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

Elizabeth A Donnelly; Paul Bradford; Matthew Davis; Cathie Hedges; Doug Socha; Peter Morassutti; Sathish Chandra Pichika

doi:10.1002/emp2.12123

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

J Am Coll Emerg Physicians Open. 2020 Jun 15;1(4):460-473. doi: 10.1002/emp2.12123. eCollection 2020 Aug.

Authors

Elizabeth A Donnelly¹, Paul Bradford², Matthew Davis³, Cathie Hedges⁴, Doug Socha⁵, Peter Morassutti⁶, Sathish Chandra Pichika⁷

Affiliations

¹ School of Social Work University of Windsor Windsor Ontario Canada.
² Department of Emergency Medicine Windsor Regional Hospital Southwest Ontario Regional Base Hospital Program University of Western Ontario London Ontario Canada.
³ Division of Emergency Medicine Southwest Ontario Regional Base Hospital Program University of Western Ontario London Ontario Canada.
⁴ Essex Windsor EMS Essex Ontario Canada.
⁵ Hastings-Quinte Paramedic Services Belleville Ontario Canada.
⁶ Southwest Ontario Regional Base Hospital Program-Windsor Site Windsor Ontario Canada.
⁷ Department of Mathematics and Statistics University of Windsor Windsor Ontario Canada.

Abstract

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.

Keywords: emergency medical services; fatigue; paramedicine; safety; stress.