Asleep at the wheel

The 5 most common emergent themes prevalent in the included articles were Sleep issues, shift lengths, response times, working as a single responder and the shift schedule.
Sleep was the most common theme by far for both the rural and metro paramedics. It could be broken down into a lack of sleep, poor sleep quality, disrupted sleep, and sleep difficulties. Many of the paramedics that were reporting sleep causing their fatigue, said that it caused them to fall asleep at the wheel or almost crash as well as having errors in drug calculations and administration and poor concentration. Sleep difficulties included paramedics suffering from insomnia despite fatigue and reportedly being ‘not a good sleeper’. The fact that this was the most common theme for rural and metro paramedics shows that this is a big reason as to why paramedics are experiencing fatigue, however, rural paramedics did report a significantly poorer sleep quality than metropolitan paramedics. Stress of the job was a common cause of why the paramedics were experiencing issues with their sleep as well as more specifically for rural paramedics, treating patients they knew brought on an extra level of stress and pressure. This is because they are more worried and focused on ensuring patient safety.

Another common theme was the shift lengths and how long they go for which was at least 40 hours a week and overtime. This theme was expressed through both metro and rural paramedics as a reason for what was causing their fatigue. Not getting consistent rest breaks or them being late or even not getting them at all, was a significant cause outlined by paramedics as contributing to their fatigue, as well as working beyond their shift end time. The shift lengths also caused long, extended hours of alertness and concentration while on the job which would impact clinical decision making and a paramedics ability to perform their role. It was also found that paramedics working 40 hours a week had a relationship with the amount of safety outcomes they reported such as injuries, safety compromising behaviours and errors or adverse outcomes. Clearly showing how shift lengths impact paramedic fatigue.

Response times was a common theme, but it was specifically focussed on rural paramedics. Since the area they cover is so large, and the properties they go to are so big and hospitals aren’t close, they have a lot further to travel than most paramedics in metro locations would. Additionally, the extended transport times for paramedics to get their patients to hospital, especially in time critical emergency situations. This was reported to cause the paramedics to feel stressed and experience fatigue after their calls. The time it took for paramedics to get from their station to their homes was also a factor that they said contributed to their fatigue.

Working as a single responder was another theme that arose that was prevalent among rural paramedics. It caused more feelings of pressure and stress to make sure everything is done right and not making any mistakes. There were reports of feeling understaffed and having a higher expectation on them to perform well. These added levels of stress and pressure lead to the paramedics being fatigued and therefore, not able to perform their job to the best of their abilities.

Another theme that was common for both metro and rural paramedics was the Shift schedule. The cumulative effect of shift work was reported to be causing paramedics fatigue. This included aspects of the job like working night shifts as well as the pressures of working on call. The night shifts being straight after day shifts didn’t give the paramedics much of a chance to get decent sleep after their day shift which leaves them fatigued for the night shifts following. Additionally, not getting much sleep during their night shifts causes them to experience more fatigue. The night shifts being so long left paramedics reporting their fatigue was due to the inability to rest. For rural paramedics, working on call can cause them to be fatigued as they don’t sleep well because they don’t want to miss a call, or they think about what they will have to do if they get a call as well as being too alert after having a call to be able to sleep. All these aspects of the shift schedule cause paramedics to experience fatigue.

Other themes that were not conveyed as often but were still included in the articles were treating patients the paramedics know. This was more specific for rural paramedics as they experienced more stress due to a higher expectation to perform well because many of their patients are known friends or family. Fatigue also occurred in response to paramedics experiencing trauma as it impacted their ability to sleep and, in some cases, caused mental health issues. All of which impacts a paramedics ability to perform their job. The excessive workload paramedics experience was associated with fatigue, as well as an increase in workplace accidents, showing how it can impact clinical decision making and driving skills at any time during a shift.