I was asked by my cousin Debbie, also a Fire Medic (Yes, it is a family business), what I thought about fatigue in EMS and the Good Morning America story about it that has been circling the EMS interwebs.
While any publicity on EMS is good these days, GMA simply told us about 3 private ambulance company employees who had a collision while being sleepy. It reported the problem, and the symptoms, but did not look into the causes.
We know that EMS can be tiring. I’ve been there. I’ve been on my 40th call in 48 hours wondering what color the sky was. Never made a medical error, never crashed an ambulance.
So why are others falling asleep and crashing? GMA mentions long hours and the need to work other jobs. These two symptoms can be placed solely on the shoulders of for profit healthcare. Companies are required to turn a profit so they put a warm body in the seat, pay them poorly and send them out on 8,10 or 12 hour shifts with no facilities, restrooms or even a place to sit down besides the cramped cab of a van. Ever been on a 12 hour road trip and needed rest stops to stretch your legs, hit the bathroom and grab a bite to eat? Now what if I told you to make that road trip but stay in the cab.
Exactly. Most of you who read this forum know this as System Status Management or “How to deploy an EMS fleet without investing in infrastructure.”
If the posting locations are good, put up a station with a heater and a rest room. Simply moving the fleet at random without an area for refuge is a recipe for disaster, as we can see.
The studies also mention employees in “Sleep deprived states.” I have been tired at the beginning of a shift and dreaded the rest of it, but without any sick or vacation time back then I was at risk of losing my job if I didn’t show up. Again, I’ll put that on the shoulders of for profit healthcare.
What I won’t do is buy into the nonsense that mistakes happen at the end of long shifts. I won’t because I have seen data that show more medical errors and collisions occurred in the first half of shifts in a large service, rather than near the end or even in the second half. I would be curious to know at what point in their shift our friends in the GMA story we at. I also won’t be surprised if we find out it was not near the end of a long shift.
No, fatigue is the result of inefficient rest. You can power through a 24 without sleep provided you can have at least 24 hours to recover, preferably 48. Running someone ragged for 12 hours in a shift, knowing that they will have time before and after shift awake, then asking them to come back in less than 12 is insane and is leading to fatigue, plain and simple.
“But Justin, that’s how we’ve always done it.” Yes, I know, that’s part of the problem.
GMA ends the story with the statement that, in the end, it is “Up to the employers to take care of their workers.”
Good luck with that, EMS. So long as profit reigns over quality of care (Some companies can make it work, I’ve seen them) we will continue to see ambulance operators tired, hungry and having to work additional hours to earn a living wage.
Fatigue in EMS is solvable but it costs money, something pre-hospital care is sorely lacking.