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EMS resiliency, readiness relies on combating fatigue

Take these steps to get quality sleep to protect against mental and physical health effects


Fatigue and poor sleep habits are commonly accepted as status quo in first response communities.

Photo/Air Mobility Command

By Amy Eisenhauer, student, Political Science at American Public University

Fatigue and poor sleep habits are commonly accepted as status quo in first response communities. Fatal traffic accidents caused by paramedics falling asleep while driving, both in ambulances and in their private vehicles, are frequently in the news. Lack of sleep also impairs decision-making, attentiveness and the ability to learn, which are all necessary when interacting with the public and other responders during an emergency response.

Unfortunately, the effects of chronic sleep deprivation and lack of quality sleep can also have serious long-term effects on first responders’ mental and physical health. Fatigue and lack of sleep have a strong association with obesity, diabetes, hypertension, cardiac disease and stroke, as well as increased development of mental health illness, notably depression, anxiety, and PTSD.

The cause of fatigue is difficult to untangle as it involves actions by both agencies and individuals.

Agencies must take responsibility by determining policies and shift schedules that ensure first responders are able to get appropriate quantity of sleep. For example, agencies need to revise schedules and adjust shift times to ensure there’s sufficient staffing and first responders aren’t forced to work overtime. Some agencies stay short-staffed because overtime is cheaper than the hiring process, which includes training, health benefits and other expenditures to employ additional staff.

Agencies also need to address culture. In many police, fire, EMS and dispatch communities, it’s considered an honorable sacrifice to be able to stay awake for multiple hours at a time or work multiple shifts consecutively. Such a culture does not encourage first responders to get the appropriate amount of quality rest.

Similarly, first responders must take responsibility for getting enough rest. Often, due to poor financial planning or other financial reasons, first responders often rely on working overtime or having multiple jobs “to get by,” which can lead to inadequate rest.

Sleep tips for EMS providers

In order to get quality sleep while not working, first responders can take steps such as:

  • Be consistent. Try to go to sleep and wake up at the same times every day, even on weekends. This is difficult with certain rotating shifts, but be consistent as much as you can. You can also adopt a routine for bedtime to signal to your body that it is time to relax and go to sleep.
  • Maintain a comfortable sleep environment. You should aim to get seven to eight hours of sleep a night. That is a long time in one place, so being comfortable is key. If your mattress and pillows match your comfort preferences (soft to firm) you are more likely to fall asleep faster and stay asleep. Temperature is also a comfort factor; being too hot or too cold can wake you from sleep. Investing in blackout curtains that keep out light and noise is a good idea for those who work nighttime shifts.
  • Adjust lighting. Light at night can limit your natural melatonin production, altering your natural circadian rhythm, potentially exposing you to cancer, diabetes, heart disease and obesity. Blue light emitted from electronics like phones, tablets and LED lights alters production of melatonin by twice as much compared to other light. Limit your exposure to blue light two to three hours before bed, or use blue light blocking glasses if you work the night shift.
  • Try reading. Reading for a short time before bed can reduce stress and potentially degenerative brain disease. This can also be a good addition to a bedtime routine. Just be aware of the presence of blue light with some tablets or electronic reading devices versus traditional books.
  • Remove distractions. Reserve your bedroom for sleeping and relaxing. Don’t bring your work, computer or cell phone into bed with you. If the television keeps you awake, take that out of your bedroom as well. Pets and co-sleepers can also interrupt your sleep, so consider devising alternate sleeping arrangements if this is the case. If you work the night shift, talk with your family about disturbing you during the day while you are trying to sleep and educate them on why you need your sleep.
  • Limit caffeine use. NASEMSO includes caffeine use in its recommendations to mitigate fatigue, but it’s important not to use caffeine too close to bedtime. Studies have found caffeine can still disrupt sleep six hours after consumption. It won’t cause you to be sleepless, but can interrupt continuous, quality sleep. Try to limit consumption of caffeinated products for at least six hours before bedtime.
  • Utilize naps. Naps don’t make up for shortened or poor nighttime sleep and are not meant as a replacement for continuous sleep, but they are an excellent short-term fix to improve mood, alertness and performance. A variety of studies have shown that naps ranging between 10 to 30 minutes are best for improving alertness and performance. A nap that is too short or too long has either no effect or leads to sleep inertia, which makes the individual drowsier on waking.

The fatigue problem in the first responder community is not a simple one to solve and involves a multitude of complexities. Addressing this mental and physical hazard will require everyone, employers and responders alike, owning their responsibility to each other and themselves to increase safety and longevity.

About the author

Amy Eisenhauer is studying Political Science at American Public University. She is a dynamic presenter at EMS conferences nationwide, raising awareness on topics such as provider suicide, response to hoarding events and career development for EMS professionals. As a certified EMT, 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, Eisenhauer has taken on challenging roles as an EMS educator and training officer. She also hosts an interactive blog, To reach her, email For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.

This article was originally posted June 4, 2018. It has been updated.

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