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EMS Safety Net
by Jim Love

How to combat sleep deprivation in EMS

Create a management culture that makes it okay to say "I need some rest"

By Jim Love

Updated July 14, 2014

It was a very routine transport of a young, stable and sedated patient from an ER to a psychiatric facility across the state.

The family was following in their own vehicle, mile after mile of the same highway.

Soon after departure, the patient was sound asleep. Not long after, so was the medic. The family witnessed the ambulance leave the highway. 

ABC News | ABC Sports News

They assumed it was pulling off for fuel or a bathroom break, until the ambulance hit a bridge abutment at full speed, its brake lights never coming on. 

The driver died. The medic, sitting in the captain's chair suffered a lacerated liver and spleen, lacerated by the patient who slid out of the stretcher straps. 

A leading cause of death

ABC News ran a story about dozing while driving, which included a report that more than 6,000 people die from falling asleep behind the wheel. It’s the second leading cause of deaths on our highways, second to drunk driving and ahead of texting while driving. Sleep deprivation is not only a hazard while driving, it also affects judgment, mood and job performance and may cause up to $31 billion annually in industrial accidents.

For example, I think back to my old days on the road, working 24-hour shifts. I remember one shift where I responded to 33 calls in 24 hours, 11 after midnight. I remember it as the busiest shift I ever had. 

Back when ambulances transported bodies to funeral homes, I remember getting a frantic 7 a.m. call from a funeral director, demanding to know where his dead person was. 

I assured him we made the delivery a couple of hours earlier and promptly went back to bed. An hour later, the on-coming crew woke us up asking, "What's with the dead guy in the back of the truck?"

I’ve made errors due to exhaustion, I’ve been sleepy behind the wheel, land I’ve ikely fallen asleep behind the wheel. I've investigated many a collision where the only explanation —  one that cannot be proven and is rarely admitted to — is that the operator fell asleep. I have also seen many in the EMS field work multiple jobs, putting 90 or 100 hours week after week. 

Many states are looking at creating or strengthening laws that punish those who drive while overly tired/exhausted.

The ABC report point out that neither opening the windows nor turning up the stereo will help. These were my two most common strategies. It says caffeine can work but only for so long..

So what is EMS to do?

Speak up

First we need to foster open communications. We should have an environment and culture where an employee can call a supervisor and say, "Man I just can't stay awake."

It seems this might be a good ruse for an employee to get out of work, or to get off early. It's also a way to possibly save a life. Consider that they are telling the truth and consider the alternative to not taking action.

Partners should watch out for each other and should speak up, and acknowledge long shifts and off-duty activities that may impact sleep. 

Departments can post a safety message about the hazards of sleep deprivation, and invite employees to speak up. Remember that sleep not only affects driving; it affects judgment and mental acuity. An exhausted medic may make an error in drug calculations, or other patient care mistakes.

As humans, we might always suffer some level of sleep deprivation and exhaustion from time to time. In EMS at least we do not work alone, and we can look out for each other.

We can speak up and we can set a culture that makes it okay to say, "I need some rest."

About the author

Jim Love began his EMS career in 1974. Since that time he has worked providing direct patient care, has been an FTO and has been an EMT instructor. He transitioned to management and has held many positions over the years including operations, later focusing on training, safety and risk management. He was the National Director of Safety and Risk for AMR. Jim has enjoyed consulting on EMS safety. Jim is currently the Program Manager for the ACETECH (A Ferno Group Company) family of products. He maintains an EMS Safety site and blog,, and can be contacted at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Ben Cohen Ben Cohen Monday, July 14, 2014 6:23:59 PM The company I work for (SeniorCare EMS) has a mid shift driver change policy, exactly to help prevent this type of thing from happening.
Jason Bryant Jason Bryant Monday, July 14, 2014 7:37:39 PM What about the patient care errors from being overly tired? That's just as bad.
Lori Wagner Lori Wagner Monday, July 14, 2014 8:51:18 PM Companies don't care some of them. It's all about the bottom line and the bosses bonus. Not about patient care and crew safety anymore
Jason Thompson Jason Thompson Tuesday, July 15, 2014 12:19:41 AM If EMS paid a living wage perhaps we wouldn't have to kill ourselves working as much as we do.
Amos E. Alexander Amos E. Alexander Tuesday, July 15, 2014 10:12:36 AM there has been more nights than I want to even count that, when i was working 12 hr shifts, I don't remember half the drive home once i got off 14 even 15 hr's after going in, cause as we all know we never get off on time. and after I went to a 24 hr shift I was working two companies and going strait from one to the other three and four shifts in a row.
Sherman Tomlinson Sherman Tomlinson Tuesday, July 15, 2014 11:48:22 AM A lot of folks are rightly concerned about the hours worked, low pay, lack of concern by management(the main cause). Hey get over it, as long as there is lame management it will never change. Finally retired after 40 years in EMS and nothing has changed, excluding equipment, yes there are some good services out there and there are not many of them. I would welcome the debate. Talk to the old timers and ask them what changes they have seen in EMS as far as management.
Budd Dunson Budd Dunson Tuesday, July 15, 2014 5:50:43 PM it is still common and necessary for rural EMTs to run 72 hour shifts to make a living wage
Robert Taylor Robert Taylor Wednesday, July 16, 2014 5:29:01 AM I can only say that with what EMS is paid in general, no one wants to loose the hours of pay. Social security details what is earned on something close to 70% of the calls that are run. The amount paid to ambulance providers make for lean margins with no chances of improving pay. I always felt lucky just to have some form of benefits.
Bunsen Beeker Bunsen Beeker Tuesday, July 22, 2014 7:52:47 PM If you work 12 hour nights (like i do), you need to sleep during the day. if you are tired, than you didn't properly prepare for your shift. you should never go to work expecting to sleep, because you will get burned (yes, been there, and done that). And I'm sorry, but telling your boss "i'm too tired to work" should get you a disciplinary notice. you are hurting the system (now we are down one ambulance), because you weren't prepared to work your job (you know, that thing that you are paid to do). The job needs to get done, and you are being paid to do the job. Don't expect sympathy from me because you're tired and you didn't get to nap while at work. That being said, management and supervisors need to be realistic: if you are running your ass off on a 24 hour shift, then you should probably switch to 12s. It's that simple. We, as a profession, want to be considered professionals, who are paid an hourly wage, and are worth more than we are usually paid. We need to switch from the "Earn Money Sleeping" mentality to "I'm in EMS, I'm ready, willing and able to do a job, and prepared to work for my entire shift; after all, that's why my boss is paying me to be here."

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