Assessment of subjective sleep quality, recovery, and work-related behavior among emergency medical service personnel: a cross-sectional study

Abstract

Background: Emergency medical services (EMSs) play a crucial role in prehospital care. EMS personnels (EMSPs) are frequently affected by sleep disturbances and stress due to irregular shift work and high job demands. However, little research has been conducted into how the behaviour and experiences of individuals in this occupational group influence their sleep quality and recovery. While previous studies have investigated these issues in isolation, little is known about the interaction between sleep quality, recovery, and individual work-related behavior and experience patterns [Germ. arbeitsbezogenes Verhaltens- und Verlebensmuster (AVEM)]. There is a lack of data on how these behavioral patterns influence sleep and recovery in this occupational group, limiting the development of targeted preventive interventions. Our objective is to examine sleep quality, recovery and stress in EMS to provide evidence for the development of preventive measures. Methods: A cross-sectional online survey was conducted from September 2017 to December 2020 among 508 EMSPs in Germany with at least three years of professional experience. Participants completed validated instruments: the Pittsburgh Sleep Quality Index (PSQI), Recovery Stress Questionnaire [Germ. Erholungs-Belastungs-Fragebogen (EBF)], and AVEM. A total of 367 EMSP also answered the Regensburg Insomnia Scale (RIS). Statistical methods included descriptive analysis, a correlation analysis using Spearman’s rho (ρ) and a general linear model (GLM) to assess associations and control for covariates. Results: The EMSP had a mean age of 32.8±9.16 years; 84.6% were male. The majority worked 12-hour shifts. Poor sleep quality (PSQI >5) was observed in 57.5% of participants. While 65% showed health-promoting AVEM patterns (G/S), 35% exhibited risk patterns (A/B) associated with higher stress and impaired recovery. Significant correlations were found between AVEM dimensions and sleep quality (e.g., satisfaction of life ρ =−0.416, P<0.001), strain (e.g., ρ =−0.601, P<0.001), and recovery indicators (ρ =−0.557, P<0.001). The remaining covariates (gender, age, field of work, training, and organisation) did not demonstrate large or medium effects in the GLM analysis. Conclusions: This study identifies meaningful associations between work-related behavior patterns, sleep, and recovery in EMSP. Although causal interpretations are limited by the cross-sectional design, the findings highlight the potential of behavioral screening for early risk detection. Future research should investigate these aspects further and include objective measures.