Background Fatigue is a known operational, staff and patient safety risk for emergency services. A fatigue risk management system (FRMS), as is used in other safety-critical industries like aviation and rail, can help manage these risks but are rare in the NHS. A multidisciplinary team that includes experts by experience from patient and staff perspectives aims to develop and usability test a FRMS for the UK NHS ambulance sector.

Methods This study has four work packages: 1) a FRMS co-designed from a systematic assessment of evidence-based strategies to reduce fatigue and promote good sleep, then explored via an online survey and workshops with staff across operations, safety and governance, human resources, and staff wellbeing; 2) semi-structured interviews with senior leaders (e.g. Director level) exploring current approaches to fatigue management and policy and political challenges for change; 3) interviews and observational ethnography on shift including in Emergency Operations Centres in four purposively selected Trusts will capture how fatigue is experienced by front-line staff and patients; 4) implementation guidance will be produced and usability tested. Findings are reported for work packages 1 and 2, with 3 and 4 in progress.

Results Twenty candidate strategies to prevent and manage fatigue were identified, with evidence quality appraised and reported against diversity criteria. These strategies were explored through an online survey (n=22), four workshops, and senior leader interviews (n=12) across 12 UK NHS ambulance services including Northern Ireland, Scotland and Wales. Identified barriers and facilitators, such as resources, staff buy-in, and fit with ways of working, are informing implementation and the next phase of the study.

Conclusion Current operational demands have reinforced the salience of fatigue management. Trusts are keen to expand/consider both established (e.g. evidence-based rotas) and innovative (e.g. dynamic fatigue measurement) strategies, but need credible evidence of operational feasibility and return-on-investment.