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Amy Eisenhauer | June 20, 2019
(4 min read) When I was a new EMT all I wanted to do was work on the ambulance answering calls with my friends. So much so that I had three jobs working on the ambulance, two of them full time. 100 hours a week, every week, doesn’t last long before the body rebels.
One morning around 4am my partner and I were roused from our nap on the crew couches by the dispatch phone. We shuffled to the ambulance, rubbing sleep from our eyes, and began to respond to the emergency. On the way, I stopped at a red light to clear the intersection before proceeding with lights and sirens. The next thing I remember was waking with my foot resting on the brake an unknown amount of time later. I looked at my partner to find out why she let me stop there for so long and found her asleep as well. Things could have ended quite differently, as depicted in the news recently; we were very lucky no one was injured or killed.
Traffic accidents, whether in the ambulance or while driving home after shift, are not the only liability brought about by fatigue for EMS providers. Fatigue causes difficulty in making critical or ethical decisions, something required on every response, even the mundane. EMS providers are responsible for asking questions to get to the root of a complaint in order to deliver appropriate care. Sometimes, EMS providers are responsible to deliver interventions that include medical math or deciding to perform a high acuity procedure – these necessitate that we are operating at optimal performance and lessen the opportunity for a medical error or accident.
Per the CDC, adults should be sleeping seven or more hours per night. Not many first responders can confidently proclaim they have great sleep hygiene. Not many Americans can say they have great sleep hygiene either, one third of Americans are chronically sleep deprived. Chronic fatigue has been linked to a higher incidence of cardiac illness, hypertension, stroke, obesity, and diabetes. Fatigue has also been associated with increased propensity for depression and PTSD.
The National Association of EMS Officials (NAEMSO) has been working on the Fatigue in EMS Project and offers a myriad of resources, references, and recommendations on their site. They have recommended 5 evidence-based guidelines for leaders to reduce the incidence of fatigue at their agencies.
EMS providers can manage their fatigue risk if working for an EMS agency that doesn’t have a plan in place. The following recommendations can be used to mitigate fatigue risk:
Like many hot topics in EMS, provider fatigue is multifaceted and not easy to solve. Personnel, staffing, financial concerns, and culture are all in the mix related to fatigue, and while we are using evidence based methods to research the issue- EMS providers and leaders must adapt the recommendations to change EMS culture and improve our service to the community and care for ourselves. Our longevity, physically and mentally, depends on it.
Amy Eisenhauer is a dynamic presenter at EMS conferences nationwide, including ZOLL SUMMIT 2019. Her topics help raise awareness about issues such as provider mental wellness, response to hoarding events, and career development for EMS professionals. She has served the New Jersey Emergency Medical Services community as a volunteer and career provider since 1995. In addition to providing high quality medical care, she has taken on challenging roles as an EMS educator and training officer. Amy is a contributing author for EMS World magazine and also hosts an interactive blog on EMS at TheEMSsiren.com, committed to improving the EMS community as a whole.
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