The website of the ICOH Committee on Shiftwork and Working Time, a committee of the International Commission on Occupational Health (ICOH)

Technical Documents and Downloads

Evidence-based guidelines for managing fatigue in EMS operations

Shift work and extended work hours, and attendant reductions in alertness and safety, are a persistent problem for emergency medical services (EMS) personnel who are tasked with delivering acute care under significant pressure. Over the past 2 years, the "Fatigue in EMS" project sponsored by the U.S. National Highway Traffic Safety Administration (NHTSA) has produced a set of systematic reviews and evidence-based guidelines for managing fatigue in EMS operations. 

The new, evidence-based guidelines aim to mitigate the effects of fatigue in EMS by addressing the impact of shift work and scheduling. The guidelines provide five specific recommendations:
- Use of fatigue/sleepiness surveys to measure and monitor EMS personnel fatigue.
- Limit EMS shifts to less than 24 hours in duration.
- Give EMS personnel access to caffeine to help stave off fatigue.
- Allow EMS personnel the opportunity to nap while on duty.
- Provide education and training in fatigue risk management to EMS personnel.

Under the leadership of Dr. Daniel Patterson at the University of Pittsburgh, the project has led to a series of publications, brought together in a special supplement of the journal Prehospital Emergency Care. Open access to the special issue can be found here:

The Standard Shiftwork Index (SSI)

You can download the the Standard Shiftwork Index (SSI) (.doc) and a brief manual (.doc) which describe the source of the various scales, their scoring, etc. A paper that describes the SSI in greater detail is:

Barton, J., Costa, G., Smith, L., Spelten, E., Totterdell, P. & Folkard, S. (1995) The Standard Shiftwork Index: A battery of questionnaires for assessing shiftwork-related problems. Work and Stress. 9, 3-30.

You can also download an abridged version of the SSI, the Survey of Shiftworkers (SOS), which excludes some of the less sensitive scales and the individual difference measures, but also includes some additional measures. The main additional measures are the retrospective ratings of alertness which are described in detail in:

Folkard, S., Spelten, E., Totterdell, P., Barton, J. & Smith, L. (1995) The use of survey measures to assess circadian variations in alertness. Sleep. 18, 355-61.

You are welcome to use either or both of these questionnaires in any non-profit-making research. The only thing we would ask is (i) that you acknowledge their source in any resultant report, and (ii) that you make copies of any reports resulting from their usage available to other users.

Meta Data

A proposed way to describe shift-schedules and irregular working hours systems as meta data by Dr. Johannes Gaertner and Dr. Simon Folkard. (Download PDF)

A proposed Standard for Storing Working-Time and Time related data (Download PDF)

Assoc. Prof. Dr. Johannes GärtnerWHO logo.jpg
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