P026 Causes and consequences of paramedic fatigue and sleep loss

Introduction Fatigue and sleep loss are prevalent among paramedics, creating challenges for clinical performance, safety, and worker well-being. Shift work exposure, high workload, and the demanding and complex nature of paramedic work likely play a role, however an in-depth understanding of contributing factors and their impacts is limited. Through a systems-thinking lens, we explored the experience of fatigue and sleep loss from the paramedic perspective, to characterise the causes and consequences. Methods Based on a qualitative design, semi-structured interviews were conducted with thirty Australian paramedics (31.0 ± 5.4 years). A scenario invention task was included, facilitating rich descriptions of fatigue and sleep loss experiences in challenging workplace contexts. Conventional content analysis was utilised to analyse data inductively. Results Paramedics connected fatigue and sleep loss to system-wide causes, including paramedic work factors (driving, unqualified partner) (30%), static and dynamic shift factors (on-call, no breaks) (30%), ambulance demand/workload and healthcare system constraints (ramping) (21%), personal vulnerabilities (job stress, preparedness) (15%), and family responsibilities (5%). Perceived consequences included impaired clinical performance and patient-centred care (39%), diminished safety (8%), and poor paramedic mental and occupational well-being (emotional dysregulation/distress, job dissatisfaction) (51%) creating workforce sustainability and service delivery issues through absenteeism and attrition. Conclusion Findings highlight system-wide factors contributing to paramedic fatigue and sleep loss, with implications for patient and worker safety, service delivery, and paramedic well-being. Multi-level approaches may be required for effective support and management. Key targets include additional supports for paramedics working without a paramedic partner, and appropriate shift scheduling and organisational break policies.