National Highway Traffic Safety Administration J. Stephen Higgins, Ph.D. Research and Program Development Office of Behavioral Safety Research 1
Agenda Background I. Project Tasks II. Optional Tasks III. The Team Iv. Comments/Questions? V. Safer Drivers. Safer Cars. Safer Roads. 2
Background Study Examines Effects of Sleep Deprivation on Shift Work Medical professionals are beginning to call fatigue the number one Droblem in our Athnin & Leailership field Studies Prove 24Hour Shifts Unsafe Study: Medics’ fatigue linked to higher injury Anothsr ethical dilemma for EMS leaders rates In the survey sample, more than half of the respondents were classified as l1& 415- ur 34g roS t wls.mt 25 fatigued - Ambulance driver fatigue a danger Distractions pose risks to patients, EMTs, Fatigue a factor in ambulance accident in Manitoba - traffic Canada By Lisa Zagaroli, and Apnl Taylor! Detroit News Washington Bureau Monday, January 27, 2003 Emergency medical technician Anne Lamberson thought she was doing her 0 1 nb when she got a priority dispatch, stepped on the ambulance’s accelerator and tried to make it to the scene as quickly as she could. -j $‘ Twoct State Coroner: fatigue a factor in administering wrong drug r— - r Thursday, August 38,201 In 2007 Coroner Peter White reported ttiat while allempling to resuscitate a • regional health authorities 78 year-old male cardiac palient a paramedic accidentally administered need 10 be made.’ Lois I morphine instead of adrenaline TIm Coroner said tattgu was a factor. I am satisfied that both officers were • Winnipeg (29 Aug. 2012)- affected by fatigue at the lime of those incidents and that resulling error is Health Authorily was invol atwns a posetbilty ii such circumstances,’ • A posilive outcome was unlikely but ihe possibiily that resuscitalion may The ambulance Slid off the have been more cilective given appropoate treatment cannot be cscluded°. Swan River after doing an several days and nights w On ambulance driuw,, by 0mw Lan,b.rzofl sar,k through or, ,rSet000tir,n fl A 1K m,urasrr ovrrsA3slwdsu rscroiesrqeSr a Brooklyn, i&V ,and Smashed 1140*50 oar dri’,sn by Osigois i5ue Three of ig,’.’a Is,.. ch,ldrwn, dkirdsflda MofOk. 2, Ouooyur, Mrk. B and Daruloic Morok, 7, ,Wra kiilod Video Safer Drivers. Safer Cars. Safer Roads. 3
Fatigue and Sleep Health i n E M S 100% F a t i g u e 75% 41: 50% 25% 0% 2010 2011 Yat Figure 20.4 Prnportin oIEMS wtrkers who selt-report severe mental and physical fatigue while at wok across diverse samples of US-based EMS workers and EMS agencies. Greater than half report fatigue at work • Half get less than 6-hours sleep per day • Greater than half report poor sleep quality • Greater than 1/3rd report excessive daytime sleepiness • Half report poor to moderate recovery between scheduled shifts • Patterson et al, 2015 (recovery); Patterson et al; 2015 (textbook); Pirrallo et al, 2012 Safer Drivers. Safer Cars. Safer Roads. 4
Fatigue linked to safety in EMS Injury : Poor Sleep a Crude •1 [• • Adjusted 0 I Fatigue Error or AE ‘a’ Poor Sleep 1 I to Fatigue I• Conronsed Safety Poor Sleep Fatigue I I I I I I I I I I 123456 0 7 10 8 9 Odds Ratio (95% CI) FIGURE 2 , Crude cluster/confounding-adjusted odds of safety outcomes associated with poor sleep and fatigue. Adjusted odds ra tios (ORs) are from Table 3. These ORs were adjusted for clustering within agencies confounding. AE adverse event; CI = confi dence interval. I Patterson et al, 2012; PMID 22023164 I Safer Drivers. Safer Cars. Safer Roads. 5
Fatigue Risk Management Programs • Robust fatigue risk management programs and hours-of-service rules in many industries — Aviation — Rail — Motor Carriers Other industries working on issue • — Transit (metro, busses) RESD NT DUTY HOUR — Medicine (residents, nurses) ENHANCING SLEEP. SUPERVISION, AND SAFETY — Mining INSTflUTE CF MEDICINE -Oil ‘ Ye* MA1 Safer Drivers. Safer Cars. Safer Roads. 6
A 2013 NEMSAC d v i s o r y c reports The NHTSA Office of EMS (OEMS) should r o s s - v a l i findings from studies and 1. d a t e involve o professions with t of f a t i g u e in EMS. This effort should a of fatigue in t h e r h a t convening of subject matter experts, individual providers of EMS services, and and federal organizations, national organizations (e.g., representatives local, from s t a t e , NAEMSP, NASEMSO) role in EMS oversight or care delivery. T h e e f f o r t NAEMT, that play a provider fatigue and safety and health o u t c o m e should clarify t h e e v i d e n c linking EMS s e should include an analysis of regulatory of p a t i providers, and t h e public. T h e effort e n t s , legal framework with respect t o t h e r e q u i r e of t h employer and employee and m e n t s e t h fatigue on safety. r e a t of federal and non-federal NHTSA (OEMS) should work through its 2. The Office of EMS investigating of fatigue of standardized method for t h e role p a r t n e r t o address t h e lack a s provider injuries. This effort may air-medical crashes, clinical errors, and in ground and i n v include developing reliable m e a s u r tool and check list for e s t i g a t o a valid and e m e n t r s . (evidence-based) information (OEMS) d i t o The NHTSA Office of EMS should s s e m i n a t 3. e programs I interventions community to m a n aid d e v e l o p of f a t i g u e a g e m e n t t h e EMS m e n t fit local needs. to Safer Drivers. Safer C a Safer Roads. r s . 7
Tasks • Tasks: — Feb. 2 2016 8am-noon. — Public stakeholder meeting — Form EBG Panel & create research questions — Literature review & grade evidence GRADE Methodology — Develop Evidence Based Guidelines — Create performance measures — Dissemination • Optional Task 1 — Additional dissemination • Optional Task 2 — Evaluation Study Optional Task 3 • — Develop and validate a biomathematical model of fatigue in EMS. — Create free scheduling tool for agencies to help assess work schedules at risk of fatigue Safer Drivers. Safer Cars. Safer Roads. 8
______________________________________________ Public Stakeholder Meeting When: Tuesday, February 2nd 2016, 8am-noon • Where: DOT Conference Center: Oklahoma C11y Room • • Who: NHTSA staff, guidelines team, invited stakeholders, other stakeholders who register (space limited) • We will: — Have presentations on Workplace Fatigue and Drowsy Driving (tentatively by NHTSA Administrator, Mark Rosekind, Ph.D.), Fatigue in EMS, Project Structure and Methods, Dissemination — Accept comments from stakeholders about fatigue management in EMS (both at the meeting and through federal register notice) Safer Drivers. Safer Cars. Safer Roads. 9
Why the GRADE methodology? Used previously for numerous EMS/emergency medicine topics • Accepted, recognized, adopted by the EMS industry • Resuscitation ORIGINAL CONTRIBUTIONS INTRODUCTION Aoaoeoni,no9UciadscaOl5 SI Pt,”.l. Arcsph’oi Maoa,.t 541 —‘dali’ in a’ Fl’, Ti* DFVFI OPM T OF EVIDD’C-HASFD PiirllospnM. GuioF1ii’Fs ESIDENC[-BASW Culnrii-.4r5 FOR PRIIIOSPITAL PRAcTir: A PRocrss A GRADE-ilAsm METI-)O[)O1OGY WHosh T1MF HAS CONIF emperature Management After Cardiac Arrest An Advisory k,tIr,n Ni. L5,’ a, MD, ( h.irh,’ (,. Ma, a, MD, NUll. I’rkr,. ian, MD. 050 , iVrk. i)ri’k. NiI’ii. jro’j’il L LV NIaIo’4 I. Shah, Mt).1 hL. Nil), Ni 4 tatement by the Advanced Life Support Task Force of the LI,lvS. iao, MiX \I.( (Ii’ 1i\i ternational Liaison Committee on Resuscitation and the THE IMPLEMENTATION AND EVALUATION OF AN EVIDENCE-BASED STATEWIDE merican Heart Association Emergency Cardiovascular Care PREHOSPITAL PAIN MANAGEMENT PRoTocol DEVELOPED USING ommittee and the Council on Cardiopulmonary, Critical Care, THE NATIONAL PRFI-IOSPITAL EVID[NC[-RASFD GUIDELINE MOOR PROCESS erioperative and Resuscitation FOR EMERGENCY MEDICAL SERVICES M,srk Hrohon, MD,Mi’H, PhI), Rwhard AIwrIa, MD, K,iIIio’o’n fyi. ilmoyn, MD, n Kaiiiyiina 1,1 Bwq Jostua C ,ha,’i W D.’r 5 l Lals W Andr’r’, 11 , La rr 0 isiuc” 1 T Io,.. I rs_r,I, SI I ‘U UI..., I I Cl.;.. LI.. * IL .......,,., m’Eis ,lc j P Psiu T Me’isy Eddy Lang LI h 1 J N COCLhI Theshoios N’ 7CWTarrTTV. ‘,,i’O’1 ,‘J (‘(ligs’ ,ijSIly5i i)r FRCA FF1CM FR 0 P ha it CUR Al S Analgesia in the emergency department: a GRADE-based sk Forcc’ evaluation of research evidence and recommendations for practice Chris l,Ipp. 0,j flhaiiaI aid Eddy LaI,y Resuscitation ,U.OthOU 511 • cor pondriø aoil,sr; CSOO DEE cIJoli,.. 511550 Onweraty sI Co gab, Fa:uty of flndc,ne, albosto Honith S.rv;rea, Cr19011,. Canada Vnlume 97 December 2 iS Pages 38—47 For Il a;ithor ensaiS, pIee j5fjjOfl. AN EVIDENCE-BASED GUIDELINE FOR PEDIATRIC PREHOSPITAL SEIZURE Revl’’/ 5111115 MANAGEMENT USING GRADE METHODOLOGY When should chest compressions be paused to analyze the . Mai’as, MD, MPH, PcIs’r .. Davan, MD, MSc, Tasm&’r’n S. WI’k, Maim—h I. Shah, MD, Chark”, ( cardiac rhythm? A systematic review and meta-analysis N’d DrPh, MPH, Kathiecn M. Brown. MD, Susan M. Fuchs, MD, Man’ F. FaIl,it, MU, Josoph L. Wrighl, MD, MPH, Eddy S. Lang, MD( M, CCF[’ (FM) sfCi Eddy Leon’ Peter I Morley’ 1 . KevIn Joshua C Reynolds 5 , Vio11ta R 5 NatiorC Safer Drivers. Safer Cars. Safer Roads. 10
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