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14 APRIL 2016 | EMSWORLD.com Safety Stategies Strategies that mitigate sleep deprivation-related errors include: 1. Individual awareness of the impact of sleep deprivation. What does it take for an individual to become sleep deprived? This is a highly subjective and variable metric. 2. Napping. In many systems napping is frowned upon before the close of normal business hours (before 1700), but this arbitrary regulation may need to be re-evaluated, especially in high-volume sys- tems. A 15–20-min safety nap has been shown to refresh and not cause the grogginess associated naps that last 1–2 hours and wake a person in the middle of a sleep cycle. See an IAFC video on sleep deprivation at www.iafc.org/sleep. 3. Identification of those at risk for sleep cycle disturbances. This involves screening for sleep apnea and other sleep disorders. CASES WITH A TWIST S l e e p H y g i e n e f o r S h i f t Wo r k e r s The promotion of regular sleep is known as sleep hygiene, which can be a challenge for shift workers. The following is a list of tips that can be used to improve sleep: Avoid working a number of night shifts in a row as you may become increasingly more sleep- deprived over several nights. Avoid frequently rotating shifts. If possible, avoid long commutes that take time away from sleeping. Keep your workplace brightly lighted to promote alertness. Limit caffeine. Avoid bright light on the way home from work. Stick to a regular sleep- wake schedule. Use blackout blinds or heavy curtains to block sunlight when you sleep during the day. Source: webmd.com/sleep-disorders 1. 2 . 3 . 4 . 5 . 6 . 7. 8 . incapable of focused thought and cannot function, there needs to be a system established to protect our patients; this would obviously require rigorous thresholds and be subject to significant scrutiny so it is not an abused process. B I B L I O G R A P H Y 1. CDC. Unhealthy sleep-related behaviors—12 States, 2009. MMWR Morb Mortal Wkly Rep. 2011;60(8):233–238. 2. Costa G. The impact of shift and night work on health. Appl Ergon, 1996;27(1):9–16. 3. Dorrian J, Tolley C, Lamond N, et al. Sleep and errors in a group of Australian hospital nurses at work and during the commute. Appl Ergon, 2008;39(5):605–613. 4. Elliot DL, Kuehl KS. Ef fects of Sleep Deprivation on Fire Fighters and EMS Responders. Final Report to IAFC. Portland, OR: Oregon Health & Sciences University, Portland, OR, 2007. 5. Fisman DN, et al. Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case cross-over study. Infect Control Hosp Epidemiol, 2007;28(1):10–17. 6. Flo E, Pallesen S, Mageroy N, et al. Shift work disorder in nurses - assessment, prevalence and related health problems. PloS One, 2012;7(4). 7. Lamond N, Dawson D. Quantifying the per formance impairment associated with fatigue. J Sleep Res, 1999;8(4):255–262. 8. Lockley SW, et al. Ef fects of health care provider work hours and sleep deprivation on safety and per formance. Jt Comm J Qual Patient Saf, 2007;33(11 Suppl):7–18. 9. Moore-Ede MC, Richardson GS. Medical implications of shift-work. Annu Rev Med, 1985;36:607–617. 10. The National EMS Advisory Council (NEMSAC). Fatigue in Emergency Medical Services. Report of the Safety Committee, May 2012. ems.gov/pdf/ nemsac/may2012/Safety_Committee_Interim_ Advisory-Fatigue.pdf. 11. Patterson PD, Suf foletto BP, Kupas DF, Weaver MD, Hostler D. Sleep quality and fatigue among prehospital providers. Prehosp Emerg Care, 2010;14(2):187—193. 12. Prevention CDC. Perceived insuffcient rest or sleep among adults—United States, 2008. MMWR Morb Mortal Wkly Rep, 2009;58(42):1175–1179. 13. Patterson PD, Weaver MD Frank RC, et al. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehosp Emerg Care, 2012 Jan–Mar 16(1) 86–97. 14. Ricci JA, Chee E, Lorandeau AL, Berger J. Fatigue in the U.S. workforce: prevalence and implications for lost productive work time. J Occup Environ Med, 2007;49(1):1–10. ABOUT THE AUTHORS David Page, MS, NRP, is director of the Prehospital Care Research Forum at UCLA. He is a senior lecturer and PhD candidate at Monash University. He has over 30 years of experience in EMS and continues to be active as a field paramedic for Allina Health EMS in the Minneapolis/St. Paul area. Will Krost, MBA, NRP, is a fourth-year medical student and a faculty member at the George Washington University School of Medicine and Health Sciences in the Departments of Clinical Research and Leadership and Health Sciences. He has over 23 years of experience in EMS operations, critical care transport and hospital administration. 4. Education for families. It is often difficult for non-EMS/fire providers to appreciate the strain shift work has on an individual. Establishing global sessions for families may help them better under- stand the importance of sleep during off-duty time. 5. Share the wealth. If possible, alternating calls, especially long transports, may provide more down time for crew rest. 6. No-go rule. While this may be counterintui- tive and violate the principles of traditional EMS operations, it is worth discussing in your service. Allowing individuals the opportunity to call in backup or refuse a run based upon their ability to function is important. If the provider feels they are Help identify errors and near-miss events that affect the safety of EMS providers and patients by reporting anonymously at www.emseventreport.com. Data collected will be used to develop policies, procedures and training programs.