Fix the late call conundrum to improve retention

Two Australian paramedics are “under investigation for misconduct” for refusing to take a late call after completing a 12-hour overnight shift. The paramedics were reportedly concerned about their level of fatigue when they turned down the overtime work, which was a non-emergent patient transfer to home.

Though I take a minor amount of comfort in knowing that the morale-crushing late call is ubiquitous worldwide, I am extremely concerned that a misconduct investigation is the result for two paramedics reporting they were too exhausted to accept the assignment. EMS1 regularly reports ambulance crashes attributed to the driver falling asleep, and near-miss and adverse incident reports to the EMS Voluntary Event Notification Tool often cite fatigue as a primary or secondary cause.

Respondents to the 2018 EMS Trend Report ranked retention as the most critical issue facing EMS by a large margin. Any service that’s not proactively mitigating paramedic fatigue, regularly sending paramedics on late calls and uses misconduct investigations as a response to self-reporting of “too tired to work” is sure to have a retention problem. Here’s what should be happening instead.   

1. Fatigue in EMS: Evidence-based guidelines were previewed at the 2017 Pinnacle EMS conference and published in January 2018. The guidelines conclude several years of NASEMSO-sponsored research and recommend guidelines for fatigue education, on-duty napping, use of caffeine as a countermeasure to fatigue, limiting shift length and fatigue monitoring.