An evaluation of fatigue management strategies utilized by advanced life support providers in KwaZulu-Natal
Authors:   , Greyling Bryan 
Published: August 2024

Personnel employed by emergency medical services in the pre-hospital environment are required to work shifts in order to ensure that help is available at any time of the day, due to the unpredictable nature of emergency situations. Shift work results in elevated levels of fatigue that are often unavoidable. Emergency medical care providers, in particular advanced life support providers, utilise informal fatigue management strategies to safeguard themselves and their patients from the harmful effects and symptoms associated with fatigue from shift work. Fatigue is a danger to the health, safety, and performance, of advanced life support providers and their patients. Currently, the use of informal fatigue management strategies within the emergency medical care services is unclear and requires additional study. Aim of the study This research determined the use of informal fatigue management strategies by local advanced life support providers. Methodology A quantitative cross-sectional study was undertaken, utilising a survey questionnaire that was used to collect relevant data on the advanced life support provider’s perceived personal experiences related to fatigue, and their utilisation of informal fatigue management strategies. In addition, associations between variables were tested using cross-tabulations. Fisher’s exact two-sided tests and Spearman’s rho were used to validate the associations between the participants’ perception of fatigue and fatigue management strategies. A total of n=66/86 participants who met the inclusion criteria completed the survey (76.7% completion rate). After reading the information letter, or viewing and starting the survey, n=20/86 (23.3%) potential participants dropped out as they did not meet the inclusion criteria. A large number of advanced life support providers did not meet the inclusion criteria due to their non- operational status. Results Participants reported their experiences of a total of 12 effects, signs, and symptoms associated with fatigue, which were primarily divided into health, safety, and performance categories. The evaluation of their fatigue management strategies consisted of 24 questions. Following this, they were then asked seven questions exploring their personal sentiments about fatigue management. The results demonstrated that the majority of the participants understood the concept of fatigue and were generally confident in their fatigue management strategies. This enabled them to reduce the risks associated with fatigue. However, nearly half the participants n=32/66 (48.5%) expressed health-related problems as a consequence of fatigue. These health-related signs and symptoms experienced by the participants may be an area of concern. Moreover, this prevented them from keeping to their regular lifestyle habits, which consisted of rest and recovery; with dietary and social implications. Of the participants, n=49/66 (74.2%) felt that fatigue management strategies improved their clinical management and safety. The participant’s length of shift duration included either 12 hour, 24 hour, or up to 48 hour standby shifts. The participants’ length of shift did not appear to impact on their making clinical management errors. Noting, n=55/66 (83.3%) participants indicated they had not made clinical management errors in the last month, while n=42/65 (64.6%) participants reported that their personal or their patients’ safety was ‘occasionally’ compromised by way of fatigue. Regarding performance, n=20/66 (30.3%) participants felt their fatigue management strategies worked when used on an ‘always’ basis. Added to this, sixteen of sixty-six participants felt their fatigue management strategies reduced their signs and symptoms associated with fatigue when used on an ‘always’ basis. Oddly, there was no link found between being able to identify the symptoms of fatigue and subsequently making use of energy drinks (caffeine) or a light snack to relieve the effects of fatigue. Conclusion When considering the data from this study, based on the advanced life support providers personal experiences, they had pro-actively developed informal fatigue management strategies as a defence mechanism. This allowed them to safeguard against the health, safety, and performance shortfalls of operating in a fatigued state that is beyond the point of safe practice. It is recommended that continued education be made available to the employers and advanced life support providers on the benefits of fatigue management. Individual providers should ensure that they optimise their rest and recovery periods. Putting into routine practice various fatigue management strategies may ensure a safe and affective essential emergency medical care service to their communities.