ABSTRACTS
Pre-Sleep Behaviors, Sleep Quality, and Fatigue-Related Risks Among Emergency Medical Services Providers: A Cross-Sectional AnalysisAuthor: Celia Sporer | Associate Professor | Queensborough Community College Associate Authors: Armstrong, Daniel
Introduction Emergency Medical Services (EMS) professionals frequently contend with irregular and extended shift schedules, leading to significant sleep disruption and fatigue-related safety risks. While sleep deficits in EMS are well documented, the role of pre-sleep behaviors in shaping sleep quality and fatigue outcomes remains understudied. This study examined associations among EMS work characteristics, pre-sleep behaviors, sleep quality, and fatigue-related outcomes in a diverse sample of EMS providers. Methods A cross-sectional online survey was administered to EMS providers across the United States (N = 254). Participants reported demographics, work characteristics, sleep behaviors, and fatigue-related outcomes. Sleep quality was assessed using self-report measures and the Sleep Disturbance subscale of the Pittsburgh Sleep Quality Index (PSQI). Daytime sleepiness was measured via the Epworth Sleepiness Scale (ESS). Pre-sleep behaviors (e.g., caffeine and alcohol consumption, screen use) were assessed for frequency during the two hours before bedtime. Multivariate analyses of variance (MANOVA) and independent samples t-tests evaluated associations among occupational variables, pre-sleep behaviors, and sleep outcomes. Results Nearly half of participants rated their sleep quality as “fairly bad” or worse, with only 12.4% reporting ≥8 hours of nightly sleep. Long shifts (≥12 hours) were significantly associated with more frequent nighttime awakenings (p = .004), while providers in urban settings reported higher pre-sleep alcohol and caffeine use (p < .05). Educational attainment was linked to increased caffeine use before bed (p = .009). Although no significant differences emerged between EMTs and paramedics on sleep quality or pre-sleep behaviors, nearly one-third of respondents acknowledged having experienced a motor vehicle accident or near-miss due to fatigue. Additionally, 24% exhibited clinically significant excessive daytime sleepiness per ESS criteria. Conclusion The findings underscore pervasive sleep deficits among EMS providers, driven in part by long shifts and urban work environments that promote maladaptive pre-sleep behaviors. EMS systems lack comprehensive fatigue management strategies, leaving providers vulnerable to performance impairments and safety risks. Interventions targeting pre-sleep behaviors, shift design, and workplace culture are needed to enhance sleep health and operational safety in EMS populations.
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