EMS Shift Work Project

Poor sleep health and fatigue are common among EMS clinicians and other first responders, contributing to increased risk of cardiovascular disease, impaired performance, and safety concerns. Pitt EMS faculty lead numerous projects addressing the impact of shift work on the health and safety of emergency care workers, with a focus on understanding mechanisms of risk and developing evidence-based interventions.

Our work recognizes that shift work creates unique physiological challenges, including blunted blood pressure dipping, endothelial dysfunction, and chronic sleep deprivation. Through experimental and observational studies, we have characterized the cardiovascular impact of night shift work and evaluated strategies for fatigue mitigation, including napping protocols of varying durations. We conducted the landmark Emergency Medical Services Sleep Health Study, a cluster-randomized trial that established the foundation for evidence-based fatigue risk management in EMS.

Building on this foundation, we developed Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services through systematic reviews and meta-analyses funded by the National Highway Traffic Safety Administration (NHTSA) and the National Association of State EMS Officials (NASEMSO). Our ongoing research extends this work by examining barriers EMS administrators face in implementing fatigue mitigation strategies, assessing long-term cardiovascular outcomes in shift workers, and evaluating novel interventions to improve the health and safety of emergency care personnel.

Current Studies

CODE 3: First Responder Sleep Health

Poor sleep health and fatigue are common among EMS clinicians and other first responders. Chiefs, Directors, Deputy Chiefs, Supervisors, and other Administrators of EMS operations face numerous challenges when it comes to addressing the sleep health and fatigue of frontline personnel. The purpose of this research study is to identify the barriers EMS Administrators experience so a NEW program can be created to help administrators. We are seeking the feedback and opinions of EMS Administrators (and frontline personnel). We want to hear from YOU! We want to know about your experiences and hear your opinions. We want to hear from Urban and Rural EMS Administrators and frontline personnel. We want to hear from Administrators and frontline personnel from all four U.S. Census Regions (Midwest, Northeast, South, and West). Participants are remunerated for their time. Participation is completely voluntary. This research study is supported by the American Academy of Sleep Medicine Foundation.

Principal Investigator: Daniel Patterson, PhD, MS, MPH, NRP

Observational Study of Shift Work and Arterial Stiffness

Investigators at the University of Pittsburgh's Department of Emergency Medicine are conducting a research study to improve our understanding of the association between shift work and cardiovascular health. Our ultimate goal is to enroll up to 100 total EMS and other healthcare shift workers. Each participant will be asked to visit our lab on the University of Pittsburgh Main Campus (Iroquois Building) and spend about 1-hour answering survey questions and having their arterial stiffness assessed with a non-invasive short test. In a cohort sub-study, we will approach up to 50 EMS shift workers to determine if they would agree to coming back to our lab and doing additional assessments in the future (every 6 months). We are recruiting public safety EMS shift workers and different types of healthcare clinician shift workers residing in and/or working in Western Pennsylvania. All participants will receive $50 dollars of remuneration and a parking voucher.

Principal Investigator: Daniel Patterson, PhD, MS, MPH, NRP

Sleep-Vibe Study

The Sleep-Vibe Study examines the impact of long duration shifts and sleep loss on cardiovascular health and performance. Participants are asked to complete two, 34-hour sessions in our applied physiology lab, which include a simulated 24-hour shift with 30-minute nap, and 5-hour recovery nap after the simulated shift. Participants can receive up to $1,500 in remuneration. This study was approved by the University of Pittsburgh IRB and is registered with clinicaltrials.gov (NCT06665672).

Download Study Flyer (PDF)

Principal Investigator: Daniel Patterson, PhD, MS, MPH, NRP

Recent Work

Does blunted blood pressure dipping during night shift work increase cardiovascular risk?: We propose that blunting of normal blood pressure dipping patterns is a clinically meaningful mechanism linking night shift work to increased cardiovascular disease risk, and represents an understudied target for intervention.
Can brief naps during night shifts improve endothelial function?: We demonstrated the feasibility of using peripheral arterial tone devices to assess endothelial function during simulated night shift work, with findings showing that brief nap opportunities may impact vascular health.
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-based guidance for napping policies in EMS organizations.
How do naps during night shifts affect blood pressure and cardiovascular health?: We tested the impact of 30-minute versus 2-hour nap opportunities during simulated night shifts, characterizing effects on blood pressure, post-shift performance, sleepiness, mood, and recovery sleep to inform optimal napping strategies.
What are blood pressure patterns in EMS night shift workers?: We used ambulatory blood pressure monitoring to characterize BP patterns during work and non-work periods in EMS night shift workers, establishing feasibility and identifying clinically relevant changes associated with shift work.
Can sleep health education improve EMS clinician sleep quality and fatigue?: We conducted a cluster-randomized trial evaluating the impact of sleep health education and training on EMS clinician sleep quality and fatigue, supported by NHTSA and NASEMSO.
What evidence supports fatigue risk management strategies in EMS?: We developed comprehensive evidence-based guidelines through seven systematic reviews and multiple meta-analyses, providing freely available resources at www.emsfatigue.org to support EMS administrators and clinicians.