Sleep deficiency is highly prevalent in the general population and is especially pervasive in shift workers. As first responders who need to be available 24-7, EMS clinicians are especially vulnerable to sleep deficiency and fatigue. More than one in three EMS clinicians experience excessive daytime sleepiness which can compromise their health and patient safety. The long-term goal of this line of research is to improve the health and safety of Emergency Medical Services (EMS) clinicians and subsequently the patients they treat. The overall objective of this application is to deliver knowledge through a sleep health program to improve sleep and sustain alertness, as well as identify and promote treatment of undiagnosed sleep disorders. The central hypothesis is that a sleep education initiative can translate to improved clinician health and more reliable patient care. This hypothesis has been formulated on the basis of similar work in police and firefighters. The rationale for the proposal is that substantial improvements in safety can be realized through screening for undiagnosed, easily treatable health conditions. The central hypothesis will be tested by pursuing the following three specific aims: (1) To estimate the prevalence of sleep disorders nationally in the EMS workforce and determine the extent to which sleep disorders are associated with medical errors and adverse events; (2) To test the hypothesis that delivery of an online educational intervention will increase knowledge of sleep health; and (3) To test the hypothesis that delivery of an online educational intervention will increase sleep quality, sleep duration, and alertness. We will enroll 5,000 EMS clinicians in a prospective nationwide survey. Participants will complete a customized sleep health education program that includes screening for sleep disorders. Subsequent web- based surveys will capture sleep duration, sleep quality, alertness and patient-safety outcomes. Objective sleep data will be collected in a subset of participants. Nearly 1 million EMS providers currently provide care to 30 million patients a year, and over half of these providers report severely impaired alertness. Medical errors and adverse events are frequent and have been associated with impaired alertness. This contribution is significant because the proposal will improve alertness and can be integrated into existing continuing education requirements. The proposal is innovative in that it seeks to address the source of impaired alertness rather than manage the symptoms. The product will seamlessly translate to widespread, practical implementation.
The proposed research is relevant to public health because deficits in the health, safety, and preparedness of EMS clinicians are expected to increase the risk of medical errors to the patient's they treat. The project is relevant to the mission of the NHLBI because it focuses on promoting health, identifying, and treating undiagnosed disease.
