Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

Martin-Gill, Christian; Higgins, J. Stephen; Van Dongen, Hans P.A.; Buysse, Daniel J.; Thackery, Ronald W.; Kupas, Douglas F.; Becker, David S.; Dean, Bradley E.; Lindbeck, George H.; Guyette, Francis X.; Penner, Josef H.; Violanti, John M.; Lang, Eddy; Patterson, P. Daniel · 2018 · ROSA P / Taylor & Francis

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Summary

This paper addresses the critical need for standardized performance measures to facilitate the implementation and evaluation of evidence-based guidelines (EBGs) for fatigue risk management in Emergency Medical Services (EMS). Motivated by the recognition that EBGs often fail to achieve their intended impact without concrete tools for dissemination and assessment, the authors sought to develop specific metrics linked to five previously established recommendations for mitigating fatigue among EMS personnel. The work was supported by the National Highway Traffic Safety Administration and aimed to bridge the gap between guideline development and practical application in prehospital care settings. The study employed a cross-sectional survey design involving an expert panel associated with the Fatigue in EMS Project. Two investigators drafted initial performance measures corresponding to the five guideline recommendations, which were then refined through iterative editing via conference calls and email. To quantify consensus, the panel used an anonymous web-based tool to rate the clarity and relevance of each draft measure on a 4-point scale. The researchers calculated the Content Validity Index (CVI) for both clarity and relevance, establishing an a priori threshold of ≥0.78 to signify agreement. This rigorous process ensured that the final measures were intelligible, relevant to the EMS community’s values and resource constraints, and aligned with the underlying systematic review findings. The panel reached agreement on all five performance measures in a single round of voting, exceeding the CVI threshold. The resulting measures include: (1) the demonstrated use of reliable fatigue or sleepiness survey instruments to monitor personnel at least quarterly; (2) the percentage of all shifts shorter than 24 hours in duration, with contiguous shifts counted as a single period; (3) the percentage of shifts where personnel have access to caffeine as a countermeasure; (4) the percentage of extended (≥12 hours) or overnight shifts where personnel are provided access and permission to nap; and (5) the percentage of personnel who have received fatigue risk management education during new employee orientation and within the previous two years. The authors also provided detailed implementation guidance for each measure, such as recommending random sampling for surveys to reduce burden and noting that caffeine access does not require free provision, only availability. The significance of this work lies in providing EMS stakeholders with a practical framework to operationalize fatigue risk management guidelines. By defining clear, measurable goals, the study facilitates the evaluation of whether guidelines are being executed as intended and whether they are improving safety outcomes. The authors conclude that these performance measures, accompanied by an implementation checklist, will help EMS agencies integrate fatigue mitigation strategies into daily operations, thereby enhancing the safety of clinicians, patients, and the public. This approach addresses a common barrier to EBG adoption by offering specific tools that translate evidence-based recommendations into actionable administrative policies.

Key finding

An expert panel validated five performance measures for EMS fatigue risk management, achieving consensus on their clarity and relevance through a Content Validity Index score of at least 0.78.

Methodology

survey

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

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