At 7 a.m., about an hour before the tip of my shift as a paramedic in Pittsburgh, my partner and I were dispatched to a patient who was vomiting violently and was not conscious. We were inside inside 10 minutes, grabbed our gear and made our option to the front door.
Walking up the front steps, I could not help but notice that my legs hurt and I had a headache – more pressure than pain. I knew the pressure because I had felt it again and again on the job. It's exhaustion from lack of sleep – inevitable with this sort of work, just a part of the job.
This was my fifteenth or sixteenth dispatch within the last 32 hours. I had little time to rest or sleep. I used to be working steadily all the time.
Nationally Registered Paramedic and A Professor of Emergency Health Care Worker Safety At the University of Pittsburgh, I actually have seen firsthand how the gap between our physical limitations and our skilled responsibilities can dangerously affect our cognitive performance.
Some emergency medical services physicians within the Pittsburgh area – a category that features EMTs, paramedics and dispatchers Work a lot of overtime.. Most of this extra time just isn't voluntary.
An audit in 2023 Many Pittsburgh EMS physicians find that routinely working 18-hour shifts – or longer – increases the chance of fatigue. Research shows that More than 80% Paramedics and EMTs report fatigue.
Fatigue under stress
When my colleague and I discovered our patient, an elderly gentleman, in an upstairs bedroom, my initial impression was that it may be gastro-related. However, he began shaking vigorously. I began getting vital signs. Soon, his wife returns with a stack of papers, the police arrive and the room quickly becomes crowded. The scene was turning chaotic, and I used to be easily distracted. My thoughts were slow resulting from my exhaustion.
After 15 to twenty minutes, we determined that the patient a Third degree heart block And Bradycardia – A slow heart rate. We treated him after which rushed him to the emergency department of the hospital.
As we left the emergency department, I reflected on that 15-minute delay. My exhaustion and distraction prevented me from immediately noticing the underlying problem. If I had recognized it earlier, we could have began treatment sooner.
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Long-term health risks
For EMS staff, sleep deprivation and fatigue could be considered a rite of passage or a part of our “war stories” that usually involve chaotic scenes and medically complex patients.
But lack of sleep has a long-term impact on our health, safety, performance and residential life. A study It found that 4 to 6 hours of sleep per night led to a dramatic decline in alertness over 14 days. Lack of sleep and fatigue related to EMS shift work may cause more difficulties. Injury or medical malpractice. This obviously raises questions for EMS physicians, since half of us get lower than that. Six hours of sleep Before shift work.
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Research also shows that. Compared to traditional day work, night shift staff, including paramedics and EMTs, face greater risk. Heart disease And A heart attack.
Sleep as a clinical intervention
There are solutions and techniques to cope with this problem. On-shift napping and scheduled rest, even short ones 30 minutescould be rehabilitative and help reduce risks. My colleagues and my very own research show that. health And performance Benefits of sleeping while working the night shift. Leading experts in sleep medicine, eg American Academy of Sleep Medicineand plenty of more Public Safety Professional GroupsSuch because the National Association of EMS Physicians, support sleeping on duty.
Despite the statistics and support from plenty of skilled organizations, many employers and members of the general public have a negative view of “sleeping on the job”. It can create Barriers for EMS Employers To formulate an official policy on gold. One of our recent studies found that the vast majority of EMS employers are willing to adopt napping policies. However, many are concerned concerning the potential costs and potential disruption to the way in which things have all the time been done.
Specific questions on naps are difficult to reply. For example, if an EMS employer asked, “What is the ideal nap duration?” There is not any clear answer to this query. Some studies have tested Nap duration or sleep strategies in keeping with the unique requirements of various occupations.
Many CEMS organizations already allow swapping but shouldn't have a proper policy. Confirming what staff members already do in official policy will show EMS clinicians that employers care and may reduce confusion by standardizing how nap strategies are implemented.
Other policies My colleagues and I actually have outlined ways to permit the secondary response crew to briefly take over for the first crew, or to permit one crew member to sleep within the passenger seat while one other crew member drives the ambulance. Another strategy is the “caffeine nap.” This happens when a crew member consumes a caffeinated beverage immediately before a brief nap. Doing so takes advantage of the shorter time it takes for the body to metabolize caffeine after which helps with alertness.
Sleeping on duty is an efficient strategy supported by the most effective current available evidence. How it's adopted, implemented and maintained will rely upon plenty of aspects, but Evidence strongly supports sleep deprivation. Better than no sleep.