What influences safety in paramedicine? Understanding the impact of stress and fatigue on safety outcomes.

OBJECTIVE: The purpose of this study was to build on extant research linking fatigue to safety outcomes in paramedicine by assessing the influence of a multiplicity of workplace stressors, including chronic and critical incident stresses on safety outcomes. METHODS: A cross-sectional survey was deployed to 10 paramedic services in Ontario. Validated survey instruments measured operational and organizational chronic stress, critical incident stress, post-traumatic stress symptomatology (PTSS), fatigue, safety outcomes, and demographics. Analysis of covariance assessed associations of workplace stresses with safety outcomes and corroborated findings using hierarchical linear model and generalized estimating equations (GEE) by taking into account paramedic service when assessing the proposed associations. A non-responder survey was conducted to asses for demographic differences in those who did and did not complete the survey. RESULTS: This survey had a response rate of 40.5% (n = 717/1767); 80% of paramedics reported an injury or exposure to pathogen, 95% reported safety compromising behaviors, and 76% reported medical errors. In the GEE analyses, paramedic injury was significantly related to fatigue (0.13, SE = 0.06, P = 0.020), critical incident stress (0.03, SE = 0.01, P < 0.01), and PTSS (0.03, SE = 0.01, P < 0.01). Safety compromising behaviors were significantly associated with fatigue (0.37, SE = 0.06, P < 0.01), organizational stress (0.06, SE = 0.01, P < 0.01), and critical incident stress (0.01. SE = 0.01, P = 0.017). Medication errors were significantly related to fatigue (0.12, SE = 0.05, P < 0.01). Finally, the bivariate analysis showed increased stress factors and fatigue was associated with increased safety outcomes. CONCLUSION: These findings illustrate that a host of different stressors may influence safety-related behaviors. For those interested in safety, these findings point to the need for a holistic focus on fatigue and stress in paramedicine.

Fatigue and Safety in Paramedicine.

OBJECTIVES: Extant research has established an empirical relationship between fatigue and safety-related outcomes. It is not clear if these findings are relevant to Canadian paramedicine. The purpose of this study was to determine if fatigue and shiftwork variables were related to safety outcomes in Canadian paramedics. METHODS: A survey was conducted with ten paramedic services in Ontario with a 40.5% response rate (n = 717). Respondents reported levels of fatigue, safety outcomes (injury, safety compromising behaviours, and medical errors/adverse events), work patterns (types of shifts, hours worked weekly) and demographic characteristics. Univariate and logistic regression analyses were used to assess for significant differences. RESULTS: In this sample, 55% of paramedics reported being fatigued at work. Fatigued paramedics were over twice as likely to report injuries, three times as likely to report safety compromising behaviors, and 1.5 times more likely to report errors/adverse outcomes. When controlling for fatigue, shift length variables did not consistently influence safety outcomes. CONCLUSION: These results create preliminary evidence of a relationship between fatigue and safety outcomes in Canadian paramedicine. While more research is needed, these findings point to the influence fatigue has on safety outcomes and provide an indication that fatigue mitigation efforts may be worthwhile.

OBJECTIF: D'après les travaux de recherche, il existe une relation empirique entre la fatigue et les résultats liés à la sécurité. Toutefois, on ne sait pas si les constatations s'appliquent à la paramédecine au Canada. L'étude avait donc pour but de déterminer si la fatigue et les variables relatives au travail par postes avaient une incidence sur les résultats liés à la sécurité chez les ambulanciers paramédicaux au Canada. MÉTHODE: Une enquête a été menée dans 10 services paramédicaux, en Ontario, et le taux de réponse a atteint 40,5% (n = 717). Les participants devaient faire état du degré de fatigue, de résultats liés à la sécurité (blessure, comportements mettant en péril la sécurité, erreurs médicales et effets indésirables), du régime de travail (type de roulement, nombre d'heures de travail par semaine) et de données démographiques. Des analyses de régression logistique et unidimensionnelle ont été effectuées afin de mettre en évidence des écarts importants. RÉSULTATS: Dans l'échantillon étudié, 55% des ambulanciers paramédicaux ont déclaré ressentir de la fatigue au travail. Ceux-ci étaient plus de deux fois susceptibles de subir des blessures, trois fois plus susceptibles d'avoir des comportements mettant en péril la sécurité et une fois et demie plus susceptibles de déclarer des erreurs ou des effets indésirables. Par ailleurs, lorsqu'on tenait compte de la fatigue, les variables relatives à la durée des postes de travail n'avaient pas la même incidence sur les résultats liés à la sécurité. CONCLUSION: Les résultats fournissent des données préliminaires sur l'existence d'une relation entre la fatigue et les résultats liés à la sécurité en paramédecine au Canada. Si le sujet demande à être approfondi, les constations font déjà ressortir l'incidence de la fatigue sur les résultats liés à la sécurité ainsi que la pertinence de trouver des moyens d'atténuation de la fatigue.

Predictors of posttraumatic stress and preferred sources of social support among Canadian paramedics.

OBJECTIVE: Emergency medical service (EMS) providers are exposed to a variety of stressors endemic to the profession. These exposures may contribute to stress reactions, including posttraumatic stress. The objective of this study was to evaluate the relationship between work-related stressors and posttraumatic stress. The secondary objective was to determine paramedics' preferred sources of support for managing work-related stress. METHODS: 269 paramedics in a county-based EMS service were invited to complete an online survey. Respondents reported their demographic characteristics, levels of chronic stress, critical incident stress, posttraumatic stress symptomatology (PTSS), and preferred sources of support for managing work-related stress. RESULTS: A total of 145 paramedics completed the survey. PTSS was significantly correlated with operational stress (p<0.001), organizational stress (p<0.001), and critical incident stress (p<0.001). Regression models revealed that chronic operational stress was a significant independent predictor of PTSS (p<0.001) and in combination with critical incident stress (p<0.01). Paramedics reported a higher preference for receiving support from a work partner, friend, or family member than from other sources (p<0.001). CONCLUSION: Both chronic and critical incident stressors appear to be significant predictors of PTSS. Our findings suggests that holistic health and wellness initiatives that address the impact of both critical incident stress and the chronic stressors associated with day-to-day operations may help mitigate PTSS. Our findings also provide preliminary evidence that interventions may benefit from a focus on peer support and on friends and family members who can support the affected paramedic.