Fatigue Management

As with many aspects of the EMS industry, little data exist on the role of fatigue in ambulance accidents or its impact on medical service delivery. The anecdotal accounts of ambulance drivers falling asleep at the wheel and employee complaints about excessive overtime that have appeared in newspapers across the country should serve as a warning to the industry to look at the effects of fatigue on EMS employees' health and safety.1

The National Transportation Safety Board (NTSB) estimates that 100,000 crashes and about 1,500 fatalities annually are caused by driver fatigue, and the development of effective fatigue countermeasures has been on the Board's "Most Wanted" list of safety improvements since the list was developed.2

Fatigue is a shorthand reference to a general state of decreased mental and physical capacity resulting from a lack of sufficient restorative sleep or a disruption of the circadian rhythm-the natural biological clock that drives the body's cycle of sleeping at night and waking at daylight-often exacerbated by on-the-job stress and poor personal habits. Working night shifts, running double shifts and often "sleeping with one eye open" while anticipating the next emergency call are part of the normal work environment of EMS employees. Such conditions place them at high risk for experiencing the detrimental impact of fatigue on their job performance and personal health.

A considerable body of research conducted during the past two decades has led to consensus on the effects of job-related fatigue and offers insights into other measures companies can take to address health and safety issues resulting from shift work.

Studies on strategies for managing fatigue divide actions into two categories: operational countermeasures that require changes in the workplace and preventive strategies or lifestyle changes that employees can adopt to help fight fatigue.

Operational Countermeasures

Education and Training

Education is the first step taken in each program developed to address job-related fatigue. Knowledgeable employees are more likely to embrace change, especially change that affects off-duty behavior, if they understand and appreciate fully the effect of fatigue on their work and in their lives. Training programs are most effective when the countermeasures to be implemented are specifically tailored to the workplace and can be linked to how they will provide relief from specific aspects of fatigue.

Most education programs are mandatory for all employees, including management, and include lectures by experts, brochures and other reference materials, websites, videotapes to disseminate information and an employee hotline.

Managing Shifts

Consider developing rotating shifts to avoid a permanent night shift workforce and provide for adequate recovery time for employees between shift changes. While many workers prefer a fixed shift schedule due to family responsibilities, research indicates that most permanent night shift workers rarely get used to their schedule. Several reasons could account for this. Daytime sleep has been found to be less restorative than nighttime sleep, so regular night shift workers never catch up on deep sleep. In addition, most companies report that their night shift workers say they return to a day schedule on their days off, and their sleep patterns are disrupted again. Rotational shifts have been found helpful in solving the problems caused by permanent shifts if the shifts are rotated forward, from a day to an evening to a night shift.

In order to help maximize the amount of restorative sleep employees can obtain, avoid quick shift changes, long work shifts and overtime, when possible. Keep night shifts to a minimum of two to four consecutive nights. At the end of a night shift, allow at least 24 hours before scheduling employees for their next shift.