While our primary concern is our patient’s health, the health of the First Responders is crucial and can affect patient care and safety. With several agencies having shifts of 12, 24 and even 48 hours, it’s easy to understand how easy it is to get fatigued. Whether treating the patient, giving meds, or driving the ambulance, the ability to remain alert can make a huge difference.
It is difficult, if not impossible, to schedule breaks and rest-time during any emergency response tour. If an employee/member bangs out last minute for illness (including fatigue), that could make the difference of having an ambulance to respond at all. Even a normally quiet tour can suddenly be interrupted by an MCI or just a rash of 9-1-1 calls. Some crews can go hours without any calls and be able to take meal breaks at convenient times; other crews can sometimes not even find the time to go to the bathroom.
There is a recent trend to extend individual tours to as much as 72-hours, or to maintain normal 12-hour shifts with a lot of overtime tacked on when things get a bit busy. Then there are calls where crews are put on standby at a scene for hours, sometimes even extending well beyond the end of shift. We know of some agencies that literally prohibit sleeping while on call between the hours of 7:00 A.M. to 11:00 P.M., and others that insist that the rigs be kept out on the road throughout an entire shift whether day or night.
When a crew member is overtired it can lead to ambulance road accidents or dire mistakes in patient care. Fatigue can also lead to undue stress which can damage both work and family relationships. Lack of sleep contributes to other longterm health issues such as cardiovascular problems and stroke.
The obligation for preventing fatigue in the EMS workplace lands on the shoulders of agency administration. Guidelines need to be established that restrict all members to a set maximum of hours with mandatory rest periods required if overtime is necessary; providing a place for crew members to rest and perhaps a small stipend for a member’s mandatory rest time would be would be more conducive to napping at work. Ideally the scheduling officer should keep track of traditionally demanding shifts and, if possible, should schedule a second crew/rig so that members can take turns responding and have the time to relax, eat meals and tend to personal needs.
Onsite sleeping accommodations should be made available for overnight crews who can respond from base and if rigs are required to be out on the road during the day, crews should be permitted to pull their rigs off road where they can lock their doors and close their eyes for short periods of time. NO employee/member should be penalized if they need to take time off for illness or fatigue. And finally, if wages and benefits were improved there would be less need for a member to pursue a second job.
What can EMS providers do for themselves? Members should get no less than six hours of sleep daily. Healthy diets which avoid excessive sugars and fats should be followed. Staying hydrated with clear liquids will help keep the body’s natural systems functioning properly. Avoid alcohol, tobacco and caffeine, and DO NOT rely on caffeine-laden power drinks to get through the day.
If shift changes are indicated, schedule them forward (clockwise), as it is an easier adjustment. Maintain a regular exercise routine; it can be low impact but it will help keep the blood and oxygen circulating in the body. Use your work calendar when scheduling appointments and social activities and allow for “breathing space” between commitments.