1. Who is the intended user for this tool?
a. This tool is designed to estimate fatigue risk to emergency medical services (EMS) personnel based on their work schedules with the goal of helping EMS administrators make decisions about the potential impact of shift scheduling on safety.
'This tool is intended as a tool or guide for both individual EMS providers as well as agencies. For best results, the user should be someone in EMS who is responsible for, or involved in, the process of making schedules for EMS employees.
2. What is effectiveness?
a. Effectiveness is an estimate of performance, scaled as a percent of a fully rested person’s normal best performance. The person’s normal best performance would equate to an effectiveness level of 100%. Effectiveness drops as a person becomes more fatigued.
'For example, an effectiveness score of 77% is equivalent to being awake for 18.5 hours continuously while an effectiveness score of 70% is equivalent to 21 hours of continued wakefulness (Dean, Fletcher, Hursh, & Klerman, 2007).
3. How is level of risk computed?
a. Level of risk for an inputted shift schedule is determined based on whether the lowest estimated effectiveness score for the entire shift falls below standard thresholds. Minimal risk is any proposed schedule where effectiveness does not drop below 77%. The tool uses 77% effectiveness as the threshold for low risk based on Federal Aviation Administration (FAA) fatigue regulations (Huerta, 2012).
'The threshold for moderate risk is a schedule with less than 20% of the shift below 70% effectiveness, based on fatigue regulations used by the Federal Rail Administration (FRA) (Szabo, 2011). The threshold for high risk is a proposed schedule that would result in effectiveness below 70% for more than 20% of the entire shift. Effectiveness scores and level of risk have been tested and validated in a shift-working population and reflect safety criteria from safety-sensitive industries. The criteria for level of risk described above have been established specifically for use in this tool. This tool does not reflect federal or state safety regulations on EMS working hours.
4. Why are the risk thresholds in the tool based on FAA and FRA regulations?
a. Research that helped benchmark safety regulations among transportation workers closely resemble shift activities of EMS workers as an occupation that requires multiple episodes of intense concentration and attention to detail per shift, with serious adverse consequences potentially resulting from a lapse in concentration. FAA and FRA regulations were used as a reference in the tool because federal or state safety regulations on EMS working hours do not currently exist (Huerta, 2021; Raslear, 2009; Szabo, 2011).
5. How is this tool specific to EMS emergency medical services technicians?
a. This tool has been informed by biomathematical modeling of EMST sleep and fatigue through the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE™) model Fatigue Avoidance Scheduling Tool (FAST®) software application. Data regarding EMST sleep and fatigue has been collected in collaboration with the University of Pittsburgh Department of Emergency Medicine EMS Shift Work Project ("The EMS Sleep Health Study: A Randomized Controlled Trial"; Patterson et al., 2021). Please visit The EMS Shift Work Project for more information.
6. What is commute time? How does commute time affect level of risk?
a. Commute time refers to the average amount of time it takes employees to travel from home to work. The tool allows the user to select a range of average commute times; 0-30 minutes, 31-60 minutes, 61-90 minutes, 91 minutes or more. These options refer to one-way travel times. Commute times options cannot reflect every worker’s schedule, but can provide a more accurate estimate depending on conditions specific to the user’s agency. Commute time can impact fatigue by limiting the amount of time between shifts that a worker would be able to sleep.
' For example, if a worker works a 12-hour shift multiple days in a row with a 30-minute one-way commute, they would have 11 hours of free time between shifts to each night (24 hours-12 hours-(30 minutes*2) = 11 hours). However, if it the average worker has a 90-minute one-way commute, free time between shifts would be 8 hours (24 hours-12 hours-(90 minutes*2) = 8 hours). The amount of time off between shifts will dictate how many hours a worker would be able to sleep.
7. How does the tool estimate the amount of time a person sleeps? How are these estimates different during work (i.e., napping) compared to free time?
a. Prediction of sleep in this tool is based on biological need for sleep. The average human requires 8 hours of sleep to recover from daily wakefulness. While a given individual may require more or less sleep, or may not take advantage of opportunities for sleep, this variability cannot reasonably be accounted for within the parameters of this tool. The tool, therefore, estimates that a worker will sleep a full 8 hours in the absence of any time restrictions. In other words, the tool assumes that if an individual has an 8-hour period of free time, that they will take advantage of that opportunity to as much sleep as possible. Time limitations due to the proposed work schedule will shorten the amount of sleep that a worker can get off-shift, but the tool will not account for individual workers’ sleep behavior. The duration of sleep during work (i.e., napping) has been determined based on EMS personnel self-report of time slept on work as well as objective data from sleep tracking wrist-worn actigraphy devices (Patterson et al., 2021). Nap duration increases with time on shift and differs between day and night shifts.
8. Why can’t I enter a shift with duration greated than 72 hours?
a. The tool is calibrated to allow for up to a 72-hour (3 consecutive days of 24-hour) shift. Shifts longer than 72 hours are not frequently utilized in EMS, which have prevented in-depth research into fatigue risk occurring during shift lengths longer than 72 hours. Therefore, only shifts up to 72 hours without a break can currently be predicted by the tool. This tool does not reflect federal or state safety regulations on EMS working hours.
9. Why is level of risk greater when working at night? How can workers avoid fatigue during night shifts?
a. The circadian rhythm is a natural, biological process that regulates sleep and activity cycles across the day in humans. Humans are biologically inclined to be active during the day and sleep at night. Even when fully rested, it is more difficult to perform at 100% effectiveness during the night. Getting a full 8 hours of sleep before working a night shift, exposure to bright light, and caffeine may help improve alertness during night shifts. The circadian rhythm takes a few days to adapt to a new schedule, so working more nights in succession, rather than working a rotating schedule, will help a worker develop a stable routine which will promote effectiveness and reduce risk (Aemmi et al., 2020 ; Boivin & James, 2002; Folkard, 2008; Gumenyuk, Roth, & Drake, 2012; Temple et al., 2018).
10. How can I reduce risk for a schedule?
a. A list of recommendations for reducing risk can be found by clicking on the information icon ⓘ, or by following this link. A list of recommendations specific to schedules with moderate or high risk will populate below the overall schedule row in the tool. Fatigue risk can be most effectively reduced by getting enough sleep, either at night, during days off, or through napping.
11. What if I want to check the level of risk on a rotating shift schedule?
a. The tool cannot model fatigue risk for a rotating schedule. Individual shifts within a rotating schedule can be independently modelled, but users should expect that fatigue risk would be elevated with schedules that change more frequently. The tool does not reflect any additional risk associated with frequent rotation between shifts with different start times or durations.
12. What if none of the schedule input options reflect the schedule I am trying to check?
a. The input options for this tool are limited to schedule parameters, which are commonly used by EMS agencies. Prediction of risk in this tool has been informed by data collected from actual EMS personnel and comparable safety-sensitive industries. The level of risk for working schedules which have not been observed in EMS cannot reliably be calculated. This tool does not reflect federal or state safety regulations on EMS working hours.
13. How can I save my results?
a. The webtool is designed to help users understand fatigue risk based on work schedules with the goal of helping EMS administrators make decisions about the potential impact of shift scheduling on safety. This tool can serve as a guide for scheduling but should not be treated as objective data. The tool does not allow the user to export results as a CSV or excel table. The user can print a copy of the webtool results or save as a pdf using the Print function.
14. Why does the tool show a breakdown of risk by number of schedule repeat? Why does the level of risk change across schedule repeats ?
a. The tool allows a user to repeat a shift schedule up to 4 times. This allows the user to see the predicted level of risk for up to a month of shifts. (For example, the level of risk for a month of working the typical 9-5 work week can be estimated by inputting an 8-hour shift, starting at 0900, 5 days on, 2 days off, repeated 4 times). Fatigue can accumulate over the course of a schedule which does not allow for sufficient recovery time between shifts, but also, the level of risk can decrease after a worker adapts to a new schedule, like a night shift. The tool provides a breakdown of each repeat of the schedule so that the user can identify how risk changes over time, and when during a schedule risk may be the worst.
15. Where can I find more information about fatigue in EMS?
a. Learn more about fatigue risk in EMS by going to https://www.emergencymedicine.pitt.edu/research/ems-shift-work-project , ' https://www.ems.gov/projects/fatigue-in-ems.html , or https://nasemso.org/projects/fatigue-in-ems/.
16. What is IBR? What is SAFTE-FAST?
a. IBR stands for the Institutes for Behavior Resources, Inc. IBR is an independent nonprofit research, services, and educational organization based in Baltimore, MD. IBR provides fatigue risk management research and consulting services to operational environments including: aviation, trucking, rail, military, and energy, among others. More information about IBR can be found at http://ibrinc.org. One of the tools that IBR uses to predict fatigue is SAFTE-FAST. SAFTE-FAST refers to the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE™) model Fatigue Avoidance Scheduling Tool (FAST) software. The SAFTE™ model is a biomathematical model that predicts cognitive performance effectiveness as a function of several interacting variables such as hours of continuous wakefulness and amount of prior sleep. The SAFTE™-FAST® software application is used to analyze, predict, and prevent fatigue-induced risk. The SAFTE™ model and SAFTE™-FAST® software application have been evaluated as fatigue risk management tools in a variety of operational settings (Gertler, Hursh, Fanzone, Raslear, & America, 2012; S. R. Hursh, Balkin, et al., 2004; S. R. Hursh et al., 2006; S. R. Hursh, Redmond, et al., 2004; Roma et al., 2012; Schwartz et al., 2021). More information about SAFTE-FAST can be found at https://saftefast.com.
17. How is this tool different from the SAFTE-FAST software?
a. This webtool is a free and publicly-available tool based on a biomathematical fatigue model designed specifically for the EMS community to help agencies create and evaluate work schedules that can help minimize the effects of fatigue. The webtool is limited in its ability to predict risk based on previous data about sleep and fatigue that has been collected from EMS personnel. SAFTE-FAST is a licensed software application. More information about SAFTE-FAST can be found in FAQ #16 or at https://saftefast.com.
18. Why isn’t the tool working when I access it from a Mac device using the Safari browser?
a. The EMS fatigue risk analyzer tool is not supported by all browsers on all platforms. If you are trying to access the tool using a Mac or iOS device, please try Chrome, Firefox, Microsoft Edge, or Internet Explorer browsers for best results.