Effects of a modified ambulance night shift system on fatigue and physiological function among ambulance paramedics.

OBJECTIVES: In the present study, we modified a night shift system for an ambulance service so that ambulance paramedics were assured of taking a nap, and examined the effects of this new system on the fatigue and physiological function of ambulance paramedics. METHODS: Ten ambulance paramedics at a fire station in the center of a large city in Japan voluntarily enrolled as subjects in this field study. They worked a 24-h shift system. There were two teams of 5 ambulance paramedics in the fire station. Three ambulance paramedics per shift usually provided the emergency services. In the traditional system, the ambulance paramedics had to deal with all emergency calls throughout a 24-h shift (T-shift). In the modified system, 2 ambulance paramedics were allotted time for naps in the 21:00-3:00 (C-shift) or 3:00-8:30 (B-shift) shift by the addition of another a firefighter (D-shift). RESULTS: There were fewer emergency dispatches and nap time was longer in the B- and C-shifts than in the T-shift. Parasympathetic nerve activities during naps in B- and C-shifts were higher than in the T-shift. The results of critical flicker fusion frequency and 3-choice reaction time in the B-shift at 7:30 tended to be higher and shorter than that in T-shift. CONCLUSIONS: The results of this study suggest that the modified night shift which ensured time for ambulance paramedics to take long, restful power naps alleviated subjective fatigue, and improved physiological functions which are often adversely affected by night workload.

Workload of the steering work on a high-speed vessel.

The higher incidence of accidents occurring on board among the high-speed vessels has motivated this study focusing on the actual operating conditions contributing to the incidence. The working activities and workload of the officers and quartermasters were compared between the conventional and high-speed vessels of regular service ferry, by recording video-pictures and heart rate of the crews during actual navigations. An autopilot equipment was installed in the conventional vessel of over 6000 tons, but not in the high-speed vessel of about 1500 tons. Either on the conventional or high-speed vessel, dominant activities of the officers were lookout and watching radar, which were conducted in standing on the conventional vessel and in sitting on the high-speed vessel. Major works of the quartermasters were lookout and radar watch in standing on the conventional vessel and steering operations with a joystick in sitting on the high-speed vessel. Despite these differences in postural conditions, the mean % heart rate increase in both crews was significantly higher on the high-speed than on the conventional vessel. In the quartermaster, the events requiring steering maneuvers on the high-speed vessel were associated with increase in heart rate. The findings as a whole suggest occurrence of substantial mental strains in the crew on the high-speed vessel. These strains, certainly derived from caring for the safety in the absence of autopilot equipment, must have intensified the workload in the crew. In connection with the workload, the necessity for some fail-safe systems, including the autopilot facilities, and educational systems for techniques of steering high-speed vessels was discussed.