Abstract
Paramedics provide exceptional emergency services especially in healthcare. The nature of services they offer call for paramedics availability every time. As a result, they have to work in shifts. The work shifts have profound effects on their physical, emotional and social wellbeing. In addition, they are frequently and progressively encountering intense workloads that are bodily, psychologically and sensitively arduous. The resulting effects are physical and mental fatigues which do not only compromise their work effectiveness, but also hamper their safety and social wellbeing
The objective of this research report is to examine peer reviewed journal articles on the effects of shift work on paramedics’ psychological, physical health and wellbeing. It similarly touches on the impact of patients and personal safety, effects of shift work on paramedics’ family life as well as the effect of shift work on paramedics’ rate of errors and injuries. Further, the research report provides conclusions drawn from various researches.
Introduction
Paramedics constitute a vital discipline within the health and medical vocation which require the provision of a twenty-four hour community service. In the Australian milieu for example, merely eight emergency ambulances proffer both non-urgent and urgent pre-hospital society services to the entire populace. In spite of this, Australian health emergency workers are supposed to work in special shift timetables that include night, afternoon and daylight alongside rotating rosters (Sofianopoulos, Williams & Archer, 2011). All these activities tend to interfere with the level of consistencies in individual’s natural circadian rhythm and sleep quality. Within the Australian locality, the pre-hospital health providers carry out their duties within the inaccessible countryside, urban and country sites. As part of their normal schedule, paramedics found in country locations can equally work on phone calls. This entails calling upon the paramedics to respond to emergencies over a twenty-four hour period.
Due to assumed responsibilities, paramedics’ gradually and recurrently encounter intricate medical workloads which in most cases are psychologically, spiritually and bodily strenuous. Pre-hospital health providers for instance, are habitually obliged to resolve intricate matters and subtle tribulations in a well-timed, autonomous and in a self-regulating style. Moreover, they are mandated to carry out medicinal prescription and injection, ambulance driving and experimental services with much concern and expertise (Alexander & Klein, 2001). Thus, paramedics are bound to work alongside a range of clinical activities which may be emotionally or practically natural. In fact, the management of paramedics is deemed essential especially, those involved in the treatment and handling of critical patients. In such cases, clinical skills are considered paramount since judgmental errors or concentration lapses may result into grave consequences (Alexander & Klein, 2001).
Paramedics should be mindful of their exposure to the suffering patients. Often, emergency workers are confined in small working areas since they are unsigned faces to organizations that are highly respected and valued within the communities being served. Patient’s requests are wide-ranging and numerous, varying from collective, lonesome and ectopic problems to crisis health check services. These require the paramedics to offer maximum care to patients being treated daily.
Nevertheless, sleep and fatigue turbulences constitute factors that compromise the performances and effectiveness of paramedics. In turn, the paramedic’s overall wellbeing and health have faced detrimental consequences while the patient’s safety has been exposed to numerous risks. It is crucial that paramedics should have restorative sleep and restful breaks. These will aid them in upholding constancy, dependability and expert approaches to the patients being attended to and in conserving the status of their personal comfort. Sofianopoulos, Williams and Archer (2011) mentioned that Courtney James, a psychologist and an investigator asserted that, pre-hospital healthcare providers have modest prospect for fine-tuning given the kind of job -shifts and revolving schedules. This ultimately disrupts their sleeping patterns and causes fatigues hence giving rise to mental ill health.
Methods
This literature review is deliberately aimed at identifying the obtainable literature on paramedics or pre-hospital healthcare providers and the impacts of shift-work. In fact, the literature will focus on shift work effects on paramedics and the consequential risks they pose to patients and pre-hospital service provider’s families. Various electronic databases were drawn on including CINAHL, AMED, ProQuest, Ovid MEDLINE, Emerald and Systematic Reviews Cochrane Database. A variety of keywords as well as abridged expressions were utilized to search for the required materials and sources. The phrases included paramedic’s health statuses, shift work and its effects, occupational stress, fatigue, circadian rhythm, sleep deficit and debt as well as sleep disorders.
Peer reviewed journals containing information regarding shift work effects on paramedics’ namely work linked stress, psychological and health disorders or disturbances, exposure of patients and family members to various risks were integrated. Information from websites, editorial columns, letters and books were not incorporated in the literature search. Only peer reviewed journal articles written in English were reviewed. In fact, the researcher selected peer reviewed articles that had summaries and headings deemed relevant to the study. The chosen articles were retrieved from previous researches.
Discussion
Shift work within the pre-hospital environment has materialized to have detrimental effects on paramedics. This in turn has resulted into compromised patient safety and clinical judgmental errors. According to a research report written by Takeyama et at. (2009), there is a strong correlation between paramedic shift workers and injury risks in work-related accidents. The report further shows that those employed in the paramedic’s shift works environments are nearly three times exposed to the risks of such professional accidents in comparison to their daytime working counterparts. In another study, the conclusions drawn on the same topic indicated that nurses working through roster rotations exhibited wake and sleep cycle disruptions (Roth & Moore, 2009). Such nurses dozed off more while working in comparison to nurses working in the evening or during day shifts.
There are surfeit researches and studies conducted that relate to shift workers. However, shift work in the field of pre-hospital healthcare service provision also called paramedics has been an area minimally studied. Council of Ambulance Authorities report acknowledged the fatigue risks reported in the field of healthcare. Various researchers therein thought that such findings could hardly be applied in paramedics or pre-hospital settings (Council of Ambulance Authorities, 2007). A topical assessment of the literature regarding the shift occupation effects on the pre-hospital healthcare providers called for further study in this area.
Patients and personal safety
Reported and unreported cases of shift work effects have significantly increased in pre-hospital service provision environment. Fatigue from shift work occasionally give rise to patients’ deaths as a result of medical or job allied errors. Moreover, paramedics face confrontations from out of control and antagonistic patients. Most of such patients could be living with mental-health issues or could be alcoholic or drug affected. The requirement is that these patients be cautiously handled. Unfortunately, there are hardly any paramedics who are working without being abused and assaulted under such circumstances. Pre-hospital workforce according to a topical account issued by Queensland administration mentioned that 94.368% paramedics testified that they were orally ill-treated or battered whilst on duty by inebriated patients (Sofianopoulos, Williams & Archer, 2011).
In the fiscal 2008-2009, one hundred and twenty ambulance officers or paramedics reported assault cases in New South Wales. This represented over 60% increase in paramedics’ assault cases from the previous fiscal year. In addition, pre-hospital healthcare providers encountered incurable and sedative patients alongside acquaintances, relatives and patients passions as the majority of the apprehensive individuals and groups envisage their respective transience. Apart from working on highly erratic and insubstantial environments, paramedics are vastly susceptible to communicable maladies which could eventually affect their health conditions and the wellbeing of their families.
Ever mounting siesta arrears, soaring occupation packs, night vocation and elongated functioning hours when merged with exhaustion might breed prospective dreadful domino effects. A study conducted by Ganza (2006) reflected the gravity of both the attitudes and issues presently encountered. For instance, the author reported that a paramedic said that some of the grave issues they faced entailed unfilled shifts, deductions in overtime rates, delayed dispatch time, insufficient resources and delayed meal breaks which lead to illnesses and fatigues. This came after a gentleman had passed on having stayed in excess of 3-hours waiting for the crisis vehicle while the pre-hospital healthcare providers were strained to progressively bounce their respite breaks and customary food to attend to the circumstances and cope up with the crisis burdens (Frakes & Kelly, 2007). Paramedic shift workers were reported to have constituted 16.0% of the entire working populace in the fiscal 2005-2006, although in overall, they sustained 27.0% of all professional injuries.
A study by Aasa et al. (2005) showed that paramedics working in rotating rosters or work shifts have double possibility of dozing off whilst they are driving to and from workplaces. In fact, such paramedics reported twofold the number of errors and accidents allied to being sleepy. They often attend to several urgency cases in a single-shift interval. Much attention should be paid to the safety of those dealing with emergency services as well as the patients they look after during these emergencies. A study by Ganza (2006) indicated that when paramedics are awake for 17 to 18 hours, they are prone to showing increasing possibility of missing information and considerable slower reaction times. This implies that, such pre-hospital health providers’ fatigues are likely to reach levels which compromise safe and sound performances.
Psychological and physical health and wellbeing
A study conducted by Kuhn (2001) examined issues that Australian ambulance paramedics face in the course of fulfilling their duties. It was observed that there are quite a number of psychological and physical parameters that affect their personal wellbeing and health. Generally, the findings indicate that most of the paramedics shift workers suffered from poor quality sleep, augmented dejection as well as weariness. Studies report that pre-hospital service providers fight for improved conditions including professional pay rates across different Australian states. This occurs while paramedics strive to realize maximum care for the communities being served whereas they battle with the psychological and physical challenges they encounter.
According to a report by Sofianopoulos, Williams and Archer (2011), it is surprising that in the last six months, paramedics reporting fatigue related problems comprised of 92.0% of the total 55 survey respondents. Most pre-hospital healthcare providers accredited their weariness to absconded or delayed food breaks, slumber obscurities, night time job schedules and shift vocations. The findings were strongly supported by the Victorian ambulance union, in a non-random survey done by this institution indicated that 98.0% of the pre-hospital healthcare providers experienced fatigue in the past twelve months. Furthermore, 87.0% of the shift work paramedics admitted that the ensuing fatigue immensely affected their work performances (Sofianopoulos, Williams & Archer, 2011). Out of the total respondents interviewed, over three quarters hold that their performance have been highly affected by fatigue as a result of shift work.
Literature reveals that both male and female paramedics working in shifts experience high levels of post traumatic, burnout and psychopathology symptoms. In fact, a UK research study found that a third of respondents reported such symptoms. The researchers asserted that urgent situation and mishaps tend to compromise the pre-hospital health providers psychologically and expressively. For instance, a research study by Fossey (1990) reported that burnout cases were experienced amongst one tenth of the ambulance paramedics’ personnel.
Paramedics working in shift recently responded to a research study where 26.7% reported the possibility of being mildly depressed whilst 10.0% exhibited modest symptoms (Frakes & Kelly, 2007). Another explorative research by Sofianopoulos, Williams and Archer (2011) that involved the then Melbourne Metropolitan Ambulance Service (MMAS) pre-hospital healthcare providers reported that 10.0% of paramedics either experienced intense or stern despairs with roughly 12.0% showing modest dejection intensities. Such health issues are not just common in Australia, but they are deemed worldwide problems among paramedic workforces. A United States report stated that EMS (emergency medical service) respondents namely the emergency medical technicians and paramedics faced the risk of decreasing physical and mental performances (Sofianopoulos, Williams & Archer, 2011).
Conversely, a report on Japanese pre-hospital health providers claimed that qualified and older paramedics are prone to suffering from more mental stress when compared with the EMTs, the emergency medical technicians (Okada et al., 2005). A Scandinavian study on ambulance personnel found that 20% of the total women and 25% of men reported either two or additional health grievances. Ambulance recruits in the United Kingdom were purportedly found to encounter advanced bodily and psychological ill- health (Mahony, 2001). Finally, a research investigating Scottish paramedic personnel found that emotional and mental wellbeing of such workforces are compromised (Mahony, 2001.
Young and Cooper (1997) research study indicated that individuals and groups working within the ambulance service environments particularly the paramedics have various psychological ill-health symptoms. Further study by Young and Cooper (1997) affirmed that pre-hospital healthcare providers or paramedics experienced higher levels of wretchedness, trauma and discontent at workplaces. In 2003-2004 and 2004-2005, both the Australian men paramedics and ambulance officers reported the sixth topmost frequency rates for the novel psychological problem claims. These studies apparently indicated that it was not just enough to address the physical facets that challenge the paramedics’ occupation.
Family life
Paramedics who work in shifts or rosters are said to endure both intellectual and physical health issues. Studies show that pre-hospital healthcare providers’ moods are usually affected by increments in depression, anxiety, irritability and headaches (Roth & Moore, 2009). These could be distressing when they endlessly flood on upshot to bring about disorders in societal and household connection. Due to work commitment, most paramedics take their leisure time sleeping or at times called on duty. Rarely do they have time to attend to family issues and other societal events. This has impacted negatively on their family relationships.
It is also a known fact that lack of sleep and constant work will lead to conditions related to depression. Among the shift workers, the depression conditions are pronounced. The studies indicate that shift workers depressions are caused by lack of social and emotional wellbeing (Van der Ploeg & Kleber, 2003). A different research study conducted by Roth and Moore (2009) suggested that vulnerable paramedics are likely to develop clinical depressions whilst they work on the basis of night shifts.
The error rates
A pre-study survey done in 2011 by Victorian-ambulance argued that Australian paramedic shift-workers suffer from fatigue and depression that have resulted into increased incidences of errors while they perform their duties.. It is also indicated that over ninety percent of the participants accepted to have made mistakes resulting from work shifts. When asked about the error, 55% have reported poor administration of medicine, 22% driving errors and 16% admitted they made poor judgement (Joyce et al., 2009). These findings corroborated with the studies done in 2008 by the same institution that found out that 98% of paramedics in shift work experience fatigue after work (Sofianopoulos, Williams & Archer, 2011). Of these, 87% admit that the fatigue have affected their work performance in terms of mistakes and errors in judgement. The findings also indicate that nine in ten (88%) believe that their work related errors results from fatigue and lack of sleep from scheduled shift work. In addition, 7 out of 10 (70%) admit that their work- related errors are at the highest level when they have night shifts (Sofianopoulos, Williams & Archer, 2011).
Joyce et al. (2009) noted that in 2007 a survey was conducted by Victorian coroner concerning the cardiac patients’ death as a result of administration of wrong drugs. The study found that the paramedics involved were on their night shifts the day before they attended to their patients. Most of the paramedics agree that such incidences normally occur due to fatigue from the night shifts and the possibilities of such errors are high (Joyce et al., 2009). Swaen et al. (2003) argue that the frequency of work related error made by paramedics engaged in shift work have significant effect on the subject and work performance. A study by Engleman and Douglas (2005) indicated that paramedics engaged in shift work have an increased risk of driving errors resulting into vehicle collisions compared to those who are not engaged in shifts.
Rate of Injuries
Shift workers are at high risk of involving themselves in injuries compared to those workers not engaged in shifts. According to Horwitz (2004), accidents resulting from shift work fatigued paramedics are something that could hardly be avoided. Injuries as a result of emergency collisions are estimated to be between 5 to 50% in Australia. These collisions are caused by shift work fatigue. Fatal road accidents resulting from shift work drivers’ ranges from 20 to 30%. Paramedics paralysed due to these injuries were 16% most of which were reported in New South Wales. Engleman and Douglas (2005) argue that emergency medical drivers have increased risk of involving in near crash accidents while returning to their residential places from post night shifts. Most emergency drivers agree that they are normally fatigued and fall asleep occasionally while driving at work and mostly when driving to and from home. Further, they agree that this has resulted into near miss fatal accidents with minor injuries (Engleman & Douglas, 2005).
Dowson and Zee (2005) agree that a lot of researches have been done pertaining to shift workers. However, those that relate to injuries remain to be an area that has not been touched. Jansen et al. (2003) reported that injuries in healthcare have always been related to other causes that are not connected to risks of fatigue accruing as a result of shift work. There is need for more research on the effects of shift work specifically on injuries. The recent literatures suggest that paramedics are continuously suffering from injuries as a result of shift work. However, few studies that have been done indicate that injuries and accidents resulting from pre-hospital health provision shift work are highly probable (Swaen et al., 2003). In other words, the probability of a paramedic shift worker involving themselves in injuries and accident is high. This is due to fatigue, psychological factors and sleep problems resulting from night shifts.
Conclusion
Shift works have profound effects on the paramedic health, physical, emotional and social wellbeing. Both physical and mental exhaustion results into accidents, injuries as well as errors. These could be avoided if proper work schedules that recognize the health implications of the paramedics are put in place. The physiological and psychological effects normally translate from the pre-hospital health providers workplaces to their homes. This in turn results into confrontations and disagreements but no family breakages, divorce and separation cases have been reported. The situation is that paramedics will continue to live in this situation unless radical changes are carried out.
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