29096 Pendragon Paramedic - Alan M. Battalanbatt.net/wp-content/uploads/2014/10/201603-Kent-Eat-Sleep-Be... · FebruaryMarch 2016 31 Introduction We live in a world that doesn’t

Publications Mail Agreement No. 40007174

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The Voice ofCanadian Paramedicinefor 38 YearsPublisherLyle Blumhagen: [email protected]

Editor in ChiefMichael Nolan:[email protected]

Contributing WritersMichael Adair Ahmed Al-HajenAlan Batt Dale BaylissDavid Cooper Ben CorriganDr. James Crane Fergal CumminsCarmen D’Angelo Deam DiMonteDr. Steven Fischer Jennifer GreeneJudah Goldstein Natalie HarrisTracey Howarth Grainne KentWendy Lund Dr. Renee MacPheeAlex (Sandy) MacQuarrie Paige MasonMichelle Navalta Ron OswaldRyan Sturm Daniel SundahlDr. Andrew Szeto Dr. Walter TavaresTow Walker

Editorial BoardMike Adair Allan BattDale Bayliss Carmen D’AngeloBecky Donelon Judah GoldsteinPeter O’Meara Walter TavaresHeather Verbaas Robin Young

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CANADIAN PARAMEDICINEThe magazine for Canada’s paramedicineprofessions.The opinions and views expressedin this magazine are those of the writers andnot necessarily those of the publisher.

Contents Copyright 2016 By PendragonPublishing Ltd., may not be reprintedwithout permission.

ISSN 1927-6710 (Print)ISSN 1927-6729 (Online)

PUBLICATIONS MAIL AGREEMENT NO.40007174RETURN UNDELIVERABLE CANADIANADDRESSES TO CIRCULATION DEPT.PO Box 579DRUMHELLER AB T0J 0Y0E-mail: [email protected]

FebruaryMarch 2016

Volume 39, No. 2See page 8 for full details on Mr. Sundahl’sgroundbreaking photo art.

Photo by Daniel Sundahl

FeatureSTORIESBETTER MENTAL HEALTH THROUGH PHOTO ART ........................................ 8

PEER SUPPORT IN THE UNITED ARAB EMIRATES ...................................... 10

VICTORIAN AMBULANCE (AUST.) PEER SUPPORT PROGRAM ...................... 12

MINDFUL MEDICS .............................................................................. 14

MENTAL HEALTH APP FOR PARAMEDICS ................................................ 17

PARAMEDICINE AND THE ROAD TO MENTAL READINESS ........................... 18

WINGS OF CHANGE—PEER SUPPORT ................................................... 22

NO, I DIDN’T KNOW ........................................................................... 24

DON’T SWEAT THE SMALL STUFF ........................................................ 26

PAVLOV’S PARAMEDIC ....................................................................... 27

FIRST CANADIAN PARAMEDIC HEALTH AND WELLNESS STUDY ................. 29

EAT, SLEEP AND BE HEALTHY—A GUIDE TO SHIFT WORK .......................... 31

THE VALUE OF SLEEP ........................................................................ 35

DepartmentsRESEARCH UPDATE ........................................................................... 36

SPOTLIGHT ON SCIENCE .................................................................... 40

PARAMEDIC SELF-ASSESSMENT .......................................................... 42

PARAMEDIC SELF-ASSESSMENT ANSWER KEY ....................................... 54

AssociationsPCC HERALDRY GRANT PROJECT ........................................................ 45

PARAMEDIC ASSOCIATION OF MANITOBA .............................................. 47

ONTARIO PARAMEDIC ASSOCIATION ..................................................... 49

Wha

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Publications Mail Agreement No. 40007174

©2015 ZOLL Medical Corporation, Chelmsford, MA, USA. X Series and ZOLL are trademarks or registered trademarks of ZOLL Medical Corporation in the

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31FebruaryMarch 2016

Introduction

We live in a world that doesn’t sleep. Aroundthe clock, there is a need for work to be done,from overnight services in hotels and restaurants,maintaining long-term industrial processes tocontinuous patient care in hospitals, and deliveryof care in the prehospital setting. Shift work isfundamental to the demanding 24/7 practice ofparamedicine. For many paramedics, a busy shiftwithout returning to station is an everyday reality.

Several studies have shown paramedics are at ahigher risk of being overweight, obese and physi-

cally unfit compared to the general population(1,2).This is not a new phenomenon, identified asearly as 1991 in Northern Ireland (3). Paramedicsare also more likely to smoke, have higher bloodpressure and higher cholesterol than the generalpopulation (1–3).This can have a negative impacton clinical care. For example, physical fitness hasbeen identified as an important component inassisting the rescuer to perform adequate chestcompressions during CPR (4,5).

These findings can in part be attributed to shiftwork. Paramedics often find themselves relyingon fast food, snacks and sometimes skipping

meals altogether, as a result of busy shifts andlack of resources. Shift work for paramedics willnot go away, so identifying ways to reduce therisk of adverse health effects should be a priorityfor the paramedic and their service. Healthierlifestyle choices, including healthy eating andincreasing physical activity can help promote thebest possible health in the paramedic.

Defining shift work and its prevalence

Shift work - essentially working outsidethe conventional 8-hour daytime work sched-

EAT, SLEEP AND BE HEALTHYA PARAMEDIC’S GUIDE TO HEALTHIER SHIFT WORK

Grainne Kent RD BSc(Hons.) PGDip(Dietetics)1, Paige Mason BA(Kinesiology)(Hons.)2,

Alan Batt DipEMT GradCertICP MSc(c) CCP2,3

1. National Health Service, United Kingdom. | 2.Fanshawe College, London, Ontario, Canada.3.Centre for Prehospital Research, University of Limerick, Ireland.

PHYSICAL HEALTHPHYSICAL HEALTH


Paramedics

… It Starts With Us

Saskatchewan’sPremier Paramedic Convention

May 9 — 11, 2016Mosaic Place, Moose Jaw, SK

Convention Brochure: [email protected]

Presentations:

Achieve Workshop- Leadership – The Essential Competencies

Nick Thain- The Journey from Leadership Competencies to Competent Leadership

Social Media and Marketing


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ule – is a reality for approximately three in tenCanadians (6). The vast majority of front-lineparamedics work a rotating shift pattern, andthese shifts vary depending on service demandand local agreements. According to Williams(7), the following categories of shift work canbe identified:• regular evening schedules (beginning after

3pm, ending before midnight)• regular night (beginning after 11pm, ending

before 11am)• rotating (day to evening and/or night)• split (two or more distinct work periods

each day)• on call (no pre-arranged schedule) and

irregular shifts (common in newly qualifiedparamedics)

Shift work and adverse health effects

Shift work makes up a large part of work inthe Canadian economy and though the socialand economic necessity of shift work is withoutquestion, it comes at a heavy cost. In 2010, theInstitute for Work and Health (8) researchedthe evidence on the effects of shift work onemployees and it was found that:• Long-term night shift workers probably

have an elevated risk of breast cancer and apotentially elevated risk of colorectal cancer.

• Shift workers are at increased risk of gastro-intestinal disorders, mental health problems(including depression) and preterm deliveryduring pregnancy.

• Shift workers, particularly those working atnight, face a higher risk of getting hurt onthe job than regular day workers.

• Compared with day workers, people whowork night shifts are likely to sleep less and/or more poorly.

• The association between shift work andheart disease is inconsistent.

Research is also ongoing into other areasand compared to individuals who work standardhours, shift workers seem to gain more weightand may be at increased risk of obesity and type2 diabetes (9–11). Disruption of the body’scircadian rhythm is thought to be the mainpathway for adverse health effects from shiftwork, particularly night work (8,11). Workingat night intrinsically goes against the “bodyclock”; a set of physiological fluctuations linkedto sunlight and temperature that occur over the24-hour day (12).

Shift work can also unsettle social andfamily relationships by putting the shift workerout of sync with the daily work and rest patternsof family, friends and the general community.This social disruption can contribute to stressand thereby to adverse health outcomes (8,11).When this is added to the findings from a

2012 study in Ottawa that paramedics havethe highest rate of posttraumatic stress disor-der (PTSD) (13), the potential negative impactof shift work becomes apparent. Shift work hasbeen shown to affect health and well-beingboth physiologically and psychologically, whichcan impact on paramedics’ professional andpersonal lives (14).

Finally, some of these health issues, may bein part related to the impact shift work has onbehaviour and lifestyle choices, such as pooreating habits, poor quality diet or increasedsmoking or alcohol consumption (8,11)

What is healthy eating?

Healthy eating means eating a variety offoods from the four main food groups in orderto feel good and maintain health.The four mainfood groups are:• fruit and vegetables• bread, rice, potatoes and other starchy foods• meat, fish, eggs, beans and other non-dairy

sources of protein• milk and dairy foods and non-dairy alter-

natives

Healthy eating combines eating the righttypes of foods; eating the recommendedamounts of foods for your age, gender andactivity levels; limiting foods and drinks thatare high in sugar, fat and salt with maintaininga good energy balance by keeping as physicallyactive as possible (15,16)

Barriers to healthy eating inparamedicine

Healthy eating may seem less achievableto paramedics working shift patterns. Timeallowed for meals and snacks, availability ofdining facilities while working shifts and accessto “healthy” convenience foods can appear tosupport this point of view. Eating high fat/sugarfoods, in a rush or on-the-go can, however,contribute to gastrointestinal problems, such asconstipation, diarrhea, gas and indigestion.

Such problems may affect the shift workers’appetite as well as the ability to form regular,appropriate eating patterns and may promotereliance on high caffeine foods and drinks forenergy. These dietary habits can perpetuategastrointestinal problems, sleep disturbances andultimately hinder healthy lifestyle practices. Shiftworking generally decreases opportunities forphysical activity and participation in sports (17).

Recommendations for healthy eatingin shift-work

It is difficult to make dietary recommenda-tions for paramedics. It is not known whethershift workers should eat during the night or

not and if nocturnal eating is to be encouraged,there is a significant lack of evidence regardingwhat should be eaten or avoided (18). Given thealtered eating habits as well as the metabolicand endocrine disturbances that occur in shiftworkers, it seems prudent to provide evidence-based nutritional recommendations for thispopulation (17). Current dietary recommen-dations for shift workers are based on healthyeating advice for the general population andthe knowledge of the metabolic consequencesof shift work and therefore tend to promotediurnal eating practices, suggesting eatingmodestly at night.

Practice good sleeping habits

Dietary advice for paramedics should beconsidered in conjunction with appropriatefatigue management strategies (18). The linkbetween sleep and maintaining a healthy weighthas been well documented and a recent updateby Beccuti and Pannain (19) confirms previ-ous findings of an association between sleeploss and an increased risk of obesity. Sleep lossand impairments related to resultant fatigueare common among professionals working inhealthcare settings. Paramedics may have ahigher prevalence of sleep disorders than otherhealthcare professionals, and left untreated,those problems could increase morbidity andmortality and potentially impair professionalperformance (20).

Caffeine consumption should be moder-ated. Drinking coffee, tea and other caffein-ated beverages can help increase alertness butconsuming more than 400mg of caffeine (about4 small cups of regular coffee) a day is notrecommended (21). Caffeine stays in the bodyfor many hours so limiting caffeine intake fouror five hours before the end of shift can helpwith relaxing prior to returning home. Visit theNational Sleep Foundation website listed inthe resource section for further tips on how tomanage shift work, diet, exercise and sleep.

Workplace strategies to promotehealthier lifestyles

Where possible, workplaces should encour-age a nutrition strategy that promotes andprovides healthy food and beverage choices.Foods and drinks should be consumed ina relaxed eating environment (18). Eatingon-the-go encourages mindless snacking.Mindful eating is associated with weight lossand maintaining a healthy weight (22).

Shift schedules should be designed to giveemployees enough time between shifts toenable them to maintain a healthy lifestyle, i.e.to exercise, to maintain regular meal times, toplan meals and snacks for shift working and todevelop sleeping patterns (18).




33FebruaryMarch 2016

Preparation is key

Planning meals around shift work sched-ules is good practice and can help to developa routine and regular eating pattern. Paramed-ics should maintain a normal day-and-nightpattern of food intake as far as possible. The“main meal” of the day should be eaten beforegoing to work. Afternoon workers should havetheir main meal in the middle of the day, ratherthan the middle of their shift. Night workersshould eat their main meal before their shift, atevening-meal time. Eating a large meal duringthe night can cause sleepiness and sluggishnessand can lead to constipation, gas or heartburn.Have a light snack before bedtime to avoidwaking due to hunger. Avoid eating a largemeal one to two hours before sleep, as this cancause difficulty falling asleep (11,18)

Prepare meals for a number of days or morefor quick and easy access. Experiment withslow-cookers or freeze portion sizes of healthymeals. This practice can help avoid the tempta-tion of using convenience foods or orderingtake-away.

Pack healthy snacks, such as prepared fruit(apple slices, banana, orange segments etc.) andeasy-to-eat vegetable pieces like baby carrotsand celery with hummus, or a small containerof mixed unsalted nuts and seeds. It can bedifficult to find healthy snacks during the after-noon and night shifts. Cafeterias are likely to beclosed, and vending machines often only carryhigh calorie drinks and snacks that are high infat/sugar/salt – avoid these, tempting as thoughthey are. A small cooler bag can easily be storedin the cab of most ambulances, response carsand other workspaces, allowing for access tohealthy, pre-prepared foods. See the additionalresources section for more snack ideas foradults.

Planning healthy meals and snacks canhelp to avoid high fat/sugar convenience foods.Avoiding fatty, fried and spicy foods, suchas hamburgers, fried chicken and curries isadvisable to reduce the risk of heartburn andindigestion. Eating too much fat also increasesthe risk of developing heart disease and type 2diabetes. High sugar drinks and food such ascola and chocolate may provide a quick boostof energy but this feeling doesn’t last long.Enjoy nutritious snacks and beverages insteadto stay alert and maintain energy levels (6). Planphysical activity and exercise in advance and inconjunction with meal planning.

Hydration

Drink fluids regularly to help avoid dehydra-tion which can increase tiredness. Keep a waterbottle nearby and sip frequently. Low fat milk,decaffeinated beverages and unsweetenedherbal teas are alternatively suitable. Avoid

drinking alcohol after work and before bed as itcan cause sleep disturbances (6).

Keeping fit

The benefits of physical activity are vast ina wide variety of physical and mental healthaspects. Physical activity has been shown todecrease stress and anxiety, improve endurance,concentration and focus, while boosting moodand energy throughout the day (23). Physicalactivity promotes metabolism, circulation, andefficient sleeping habits.Furthermore, it has beenshown that physical fitness can play an import-ant role in the regulation of circadian rhythmdisturbances that result from shift work (17).

As previously mentioned, shift work is anindependent predictor of increases in bodymass, BMI, prevalance of obesity, and waist tohip ratio (17). A study by Samaha et al. survey-ing nurses who work irregular shift work foundthat a lack of regular exercise and recreationalactivities contributed to chronic fatigue (24).On the other end of the spectrum, physicalactivity has been shown to increase both theduration, and the quality of sleep. Physicalfitness has been shown to increase the amountof slow-wave sleep (SWS) – the phase of sleepthat is responsible for brain restoration andrecovery. Atkinson et al. also found that appro-priately timed exercise can decrease feelings offatigue, tiredness, fogginess, and other shortterm effects of shift work by adjusting circa-dian rhythms and inducing phase delays in thesecretion of melatonin (17). In a simulated shiftwork environment, prior exercise was shownto lower blood pressure throughout a subse-quent night shift in healthy individuals withina normotensive range (25). These findingssuggest that regular exercise may thereforemoderate the association between shift workand raised blood pressure. Moreover, physi-cal activity has been shown to be beneficial byreducing anxiety, providing long term antide-pressant effects, improving quality and durationof sleep, promoting a more favourable circadianphase, and boosting mood and energy (17).

Despite the well known benefits of physi-cal activity, many shift workers find thattheir physical fitness is inevitably pushed tothe bottom of their list of priorities. Severalstrategies for paramedics to improve physicalactivity while battling an irregular scheduleinclude: blocking out a specific pre-shift timefor exercise, focusing on intensity of workoutversus duration, performing simple exerciseson shift, and utlizing external resources thatpromote physical activity.

Exercise can enhance paramedic alertnessat work in addition to increasing neural activ-ity and clinical performance. Blocking out 20minutes (or more) prior to a shift to performphysical activity will boost their mood and

combat fatigue while working. That being said,the best time for paramedics to work out iswhen they feel like it or will commit to actuallygoing, whether it be pre or post shift. Further-more, the goal of exercise must be shifted fromduration to intensity. Circuit weight trainingwill burn more calories than interval training,and significantly more than steady cardiovascu-lar activity (26).

A sample work schedule of four days on/four days off can be complimented with veryintense strength training on the first and thefourth day off, with walks and other recreationalforms of physical activity on work days. Whentime is limited, strength training provides themost “bang for your buck”. No other type ofexercise will see the most results with the leastamount of time spent exercising. Exhausting allmuscle groups (large and small) will burn morecalories during the workout, as well as at rest(27). Squats, deadlifts, overhead presses andpull-ups promote both upper body and lowerbody strength that is imperative in the field ofparamedicine.

Workouts should focus on strength andendurance (increased repetitions and decreasedweight), core stability (planks), rotationalstrength (medicine ball twists), and functionalexercises (cable row combined with squat). Freeweights should be utilized in place of machinesin order to promote the development of stabi-lizer muscles and smaller muscle groups thatare easily injured while on the job.

Simple bodyweight exercises can easilybe performed while on shift, such as squats,walking lunges, stair climbs, and staticstretches. Sitting on an exercise ball while atwork can promote proper posture, core strengthand rotational stability. Furthermore, resistancebands can be utilized efficiently while at baseto develop stabilizer muscles and promote gripstrength. Numerous external resources exist tohelp promote a healthy active lifestyle whilekeeping participants accountable for theirsuccesses and commitments. Several free appli-cations available for iOS and Android are listedin the Resources section.

Conclusion

Shift work can cause adverse health effects,and the nature of paramedic work placesparamedics at a higher risk of unhealthy eatingand poor physical fitness. Healthier lifestylechoices, including increased physical activityand healthy eating can help to reduce the risk ofadverse health effects on paramedics. Paramed-ics need to take responsibility for their healthand practice healthy eating. Employers alsohave an obligation to help paramedics makehealthy eating and physical fitness a priority.




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Resources• EatRight Ontario - www.eatrightontario.ca

o Nutrition Tips for Shift Workers ando Healthy Snacks for Adults

• National Sleep Foundation - https://sleep-foundation.org

• Fitness Apps:o Tabata Timer – 4 mins of exercise at very

high intensity (8 cycles of 20 seconds ofexercise, 10 seconds of rest).

o FitStar – involves workouts that don’trequire any equipment (can be completedat home, at work, or on the run).

o 7 Minute Workout – squeeze in a workoutanytime with a variety of intensity levels.

o JEFIT – detailed instructions, thousandsof routines, workout planner, exercise log,and progress tracker.

Disclaimer

The views and opinions expressed in thisarticle are those of the authors and do notnecessarily reflect the official policy or positionof their employers or organisations.

References

1. Buzga M, Jirak Z, Buzgova R. State ofphysical health and fitness of paramedicsin Czech republic. Wulfenia. 2015;22(3).

2. Tsismenakis AJ, Christophi C a,Burress JW, Kinney AM, Kim M, KalesSN. The obesity epidemic and futureemergency responders. Obesity (SilverSpring). Nature Publishing Group;2009;17(8):1648–50.

3. Gamble RP, Stevens AB, McBrien H,Black A, Cran GW, Boreham CAG.Physical-Fitness and OccupationalDemands of the Belfast AmbulanceService. Br J Ind Med. 1991;48(9):592–6.

4. Lucía A, Heras JF De, Pérez M, ElviraJC, Álvarez AJ, Chicharro JL, et al. TheImportance of Physical Fitness In theclinical investigations in critical careThe Importance of Physical Fitness Inthe Performance of Adequate Cardio-pulmonary Resuscitation *. Chest.1999;115(1):158–64.

5. Gutwirth H, Victoria A, Williams B,Boyle M. CPR compression depth andrate in relation to physical exertion inparamedic students. 2007;4(2).

6. Dietitians of Canada. 10 Nutrition TipsFor Shift Workers [Internet]. 2013 [cited2015 Dec 12]. Available from: http://www.dietitians.ca/Your-Health/Nutri-tion-A-Z/Healthy-Eating/10-Nutrition-Tips-for-Shift-Workers.aspx

7. Williams C. Work-life balance of shift

workers. Stat Canada. 2008;Catalogue(75):5–16.

8. Saunders R. Shift work and health. Insiti-tute for Work and Health. 2010.

9. Antunes LC, Levandovski R, Dantas G,Caumo W, Hidalgo MP. Obesity and shiftwork: chronobiological aspects. Nutr ResRev. 2010;23(01):155–68.

10. Eberly R, Feldman H. Obesity and ShiftWork in the General Population. InternetJ Allied Heal Sci Pract. 2010;8(3):1–9.

11. Wang X-S, Armstrong MEG, Cairns BJ,Key TJ, Travis RC, Nicholson PJ. Shiftwork and chronic disease: the epidemio-logical evidence. Occup Med (Chic Ill).2011;61(6):443–4; author reply 444.

12. European Food Information Council.Shift work: implications for health andnutrition [Internet]. 2012 [cited 2015 Dec12]. Available from: http://www.eufic.org/article/en/artid/Shift-work-implications-for-health-and-nutrition/

13. Drewitz-Chesney C. Posttraumatic stressdisorder among paramedics: exploring anew solution with occupational healthnurses using the Ottawa Charter as aframework. Workplace Health Saf. 2012Jun;60(6):257–63.

14. Sofianopoulos S a, Williams B a, ArcherF a, Thompson BB. The exploration ofphysical fatigue, sleep and Depression inparamedics: A pilot study. J Emerg PrimHeal Care. 2011;9(1).

15. British Dietetic Association. Food FactSheet: Healthy Eating [Internet]. 2014.Available from: https://www.bda.uk.com/foodfacts/HealthyEating.pdf

16. Government of Canada. What is HealthyEating? [Internet]. 2015 [cited 2015 Dec12]. Available from: http://healthycanadi-ans.gc.ca/

17. Atkinson G, Fullick S, Grindey C,Maclaren D. Exercise, energy balanceand the shift worker. Sports Med.2008;38(8):671–85.

18. Lowden A, Moreno C, Holmbäck U,Lennernäs M, Tucker P. Eating and shiftwork - Effects on habits, metabolism, andperformance. Scand J Work Environ Heal.2010;36(FEBRUARY):150–62.

19. Beccuti G, Silvana Pannain. Sleep andobesity. Curr Opin Clin Nutr Metab Care.2011;14(4):402–12.

20. Elliot DL, Kuehl KS. Effects of SleepDeprivation on Fire Fighters and EMSResponders. 2007;i – 95.

21. International Food Information Council.IFIC Review: Caffeine and Health: Clari-fying the Controversies [Internet]. 2014.Available from: http://www.foodinsight.org/Content/3147/Caffeine_v8-2.pdf

22. Olson KL, Emery CF. Mindfulnessand Weight Loss. Psychosom Med.

2015;77(1):59–67.23. De Matos MG, Calmeiro L, Da

Fonseca D. [Effect of physical activityon anxiety and depression]. Presse Med.2009;38(5):734–9.

24. Samaha E, Lal S, Samaha N, WyndhamJ. Psychological, lifestyle and copingcontributors to chronic fatigue inshift-worker nurses. J Adv Nurs.2007;59(3):221–32.

25. Fullick S, Morris C, Jones H, AtkinsonG. Prior exercise lowers blood pressureduring simulated night-work withdifferent meal schedules. Am J Hypertens.2009;22(8):835–41.

26. Paoli A, Pacelli QF, Moro T, MarcolinG, Neri M, Battaglia G, et al. Effects ofhigh-intensity circuit training, low-inten-sity circuit training and endurance train-ing on blood pressure and lipoproteinsin middle-aged overweight men. LipidsHealth Dis. 2013;12(1):131.

27. Heydari M, Freund J, Boutcher SH.The effect of high-intensity intermit-tent exercise on body compositionof overweight young males. J Obes.2012;2012:480467.

ABOUT THE AUTHORSGrainne Kent is a RegisteredDietitian in the UK withprevious prehospital careexperience with the Irish RedCross.

Email: [email protected]

Twitter: @brinny_kent

Paige Mason holds a degreein Kinesiology specializingin Athletic Therapy and is aStudent Paramedic in Ontario,Canada.


Twitter: @PaigeMason2

Alan Batt is a critical careparamedic, educator andresearcher based in Ontario,Canada.


Twitter: @alan_batt




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29096 Pendragon Paramedic - Alan M. Battalanbatt.net/wp-content/uploads/2014/10/201603-Kent-Eat-Sleep-Be... · FebruaryMarch 2016 31 Introduction We live in a world that doesn’t