SleepTrackTXT Feasibility and Pilot Study

More than half (55%) of Emergency Medical Services (EMS) shift workers report severe mental
and physical fatigue while at work,(Patterson et al, 2012) 36% report excessive daytime
sleepiness,(Pirrallo et al; 2012) and 60% poor sleep quality.(Patterson et al; 2012)
Sleepiness or fatigue while on duty can result in injuries to EMS workers and medical errors
for patients.(Patterson et al; 2012) The investigators' recent research shows that odds of
injury among fatigued EMS workers are 1.9 times higher than non-fatigued workers.(Patterson
et al; 2012) Additional data show that other emergency workers (e.g., emergency physicians
and nurses) are vulnerable to sleepiness and fatigue while at work.(Fisman et al; 2007;
Machi et al; 2012; Thomas et al; 2006; Geiger-Brown et al; 2012).

There are a number of individual and system factors that influence sleepiness and fatigue
during shift work for emergency workers. Individual factors include sleep hygiene, medical
conditions like obstructive sleep apnea, and other factors.(Schaefer et al; 2012; Simon et
al; 2012) System factors include shift length, patient care intensity, and workload. Many
factors are modifiable, yet some are more difficult than others to change or control.
Reducing shift length and customary patterns of shift work, such as 12-hr and 24-hr shifts,
is not feasible for many employers and shift workers in the emergency medicine care setting.
In some locations, >80% of EMS workers hold multiple jobs, 40% work more than 16 shifts per
month, and many accumulate unsafe amounts of overtime in order to make a livable
wage.(Patterson et al, 2010; Patterson et al, 2012; Bauder 2012) Other shift workers in
emergency care settings face the same or similar obstacles as do EMS shift workers.

An objective of this research study is to pilot test real-time assessment of emergency care
worker sleepiness and fatigue. The investigators seek to determine if text-messaging
fatigue-reduction strategies to emergency care workers that report a high-level of
sleepiness or fatigue at the start or during their shift reduces perceived sleepiness or
fatigue at the end of shift. A long term goal of this research is to determine if this
innovative text-messaging tool can be used to reduce the likelihood of fatigue-related
injury among emergency care shift workers.

Aim 1: To determine if real-time assessments of perceived sleepiness and fatigue using
text-messaging impacts a worker's Attitudes, Perceived Norms, Self-Efficacy, Alertness
Habits, Perceived Importance of Fatigue, Knowledge of Sleepiness/Fatigue, and Perceptions of
Environmental Constraints regarding behaviors that can improve alertness during shift work.

Rationale: The investigators recognize that emergency care shift workers hold different
beliefs and attitudes about the risk of sleepiness and fatigue on duty and are at different
stages of adopting risk-reduction behaviors. Behavioral research shows that modifying one or
more of these factors can impact future behavior and potentially reduce risk over the long
term. Approach: The investigators have developed a list of candidate items that
operationalize the Integrative Model of Behavioral Prediction. The investigators will
administer these candidate items at baseline and again at the end of the study period to
assess impact.

Aim 2: To determine if text-messaging emergency care workers fatigue-reduction strategies in
real-time at the start and during shift work reduces worker perceived sleepiness and fatigue
at the end of shift work.

Approach: At baseline, the investigators will randomly assign 100 emergency care workers to
one of two groups (the control group or intervention group). The control group (n=50 / 50%)
will receive standard text-message questions of sleepiness and fatigue at the beginning,
during, and end of shift. The other 50% (n=50) will be assigned to our intervention group
and receive the same text-message questions as the control group, as well as additional
text-messages that include strategies that the investigators hypothesize will lead to a
reduction in perceived sleepiness or fatigue at the end of shift work. With 100 EMS workers
(50% intervention / 50% control), the investigators have 80% power to detect a difference
(effect size of 0.78) in the self-reported fatigue levels reported at the end of shift by
the control and intervention groups. The investigators will collect data over a 90-day study
period.

Eligibility Criteria include:

1. The study subject must be 18 years of age or older;

2. The study subject must currently work in the emergency medicine setting as an emergency
physician, emergency nurse, or emergency medical technician (EMT) / paramedic worker;

3. The study subject must work shifts as part of your employment in the emergency medicine
setting;

4. The study subject must have a cell-phone / smartphone that can receive and send
text-messages;

5. The study subject must be willing to take part in a research study where he/she is
required to send and receive multiple text-messages at the start, during, and end of
scheduled shift work?

Inclusion Criteria:

1. Are 18 years of age or older;

2. Currently work in the emergency medicine setting as an emergency physician, emergency
nurse, or emergency medical technician (EMT) / paramedic worker;

3. Currently working shifts as part of your employment in the emergency medicine
setting;

4. Have a cell-phone / smartphone that can receive and send text-messages;

5. Willing to take part in a research study where you are required to send and receive
multiple text-messages at the start, during, and end of your shift work?

Exclusion Criteria:

1: Those that do not meet inclusion criteria.