Yonago Acta medica 2011;54:37–40

Current Duty Arrangements and Circumstances ofEmergency Medical Technicians: Findings ofan Electronic Questionnaire Survey Conducted at the 16th
National Ambulance-Crew Symposium
Takenobu Hosoda, Hiroteru Okamoto*, Takako Wada† and Youichi Kurozawa
Division of Health Administration and Promotion, Department of Social Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, *Department of Hygiene and Public
Health, School of Medicine, Kyorin University, Mitaka 181-8611 and †Department of Paramedics,Faculty of Health Sciences, Kyorin University, Hachioji 192-8508, JapanTo assess the working arrangements and effects on the health of medical emergency transport personnel, we conducted an electronic questionnaire survey among participants of
the 16th National Ambulance-Crew Symposium in 2008. Answers were obtained from 58
participants (56 males, 2 females): 58 questionnaires were fully completed and suitable foranalysis. Of the 58, 47 respondents were emergency medical technicians (including thosewith additional roles). In the analysis of the responses, we observed a negative correlation
between the number of emergency transport dispatches (in 1 day) and total nap time, andbetween the number of night emergency transports per shift and quality of sleep. Thesefindings suggested that an increase in the number of emergency transports was associatedwith a decrease in nap time and sleep quality.
Key words: emergency paramedics; nap; workplace

Until 2005, the number of emergency transportdispatches in Japan had increased annually. The
number of dispatches decreased in 2006, but rose
again in 2007. Since 2005, the annual number ofemergency transport dispatches had been in excess of 5,000,000 (Fire and Disaster Management
Agency, 2008a). In the emergency medical caresystem of Japan, fire departments are responsible
for emergency medical transport. Emergency medical technicians perform emergency medical careat the scene and transport patients to hospitals. An
ambulance team consists of 3 people, and always
includes a captain. At least 1 of the 3 personnel is aqualified ambulance paramedic.
Emergency medical technicians are on duty for
24 h per shift from 8:30 AM until 8:30 or 8:40 AM

the next day. The working hours include breaks
and sleep time. Due to the increase in the numberof emergency transport dispatches, personnel havebeen unable to take their designated break and sleeptimes. Degrees of fatigue and stress vary among
emergency medical technicians (Takahashi et al.,2005). A study of ambulance paramedics in Tottori
Prefecture found an increase in general fatigue andhealth problems. Despite this, few personnel reported chronic fatigue or lack of motivation due toworking conditions (Hosoda et al., 2006).
To assess the working arrangements and effects on the health of medical emergency transportpersonnel, we conducted an electronic questionnaire survey among participants of the 16th National Ambulance-Crew Symposium in 2008.
37

T. Hosoda et al.

Table 1. The characteristics of respondents tothe electronic questionary survey (n = 58)

Results

Characteristics

Median Respondent[range]Number		(%)
Age (year)
40 [19–57]
18–19 		20–29 		30–39 		40–49		50–59 		GenderMale		Female		Team or Staff
Ambulance team member* 		
Fire Suppression team member		Rescue team member		
District Command team member		
Staff of Fire Defense Headquarter orother facilities		

Fifty-eight of the questionnaires were fully completed and suitable for analysis. Table 1 shows
the characteristics of the survey respondents. Themedian age was 40 years, with a range of 19 to 57years. The majority of the respondents were male
(56 males, 2 females). Forty-seven of the respondents were emergency medical technicians (including those with additional roles). Table 2 shows thecharacteristics of the emergency medical technicians. The median age was 40 years, with a rangeof 25 to 57 years. Twenty-five (53%) of the paramedics held the position of captain. The medianlength of service was 21 years (range, 2–36 years).
The median number of emergency transports
per shift was 7 (range, 1–15), of which 2 (1–15)
were at night. The median total nap time per shift
was 4 h (range, 2–5 h). Six persons (13%) tooknaps in private rooms at firefighting stations, and87% took naps in shared rooms. The median sleep
time immediately following the duty period was 6h (range, 4.5–10 h). The median sleep time on daysoff was 7 h (range, 4–9 h). Twelve persons (26%)
were dissatisfied with their quality of sleep.
Table 3 shows significant findings of the correlation analysis. There was a negative correlation
between the number of emergency transport dispatches (in 1 day) and total nap time, and between
the number of night emergency transports per shiftand quality of sleep.

1 (2)
11 (19)15 (26)22 (38)9 (16)
56 (97)2 (3)47 (81)
4 (7)
1 (2)
2 (3)
4(7)

*Including members in additional posts.

Materials and Methods
The electronic survey was conducted during theopening discussion of one of the programs of the
16th National Ambulance-Crew Symposium heldon January 25, 2008. The theme of the open discussion was the actual working conditions andstate of health of emergency medical technicians.
The survey method was as follows: questions wereshown on a large display screen and respondents
answered individually on handheld keypads.
Therefore, individuals were able to choose whether
to respond to the questions or not. The sleep time
we investigated in the present study was the periodof sleep. Similarly, the nap time was the period ofsleep during office hours.

Discussion
The average age of reserve firefighting staff in Japan was 41.8 years in April 2007, different to thatfound in this investigation. The participants in thissurvey were not representative of reserve firefighting staff. The percentage of firefighters also working as reserve ambulance team members observedin this investigation was 81%. In contrast, the percentage of reserve firefighting staff in Japan who
were also ambulance team members was 38% in

Data analysis
The responses to each question were collated foranalysis. Spearman’s rank correlation coefficient
tests were performed to identify significant associations. Statistical analyses were performed using
SPSS version 11.0 (SPSS Japan, Tokyo, Japan).
38Duty circumstances of ambulance crew

Table 2. The characteristics and findings from surveyed ambulance team members
Characteristics		

Median[range]

Total numberGenderAge group(year)

Position on ambulance teams
Size of firefighting headquarters(number of personnel)

Length of service(year)

Ambulance paramedic duty arrangements
Geographical feature of jurisdiction area

Number of emergency transports per shift

Length of time required for emergency
transports(min)
Number of night emergency transports
per shift
Total nap time per shift(h)Sleep time after the duty(h)Sleep time on days off(h)Structure of nap rooms
Quality of sleep

Category

Respondent
Number (%)

							Male			Female
40 [25 – 57]
20–29			30–39			40–49			50–59			Captain			
Member			
0–199			200–399			
400–599			
600–799			
800 and over
21 [ 2 – 36]
0– 9.9			
10–19.9			
20–29.9			
30 and over			2 part system			
3 part sysytem			
Daily			Urban			Rural			Others
7 [ 1 – 15]
0– 2			3– 5			6– 8			9–11			12 and over60 [33–170]
30– 59			
60– 89			
90–119			
120 and over2 [ 1 – 5]
0–1.9			2–3.9			4–5.9			6 and over4 [ 2 – 5]
0–1.9			2–2.9			3–3.9			4–4.9			
5 and over
6 [4.5–10]
4–5.9			6–7.9			8–9.97 [ 4 – 9]
4–5.9			6–7.9			8–9.9			Private room			Shared room partitioned with screens			
Shared room not partitioned by screens			
Quality of sleep satisfaction			
Dissatisfaction			
Neither

47 (100)
46 ( 98)
1 ( 2)
8 ( 17)14 ( 30)
19 ( 40)
6 ( 13)25 ( 53)
22 ( 47)
14 ( 30)
4 ( 9)
4 ( 9)
9 ( 19)16 ( 34)
9 ( 19)9 ( 19)23 ( 49)
6 ( 13)29 ( 62)17 ( 36)
1 ( 2)
38 ( 81)2 ( 4)
7 ( 15)4 ( 9)
14 ( 30)
16 ( 34)
12 ( 26)
1 ( 2)
16 ( 34)
25 ( 53)
4 ( 9)
2 ( 4)
9 ( 19)31 ( 66)
7 ( 15)0 ( 0)
4 ( 9)
19 ( 40)
14 ( 30)
9 ( 19)1 ( 2)
8 ( 17)27 ( 57)
12 ( 26)
5 ( 11)23 ( 49)
19 ( 40)
6 ( 13)21 ( 45)
20 ( 43)
11 ( 23)
12 ( 26)
24 ( 51)

39

T. Hosoda et al.

Table 3. Significant findings from Spearman’s rank correlation coefficient test on associations between responses
Test item

Numberof transports“Number of emergency transports per shift” versus “Total nap time per shift”“Number of night emergency transports per shift” versus “Quality of sleep”

4747rt–0.487 –3.743
0.393 2.869

P0.0005**
0.0062** P < 0.01.
** P < 0.001.

April 2008 (Fire and Disaster Management Agency, 2008a, 2008b). The difference between thesefindings is likely to be due to data collection methods. It is likely that the findings were affected by
the fact that the symposium where the research forthis paper took place was intended for emergency
medical technicians. There is no information available regarding the percentage of different ranks (e.g.,captains) within the national emergency services.
However, the nature of the symposium predetermined a high percentage of captains amongst attendees.
There was a median emergency transport of
7 during 1 duty day, with a median dispatch timeof 60 min. From this, it can be estimated that theminimum time required for dispatches per shift
was 7 h. There are no national figures available
for the average number of emergency transports
per shift; however in 2004, the average number ofemergency transports by the Tokyo Fire Department was reported to be 8.7. The median totalnap time on duty days was 4 h. According to theTokyo Fire Department’s rules on working hours,
emergency medical technicians working 24-hshifts must work 16 h during a duty day (Motohashiet al., 2005). Therefore, it seems likely that when
there are a high number of emergency calls, mostof paramedics’ time is occupied by emergency
transport-related duties.
Significant associations were found between
the average number of emergency transports per
shift and total nap time per shift, and between theaverage number of night emergency transports per
shift and sleep quality. These findings suggested
that an increase in the number of emergency trans-ports was associated with a decrease in nap timeand sleep quality. However, only 13% had accessto private rooms for nap purposes. Therefore,making improvements in sleeping facilities is necessary for the health of ambulance team members.
Acknowlegments: This study was performed using theOpen Discussion’s records of the 16th National AmbulanceCrew Symposium. We thank the respondents and staff ofthe Symposium.
References
1 Fire and Disaster Management Agency of Ministry ofInternal Affairs and Communications, Japan. Shobo NoUgoki, 2008 [The present situation of emergency andrescue for 2008.] Tokyo: Fire and Disaster ManagementAgency; 2008a. p. 3–19 (in Japanese).
2 Fire and Disaster Management Agency of Ministry ofInternal Affairs and Communications, Japan. Shobo
Hakusho, 2008 [The firefighting white paper for 2008.]
Tokyo: Fire and Disaster Management Agency; 2008b.
p. 130–144 (in Japanese).
3 Hosoda T, Tanigaki S, Haraguchi Y, Nishina Y, Miyagai
H, Watanabe K, et al. [The fatigue of the Emergency
Medical Technician and basic investigation about thestress.] Kosei No Shihyo 2006;53(7):32–41 (in Japanese).
4 Motohashi A, Ochiai H, Yoshida Y, Kikuchi A, Saito
Y. How times for meals, rest periods and naps on dutyof ambulance personnel per one-day shift decrease,with increase in the number of ambulance runs. RodoKagaku 2005;81:169–181 (in Japanese with English abstract).

Received May 16, 2011; accepted June 8, 2011
Corresponding author: Takenobu Hosoda, DMD, CSW, PhD40