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Home > Topics > Safety
January 08, 2013
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EMS Safety Net
by Jim Love

The hazards of sleep deprivation in EMS

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

By Jim Love

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

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

Not long after departure, the patient was sound asleep. Not long after the patient fell asleep, so too did the medic in the back. Not long after, the family witnessed the ambulance leave the highway. 

They assumed the ambulance was pulling off for fuel or a bathroom break. That is 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. 

The conclusion was that the driver fell asleep.

A leading cause of death
According to a recent story on ABC News, and the video report in this article, more than 6,000 people fall asleep while driving, and die. Exhausted driving is 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 a year in industrial accidents.

I think back to my old days on the road, first working 24-hour shifts. I remember one shift responding to 33 calls in 24 hours, 11 after midnight. I remember as this was the busiest shift I ever had. 

Way back in the very old days, when ambulances also transported bodies to funeral homes, following a very busy shift I recall getting a frantic call at 7:00 AM 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?"

Later, after I stopped working 24-hour shifts, I recall sitting on post, hour after hour, falling asleep, not because I was overly tired more like just bored. 

So my point is…been there, done that. I've been sleepy behind the wheel, likely fallen asleep behind the wheel and made errors due to exhaustion.

I've investigated many a collision where the only explanation — but 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, 90-100 hours a week, every week. 

The ABC story also discussed the phenomenon called "Micro Sleep," brief transitions from a wakeful state to being asleep, perhaps in as little as a second. Sleep error can follow only one poor night's sleep. In the cases of Micro Sleep, the eyes may still be open.

Many states are looking at creating or strengthening laws that punish drivers who drive while overly tired/exhausted. I'm not sure this is the best answer but I am sure that it will come. 

The report goes on to say that neither opening the windows nor turning up the stereo will help.  These were my two most common strategies.  They did state that coffee (caffeine) will help but only for a period of time.

Open communications
So what is EMS to do? 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, 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.

Fore knowledge can take a claim of negligence and turn it to gross negligence. Partners should watch out for each other and should speak up. Be aware of long shifts and the off-duty activities that may impact sleep. 

Post a safety message about the hazards of sleep deprivation. Invite employees to let you know.  Remember too that sleep not only affects driving; as it affects judgment and mental acuity, a medic suffering exhaustion may make an error in drug calculations and/or make 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. We can look out for each other. We can speak up and we can set a culture that makes it OK 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
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