The National Association of State EMS Officials (NASEMSO) recently released their evidence-based guidelines for Fatigue Risk Management. The distribution of these guidelines and associated materials concludes phase 1 in their Fatigue in EMS project. Here are their top recommendations from the infographic provided in the materials:
Quite honestly I found the full text an interesting read, despite being dryer than the Sahara Desert. I appreciate the fact that when making the recommendations they took many factors into account including the differences between urban and rural systems. The two seemingly most controversial recommendations, working less than 24-hour shifts and allowing napping during shift, actually seem to balance one another out.
Shift length has always been controversial. In 2016 I wrote a column on EMS1 titled How many hours make a paramedic or EMT shift? that really addressed more the managerial scheduling challenges and options available to EMS agencies. Too often EMS agencies and managers get stuck doing things because “that’s how they’ve always been done” or in an effort to differentiate themselves from those around them they become regressive in active practices that are actually decades old. The continued existence of 24-hour tours is one of those things especially in urban, suburban, or small communities.
Napping during shift is another controversial topic. For rural communities that continue on the 24-hour tour path, napping is actually possibly the counter-measure that can be used to argue for their continuation. In urban areas, where a street corner is often the posting location for the ambulance, sleeping while on-duty may be forbidden and could be seen as a terminable offense. The sight or photo of EMS personnel sleeping in the ambulance between calls creates a public perception issue and contributes to the proliferation of the Earn Money Sleeping moniker. While the material identifies the environment for optimal napping, it recognizes this is not always possible and a nap while belted in the front of the ambulance is better than no nap at all.
I do want to point out that the study also endorses the availability of caffeine as a fatigue deterrent and uses a coffee pot as an illustration. This is NOT a recommendation for an over-consumption of the various energy drinks and shots that are currently on the market. While these drinks do contain caffeine they also contain other chemicals and additives that have short-term gains but long-lasting effects up to and including the possibility of death. Caffeine should be consumed in moderation and as a tool to mitigate fatigue, it is NOT a solution for it. The only safe and proven solution for fatigue is in fact sleep.
What are your thoughts on the recommendations? Does your EMS Agency do anything currently to mitigate fatigue?? Will these recommendations make a difference at your agency??? Let us know in the comments…