How to combat sleep deprivation in EMS

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

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. 

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."

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