻压力，以改善EMS工作人员的健康和福祉。
