Sleep in EMS

RocketMedic

RocketMedic

Californian, Lost in Texas
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This weekend, I pulled my first long week. I'm an active-duty soldier, and I work part-time in Van Horn, Texas. Despite a 5-hour sleep period between the end of my Army-mandated ball and my commute to Van Horn, I was feeling a bit tired by the end of my shift...and it didn't get any better. I took my wife to dinner (part of our working date weekend) and went to bed- only to get called out for a transfer to El Paso. Patient care wasn't an issue, but I had to rely on my partners to keep awake and my EMT drove home- and when we got toned out on arrival again, I made a documentation mistake.

I can easily see sleep deprivation becoming a major issue in my career, or in any EMS career. What do y'all do to manage your sleep?
 
I sleep as much as possible on shift.

Your partner was driving back, use the time to take a nap.
 
He was pretty tired too, we were keeping eachother awake.
 
15 minute safety nap.

I take a nap every afternoon I work. With a 2.5 hour turnaround per call, it doesn't take long to work up an all nighter.
 
I can't sleep on shift unless it's a shift that goes past 0200ish. We average 10 calls per unit per shift on 12 hr shifts. 16 hour shifts tend to have a lower call volume near EOS since dispatcher usually put that car on a post on the edge of our call area. We use a rest model that includes consecutive shifts worked (minimum of 8 hrs off between shifts), unit work hours, and reported sleep. If you fall within the 'rest deprived' parameters or if we tell a sup that we feel we cannot provider good care due to exhaustion they pull us off the unit. Full time here is 12hrsx4 days. I work per diem so I haven't had a problem. If you don't feel as though you are alert enough to provide patient care you should notify a supervisor and they *should* pull you off the unit.

Mistakes at the ALS level from exhaustion/sleep deprivation can be fatal, in a worst case scenario.

Just my 0.02
 
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Why Stand When You Can Sit, Why Sit When You Can Lay Down, Why Lay Down When You Can Sleep.
 
NVRob said:
I can't sleep on shift unless it's a shift that goes past 0200ish. We average 10 calls per unit per shift on 12 hr shifts. 16 hour shifts tend to have a lower call volume near EOS since dispatcher usually put that car on a post on the edge of our call area. We use a rest model that includes consecutive shifts worked (minimum of 8 hrs off between shifts), unit work hours, and reported sleep. If you fall within the 'rest deprived' parameters or if we tell a sup that we feel we cannot provider good care due to exhaustion they pull us off the unit. Full time here is 12hrsx4 days. I work per diem so I haven't had a problem. If you don't feel as though you are alert enough to provide patient care you should notify a supervisor and they *should* pull you off the unit.

Mistakes at the ALS level from exhaustion/sleep deprivation can be fatal, in a worst case scenario.

Just my 0.02
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Haha my supervisor would be like "okay well you do these last two calls...."

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Heading to work in 30 minutes to hopefully sleep through the night :D but if not.. took a nap this afternoon, so I'll be okay. On longer shifts I'll make it a point to take a cat nap. We are generally not slammed all day so there are several opportunities to snooze.
 
On 24s if I'm not otherwise engaged you'll often find me asleep.

If your CAAS accredited you have to have a policy addressing this.

One place ground EMS could learn a huge amount from HEMS is rest periods. One of the most idiotic things I've ever had to deal with is an FD that said you couldn't sleep before 2200 when 70% of that trucks calls were after 2200.
 
We work 24 hour on call, 7 days on/7 off. We have no regulations, but if my staff works more than 16 hours in the unit I'll make sure they get 8 hours of down time. I'll call in a backup crew for them.
 
It is in our policy manual that a crew can request to be pulled off the road. The majority of our BLS shifts are 10s, so it's not much of an issue for me. A busy 13 is a long day and it might be a task to keep the driver alert on the way back to base, but that's about it. The medics work 24s, and it did become an issue for those working on non-dedicated ALS units. For the last 4 months the "first out" transfer truck had to take every call if it was at base, even if they had just returned and a second transfer truck was in service. Now they rotate and the crew fatigue problems have gone away.

What really worries me is after the shift, you've got guys driving home following a busy shift (and possibly a buys shift the night before at a different agency) that are alone in their vehicles and often commuting an hour. That is what is really not safe.
 
usalsfyre said:
On 24s if I'm not otherwise engaged you'll often find me asleep.

If your CAAS accredited you have to have a policy addressing this.
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We are CAAS, CAMTS and NAED accredited. I'm guessing this is where our fatigue procedure stems from. The rest policy applies to our dispatchers as well.

In a rural station I can see 48 hour shifts working. They were talking about moving some of our FD stations to 48s though. I don't agree with that.

FD and EMS are separate entities however we get an Engine crew on any Priority 1-2 call.
 
Sasha said:
Haha my supervisor would be like "okay well you do these last two calls...."
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Our sups get grumpy if we get the sleepies while driving or attending. I saw an epic DriveCam of an EMT straight up asleep sitting in the drivers seat at a stoplight. Medic was in the passenger seat, looked up from his chart, noticed and triggered the manual trigger on the cam.
 
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NVRob said:
Our sups get grumpy if we get the sleepies while driving or attending. I saw an epic DriveCam of an EMT straight up asleep sitting in the drivers seat at a stoplight. Medic was in the passenger seat, looked up from his chart, noticed and triggered the manual trigger on the cam.
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I want to see that
 
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Flightorbust said:
I wanna see that
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They are not for public viewing unless released by our company, otherwise I would gladly post it up.

I agree with usals about ground learning something from HEMS pilots when it comes to rest.
 
Did what you are doing, sort of in reverse.

24 hr on/24 off USAF FD shifts, then civilian ambulance on off days . One day a week off every other week, and the alternating weekend day. Married, no kids at the time.

Some folks can adjust to it, and some can't. The older people get the fewer people can, or want to, do that. Cramming naps and just resting can help, but you need good concentrated sleeping sack time for health.
If you cite fatigue as a factor in an "adverse patient event" the company will likely pull out their policy manual which will have something that says you should not have accepted so many shifts, or worked tired...and they are right.
 
We have a mandated 10 hour fatigue window between shifts. If this window is infringed upon, you start your next shift later to make a 10 hour gap.


We can sleep when not on a call, but are often never back at station. Some nightshifts (12 hours) you may get no sleep, others 3-4 hours on a really good night.
 
mycrofft said:
24 hr on/24 off USAF FD shifts, then civilian ambulance on off days . One day a week off every other week, and the alternating weekend day. Married, no kids at the time.

Some folks can adjust to it, and some can't. The older people get the fewer people can, or want to, do that. Cramming naps and just resting can help, but you need good concentrated sleeping sack time for health.
If you cite fatigue as a factor in an "adverse patient event" the company will likely pull out their policy manual which will have something that says you should not have accepted so many shifts, or worked tired...and they are right.
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That's crazy, sir. That's the very definition of living to work.
 
I put wife through school

Then her work plus my Guard and working less civilian ambulance put me through mine.
Try our dispatch schedule of eight hour shifts. Two days, three swings, four mids, three off; four swings, three mids, two off. I lasted ten months, the record was eighteen and the guy left with a psych discharge, allegedly.
 
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