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The hazards of sleep deprivation in EMS


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Safety Article

January 08, 2013

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

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.
Kenneth Drum Kenneth Drum Tuesday, January 08, 2013 5:56:43 PM I live in W.V. where a hardees drive thru employee makes more than an emt .. You have to work sleep deprived to exist ..
Angie Gurley Angie Gurley Tuesday, January 08, 2013 5:58:10 PM That sucks!
Jasen Cross Jasen Cross Tuesday, January 08, 2013 7:23:01 PM You chose that!!! Everything about that you chose. Over other things.....also your kids and grandkids and family in NC say hello. Send pics so we remember what ya look like.
Alan W. Rose Alan W. Rose Tuesday, January 08, 2013 8:12:31 PM I read once that the best way to stay awake when driving drowsy is to look at things and talk to yourself aloud about the things you see. For example, "The speed limit is 55, the sign is white with black letters." Not that drowsy driving is OK, but sometimes you find yourself in that position. I do believe that employers should monitor the sleep time of their employees between jobs, or perhaps EMS providers should be required to self-report like truck drivers.
Julia Harris Julia Harris Tuesday, January 08, 2013 10:22:24 PM I was wheels turning in a truck for 36 straight hours one time and that was the second day of a 48 hour shift. It was scary! I still like 24 hour shifts but I don't pull those kind of hours anymore.
Nita Jones Nita Jones Wednesday, January 09, 2013 9:21:26 AM I hope you remember that on your NEW JOB!!! So happy for you, 'Lizbeth!!!! All my love!!
Jake Stein Jake Stein Thursday, January 10, 2013 9:21:27 AM Truck drivers have rules but no on in EMS wants to be known as an "Ambulance Driver" and to take the time to appreciate the responsibility of it. No other profession allows their staff to work 24 hours shifts. But EMS and the Fire department will continue to fight for 24 hour shifts because of tradition. Any department which tries to break the norm for safety will feel the strength of the union which is not about safety but protecting tradition even it things have changed over the past 200 years. Most will go into EMS because of the cool 24 hour shifts. They can eat, sleep and place house just like on TV. Many in EMS believe a LODD death is just part of the job even though MOST can be prevented. But, that wouldn't be as cool. Until the EMS providers change their own attitudes, deaths will continue.
Jake Stein Jake Stein Thursday, January 10, 2013 5:36:15 PM A Hardee's employee also sees alot more people each day and must excercise good customer relations. They are also entrusted with the safety of people eating the food and are dealing with $1000s of dollars everyday. Any Hardee's employee can expect to be fired for poor customer service, any damage to equipment and any miscounted money. EMTs get their ambulances stolen and get a pat on the back. EMTs pull dangerous pranks which could put their co-workers and the public at risk but are seen as superstars of the profession and the forums. Most in EMS would fail if they had the same accountability as a Hardee's employee.
Ann Lennox Ann Lennox Sunday, January 13, 2013 3:59:25 PM I find this very REAL!!!! There is nothing fake about this pandemic of sorts. Especially but surely not limited to private ambulance companies. It's to bad that we don't live in a society that can say to our bosses and/or dispatchers "Hey. It might not be safe for us to do this trip right now!" All the company sees is a loss in possible profit and a "lazy" employee. I pray one day this changes for us all!!!!! If not for our own safety but for the safety of our pt's...cuz that's what's it's all about right?!?!
Ann Lennox Ann Lennox Sunday, January 13, 2013 4:01:22 PM Self reporting a sleep schedule would be a blessing to our community!!!!!!
Ken Skaggs Ken Skaggs Wednesday, January 16, 2013 4:48:41 AM 24 hour shifts are dangerous for EMS, And it is time for the DOT to regulate driving hours for both public AND private providers.
Anne Marie Akyaz Roldan Anne Marie Akyaz Roldan Friday, January 18, 2013 4:14:05 AM I drove around with a partner that was always tired and would fall asleep behind the wheel at a red light, and it sucks because not only did I have to take care of the patient I also had to check and make sure my partner didn't fall asleep it caused a lot of anxiety for me that after every call I would tell him go to sleep get some rest.. Thank God his driving skills were amazing or we would have gotten into a lot of accidents.. Don't know how we did it
Jake Stein Jake Stein Wednesday, February 06, 2013 5:18:50 PM Name any other job which allows its employees to work 24 hours or even 48 or 72 hours straight. Others have said NO. Even some states have passed legislation which forces employers to pay 1.5x and 2x the wage for hours over 8. Even Police and Correctional agencies have closely looked at hours worked. Only EMS employees have begged to be exempt from all forms of Even hospitals have limited the number of hours residents can be on call. Hospitals have also gone to using Hospitalists or NPs rather than trying to call attendings at night. Surgeons will have PAs work during off ours to cover. This is because the private ambulance company employees want to be just like the firefighters. It is the employees which continue to keep the 24 hours shifts around just to be cool like they see on TV where everyone is sleeping, playing house and having lots of sex at the station during the 24s.
BEARiatrics Inc. BEARiatrics Inc. Wednesday, April 03, 2013 1:01:00 PM Very good article. 24 hour shifts lead to irregular eating habits which eventually turns into obesity and sleep apnea making it a deadly combination. Does your overweight partner show signs of sleep apnea? Do they bring their CPAP with them to work? If they don’t bring it, encourage them to do so. Let them know that you will beat the crap out of the first person who makes fun of them, and you really want to go home and see your kids after your shift together.