Effects of Sleep Deprivation on Fire Fighters and EMS ... - NAEMT

<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and EMS Responders
The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the accreditation
<strong>of</strong> post-M.D. medical training programs within the U.S. Their website (http://www.acgme.org/
acWebsite/dutyHours/dh_index.asp) has extensive information <strong>of</strong> work hour issues, including pdf
files <strong>of</strong> their reports and updates, annotated bibliographies and position papers <strong>of</strong> other medical
societies.
Diaries or activity logs correlate with direct observation <strong>of</strong> individuals, and the diaries were used to
validate the self reported information.
Data on patient errors was collected, and the researchers found that extended-duration work shifts
were associated with an increased risk <strong>of</strong> significant medical errors and adverse events. However,
self reports <strong>of</strong> errors are subject to recall bias and are difficult to validate. For those outcomes, it
also was problematic to control for the many potential confounding factors, such as level <strong>of</strong>
supervision and other work-related issues. A more firm outcome was motor vehicle crashes when
driving home from work. For these events, intern fatigue was a primary variable, and those crashes
were substantiated with accident reports, insurance claims, photographs or other documentation.
The investigators found that interns who had worked 24 hours or longer were 2.3 times more likely
to have a motor vehicle crash driving home from work. In addition to an adverse impact from one
long day <strong>of</strong> work, repeated prolonged work days also had a detrimental effect. An almost linear
relationship was observed between the number <strong>of</strong> extended shifts per month and car crashes; on
the typical longer work schedule (every third night), the risk <strong>of</strong> a crash on the commute from work
was increased 162 percent.
The same researchers who did the web-based intern survey also conducted a small prospective
randomized crossover trial among interns working in the Medical Intensive Care Unit and the
Coronary Care Unit at the Brigham and Women’s Hospital in Boston. Each intern served as his or
her own control as they worked in random order for three weeks under two different work hour
situations: 1) a traditional schedule <strong>of</strong> approximately 80 hours per week and 2) a 60 hour schedule,
which also eliminated shifts longer than 24 hours. Again, the interns’ habits were closely monitored,
and they completed daily sleep and work hour diaries and underwent continuous ambulatory
recordings for three or four days a week. In this situation the patient care outcomes could be
directly assessed using direct observation by other physicians, regular chart reviews by two highlytrained
nurses, voluntary intern self-reports and computerized event-detection monitoring systems.
The investigators found that interns working a traditional schedule made 36 percent more serious
medical errors and five times more serious diagnostic errors, both <strong>of</strong> which were highly significant
differences. Even though there was less continuity <strong>of</strong> care and more transferring management
among interns, errors still were fewer among the interns with more rest.
Collectively, the findings from the studies demonstrated an increased risk to both residents and patients
<strong>of</strong> continuing to permit long work hours and extended duration work shifts. When working long hours,
physicians were at a higher risk <strong>of</strong> lapses <strong>of</strong> vigilance and committing serious medical errors, and they
were more than twice as likely to crash their cars while driving home. Other medical providers also are
adversely affected by long work hours. For nurses, the risk <strong>of</strong> needle stick injury significantly increases
after extended work hours (Ayas et al., 2006), and the risk <strong>of</strong> nursing errors is greater when working
more than 12 continuous hours or more than 40 hours per week (Buss-Frank, 2005).
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