[PPT] - Agenda Background I. Project Tasks II. Optional Tasks III. The PowerPoint Presentation

SLIDE 1

National Highway Traffic Safety Administration

J. Stephen Higgins, Ph.D.

Research and Program Development

Office of Behavioral Safety Research

1

SLIDE 2

Agenda

Background Project Tasks Optional Tasks The Team

Comments/Questions?

I. II.

III.

Iv.

V.

Safer Drivers. Safer Cars. Safer Roads.

2

SLIDE 3

Background

Study: Medics’ fatigue linked to higher injury

rates

In the survey sample, more than half of the respondents were classified as fatigued

Ambulance driver fatigue a danger

Distractions pose risks to patients, EMTs, traffic

By Lisa Zagaroli, and Apnl Taylor! Detroit News Washington

Bureau Monday, January 27, 2003

Emergency medical technician Anne Lamberson thought she was doing her nb when she got a priority dispatch, stepped on the ambulance’s accelerator and tried to make it to the scene as quickly as she could.

r

r— -

Study Examines Effects of Sleep Deprivation on Shift

Work

Medical professionals are beginning to call fatigue the number one Droblem in our

field

Athnin & Leailership

Fatigue a factor in ambulance accident in Manitoba - Canada

Studies Prove 24Hour Shifts Unsafe

Anothsr ethical dilemma for EMS leaders

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Thursday, August 38,201 regional health authorities need 10 be made.’

Lois I Winnipeg (29 Aug. 2012)- Health Authorily was invol The ambulance Slid off the Swan River after doing an several days and nights w

State Coroner: fatigue a factor in administering wrong drug

In 2007 Coroner Peter White reported ttiat while allempling to resuscitate a

78 year-old male cardiac palient a paramedic accidentally administered morphine instead of adrenaline

TIm Coroner said tattgu was a factor. I am satisfied that both officers were

affected by fatigue at the lime of those incidents and that resulling error is

atwns a posetbilty

ii such circumstances,’

A posilive outcome was unlikely but ihe possibiily that resuscitalion may

have been more cilective given appropoate treatment cannot be cscluded°.

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Safer Drivers. Safer Cars. Safer Roads.

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3

SLIDE 4

Fatigue and Sleep Health

i n E M S

Greater than half report fatigue at work
Half get less than 6-hours sleep per day
Greater than half report poor sleep quality
Greater than 1/3rd report excessive daytime sleepiness
Half report poor to moderate recovery between scheduled shifts

Patterson et al, 2015 (recovery); Patterson et al; 2015 (textbook); Pirrallo et al, 2012

Safer Drivers. Safer Cars. Safer Roads.

F a t i g u e

100% 75%

41:

50% 25% 0% 2011

Yat Figure 20.4 Prnportin oIEMS wtrkers who selt-report severe mental and physical fatigue while at wok across diverse samples of US-based EMS workers and EMS agencies. 2010

4

SLIDE 5

Fatigue linked to safety in EMS

Poor Sleep Fatigue Poor Sleep Fatigue

Conronsed Safety

Poor Sleep Fatigue

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Odds Ratio (95% CI)

a

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Adjusted

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FIGURE 2

, Crude

cluster/confounding-adjusted odds of safety

utcomes associated with poor sleep and fatigue. Adjusted odds ra

tios (ORs) are from Table 3. These ORs were adjusted for clustering within agencies

confounding. AE

adverse event; CI = confi dence interval. Safer Drivers. Safer Cars. Safer Roads.

I Patterson et al, 2012; PMID 22023164 I

Injury Error or AE

5

SLIDE 6

Fatigue Risk Management Programs

Robust fatigue risk management

programs and hours-of-service rules

in many industries

— Aviation — Rail — Motor Carriers

Other industries working on issue

— Transit (metro, busses) — Medicine (residents, nurses) — Mining

Oil

RESD NT DUTY HOUR

ENHANCING SLEEP. SUPERVISION, AND SAFETY

INSTflUTE CF MEDICINE

‘ Ye* MA1

Safer Drivers. Safer Cars. Safer Roads.

6

SLIDE 7

2013 NEMSAC

A d v i s

r

y

1.

The

NHTSA

Office

f

EMS

(OEMS)

should c r

s

s

v

a l i d a t e findings from studies and reports

f fatigue

in

t

h e r professions

with

t h a t

f

f a t i g u e

in EMS.

This effort should involve a convening of

subject matter experts,

individual providers of

EMS

services, and representatives from

local,

s t a t e ,

and federal organizations, national organizations (e.g.,

NAEMT, NAEMSP,

NASEMSO)

that

play a role

in EMS

versight or care

delivery.

T h e e f f

r

t should

clarify

t h e e v i d e n c e

linking

EMS

provider fatigue and safety and health

u

t c

m

e s

f

p a t i e n t s , providers, and t h e

public.

T h e effort should include an analysis of regulatory r e q u i r e m e n t s

f

t h e

employer and employee and

legal

framework

with

respect t

t

h e t h r e a t

f

fatigue

n safety.

2.

The

NHTSA

Office

f

EMS

(OEMS)

should work through its federal and non-federal

p a r t n e r s t

address

t h e

lack

f

a

standardized method

for investigating

t h e

role

f

fatigue

in

ground and air-medical crashes,

clinical

errors, and provider injuries. This effort may include developing

a valid

and reliable m e a s u r e m e n t tool and check

list for

i n v e s t i g a t

r

s .

3.

The

NHTSA

Office

f

EMS

(OEMS)

should d i s s e m i n a t e (evidence-based) information t

t

h e

EMS

community to aid d e v e l

p

m e n t

f

f a t i g u e m a n a g e m e n t programs I interventions to

fit local

needs.

Safer

Drivers.

Safer

C a r s .

Safer

Roads.

7

SLIDE 8

Tasks

Tasks:

— Public stakeholder meeting — Feb. 2 2016 8am-noon. — Form EBG Panel & create research questions — Literature review & grade evidence — Develop Evidence Based Guidelines

— Create performance measures — Dissemination

Optional Task 1

— Additional dissemination

Optional Task 2

— Evaluation Study

Optional Task 3

— Develop and validate a biomathematical model of fatigue in EMS. — Create free scheduling tool for agencies to help assess work

schedules at risk of fatigue

Safer Drivers. Safer Cars. Safer Roads. GRADE Methodology

8

SLIDE 9

Public

Stakeholder

Meeting

When: Tuesday, February 2nd 2016, 8am-noon
Where: DOT Conference Center: Oklahoma C11y Room
Who: NHTSA staff, guidelines team, invited stakeholders,
ther stakeholders who register (space limited)
We will:

— Have presentations on Workplace Fatigue and Drowsy Driving

(tentatively by NHTSA Administrator, Mark Rosekind, Ph.D.), Fatigue in EMS, Project Structure and Methods, Dissemination

— Accept comments from stakeholders about fatigue management

in EMS (both at the meeting and through federal register notice)

Safer Drivers. Safer Cars. Safer Roads.

______________________________________________ 9

SLIDE 10

Why the GRADE methodology?

Used previously for numerous EMS/emergency medicine topics
Accepted, recognized, adopted by the EMS industry

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THE IMPLEMENTATION AND EVALUATION OF AN EVIDENCE-BASED STATEWIDE PREHOSPITAL PAIN MANAGEMENT PRoTocol DEVELOPED USING THE NATIONAL PRFI-IOSPITAL EVID[NC[-RASFD GUIDELINE MOOR PROCESS FOR EMERGENCY MEDICAL SERVICES

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Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice

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AN EVIDENCE-BASED GUIDELINE FOR PEDIATRIC PREHOSPITAL SEIZURE MANAGEMENT USING GRADE METHODOLOGY

Maim—h I. Shah, MD, Chark”, (

. Mai’as, MD, MPH, PcIs’r .. Davan, MD, MSc, Tasm&’r’n S. WI’k,

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Resuscitation

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mmittee and the Council on Cardiopulmonary, Critical Care,

erioperative and Resuscitation

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Safer Drivers. Safer Cars. Safer Roads.

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When should chest compressions be paused to analyze the cardiac rhythm? A systematic review and meta-analysis

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SLIDE 11

Why the GRADE methodology?

The GRADE process uses a formalized, transparent, and reproducible

system to assess level of evidence to specific questions.

Results in clear, executable recommendations designated as either

strong or weak.

Makes clear separation between quality of evidence and strength of

recommendations

— (for example: quality of evidence may be weak, but benefits of a

recommendation may far outweigh risk, thus an expert panel may offer a strong recommendation).

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A National Model for Developing,

Implementing, and Evaluating Evidence-based Guidelines for Prehospital Care

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RATING QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS

GRADE: an emerging consensus on rating quality

f evidence and strength of recommendations

Guidelines are rcon5tstetii in how hey rate the qiflity of e’idenc’e and h[io streigIh of

recommendations. ihisarticie explores the adeantages of the GWtDE system, which is ncreasingI

being wiopteci byorganiwitions wodct,adc

Safer Drivers. Safer Cars. Safer Roads.

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SLIDE 12

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SLIDE 13

The

E x p e r t

Panel

Expeit

p a n e l

will

i n c l u d e

( a t

a

m i n i m u m ) :

E M S

r e s e a r c h e r s ,

clinicians,

E M S

administrators, g

v

e r n m e n t r e p r e s e n t a t i v e , p a t i e n t a d v

c

a t e , f a t i g u e a n d sleep s c i e n t i s t s , a n d

GRADE

M e t h

d
l
g

i s t

( D r .

Lang)

Panel

charged

with:

1 .

D e v e l

p

i n g

questions to guide the literature review

2 .

R e v i e w i n g

synthesis

f

l i t e r a t u r e provided

by

research team

3. R e v i e w i n g

draft recommendations offered

by

research team

4 . Rating relevancy and clarity of draft

recommendations

5 .

R a t i n g relevancy, c l a r i t y ,

a n d

f e a s i b i l i t y

f draft performance

measures p r

p
s

e d

by

research team

S a f e r

Drivers.

Safer

Cars.

S a f e r

Roads.

_____________________________________________

1 3

SLIDE 14

Literature Review

&

Evidence Table

Guided by questions from expert panel
We will use established methods for reviewing and rating

quality of literature (i.e., GRADE methodology)

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RATING QUALITY OF EVIDENCE AND STRENGTH OF RECOMMENDATIONS

GRADE: an emerging consensus on rating quality

f evidence and strength of recommendations

Guidelines are inconsistent in how they rate the quality of evidence and the strength of

recommendations. This article explores the advantages of the GRADE system, which is increasingly

being adopted by organisations worldwide

Safer Drivers. Safer Cars. Safer Roads.

_____________________________________________

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SLIDE 15

Performance measures

Research team with help from Expert Panel will develop

measures

— with consideration to what data may already be available /

collected by EMS systems

— creating standardization — thus opportunities for comparisons

across systems

What can we or others do with them

— Evaluate effectiveness/impact of FRMP5

Safer Drivers. Safer Cars. Safer Roads.

_____________________________________________

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SLIDE 16

Dissem i naUon

Presentations at National Conferences
Targeted press releases and webinars:

— State EMS Offices — National EMS Organizations — EMS Stakeholders — EMS Agencies — Consumers

Article(s) for trade publication
Pamphlet for wide distribution
Also additional Optional Task for more dissemination

Safer Drivers. Safer Cars. Safer Roads.

_______________________________________

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SLIDE 17

Optional Task 2: Evaluation Study

Experimental study of n=1O EMS agencies
Proposed inclusion criteria:

— (>or =) to 100 EMS clinicians; — Use mix of shift durations/schedules (e.g., <12-hour, 12-hour,

16-hour, 24-hour and other shift durations);

— Variation in periods of inter-shift recovery.

Measures of potential interest

— Point prevalence of fatigue, sleep health/quality over time, inter

shift recovery, safety culture, work-related injury, other performance measures

Safer Drivers. Safer Cars. Safer Roads.

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SLIDE 18

Optional Task

Goals

2’

J. Biomathematical Model

— Sample sleep patterns of EMS clinicians to customize sleep

inputs to model-based analyses

— Validate a biomathematical model for use in scheduled EMS

perations

— Develop a model-based tool to assist personnel managing

fatigue risk associated with scheduled EMS operations

Safer Drivers. Safer Cars. Safer Roads.

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SLIDE 19

Project Schedule

Task

C.32

C3

1 3

C.3.4 1-6 months 6-12 months Revise Work Plan Meeting: EBG Panel

Final Report Briefing-DOT

Dissemination

Safer Drivers. Safer Cars. Safer Roads.

1218 months

18-24 months Letter Report Literature Review Evidence Table

C36

C3.7 C.38

Meeting: Guidelines Panel Letter Report Performance Measures Draft Report

19

SLIDE 20

Our contract team

Financial & Overall

Project Management

Meeting organization
Dissemination

C.’aro1ins I 1ca1thCre Svstcn

Daniel Patterson

Department of Emergency Medicine

Steve Hursh, Francine James, Lauren Waggoner

EBG Creation Process

Management

Research Project

Management

Dissemination
Optional Task:

Biomathematical model

f EMS fatigue &

personnel scheduling tool

Safer Drivers. Safer Cars. Safer Roads.

Dia Gainor and Kathy Robinson

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SLIDE 21

Complete Project Team

Steve Higgins, PhD

— NHTSA

Dia Gainor

— NASEMSO

Kathy Robinson

— NASEMSO

Daniel Patterson, PhD

— Carolinas Emerg.Med.

Mike Runyon, MD

— Carolinas Emerg.Med.

Melanie Hogg

— Carolinas Emerg.Med

Charity Moore, PhD

— Carolinas

Caroline Axthelm

— Carolinas

Jon Studnek, PhD, NRP

— Carolinas / MEDIC

Allison Infinger, MSPH

— Carolinas / MEDIC

Laura Barger, PhD

— Harvard

Eddy Lang, MD

— University of Calgary

Steve Hursh, PhD

— Institute for Behavior Resources, Inc.

Francine James, PhD

— Institute for Behavior Resources, Inc.

Lauren Waggoner, PhD

— Institute for Behavior Resources, Inc.

Safer Drivers. Safer Cars. Safer Roads.

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