Emergency Medical Services

The care and transport of patients outside of the hospital is the responsibility of tens of thousands of professionals in over 2,000 Emergency Medical Services (EMS) agencies and even more first responder systems across the United States. EMS is one pillar of public health and a key asset in the resilience of the public to natural or other disasters, serving as the frontline of emergency care for all conditions and the first point of entry for many patients to the health care system.

We study how to optimally design and deploy EMS agencies, how clinical interventions can best impact patient outcomes, and how EMS personnel can optimally interface as part of integrated health care delivery systems. Through the EMS Evidence-Based Practice Center, a multidisciplinary team with expertise in emergency medicine, prehospital emergency care, clinical research, public health, epidemiology, biostatistics, and library sciences performs systematic review and meta-analyses to aid the decision-making of EMS medical directors, administrators, and clinicians. 

Our research portfolio spans the full spectrum of EMS operations and workforce wellness. Through the EMS Agency Research Network, a five-year project supported by the Center for Leadership, Innovation, and Research and the Pittsburgh Emergency Medicine Foundation, we explored patient adverse events, safety culture, fatigue and sleep, teamwork, and employee turnover. Our work provides evidence-based guidance on critical operational questions, from optimal shift lengths and napping policies to fatigue risk management and workplace safety culture, while advancing the science of prehospital emergency care delivery.

Select Work

Does night shift work affect endothelial function in EMS workers?

We conducted a scoping review examining the acute effects of night shift work on endothelial function with and without naps, identifying gaps in knowledge and opportunities for intervention to protect cardiovascular health.

What masking policies should healthcare and public safety workers follow in non-patient care areas?

We systematically reviewed evidence on masking by healthcare and public safety workers in non-patient care areas to mitigate SARS-CoV-2 infection, informing policy decisions during the COVID-19 pandemic.

What is the optimal nap duration for night shift workers?

We conducted a systematic review of experimental studies comparing brief (≤30 minutes), moderate (31-60 minutes), and long duration (61+ minutes) naps, providing evidence to guide napping policies in EMS and similar shift work settings.

How does shift work impact blood pressure in EMS clinicians?

We performed a systematic review and meta-analysis examining the impact of shift work on blood pressure among EMS clinicians and related shift workers, quantifying cardiovascular risks associated with shift work patterns.

Can "banking" or extending sleep before shifts mitigate fatigue?

We systematically reviewed evidence on whether pre-shift sleep extension by shift workers can mitigate fatigue or improve health, safety, and performance outcomes.

What is the state of fatigue risk management in EMS?

We documented the absence and need for fatigue risk management in EMS through national assessment, establishing the foundation for evidence-based guideline development.

Do naps during shifts improve performance and reduce sleepiness in EMS personnel?

We conducted a systematic review and meta-analysis of napping during shift work, quantifying effects on sleepiness and performance in EMS personnel and similar shift workers.

Which survey instruments reliably measure work-related fatigue in EMS?

We systematically reviewed the reliability and validity of survey instruments to measure work-related fatigue in the EMS setting, identifying validated tools for research and operational use.

Should EMS agencies use shorter or longer shift durations?

We systematically reviewed evidence comparing shorter versus longer shift durations to mitigate fatigue and fatigue-related risks in EMS personnel, informing scheduling decisions.

Does caffeine improve performance in fatigued shift workers?

We conducted a systematic review and meta-analysis of caffeine effects in fatigued shift workers, with implications for EMS personnel seeking fatigue countermeasures.

Can fatigue training improve safety outcomes in EMS?

We performed a systematic review and meta-analysis examining the effect of fatigue training on safety, fatigue, and sleep in EMS personnel and other shift workers.

Do fatigue models improve EMS operations?

We systematically reviewed whether implementation of biomathematical models can mitigate fatigue and fatigue-related risks in EMS operations.

Can task load interventions reduce fatigue in EMS personnel?

We systematically reviewed the effect of task load interventions on fatigue in EMS personnel and other shift workers, identifying strategies to optimize workload.

What evidence-based guidelines should guide EMS fatigue risk management?

We developed comprehensive evidence-based guidelines for fatigue risk management in EMS through systematic reviews funded by NHTSA and NASEMSO, with proposed performance measures and implementation strategies.

What is the state of workplace safety culture in EMS?

We developed and validated the Emergency Medical Services Safety Attitudes Questionnaire, documenting variation in EMS workplace safety culture and associations between safety culture and safety outcomes.

How do sleep quality and fatigue affect EMS provider safety?

We characterized sleep quality and fatigue among prehospital providers and demonstrated associations between poor sleep, fatigue, and safety outcomes in EMS, establishing the case for fatigue risk management interventions.

What is the relationship between shift length, fatigue, and safety in EMS?

We examined the complex relationships between shift length, fatigue, and safety in EMS, identifying trade-offs and considerations for optimal scheduling policies.

What drives turnover in EMS and what are the costs?

We conducted a longitudinal study of turnover and the cost of turnover in EMS, quantifying the financial impact and identifying factors that influence workforce retention.

How does partner familiarity affect teamwork in EMS?

We documented variation in Emergency Medical Technician partner familiarity and developed validated measures of teamwork and conflict among EMS personnel, establishing the importance of crew resource management.

How can we measure adverse events in EMS?

We established content validity for measuring adverse events in both ground and helicopter EMS, developing and validating the EMS Provider and Patient Safety Inventory Tool to identify safety concerns in prehospital care.

Investigators with this Research Interest