Fatigue, Promoting NEMSIS Among Issues Addressed by NEMSAC

What is the impact of fatigue on EMS providers and more important, the patients they treat? That’s one of the issues that National EMS Advisory Council (NEMSAC) members believe need to be examined in depth throughout the country.

Shift work that prevents EMS providers from having a good night’s sleep could very well be affecting their performance and threaten patient care, safety committee members told fellow NEMSAC colleagues at a recent meeting in the nation’s capital. Among the reasons for the fatigue include shift work and the unpredictable nature of call volumes, as well as some EMS providers working multiple jobs.

The group noted that there is some research out there about the correlation between fatigue and the possible impact on EMS. However, more needs to be done.

Among the studies referenced was one published in 2007 that was funded by the International Association of Fire Chiefs (IAFC): “EMS responders are at risk for the decrements in mental and physical performance that have been well documented among others working long hours and during the night.”

After a search of available research on the topic, members determined that the true affect between fatigue and patient care is still unknown: “The variation of findings across studies highlights the need to more fully investigate the relationships between shift structure, fatigue and safety outcomes among EMS clinicians.”

After discussion, NEMSAC made several recommendations to NHTSA regarding fatigue.

• They include:The NHTSA Office of EMS (OEMS) should cross-validate findings from studies and reports of fatigue in other professions with that of fatigue in EMS. This effort should involve a convening of subject matter experts, individual providers of EMS services, and representatives from local, state and federal organizations, and national organizations (e.g., NAEMT, NAEMSP) that play a role in EMS oversight or care delivery. The effort should clarify the evidence linking EMS provider fatigue and safety outcomes of patients, providers and the public.
• The NHTSA Office of EMS (OEMS) should work through its federal and non-federal partners to address the lack of a standardized method for investigating the role of fatigue in ground and air-medical crashes. This effort may include developing a valid and reliable measurement tool and check list for investigators.
• The NHTSA Office of EMS (OEMS) should disseminate (evidence-based) information to the EMS community to aid development of fatigue management programs/interventions to fit local needs.

Another NEMSAC group—the medical oversight and research committee—has been tackling the National EMS Information System (NEMSIS) project and believes the more needs to be done to encourage participation.

Currently, 38 states are participating in the data base. However, the group says it believes NEMSIS is not being utilized appropriately.
Data garnered through NEMSIS will be used to evaluate patient care on local, state and national levels, as well as a help officials establish evidence-based protocols.

“NEMSIS could be used as a profoundly valuable research tool to help prospectively answer questions related to care in the out of hospital environment,” they wrote in a document.

While the information could improve healthcare, there are a number of challenges at all levels that need to be addressed. One of the key factors is the lack of understanding of how valuable NEMSIS is. After studying the issues, the group issued several recommendations:

• The FICEMS should lead the effort in supporting and establishing technical and political solutions that encourage and enable state and national datasets (i.e., healthcare, traffic, public health) to be “linked” with NEMSIS-compliant data to enrich the descriptions and to understand the determinants of “healthcare events” experienced by individual patients or related to disaster situations.
• The FICEMS should support the development of administrative and political (e.g., sample state legislation) strategies that facilitate the use of NEMSIS data in public health/public safety surveillance.
• The FICEMS should work with member agencies to revisit opportunities for incorporating language into federal grant guidance that aligns with the FICEMS position statement set forth in 2008, calling for federal funding to support the establishment and development of NEMSIS compliant information systems in addition to the transition to NEMSIS V3.
• The FICEMS should work with its member agencies to consider how NEMSIS data and information systems could be utilized to respond to the Gap Analysis of EMS Related Research as well as to achieve program objectives when developing strategic direction or grant guidance related to emergency care topics, including preparedness and mass casualty incidents.

The group also had a few suggestions for NHTSA such as identifying barriers to the real time surveillance of local and state EMS data to be used for quality improvement and compliance with NEMSIS. They also said NHTSA needs to publicize NEMSIS, and what keen information can be obtained.
Updates and the final recommendations from NEMSAC are being developed, and will be published in the near future.

Drew Dawson, NHTSA EMS director, said he was impressed with the work of the committees and that he and his staff are always impressed at the level of participation and discussion among the NEMSAC members. All 25 members were present during recent public meeting in Washington, D.C., and Dawson said that alone shows how committed the council is to making EMS better.

Susan Nicol is a member of the EMS World news team.