The Sleep Health and Fatigue Education Program for the Administrators of Emergency Medical Services Agencies

Poor sleep and fatigue are widespread among first responder personnel such as EMTs and paramedics. Prior research shows that greater than 80% of frontline EMS personnel report fatigue. Unfortunately, there is no gold standard education program specifically for the administrators of EMS / first responder operations that raises awareness of current evidence based guidelines for sleep health and fatigue risk management.

The investigators aim to pilot test an education program specifically designed for employers (administrators) of U.S.-based EMS / fire operations. Data from this pilot study will provide much needed data regarding this type of education program and guide future, larger studies focused on poor sleep and fatigue in first responder operations.

A short education program focused on importance of sleep health and fatigue delivered to emergency medical services administrators (EMS Administrator Arm)

Other: Sleep Health/Fatigue Education Program

Frontline EMS personnel employed at EMS agencies where EMS administrators are exposed to the Sleep Health and Fatigue Education Program

Other: Sleep Health/Fatigue Education Program

A short education program focused on importance of sleep health and fatigue delivered to emergency medical services administrators

Time frame: At baseline and at 6-9 months follow-up

A single question: "Did participant's EMS agency create a new or change an existing policy after watching the CODE3 Sleep \& Fatigue in EMS Program? \_\_Yes. \_\_No."

Time frame: At baseline and at 6-9 months follow-up

Sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) among frontline EMS personnel. The PSQI solicits self-reported responses on 19 survey items that primarily use a Likert type response scale that are weighted using prescribed formulas and reference the prior month. Scores range from 0 - 21 with scores 6- 21 indicating poor sleep quality. A PSQI score decrease \> = 3 points is considered clinically meaningful and associated with a reduction in signs and symptoms of poor sleep.

Time frame: At baseline and at 6-9 months follow-up

Sleep health as measured by the RU-SATED survey instrument (Regularity, Satisfaction, Alertness, Timing, Efficiency, and Duration). The survey solicits self-reported responses on a Likert type response scale to 6 items that reference the prior month. Six items, each scored 0-2. Response of 0 = Never/rarely; 1 = Sometimes; 2 = Usually/always. Total score = sum of six items. There are no universally established clinical cut points for the RU-SATED; however, higher scores suggest good sleep health.

Time frame: At baseline and at 6-9 months follow-up

Daytime sleepiness is measured with the Epworth Sleepiness Scale (ESS). The ESS solicits self-reported responses on a Likert type scale to 8 items. Items are scored using a prescribed algorithm with scores ranging from 0 - 24. Higher scores indicate greater daytime sleepiness. A score decrease of \> = 2 points is considered clinically meaningful and associated with a reduction in signs and symptoms of daytime sleepiness.

Time frame: At baseline and at 6-9 months follow-up

Fatigue (mental and physical) is measured with the Chalder Fatigue Questionnaire (CFQ). The CFQ solicits self-reported responses on a Likert type response scale to 11 survey items. One approach to scoring includes: Less than usual = 0; No more than usual = 1; More than usual = 2; Much more than usual = 3. The more commonly used approach to scoring (bimodal approach) includes: Less than usual = 0; No more than usual = 0; More than usual = 1; Much more than usual = 1. Scores \> = 4 suggest severe mental and physical fatigue.

Time frame: At baseline and at 6-9 months follow-up

Chronic fatigue (CF) is measured with the CF sub-scale survey instrument of the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Responses for the CF sub-scale are solicited for 5 items using a Likert response scale: 0 = strongly disagree to 6 = strongly agree. Scoring involves summing the 5 items, dividing by 30 and then multiplying by 100. Scores range from 0 to 100. Final scores 0 - 25 suggest Low CF; scores 26 - 50 suggest Low to Moderate CF; scores 51 - 75 suggest Moderate to High CF; scores 76 to 100 suggest High CF.

Time frame: At baseline and at 6-9 months follow-up

Acute fatigue (AF) is measured with the AF sub-scale survey instrument of the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Responses for the AF sub-scale are solicited for 5 items using a Likert response scale: 0 = strongly disagree to 6 = strongly agree. Scoring involves summing the 5 items, dividing by 30 and then multiplying by 100. Scores range from 0 to 100. Final scores 0 - 25 suggest Low AF; scores 26 - 50 suggest Low to Moderate AF; scores 51 - 75 suggest Moderate to High AF; scores 76 to 100 suggest High AF. Two items of the AF sub-scale are reverse scored/coded.

Time frame: At baseline and at 6-9 months follow-up

Intershift Recovery between shifts (IR) is measured with the IR sub-scale survey instrument of the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Responses for the IR sub-scale are solicited for 5 items using a Likert response scale: 0 = strongly disagree to 6 = strongly agree. Scoring involves summing the 5 items, dividing by 30 and then multiplying by 100. Scores range from 0 to 100. Final scores 0 - 25 suggest Low IR; scores 26 - 50 suggest Low to Moderate IR; scores 51 - 75 suggest Moderate to High IR; scores 76 to 100 suggest High IR. Three items of the IR sub-scale are reverse scored/coded.

The CODE3 First Responder Sleep Health Program