• Rebecca E Cash, Sarah E Anderson, Kathryn E Lancaster, Bo Lu, Madison K Rivard, Carlos A Camargo, and Ashish R Panchal.
• Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (REC, CAC).
• Prehosp Emerg Care. 2020 Sep 1; 24 (5): 644-656.

AbstractBackground: Emergency medical services (EMS) personnel frequently encounter occupational factors that increase the risk of poor sleep and stress. The national prevalence of poor sleep and stress in EMS personnel is unclear, especially differences between personnel at the basic (BLS) versus advanced (ALS) life support levels. The objectives of this study were to: (1) estimate the prevalence of sleep and stress metrics in EMS personnel; and (2) compare these metrics between BLS and ALS-certified personnel. Methods: This study was a survey of recertifying nationally-certified EMS personnel working in civilian settings. Respondents completed an electronic questionnaire assessing their sleep quality; workday, non-workday, and average sleep duration; sleep debt; perceived stress; and chronic stress. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (PR) comparing BLS (emergency medical technician) to ALS (advanced emergency medical technician and paramedic) for each metric. Models were adjusted for age, sex, minority status, education level, EMS agency type, service type, EMS role, and significant interactions. Results: A total of 17,913 (response rate = 19%) responses were received with 17,522 included in the analysis. Adjusted PRs were significantly higher for ALS-certified personnel compared to BLS-certified for poor sleep quality (PR: 1.23, 95% CI: 1.20-1.27) and short (<7 hours) or long (≥9 hours) workday sleep duration (PR: 1.17, 95% CI: 1.15-1.19). Significant interactions were found between certification level and sex (average sleep duration) or age category (sleep debt, perceived stress, and chronic stress). The highest prevalence of short or long average sleep duration was among ALS men. Sleep debt, perceived stress, and chronic stress differed by age group between certification levels with higher PRs for ALS regardless of age group. Conclusions: There is a high prevalence of poor sleep and stress in EMS personnel, with evidence of the highest prevalence among ALS-certified personnel. Evidence of effect modification by age category and among BLS and ALS personnel suggests that interventions could target certain subgroups, such as older ALS personnel, to be most effective. Continued focus on sleep health and stress reduction is needed to improve the health and well-being of the EMS workforce.

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