Drunken Ambulance Drivers

We may as well be.  That’s one of the findings discussed in Danial Patterson’s study about sleep deprivation in EMS, which is thoroughly described by Rogue Medic.  EMS World Magazine has also covered this topic recently. A few articles can be found  here, here, and here.

I don’t know what happened to the EMT in Kentucky who allegedly fell asleep while caring for a patient,  I do know that I have felt less alert while driving emergency vehicles than I do after drinking a few beers.  I would not, nor should I be, eligible to work at night if I enjoy a frosty beverage at 2 in the afternoon.  But some people are made to work 12 more hours after a busy 24 hour shift.

When I sat down with the schedule at my first EMS job, I ended up getting off midnight from one truck and coming back at 0600 on another.  When I realized this and asked for a change, I was told that nothing else was open.  We frequently we got out late and often finished after 2 AM.

At another job we did 24’s.  Once while transferring a patient from DC to Baltimore at 3 AM, I felt the  ambulance swerved from side to side while my partner nodded off in the driver’s seat.  At another service we did consecutive 14 hour night shifts that ended at 8 AM.  Sometimes with late calls I got out after 10 AM before having to be back at 1800.

Shift schedules in EMS seem to serve us more than patients.  Long shifts are easier to schedule than shorter ones, and we are willing to work more than 40 hours each week in order to get more whole days off.  We also wear our lack of sleep like a badge of honor under our eyes.  Employees of the month at one service were the ones who always came in or stayed over.  The quality of care they delivered while there was not a factor.

We are lying to ourselves if we believe we can perform at a high level with chronic sleep deprivation.  On one hand it is our responsibility to be rested when we arrive at work.  It is our fault if we do yard work all day, work a part-time job, or ride on volunteer fire trucks in the 10 hours between night shifts.  But life also happens, like when a child throws up all day.  Then is it better to call out sick?

Don Lundy made some excellent points about work readiness in this  EMS Leadership podcast. Austin/Travis County EMS also took on this issue when they hired Circadian Solutions to design a better shift schedule. Moving away from 24 hour shifts was expensive, and I applaud them for investing in community  and provider safety.

We are invited into peoples lives at the worst moments of their lives, and these moments often occur while normal people are sleeping.  As a profession we need to figure out schedules that balance alertness during shift, our long-term health, and time off.

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