Barth Jennifer, Greene Jennifer A, Goldstein Judah, Sibley Aaron
Division of Paramedicine, Department of Biology, University of Prince Edward Island, Charlottetown, CAN.
Division of Emergency Medical Services, Department of Emergency Medicine, Dalhousie University, Halifax, CAN.
Cureus. 2022 Apr 1;14(4):e23730. doi: 10.7759/cureus.23730. eCollection 2022 Apr.
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.
作为一门专业，急救医学在临床实践、职责和工作量方面不断发展。随着时间的推移，人口统计学和分布的变化改变了对院前急救医疗服务（EMS）的需求和可及性。这些因素也可能影响许多EMS组织的排班政策。然而，几乎没有证据表明存在能减少院前急救医护人员压力增加或疲劳等不良健康事件的最佳轮班排班模式。我们的目标是描述轮班排班模式变化与EMS提供者健康结果之间的关联，如疲劳、压力、睡眠质量以及总体心理和生理健康。我们还试图找出知识空白。我们对PubMed、CINAHL、Embase和Cochrane数据库进行了检索，以查找2000年1月至2020年12月期间发表的原始研究、系统评价和荟萃分析。纳入了报告陆地救护车系统中具有明确轮班排班模式的院前人员可测量医疗结果的研究。我们的检索策略共获得188项研究，其中11项符合纳入标准（八项横断面调查、一项单病例报告、一项回顾性队列研究、一项前瞻性队列研究和一项系统评价），通过参考文献列表筛选又发现一项研究，最终有12项研究可供审查。所有出版物都包含轮班排班特征的描述，并共享类似的感兴趣结果，尽管在比较对象和结果评估方面存在差异。大多数研究表明，急救医护人员轮班工作人群中疲劳、压力、心理健康问题以及总体健康状况不佳的发生率很高。该案例研究报告称，从24小时轮班模式改为8小时轮班后，疲劳、警觉性和睡眠质量水平有所改善。我们没有对任何一项研究进行深入的偏倚风险评估。梅尔尼克证据等级从IV到VI不等，表明评估急救医护人员轮班排班模式影响的证据质量较低，回顾性队列研究设计评为IV级，系统评价评为V级，前瞻性队列研究、病例报告和调查评为VI级。证据的低质量和数量表明需要进一步研究，以明确评估特定排班模式与健康结果之间的关系。
