Transition to shift work: Sleep patterns, activity levels and physiological health of early-career paramedics

Introduction:

The physiological impact of transitioning from full-time study to work in occupations that involve high-stress environments and shift work may plausibly impact sleep patterns and quality. There are limited studies focusing on the transition to shift work in graduate paramedics.

Objective:

This study aimed to assess early metabolic markers of health, activity and sleep quality during the first 5 months of rostered shift work in a cohort of 28 graduate paramedics.

Method:

Participants were tested for 4-week blocks before starting shift work (baseline), and during their 1^st and 5^th month of shift work. In each block, sleep and activity levels were monitored on workdays and non-working days using a wrist-worn actigraph. Health and wellbeing assessments were also conducted at regular intervals across the study protocol.

Results:

The number of sleep episodes, overall sleep quantity and self-reporting of poor sleep quality increased during shift work, however sleep efficiency did not differ significantly. All sleep metrics recorded during non-work days were not different to baseline with exception of the night before returning to work, for which reduced sleep duration was recorded. Sedentary behaviour increased across the study, attributable to a decline in light exercise. No significant changes occurred in vigorous physical activity, average steps recorded per day, fasting blood glucose levels, systolic and diastolic blood pressure or participants’ weight, however waist circumference did increase significantly. 

Conclusion:

Results of this study may indicate that early risk factors for major medical conditions are presenting in the first six months of ambulance work, warranting further large-scale and longitudinal studies to gauge implications for paramedic health. The alterations to sleep patterns observed for paramedics commencing their employment may merit a range of changes, including training around sleep habits, health advice and a review of rostering and shift practices.

Jason Betson – Bio information:

Employment

Australian Catholic University (ACU) - Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine (Melbourne Campus)

• Senior Lecturer / Course Coordinator (CC): Bachelor of Paramedicine (Melbourne Campus), September 2019 - Present
• National Course Coordinator (NCC): Bachelor of Paramedicine (Professional Entry), September 2018 - Present
• Lecturer (Level B): Bachelor of Paramedicine (BP), April 2014 - Present

Ambulance Victoria (AV) - People and Culture

• Coordinator, Multicultural Employment Program, January 2019 - July 2019

Ambulance Victoria (AV) - Clinical Delivery

• Advanced Life Support Paramedic, April 2006 - Present
• Emergo Trainer, Emergency Management Unit, 2018 - Present
• Manual Handling Facilitator, Health and Safety Unit, 2019 - Present
• Graduate Study Day Facilitator, Clinical Education, 2019 - Present

Education

Doctor of Philosophy (commenced), University of Southern Queensland, 2021-current

Master of Medical Science (Research), University of Tasmania, 2019.

Diploma of Paramedic Studies, Monash University, 2009.

Graduate Diploma of Education, Latrobe University, 2002.

Bachelor of Applied Science, University of Ballarat, 1997.

Conference presentations:

Betson, J. Adaptation to shift work by Graduate Paramedics in Victoria. Oral presentation - EMS Conferences Australia: August 2019, Bali, Indonesia.

Betson, J, Kirkcaldie, M, Edwards, D & Dwyer, RM. Sleep Patterns and Physiological markers of stress in Graduate Paramedics. Poster presentation - UTAS Research Week: September 2015, UTAS Hobart Campus.

Journal publications:

Manuscript accepted by Sleep Health (pre-publication):

Betson, J, Kirkcaldie, M, Zosky, G & Ross, RM. Transition to shift work: Sleep patterns, activity levels and physiological health of early-career paramedics.

Research Interests:

During my extensive experience as a paramedic working rotational shift work, I feel that shift work has altered my sleep patterns. I have identified a gap in the literature regarding the effects of shift work on graduate paramedics. My area of interest is how this impacts the health of the paramedic in the acute phase and potentially as a chronic condition. My broader research interests are centred on investigating the effects of shift work on new recruits, a field that has historically lacked innovative research.

Along with a colleague, I was awarded a Teaching Development Grant for $6000 to undertake a project titled "The quality of sleep in final year Paramedicine students". This grant evolved into a major research interest for me. My Masters research project, completed in 2020, was the first quantifiable investigation of sleep and health of graduate paramedics from anywhere in the world. 

My continued passion for research saw me commence a PhD study in semester 1 of 2021. This project is focused on improving undergraduate paramedicine education by providing avenues for students to adopt a challenge appraisal of high acuity simulations. This contemporary project will be supervised by highly experienced experts in the fields of psychology and curriculum development.