Final Project

Establishing the prevalence of fatigue in frontline ambulance service personnel in the United Kingdom

Across the globe it is widely documented that paramedics experience high levels of fatigue and this has been shown to negatively impact on the incidence of clinical errors, driving safety, clinician injury and staff burnout. With little UK based research identified, this project set out to establish the prevalence of fatigue in a small sample of frontline ambulance service personnel within the UK to determine whether the findings are comparable to other countries. Several potential fatigue influencing factors were identified which could be used to better target fatigue management measures.

Emergency ambulances (Source: original image)
Clinical grade of participants


A mixed methods approach was adopted for this study. Participants (n=15) recorded their sleep habits, shifts and twice-daily fatigue scores across a two-week period. Additionally, a sub-sample (n=4) were interviewed to gain a deeper understanding of their experiences of fatigue whilst working for an ambulance service in the UK.

Participants were of four clinical grades: emergency care assistant (ECA), newly qualified paramedic (NQP), paramedic and trainee specialist paramedic (trainee SP).

The mean age of participants was 40.73 years and mean length of service 9.59 years.

Quantitative results

  • Night shifts (starting from 18:00) were found to be the most fatiguing shift type compared to day shifts (starting before 10:00) or late shifts (starting between 10:00 – 17:59).
  • On average, fatigue levels were highest in the NQP and lowest in ECAs.
  • The lowest total sleep duration recorded was just 70 minutes between a rest day and a day shift.
  • The most fatiguing type of work was found to be where participants had a roughly equal split of time between attending incidents and holding at hospital, whilst the least fatiguing type of work was when participants were holding outside hospital for the majority or whole duration of their shift.
Distribution of fatigue scores by shift type
Word cloud produced from the interview transcripts

Qualitative results

Thematic analysis identified eight key themes:

  • Impacts of shift work (e.g. lack of routine and reduced time with family).
  • Impacts of fatigue (e.g. reduced concentration levels, compassion fatigue and safety concerns around driving and micro sleeps).
  • Impacts on fatigue (e.g. mental stimulation, shift type and lack of sleep).
  • Management of fatigue (e.g. use of caffeine, napping and prioritisation of sleep).
  • Shift planning (e.g. the advantages and disadvantages of full time relief compared with following a rota).
  • Rest periods (e.g. the minimum required length).
  • Comparison to other industries (both with and without shift work).
  • Suggested improvements to reduce fatigue levels.
Variation in fatigue levels (source: original image)


It can be summarised that the ambulance service personnel within this study were moderately fatigued and often experience peaks of high fatigue due to their work. Night shifts were found to be the most fatiguing shift type, however this could be contributed to by cumulative fatigue across the cycle of shifts as night shifts are usually the final shift type in a rotational shift pattern.

Whilst age and years of service have been identified as predictors of fatigue in previous studies, no significant correlations between these factors were observed. However, it must be noted that the small sample size of this research may contribute towards a type 2 error. Clinical grade has been identified as a potential predictor of fatigue in this study with ECAs having the least clinical responsibility amongst participants and the lowest fatigue levels, however this finding is again limited by the small sample size and unequal numbers of participants of each clinical grade.

Rapid response vehicle (source: original image)

Real world implications

The findings from this study suggest that like emergency medical services across the globe, ambulance service personnel in the UK experience high levels of fatigue, with resultant negative implications for staff, their families, and patients alike.

Further research is required to determine causality between
shift type, type of work and clinical grade as potential fatigue-influencing factors.

By gaining a more thorough understanding of fatigue-influencing factors, it would enable fatigue management approaches to be better targeted.

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  • BSc (Hons) Paramedic Practitioner (2020)


  • >3 years post-registration experience working as a paramedic.
  • Current employment: Trainee Human Factors Health and Safety Specialist.

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