New Methodologies to Fight EMS Fatigue

It’s no secret that if you work in the EMS industry, you don’t have a 9 to 5 job. We work 12-hour shifts, 24-hour shifts, sometimes midnight tours of duty, dayshift, and even sometimes must switch back and forth between them. EMS can be a scheduling nightmare that bleeds over into the rest of your life.

We talked before about insomnia and shift work, and methods to help increase your solid sleep time. But the syndrome of EMS fatigue goes far beyond getting inadequate rest at night or during the day (depending on when you work). It is a collection of symptoms that can erode your ability to deal with normal occurrences in life. And fatigue can cause real physical health problems if left unchecked.

Yes, EMS fatigue is related to good sleep health and habits, but missing a few hours of sleep here and there isn’t the only culprit. A lot of EMS personnel work at multiple agencies to make extra money; they take overtime (both voluntary and being ordered in); in busy systems, poor utilization of resources and deployment increased workload and patient call volume. And in many agencies, there is no scheduled rest period or napping while on duty. We must always be at the ready.

And with the amount of shifts we work? There’s virtually no recovery between them. Adequate sleep is usually 6 to 7 uninterrupted hours per night/day. Name the last time you got that much sleep between shifts.

So what exactly is fatigue? The Oxford Dictionary defines it as this: “Extreme tiredness resulting from mental or physical exertion or illness. A reduction in the efficiency of a muscle or organ after prolonged activity. A lessening in one’s response to or enthusiasm for something, caused by overexposure.”

EMSSounds spot-on to me, if we’re relating it to EMS fatigue. Not only your physical strength is limited, but your mental strength as well. Reaction times slow, decision-making is impacted and you might just engage in risky behavior (driving fast, lifting improperly, giving the wrong medication). Given all of this, EMS fatigue is contributing to poor safety practices by clinicians, and possibly negative patient outcomes. The risk of injury for everyone involved increases.

So what can we do about it? Most EMS agencies do not have a plan in place to evaluate their EMS personnel’s sleep health, or be able to identify an employee suffering from fatigue. They need to address EMS fatigue and how the role adequate sleep and rest between shifts plays a strong role, and then put into place recommendations made based on evidenced-based studies. Years ago, we just called it “burn out.”

The Emergency Medical Services Agency Research Network, which focuses on EMS clinician safety, began Phase II of their study on EMS fatigue in late January of 2016 and they came up with a not-so-surprising figure:  half of all EMS clinicians get less than 6 hours of sleep between shifts. And that means very low recovery between duty times.

Agency administrators need to jump on the bandwagon here and get policies in place. Instead of labeling a tired paramedic as just being burned out, they need to recognize that inadequate sleep health and EMS fatigue are very real threats to safety. They can also help by getting involved in research to better box in the problem, so that we can find solutions for our EMS workers. Let’s face it:  shift work will never change, but we can combat the untoward effects by working together and studying the problem.

EMS fatigue is poorly managed at the admin level. So the first step needs to be a fatigue management risk system. And we need strong, dedicated leaders for that. Countermeasures that are tailored to each EMS worker need to be defined and put into practice; EAP just isn’t enough anymore. Give your folks some resting time. Beef up staffing to reduce call volume and workload. Create swing shifts to handle the call spikes during peak hours. Try to limit shift extensions.

Encourage them to participate in some kind of physical activity, even if it is just stretching or walking. Maybe suggest that they limit caffeine and energy drink consumption while on duty. This sounds like a backwards suggestion, but the more of these drinks you consume, the harder it is to shut down at night (or during the day) to get that necessary uninterrupted sleep.

Finally, encourage them to talk about any topic to partners, to company officers, to anyone that will engage in conversation. Stimulating the brain can reduce mental fatigue, and may be the difference between separating “safe” and acceptable fatigue from unsafe, unstable EMS fatigue.

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire
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