Scott, the paramedic supervisor, believes that more personnel are
needed for his program to work effectively. “Put more people on the
trucks,” he suggests. “My goal is to get folks to have the luxury to work
just one job at 40 hours a week. That’s my dream. Obviously this is
impacted by reimbursement and turnover. We need this not only for
physical health, but also for mental health.”
George, a paramedic with five years’ experience in a busy urban sys-
tem, advocates a focus on shift scheduling as part of a comprehensive
fatigue risk management program. “The big killers are transitions/
rotations in shift schedules in a short window of time. This can impact
alertness and fatigue. The rotation is tough for a lot of clinicians. Try-
ing to build in consistency as much as possible.”
Thomas, the clinician, supervisor and educator with 45 years of
experience in EMS believes that rest during shifts should be priority.
“We’ve created this monster that sleep deprivation in EMS is accept-
able.” He recommends, “We create a policy that a truck could be off
for an hour during the shift to clean up or even take a break, rest, catch
up on charts, etc. We need to schedule ‘regeneration’ time.”
The journey from not having a fatigue risk management program
to one that’s woven into the fabric of the organization won’t be easy.
The evidence-based guidelines prepared for EMS with support from
NHTSA and in coordination with the NASEMSO can aid admin-
istrators in their decisions regarding creating new fatigue risk man-
agement programs or modifying existing programs and guidelines.
For the first time, administrators can make decisions regarding
specific strategies and feel confident that their decisions are informed
by a synthesis of the best available evidence. Individual clinicians may
also use these materials to question their organization’s approach to
The guidelines for fatigue risk management in EMS doesn’t prescribe a specific approach to fatigue mitigation, and administrators
shouldn’t perceive that the guideline is prescriptive or restrictive. It’s not.
There’s tremendous flexibility in how systems may apply the five
recommendations and strategies studied. The burden on administrators and individual clinicians is high.
If fatigue is as widespread a problem in EMS as we all perceive it to
be, then we must act. Fatigue in the EMS workplace can’t be ignored.
Patients and the public call upon EMS in their moment of greatest
need. In those moments, they deserve us at our best, not when we’re
“dead tired” and unable to perform optimally. JEMS
P. Daniel Patterson, PhD, MPH, MS, NRP, is assistant professor of emergency medicine and
primary investigator for the EMS Agency Research Network at the University of Pittsburgh.
Author Note: Multiple EMS clinicians from across the U. S. were interviewed for this article. All
were referenced with an alias to maintain confidentiality, which was a condition agreed upon
prior to the interview. The interpretation of research and opinions described in this article do
not reflect the views/opinions of the NASEMSO, NHTSA or the University of Pittsburgh. The views
and opinions expressed in this article are those of the author and those interviewed, no other.
Learn more from P. Daniel Patterson at the EMS Today Conference, Feb.
21–23 in Charlotte, N.C. His session, Fatigue and EMS: The New Silent Killer,
will be held on Thursday, Feb. 22 from 8:00–9: 30 a.m. EMS Today.com
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