National Association of EMS Physicians (NAEMSP): Annual Meeting

SAN DIEGO – Initial shockable rhythm during resuscitation for out-of-hospital cardiac arrest was the strongest predictor of survival, a large retrospective analysis found. However, conversion to subsequent shockable rhythm significantly influenced postarrest survival and neurological outcomes.

“Our study supports that some patients with initial nonshockable rhythm can benefit from early rhythm analysis to provide shocks if indicated with a period of CPR rather than delayed rhythm analysis,” lead study author Dr. Marcus E.H. Ong said in an interview in advance of the annual meeting of the National Association of EMS Physicians.

Traditional resuscitation efforts are focused on early defibrillation to patients with shockable rhythms, as this is thought to have the best prognosis, according to Dr. Ong of the department of emergency medicine at Singapore General Hospital. “However, only a minority of out-of-hospital cardiac arrests present with initial shockable rhythm, especially in Asia,” he said. “A number of patients with initial nonshockable rhythm actually revert to a shockable rhythm after a period of resuscitation. If conversion to subsequent shockable rhythm is a strong predictor of subsequent outcomes, this finding might have an important implication for clinical prognostication and selection of subsequent therapies.”

The researchers retrospectively evaluated all cases of adult out-of-hospital cardiac arrest (OHCA) collected by the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in seven Asian countries during 2009-2012. PAROS is a resuscitation clinical research network established in collaboration with EMS agencies and academic centers in Singapore, Japan, South Korea, Malaysia, Thailand, Taiwan, and United Arab Emirates. The primary outcome was survival to hospital discharge. The researchers evaluated the outcomes of OHCA based on three groups – initial shockable rhythm, subsequent shockable rhythm, and remained in shockable rhythm – and developed a two-stage model to assess the influence of initial rhythm and subsequent conversion rhythm on survival to admission (first stage) and survival to discharge (second stage).

Dr. Ong and his associates reported results from 5,356 OHCA cases with initial shockable rhythm and 33,974 cases with initial nonshockable rhythm. The researchers found that OHCA with initial shockable rhythm and subsequent conversion to shockable rhythm independently predicted survival to hospital discharge (odds ratios of 6.10 and 2.00, respectively). Following adjustment of baseline and prehospital characteristics, subsequent conversion to shockable rhythm significantly improved survival to admission (OR, 1.53), survival to discharge (OR, 2.00), postarrest overall outcomes (OR, 5.12), and cerebral performance outcomes (OR, 5.39).

In the two-stage analysis, Dr. Ong and his associates found that subsequent conversion to shockable rhythm significantly influenced survival to admission (OR, 1.27) and survival to discharge (OR, 1.42), good overall outcomes (OR, 2.14) and cerebral performance outcomes (OR, 2.2).

“We believe these large, multinational, population-based, prospective cohort data show clearly that while survival and neurological outcomes after OHCA were most favorable in patients presenting with initial shockable rhythm, outcomes were much better in those with subsequent shockable rhythm conversion compared to those with persistent nonshockable rhythm,” Dr. Ong said. “The patients with converted shockable rhythm appear to be more similar in terms of outcomes to those with initial shockable rhythm, compared with those with initial nonshockable rhythms.”

He went on to note that initial shockable rhythm is usually used as a selection criterion for postresuscitation care such as therapeutic temperature management, urgent percutaneous coronary intervention, and extracorporeal membrane oxygenation. “However, our study results suggest that this approach ignores a group of initially nonshockable rhythms that will convert to shockable during resuscitation,” he said. “Our results suggest that patients with initial nonshockable rhythms with subsequent conversion to shockable should be given the same therapeutic benefit of these aggressive postresuscitation interventions.”

Dr. Ong acknowledged certain limitations of the study, including the fact that other confounders may have affected the outcomes of OHCA, such as quality and process of resuscitation, in-hospital care, the number of shocks given, and time to shocks. “There might be variations in patient, EMS, and hospital factors including resuscitation protocols which might have affected the outcomes,” he said. “However, this study managed these risks with the use of a multinational registry involving a relatively large number of cardiac arrest cases and usage of a standardized template for data collection and adjustment of the country variance in all analysis models.”

Dr. Ong reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Initial shockable rhythm during resuscitation for out-of-hospital cardiac arrest was the strongest predictor of survival, a large retrospective analysis found. However, conversion to subsequent shockable rhythm significantly influenced postarrest survival and neurological outcomes.

“Our study supports that some patients with initial nonshockable rhythm can benefit from early rhythm analysis to provide shocks if indicated with a period of CPR rather than delayed rhythm analysis,” lead study author Dr. Marcus E.H. Ong said in an interview in advance of the annual meeting of the National Association of EMS Physicians.

Traditional resuscitation efforts are focused on early defibrillation to patients with shockable rhythms, as this is thought to have the best prognosis, according to Dr. Ong of the department of emergency medicine at Singapore General Hospital. “However, only a minority of out-of-hospital cardiac arrests present with initial shockable rhythm, especially in Asia,” he said. “A number of patients with initial nonshockable rhythm actually revert to a shockable rhythm after a period of resuscitation. If conversion to subsequent shockable rhythm is a strong predictor of subsequent outcomes, this finding might have an important implication for clinical prognostication and selection of subsequent therapies.”

The researchers retrospectively evaluated all cases of adult out-of-hospital cardiac arrest (OHCA) collected by the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in seven Asian countries during 2009-2012. PAROS is a resuscitation clinical research network established in collaboration with EMS agencies and academic centers in Singapore, Japan, South Korea, Malaysia, Thailand, Taiwan, and United Arab Emirates. The primary outcome was survival to hospital discharge. The researchers evaluated the outcomes of OHCA based on three groups – initial shockable rhythm, subsequent shockable rhythm, and remained in shockable rhythm – and developed a two-stage model to assess the influence of initial rhythm and subsequent conversion rhythm on survival to admission (first stage) and survival to discharge (second stage).

Dr. Ong and his associates reported results from 5,356 OHCA cases with initial shockable rhythm and 33,974 cases with initial nonshockable rhythm. The researchers found that OHCA with initial shockable rhythm and subsequent conversion to shockable rhythm independently predicted survival to hospital discharge (odds ratios of 6.10 and 2.00, respectively). Following adjustment of baseline and prehospital characteristics, subsequent conversion to shockable rhythm significantly improved survival to admission (OR, 1.53), survival to discharge (OR, 2.00), postarrest overall outcomes (OR, 5.12), and cerebral performance outcomes (OR, 5.39).

In the two-stage analysis, Dr. Ong and his associates found that subsequent conversion to shockable rhythm significantly influenced survival to admission (OR, 1.27) and survival to discharge (OR, 1.42), good overall outcomes (OR, 2.14) and cerebral performance outcomes (OR, 2.2).

“We believe these large, multinational, population-based, prospective cohort data show clearly that while survival and neurological outcomes after OHCA were most favorable in patients presenting with initial shockable rhythm, outcomes were much better in those with subsequent shockable rhythm conversion compared to those with persistent nonshockable rhythm,” Dr. Ong said. “The patients with converted shockable rhythm appear to be more similar in terms of outcomes to those with initial shockable rhythm, compared with those with initial nonshockable rhythms.”

He went on to note that initial shockable rhythm is usually used as a selection criterion for postresuscitation care such as therapeutic temperature management, urgent percutaneous coronary intervention, and extracorporeal membrane oxygenation. “However, our study results suggest that this approach ignores a group of initially nonshockable rhythms that will convert to shockable during resuscitation,” he said. “Our results suggest that patients with initial nonshockable rhythms with subsequent conversion to shockable should be given the same therapeutic benefit of these aggressive postresuscitation interventions.”

Dr. Ong acknowledged certain limitations of the study, including the fact that other confounders may have affected the outcomes of OHCA, such as quality and process of resuscitation, in-hospital care, the number of shocks given, and time to shocks. “There might be variations in patient, EMS, and hospital factors including resuscitation protocols which might have affected the outcomes,” he said. “However, this study managed these risks with the use of a multinational registry involving a relatively large number of cardiac arrest cases and usage of a standardized template for data collection and adjustment of the country variance in all analysis models.”

Dr. Ong reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Initial shockable rhythm during resuscitation for out-of-hospital cardiac arrest was the strongest predictor of survival, a large retrospective analysis found. However, conversion to subsequent shockable rhythm significantly influenced postarrest survival and neurological outcomes.

“Our study supports that some patients with initial nonshockable rhythm can benefit from early rhythm analysis to provide shocks if indicated with a period of CPR rather than delayed rhythm analysis,” lead study author Dr. Marcus E.H. Ong said in an interview in advance of the annual meeting of the National Association of EMS Physicians.

Traditional resuscitation efforts are focused on early defibrillation to patients with shockable rhythms, as this is thought to have the best prognosis, according to Dr. Ong of the department of emergency medicine at Singapore General Hospital. “However, only a minority of out-of-hospital cardiac arrests present with initial shockable rhythm, especially in Asia,” he said. “A number of patients with initial nonshockable rhythm actually revert to a shockable rhythm after a period of resuscitation. If conversion to subsequent shockable rhythm is a strong predictor of subsequent outcomes, this finding might have an important implication for clinical prognostication and selection of subsequent therapies.”

The researchers retrospectively evaluated all cases of adult out-of-hospital cardiac arrest (OHCA) collected by the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in seven Asian countries during 2009-2012. PAROS is a resuscitation clinical research network established in collaboration with EMS agencies and academic centers in Singapore, Japan, South Korea, Malaysia, Thailand, Taiwan, and United Arab Emirates. The primary outcome was survival to hospital discharge. The researchers evaluated the outcomes of OHCA based on three groups – initial shockable rhythm, subsequent shockable rhythm, and remained in shockable rhythm – and developed a two-stage model to assess the influence of initial rhythm and subsequent conversion rhythm on survival to admission (first stage) and survival to discharge (second stage).

Dr. Ong and his associates reported results from 5,356 OHCA cases with initial shockable rhythm and 33,974 cases with initial nonshockable rhythm. The researchers found that OHCA with initial shockable rhythm and subsequent conversion to shockable rhythm independently predicted survival to hospital discharge (odds ratios of 6.10 and 2.00, respectively). Following adjustment of baseline and prehospital characteristics, subsequent conversion to shockable rhythm significantly improved survival to admission (OR, 1.53), survival to discharge (OR, 2.00), postarrest overall outcomes (OR, 5.12), and cerebral performance outcomes (OR, 5.39).

In the two-stage analysis, Dr. Ong and his associates found that subsequent conversion to shockable rhythm significantly influenced survival to admission (OR, 1.27) and survival to discharge (OR, 1.42), good overall outcomes (OR, 2.14) and cerebral performance outcomes (OR, 2.2).

“We believe these large, multinational, population-based, prospective cohort data show clearly that while survival and neurological outcomes after OHCA were most favorable in patients presenting with initial shockable rhythm, outcomes were much better in those with subsequent shockable rhythm conversion compared to those with persistent nonshockable rhythm,” Dr. Ong said. “The patients with converted shockable rhythm appear to be more similar in terms of outcomes to those with initial shockable rhythm, compared with those with initial nonshockable rhythms.”

He went on to note that initial shockable rhythm is usually used as a selection criterion for postresuscitation care such as therapeutic temperature management, urgent percutaneous coronary intervention, and extracorporeal membrane oxygenation. “However, our study results suggest that this approach ignores a group of initially nonshockable rhythms that will convert to shockable during resuscitation,” he said. “Our results suggest that patients with initial nonshockable rhythms with subsequent conversion to shockable should be given the same therapeutic benefit of these aggressive postresuscitation interventions.”

Dr. Ong acknowledged certain limitations of the study, including the fact that other confounders may have affected the outcomes of OHCA, such as quality and process of resuscitation, in-hospital care, the number of shocks given, and time to shocks. “There might be variations in patient, EMS, and hospital factors including resuscitation protocols which might have affected the outcomes,” he said. “However, this study managed these risks with the use of a multinational registry involving a relatively large number of cardiac arrest cases and usage of a standardized template for data collection and adjustment of the country variance in all analysis models.”

Dr. Ong reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – In the setting of traumatic brain injury, increases in systolic blood pressure after the nadir are independently associated with improved survival in hypotensive patients.

In addition, even substantial blood pressure increases do not seem to harm normotensive patients. These findings come from a subanalysis of the ongoing National Institutes of Health–funded Excellence in Prehospital Injury Care (EPIC) TBI study.

“Very little is known about the patterns of blood pressure in traumatic brain injury in the field,” principal investigator Dr. Daniel W. Spaite said at the annual meeting of the National Association of EMS Physicians. “For instance, nobody knows whether it’s better to have your blood pressure increasing, stable, or decreasing in the field with regard to outcome, especially mortality. Typical studies that do have EMS data linked only have a single blood pressure measurement documented, so there’s no knowledge of trends in EMS blood pressure in TBI.”

Dr. Spaite, professor and Virginia Piper Endowed Chair of Emergency Medicine at the University of Arizona, Tucson, and his colleagues evaluated the association between mortality and increases in prehospital systolic blood pressure after the lowest recorded measurement in major TBI patients who are part of the EPIC study – the statewide implementation of TBI guidelines from the Brain Trauma Foundation and the NAEMSP. Data sources include the Arizona State Trauma Registry, which has comprehensive hospital outcome data. “The cases are then linked and the EMS patient care reports are carefully abstracted by the EPIC data team,” Dr. Spaite explained. “This included major TBI (which is, clinically, both moderate and severe) and all patients whose lowest systolic BP was between 40 and 300 mm Hg.”

The researchers used logistic regression to examine the association between the increase in EMS systolic blood pressure (SBP) after the lowest EMS blood pressure and its association with adjusted probability of death. They then partitioned the study population into four cohorts based on each patient’s prehospital systolic BP (40-89 mm Hg, 90-139 mm Hg, 140-159 mm Hg, and 160-300 mm Hg). In each cohort, they identified the independent association between the magnitude of increase in SBP and the adjusted probability of death.

Dr. Spaite reported findings from 14,567 TBI patients. More than two-thirds (68%) were male, and their mean age was 45 years. The researchers observed that, in the hypotensive cohort, mortality dropped significantly if the SBP increased after the lowest SBP. “Improvements were dramatic with increases of 40-80 mm Hg,” he said. In the normotensive group, increases in SBP were associated with very slight reductions in mortality. Even large increases in SBP, such as in the range of 70-90 mm Hg, did not appear to be detrimental.

In the mildly hypertensive group, large systolic increases were associated with higher mortality. “Interestingly, even if your lowest [SBP] is between 140 and 159 mm Hg, until you get above an increase of 40 mm Hg above that, you don’t start seeing increases in mortality,” Dr. Spaite said. In the severely hypertensive group, mortality was higher with any subsequent increase in SBP, “which doesn’t surprise any of us,” he said. “It’s dramatically higher if the increase is large.”

Dr. Spaite emphasized that the current analysis is based on observational data, “so this does not prove that treating hypotension improves outcome. … That direct question is part of the EPIC study itself and awaits the final analysis, hopefully in mid-2017. This is the first large report of blood pressure trends in the prehospital management of TBI.”

He concluded that the current findings in the hypotensive and normotensive cohorts “support guideline recommendations for restoring and optimizing cerebral perfusion in EMS traumatic brain injury management. What is fascinating about the literature is that the focus in TBI has always been on hypotension, but there’s very little information about what’s the best or the optimal blood pressure.”

EPIC is funded by the National Institutes of Health. Dr. Spaite reported having no relevant financial disclosures.

SAN DIEGO – In the setting of traumatic brain injury, increases in systolic blood pressure after the nadir are independently associated with improved survival in hypotensive patients.

In addition, even substantial blood pressure increases do not seem to harm normotensive patients. These findings come from a subanalysis of the ongoing National Institutes of Health–funded Excellence in Prehospital Injury Care (EPIC) TBI study.

“Very little is known about the patterns of blood pressure in traumatic brain injury in the field,” principal investigator Dr. Daniel W. Spaite said at the annual meeting of the National Association of EMS Physicians. “For instance, nobody knows whether it’s better to have your blood pressure increasing, stable, or decreasing in the field with regard to outcome, especially mortality. Typical studies that do have EMS data linked only have a single blood pressure measurement documented, so there’s no knowledge of trends in EMS blood pressure in TBI.”

Dr. Spaite, professor and Virginia Piper Endowed Chair of Emergency Medicine at the University of Arizona, Tucson, and his colleagues evaluated the association between mortality and increases in prehospital systolic blood pressure after the lowest recorded measurement in major TBI patients who are part of the EPIC study – the statewide implementation of TBI guidelines from the Brain Trauma Foundation and the NAEMSP. Data sources include the Arizona State Trauma Registry, which has comprehensive hospital outcome data. “The cases are then linked and the EMS patient care reports are carefully abstracted by the EPIC data team,” Dr. Spaite explained. “This included major TBI (which is, clinically, both moderate and severe) and all patients whose lowest systolic BP was between 40 and 300 mm Hg.”

The researchers used logistic regression to examine the association between the increase in EMS systolic blood pressure (SBP) after the lowest EMS blood pressure and its association with adjusted probability of death. They then partitioned the study population into four cohorts based on each patient’s prehospital systolic BP (40-89 mm Hg, 90-139 mm Hg, 140-159 mm Hg, and 160-300 mm Hg). In each cohort, they identified the independent association between the magnitude of increase in SBP and the adjusted probability of death.

Dr. Spaite reported findings from 14,567 TBI patients. More than two-thirds (68%) were male, and their mean age was 45 years. The researchers observed that, in the hypotensive cohort, mortality dropped significantly if the SBP increased after the lowest SBP. “Improvements were dramatic with increases of 40-80 mm Hg,” he said. In the normotensive group, increases in SBP were associated with very slight reductions in mortality. Even large increases in SBP, such as in the range of 70-90 mm Hg, did not appear to be detrimental.

In the mildly hypertensive group, large systolic increases were associated with higher mortality. “Interestingly, even if your lowest [SBP] is between 140 and 159 mm Hg, until you get above an increase of 40 mm Hg above that, you don’t start seeing increases in mortality,” Dr. Spaite said. In the severely hypertensive group, mortality was higher with any subsequent increase in SBP, “which doesn’t surprise any of us,” he said. “It’s dramatically higher if the increase is large.”

Dr. Spaite emphasized that the current analysis is based on observational data, “so this does not prove that treating hypotension improves outcome. … That direct question is part of the EPIC study itself and awaits the final analysis, hopefully in mid-2017. This is the first large report of blood pressure trends in the prehospital management of TBI.”

He concluded that the current findings in the hypotensive and normotensive cohorts “support guideline recommendations for restoring and optimizing cerebral perfusion in EMS traumatic brain injury management. What is fascinating about the literature is that the focus in TBI has always been on hypotension, but there’s very little information about what’s the best or the optimal blood pressure.”

EPIC is funded by the National Institutes of Health. Dr. Spaite reported having no relevant financial disclosures.

SAN DIEGO – In the setting of traumatic brain injury, increases in systolic blood pressure after the nadir are independently associated with improved survival in hypotensive patients.

In addition, even substantial blood pressure increases do not seem to harm normotensive patients. These findings come from a subanalysis of the ongoing National Institutes of Health–funded Excellence in Prehospital Injury Care (EPIC) TBI study.

“Very little is known about the patterns of blood pressure in traumatic brain injury in the field,” principal investigator Dr. Daniel W. Spaite said at the annual meeting of the National Association of EMS Physicians. “For instance, nobody knows whether it’s better to have your blood pressure increasing, stable, or decreasing in the field with regard to outcome, especially mortality. Typical studies that do have EMS data linked only have a single blood pressure measurement documented, so there’s no knowledge of trends in EMS blood pressure in TBI.”

Dr. Spaite, professor and Virginia Piper Endowed Chair of Emergency Medicine at the University of Arizona, Tucson, and his colleagues evaluated the association between mortality and increases in prehospital systolic blood pressure after the lowest recorded measurement in major TBI patients who are part of the EPIC study – the statewide implementation of TBI guidelines from the Brain Trauma Foundation and the NAEMSP. Data sources include the Arizona State Trauma Registry, which has comprehensive hospital outcome data. “The cases are then linked and the EMS patient care reports are carefully abstracted by the EPIC data team,” Dr. Spaite explained. “This included major TBI (which is, clinically, both moderate and severe) and all patients whose lowest systolic BP was between 40 and 300 mm Hg.”

The researchers used logistic regression to examine the association between the increase in EMS systolic blood pressure (SBP) after the lowest EMS blood pressure and its association with adjusted probability of death. They then partitioned the study population into four cohorts based on each patient’s prehospital systolic BP (40-89 mm Hg, 90-139 mm Hg, 140-159 mm Hg, and 160-300 mm Hg). In each cohort, they identified the independent association between the magnitude of increase in SBP and the adjusted probability of death.

Dr. Spaite reported findings from 14,567 TBI patients. More than two-thirds (68%) were male, and their mean age was 45 years. The researchers observed that, in the hypotensive cohort, mortality dropped significantly if the SBP increased after the lowest SBP. “Improvements were dramatic with increases of 40-80 mm Hg,” he said. In the normotensive group, increases in SBP were associated with very slight reductions in mortality. Even large increases in SBP, such as in the range of 70-90 mm Hg, did not appear to be detrimental.

In the mildly hypertensive group, large systolic increases were associated with higher mortality. “Interestingly, even if your lowest [SBP] is between 140 and 159 mm Hg, until you get above an increase of 40 mm Hg above that, you don’t start seeing increases in mortality,” Dr. Spaite said. In the severely hypertensive group, mortality was higher with any subsequent increase in SBP, “which doesn’t surprise any of us,” he said. “It’s dramatically higher if the increase is large.”

Dr. Spaite emphasized that the current analysis is based on observational data, “so this does not prove that treating hypotension improves outcome. … That direct question is part of the EPIC study itself and awaits the final analysis, hopefully in mid-2017. This is the first large report of blood pressure trends in the prehospital management of TBI.”

He concluded that the current findings in the hypotensive and normotensive cohorts “support guideline recommendations for restoring and optimizing cerebral perfusion in EMS traumatic brain injury management. What is fascinating about the literature is that the focus in TBI has always been on hypotension, but there’s very little information about what’s the best or the optimal blood pressure.”

EPIC is funded by the National Institutes of Health. Dr. Spaite reported having no relevant financial disclosures.

SAN DIEGO – Among emergency medical services clinicians, shift length alone was not associated with sleep duration, sleep quality, or self-reported fatigue at the start or end of shift work, preliminary results from a pilot study showed.

“There is a compelling need to address the sleep health and fatigue of EMS clinicians,” lead study author P. Daniel Patterson, Ph.D., said in an interview. “Reports of EMS clinicians falling asleep while driving ambulances have increased in recent history. There is a palpable concern for the safety of patients and clinicians. Prior studies show half of EMS clinicians report excessive mental and physical fatigue while at work; half get less than 6 hours of sleep daily, half rate their sleep quality as poor, and more than one-third report excessive daytime sleepiness.”

In an effort to characterize the sleep-wake and shift patterns of EMS clinicians working diverse shift schedules, Dr. Patterson, research director for MedCenter Air in the department of emergency medicine at Carolinas HealthCare System Medical Center, Charlotte, N.C., and his associates randomly selected 20 EMS clinicians participating in a randomized pilot trial that used text messaging to determine how real-time assessments of perceived sleepiness and fatigue impacts alertness and other behavior during shift work. These individuals provided detailed sleep diaries for 14 straight days in addition to reports of their fatigue in real time during shift work. The researchers used descriptive statistics to characterize sleep patterns in relation to shift work and self-reported fatigue during shifts.

Of the 20 study participants, 14 recorded at least one shift during the 14-day observation period. The mean number of shifts among these 14 participants was five, the most common shift duration worked was 24 hours (49%), and they had a mean of 34 hours off between scheduled shifts. Dr. Patterson, who is a practicing, nationally registered paramedic, reported at the annual meeting of the National Association of EMS Physicians that the shift length for eight of the study participants did not vary, while six worked shifts that ranged from 5 to 48 hours. The researchers found that when participants worked an extended shift of 24 hours, they slept significantly less before the shift than when working a shift of shorter duration (P = .0001). Participants who worked 24-hour shifts averaged 4.9 hours of sleep/rest during scheduled shifts, compared with 0.5 hours of total sleep/rest during shifts of shorter duration (P less than .0001). Dr. Patterson also reported that there appeared to be no differences based on shift duration (24 hours vs. other duration) in total sleep during the 24 hours after a scheduled shift.

He underscored the preliminary nature of the findings and acknowledged the potential for selection bias. “Much of our data are based on clinician self-report. Where possible, we used reliable and valid instruments and tools tested in the EMS setting to improve the internal validity.”

In a separate study presented during a poster session at the meeting, Dr. Patterson and his associates reported they are analyzing detailed sleep diaries and other sleep health information to evaluate psychomotor vigilance in more than 100 air-medical clinicians located in the South, Midwest, and Northeast United States.

Dr. Patterson also made a plea for EMS clinicians to participate in studies focused on their sleep health and fatigue. “We need these data to guide the development of fatigue risk management programs.”

Dr. Patterson disclosed that the study involving 14 EMS clinicians was funded by the Pittsburgh Emergency Medicine Foundation, the MedEvac Foundation, and by a career development award from the National Center for Resources and the National Institutes of Health. He reported that funding for the second study of air-medical clinicians is funded by the MedEvac Foundation.

dbrunk@frontlinemedcom.com

SAN DIEGO – Among emergency medical services clinicians, shift length alone was not associated with sleep duration, sleep quality, or self-reported fatigue at the start or end of shift work, preliminary results from a pilot study showed.

“There is a compelling need to address the sleep health and fatigue of EMS clinicians,” lead study author P. Daniel Patterson, Ph.D., said in an interview. “Reports of EMS clinicians falling asleep while driving ambulances have increased in recent history. There is a palpable concern for the safety of patients and clinicians. Prior studies show half of EMS clinicians report excessive mental and physical fatigue while at work; half get less than 6 hours of sleep daily, half rate their sleep quality as poor, and more than one-third report excessive daytime sleepiness.”

In an effort to characterize the sleep-wake and shift patterns of EMS clinicians working diverse shift schedules, Dr. Patterson, research director for MedCenter Air in the department of emergency medicine at Carolinas HealthCare System Medical Center, Charlotte, N.C., and his associates randomly selected 20 EMS clinicians participating in a randomized pilot trial that used text messaging to determine how real-time assessments of perceived sleepiness and fatigue impacts alertness and other behavior during shift work. These individuals provided detailed sleep diaries for 14 straight days in addition to reports of their fatigue in real time during shift work. The researchers used descriptive statistics to characterize sleep patterns in relation to shift work and self-reported fatigue during shifts.

Of the 20 study participants, 14 recorded at least one shift during the 14-day observation period. The mean number of shifts among these 14 participants was five, the most common shift duration worked was 24 hours (49%), and they had a mean of 34 hours off between scheduled shifts. Dr. Patterson, who is a practicing, nationally registered paramedic, reported at the annual meeting of the National Association of EMS Physicians that the shift length for eight of the study participants did not vary, while six worked shifts that ranged from 5 to 48 hours. The researchers found that when participants worked an extended shift of 24 hours, they slept significantly less before the shift than when working a shift of shorter duration (P = .0001). Participants who worked 24-hour shifts averaged 4.9 hours of sleep/rest during scheduled shifts, compared with 0.5 hours of total sleep/rest during shifts of shorter duration (P less than .0001). Dr. Patterson also reported that there appeared to be no differences based on shift duration (24 hours vs. other duration) in total sleep during the 24 hours after a scheduled shift.

He underscored the preliminary nature of the findings and acknowledged the potential for selection bias. “Much of our data are based on clinician self-report. Where possible, we used reliable and valid instruments and tools tested in the EMS setting to improve the internal validity.”

In a separate study presented during a poster session at the meeting, Dr. Patterson and his associates reported they are analyzing detailed sleep diaries and other sleep health information to evaluate psychomotor vigilance in more than 100 air-medical clinicians located in the South, Midwest, and Northeast United States.

Dr. Patterson also made a plea for EMS clinicians to participate in studies focused on their sleep health and fatigue. “We need these data to guide the development of fatigue risk management programs.”

Dr. Patterson disclosed that the study involving 14 EMS clinicians was funded by the Pittsburgh Emergency Medicine Foundation, the MedEvac Foundation, and by a career development award from the National Center for Resources and the National Institutes of Health. He reported that funding for the second study of air-medical clinicians is funded by the MedEvac Foundation.

dbrunk@frontlinemedcom.com

SAN DIEGO – Among emergency medical services clinicians, shift length alone was not associated with sleep duration, sleep quality, or self-reported fatigue at the start or end of shift work, preliminary results from a pilot study showed.

“There is a compelling need to address the sleep health and fatigue of EMS clinicians,” lead study author P. Daniel Patterson, Ph.D., said in an interview. “Reports of EMS clinicians falling asleep while driving ambulances have increased in recent history. There is a palpable concern for the safety of patients and clinicians. Prior studies show half of EMS clinicians report excessive mental and physical fatigue while at work; half get less than 6 hours of sleep daily, half rate their sleep quality as poor, and more than one-third report excessive daytime sleepiness.”

In an effort to characterize the sleep-wake and shift patterns of EMS clinicians working diverse shift schedules, Dr. Patterson, research director for MedCenter Air in the department of emergency medicine at Carolinas HealthCare System Medical Center, Charlotte, N.C., and his associates randomly selected 20 EMS clinicians participating in a randomized pilot trial that used text messaging to determine how real-time assessments of perceived sleepiness and fatigue impacts alertness and other behavior during shift work. These individuals provided detailed sleep diaries for 14 straight days in addition to reports of their fatigue in real time during shift work. The researchers used descriptive statistics to characterize sleep patterns in relation to shift work and self-reported fatigue during shifts.

Of the 20 study participants, 14 recorded at least one shift during the 14-day observation period. The mean number of shifts among these 14 participants was five, the most common shift duration worked was 24 hours (49%), and they had a mean of 34 hours off between scheduled shifts. Dr. Patterson, who is a practicing, nationally registered paramedic, reported at the annual meeting of the National Association of EMS Physicians that the shift length for eight of the study participants did not vary, while six worked shifts that ranged from 5 to 48 hours. The researchers found that when participants worked an extended shift of 24 hours, they slept significantly less before the shift than when working a shift of shorter duration (P = .0001). Participants who worked 24-hour shifts averaged 4.9 hours of sleep/rest during scheduled shifts, compared with 0.5 hours of total sleep/rest during shifts of shorter duration (P less than .0001). Dr. Patterson also reported that there appeared to be no differences based on shift duration (24 hours vs. other duration) in total sleep during the 24 hours after a scheduled shift.

He underscored the preliminary nature of the findings and acknowledged the potential for selection bias. “Much of our data are based on clinician self-report. Where possible, we used reliable and valid instruments and tools tested in the EMS setting to improve the internal validity.”

In a separate study presented during a poster session at the meeting, Dr. Patterson and his associates reported they are analyzing detailed sleep diaries and other sleep health information to evaluate psychomotor vigilance in more than 100 air-medical clinicians located in the South, Midwest, and Northeast United States.

Dr. Patterson also made a plea for EMS clinicians to participate in studies focused on their sleep health and fatigue. “We need these data to guide the development of fatigue risk management programs.”

Dr. Patterson disclosed that the study involving 14 EMS clinicians was funded by the Pittsburgh Emergency Medicine Foundation, the MedEvac Foundation, and by a career development award from the National Center for Resources and the National Institutes of Health. He reported that funding for the second study of air-medical clinicians is funded by the MedEvac Foundation.

dbrunk@frontlinemedcom.com