Sleep studies in two Ambulance Trusts highlights dangers of fatigue

A ground-breaking study into sleep and fatigue at South Central Ambulance Service (SCAS) has led to the reduction of 12-hour shifts.

Evidence from the trial showed that lack of sleep and fatigue increased the risk of harm to both ambulance crews’ health and the care they gave to their patients.

Research has shown for a long time that lack of sleep and fatigue increases rates of cancer by 50%, stroke by 15%, diabetes and obesity. It is also a factor behind increased anxiety, depression, PTSD and Alzheimers.

Former RAF navigator Jason Eden, founder and CEO of Sleep and Fatigue Research (SAFR) Ltd, said the difference between how tired you feel and how tired you are is significant; meaning that individuals are often the worst judges on how tired they are.

Jason presented his findings based on sleep data collected from 90 operations staff at SCAS over a four-week period to members of the Association of Ambulance Chief Executives (AACE) Council, consisting of chairs and chief executives of all NHS ambulance services in the UK.

Levels of alertness among SCAS staff were reasonably good across crews working in Basingstoke, Didcot, Nursling and Wexham and in line with most 24/7 organisations. Despite this, nearly half (45%) of participants’ working time was spent in the zone for alertness levels where the rate of potential accidents doubles.

However, the most significant results were found during night shift. Jason said:

People working night shift found it more difficult to sleep and when they did sleep, they slept less effectively. Alertness levels at night were very low.

He said the average amount of sleep across the study group was seven hours 18 minutes, but more than half of participants (60%) slept four hours or less on at least one day and one in five had less than two hours sleep, warning;

This leads to a significant decrease in performance and an elevated likelihood of being involved in an incident.

His research also found that 12 hour shifts in general have a 30% increase in the relative risk of being involved in an incident. Night shifts have an even higher risk compared to day shifts and consecutive 12-hour shifts increases the risks to health and accidents even more.

As a result, SCAS say that there will be no more 12-hour night shifts by March 2020.

Rob Ellery, operations manager at SCAS, added:

Our unions and staff representatives were on board with this study from the start and as a result we will have no 12-hour night shifts from 6 March.

He added that 12-hour day shifts will continue, but there will only be two consecutive 12-hour shifts planned together, saying;

We have a duty of care to our staff and their health and wellbeing. Equally, our staff have a duty of care to their patients to come to work fit and able to carry out their duties.

In a separate sleep and fatigue study, carried out by the University of East Anglia, 78% of ambulance service participants recorded poor sleep quality with most shift workers reporting severe fatigue.

The research by Prof Kirsty Sanderson received 700 responses from a cross section of staff at the East of England Ambulance Service (EEAST). Her findings showed that 70% of staff arrived for shift with inadequate rest. Half of all respondents said they were trying to improve their alertness at work and one in three were using a sleep tracker.

Comments from some EEAST staff included:

  • “Other workplaces actively get staff to consider their fatigue levels, for example the airline industry. Staff are actively encouraged to reflect on their fatigue levels. The trust should start recognising fatigue is a risk.”
  • “For call handlers on day shifts, 11 hours of taking non-stop calls is tough. We actually can have a huge impact on the heath and safety of the patient if we are fatigued.”

Prof Sanderson recommended trusts use models for shift scheduling; ensure that policies and procedures for self-identifying dangerous fatigue are in place; and promote good sleep habits among employees.

A large-scale NHS funding bid is now being prepared to the National Institute for Health Research aimed at reducing the number of ambulance staff reporting fatigue while at work.