...sometimes.
Fellow blogger Rescue Monkey posted this link about EMS workers in Louisville, KY being too tired to work effectively.
I know how they feel. All too well.
If one knows anything about EMS it’s that shift work and long hours are part of it. Personally I’m not a fan of working 24, 48, 72 hours or even more at once but it’s all too often the norm in our field. Typically when management hears from employees about shifts, it’s been my experience that the conversation typically goes like this:
Employee: “I really wish I could sleep in my own bed more often Could we look at having shorter shifts?”
Higher-Up: “We work 24 hours on, 48 hours off here. If you don’t like it, go somewhere else!”
E: “But don’t you think it would benefit our patients to get more rest? I’m afraid of making a mistake.”
H-U: “We’ve done it this way for 30 years and if you don’t want to, I’ll find someone who does!”
Forget what’s best for our patients and ourselves, let’s keep a stupid and dangerous tradition alive!
Sure, something like this might be ok in a system that has a low call volume and where most of the time the crews get to take naps between calls or who normally sleep most of the night. But what about in busy systems where head may not meet pillow for very long in a 24 hours period? In every system I’ve ever been a part of, I’ve worked at least 24 hours at a time and the hours I was allowed to sleep were restricted (usually 2200 is the time most places “allow” crews to go to bed). Personally I don’t get the big deal of taking a nap in the middle of the day. The “safety nap” isn’t a bad idea.
And yet, management continues to be content to allow medics and EMTs to work long periods of time without sleep. Countless studies have shown that sleep deprivation leads to a lack of mental sharpness. To me this opens the door to mistakes and I have no doubt that it’s happened. I pray with every shift that I don’t fall into this trap. I honestly don’t know how I would live with myself if I made a big mistake with a patient due to lack of sleep and the outcome was, well, not good.
It might be enough for me to hang up my scope. I’m sure I wouldn’t be the first.
So what’s the solution? Most areas have a shortage of medics and EMTs. We have to make sure that our locales are covered adequately but we also have a duty to our workers to make sure they’re taken care of. Shorter shifts would be ideal but may not always be feasible to meet call volume needs. Priority dispatch would be great but the public always knows the buzzwords – chest pain, shortness of breath, etc. – that would trigger an immediate response even in a system where phone triage takes place.
The truth is, I don’t have the solution. EMS 2.0 presents some good possible solutions that would help. In the meantime, we just have to do the best we can. In the words of a wise medic I know, we should “pray everyday that our hands never fail us.”
Same goes for our minds.
Besides risking a mistake with our patient, don’t forget shift work can also risk the safety of ourselves and the general public. Studies have shown that driving while tired has the same effects as driving while intoxicated ( http://www.aaafoundation.org/resources/index.cfm?button=drowsyfaq ). The trucking industry has federal mandates for rest periods and required time off based on length of time spent on the road. Yet services have no problem throwing us out their for such extended periods. How many lives have to be risked to keep the unit in service? I wonder if anyone has done an actual cost benefit analysis on shift work, although I highly doubt it
I’d be interested to see that myself. I’ve always found it odd that we don’t have restrictions on how long we can be on duty at any one time.