'We’ve become numb:' Combatting PPE fatigue

More PPE training is unlikely to address PPE fatigue; here are 7 strategies that will


Folks are tired.

Tired of trying to figure out if the charge nurse is smiling behind the mask in overcrowded emergency departments. Tired of trying to figure out when that postponed vacation can be rescheduled. Tired of everything caused by COVID-19. It’s no wonder that some folks are slipping on their use of PPE.

We’ve become numb to the news about COVID-19. As I write this, more Americans are dying daily than ever; more than the entire population of the town I first ran ambulance calls in at the beginning of my career. There’s not an available ICU bed within 200 miles of our house. The new, even more contagious version of the virus is showing up nearly everywhere. And yet around the corner from our house yesterday, I saw a crew take off their masks when they got back in their ambulance after a no transport. Hopefully, they live together in the same safe pod when they are not at work. Otherwise, they are exposing each other.

"We all need to stay vigilant and combat PPE fatigue to keep ourselves, the people we love, the patients we treat and our communities safe," Mike Taigman writes. (AP Photo/Jae C. Hong)

Before you run off and create another training program, keep in mind that by now, almost everyone in EMS knows that COVID-19 can be deadly or disabling; that the virus’s primary transmission path is aerosol or droplets; that masks, physical distancing, keeping air moving and hand washing all decrease the likelihood of getting and giving it.

More PPE training is unlikely to address PPE fatigue.

This may be the darkest introduction to an article that I’ve ever written. When asked a question about these dark times during a book reading days ago, author Anne Lamott said, “These are dark, dark times. When it’s darkest out, it’s the best time to see the stars. But you have to look up. We forget to look up.”

So, let’s look up at some strategies to keep up our virus transmission prevention strategies at work and at home even when fatigued.

  1. Manage your overall fatigue. Read the Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services by Daniel Patterson, PhD, et. al. and follow them. If you manage your overall fatigue effectively, you are more likely to keep up your prevention practices. Things like shifts less than 24 hours long, access to caffeine, providing on-duty nap opportunities and education in fatigue risk management can help.
  2. Commit to being the example-setter, not the group-follower. It’s common to take our lead from other people. When everyone has their mask around their chin, sipping coffee and chatting elbow to elbow around the station dining table, it’s natural to think, “I feel silly being the only one with my mask on.” Commit to setting a good example when you’re around others.
  3. Keep your risk assessments simple. Air that has or recently has had people in it who are not in your COVID-19-safe pod is potentially dangerous. It’s more dangerous if it’s still air, if the people involved are unwell, or if the people involved are unmasked. To decrease your risk with this bad air you can:
    • Stay out of it by physical distancing
    • Wear a mask
    • Increase the air flow through the area.
    • Our 9-year-old son has these assessment and mitigation practices hardwired. When we are out for a walk and he sees unmasked people in our path, he steps well out of their way to let them pass or we swing wide and walk around them.
  4. Get yourself a “battle buddy” and make sure no one on your team is without one. Originally created by the U.S. Army, the battle buddy system was focused on ensuring soldier’s had someone watching their metaphorical back, to prevent suicide, but the concept can be used to shore up each other’s PPE use on calls and off. For this to work, you both have to commit to the other that you’ll speak up and not let your buddy expose themselves unnecessarily.
  5. Avoid shaming people into PPE compliance. Shame causes people to hide their unsafe behavior and causes additional stress-fatigue.
  6. Many, if not most of us, like to think of our work colleagues as family. Keep in mind, that’s not the same as your COVID-19-safe family pod. I know that in work situations where you live together, sleep under the same roof together, eat together and save lives together, it feels safe. It feels like family. But the number of possible virus exposures within these professional families is too high to be considered safe. It’s important to use your masks in your rigs and in the station unless you’re in your private bedroom.
  7. Use less garlic in your cooking. It will make mask use more pleasant.

And, though it will not reduce the need for PPE, get vaccinated

I believe that there will be an end to this pandemic and that mass vaccination is the path to getting there. In the meantime, we all need to stay vigilant and combat PPE fatigue to keep ourselves, the people we love, the patients we treat and our communities safe. I look forward to seeing you at a conference when we’ve gotten through this. Maybe we will take a nighttime walk and look up at the stars.

Read next: A plea for renewed commitment to COVID-19 prevention: Recent first responder LODDs underscore the virus’ devastating impact on public safety

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