Article Text

Download PDFPDF
Effects of sleepiness on clinical decision making among paramedic students: a simulated night shift study
  1. Danielle Bartlett1,2,
  2. Sara Hansen2,
  3. Travis Cruickshank1,2,3,
  4. Timothy Rankin4,
  5. Pauline Zaenker1,2,
  6. Gavin Mazzucchelli2,
  7. Matthew Gaston2,
  8. Dirk Du Plooy2,
  9. Zahed Minhaj2,
  10. William Errey2,
  11. Tyron Rumble2,
  12. Taylor Hay2,
  13. Alecka Miles2,
  14. Brennen Mills2
  1. 1 Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
  2. 2 School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  3. 3 Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
  4. 4 Centre for Sleep Science, Faculty of Science, University of Western Australia, Crawley, Western Australia, Australia
  1. Correspondence to Dr Danielle Bartlett, Edith Cowan University, Joondalup, WA 6027, Australia; d.bartlett{at}


Objective Paramedics are at the forefront of emergency healthcare. Quick and careful decision making is required to effectively care for their patients; however, excessive sleepiness has the potential to impact on clinical decision making. Studies investigating the effects of night shift work on sleepiness, cognitive function and clinical performance in the prehospital setting are limited. Here, we aimed to determine the extent to which sleepiness is experienced over the course of a simulation-based 13-hour night shift and how this impacts on clinical performance and reaction time.

Methods Twenty-four second year paramedic students undertook a 13-hour night shift simulation study in August 2017. The study consisted of 10 real-to-life clinical scenarios. Sleepiness, perceived workload and motivation were self-reported, and clinical performance graded for each scenario. Reaction time, visual attention and task switching were also evaluated following each block of two scenarios.

Results The accuracy of participants’ clinical decision making declined significantly over the 13-hour night shift simulation. This was accompanied by an increase in sleepiness and a steady decline in motivation. Participants performed significantly better on the cognitive flexibility task across the duration of the simulated night shift and no changes were observed on the reaction time task. Perceived workload varied across the course of the night.

Conclusion Overall, increased sleepiness and decreased clinical decision making were noted towards the end of the 13-hour simulated night shift. It is unclear the extent to which these results are reflective of practising paramedics who have endured several years of night shift work, however, this could have serious implications for patient outcomes and warrants further investigation.

  • paramedics
  • clinical management
  • paramedics
  • education
  • performance improvement

Data availability statement

Deidentified data will be made available on reasonable request to the corresponding author.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Deidentified data will be made available on reasonable request to the corresponding author.

View Full Text


  • Handling editor Caroline Leech

  • Contributors SH, AM and BM conceptualised the study, developed the scenarios and were responsible for the running of the study. All authors contributed to data collection and entry. DB, MG, DDP, ZM, WE, TR, TH, AM and BM contributed to the analysis and interpretation of the data. DB wrote the manuscript. All authors contributed to the editing of the manuscript.

  • Funding This work was supported by a Teaching and Learning grant awarded by the Edith Cowan University School of Medical and Health Sciences.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.