Sleep Dysfunction, Accidents, and Intent to Leave Among Emergency Medical Services Providers A Cross-Sectional Study
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Abstract
Emergency medical services (EMS) providers operate under occupational conditions that carry substantial risk for sleep disruption and fatigue-related impairment. Extended shifts, overnight assignments, rotating schedules, and secondary employment are structural features of many EMS systems that consistently interfere with adequate sleep. The relationships among sleep quality, daytime sleepiness, sleep disturbance, occupational fatigue, fatigue-related safety outcomes, and workforce retention were examined among a cross-sectional sample of 254 EMS providers. Sleep quality was assessed using self-report measures, daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS), and sleep disturbance was assessed using a sleep disturbance index derived from the Pittsburgh Sleep Quality Index (PSQI). Results indicated that poor sleep quality and fatigue were widespread: 63.7% of participants rated their sleep quality as bad or fairly bad, and 47.6% reported considerable or intense sleepiness while at work. Providers who reported fatigue-related driving accidents or near-miss incidents demonstrated significantly higher ESS scores than those who did not (M = 9.33 vs. 7.28, p = .001, d = 0.49). Regression analyses revealed that sleep variables explained limited variance in intent to leave, though work-related sleepiness approached significance as a predictor of turnover intentions in both models. Shift length emerged as a significant independent predictor of intent to leave EMS (p = .033), with providers working longer shifts reporting lower turnover intentions. Findings suggest that fatigue within EMS extends beyond wellness concerns to carry meaningful implications for operational safety and, to a lesser extent, workforce sustainability.
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