We know sleep is important, so why do we often find ourselves getting too little of it?
Fatigue is not a new problem for EMS providers, but there’s a big difference between feeling worn out after a particularly busy shift and actual fatigue caused by sleep deprivation. And managing fatigue is the responsibility of both the provider and the agency they work for.
Maybe you’re saying, “Sure, I could stand to get a few more hours of shut-eye every night, but I’m still able to perform my duties just fine, even if I am a little tired.” Or, “I can function fine on just a few hours of sleep every night.” Well, perhaps you can. But a functional alcoholic is still an alcoholic. Just because you’re managing the day-to-day right now doesn’t mean there’s not a greater underlying problem.
“Any industry or entity that has to work in a 24/7 world is going to face fatigue,” says Bill Davis, vice president of operations for CIRCADIAN, a global leader in providing 24/7 workforce performance and safety solutions for businesses that operate around the clock. “Our bodies were designed to be awake during the day and find the safety of the cave at night so we could recharge our batteries. From the time humans have existed on the face of the earth, we naturally got up with the sun, did what we needed to do during the day, and when it got dark outside, there wasn’t anything else we could do. It’s only been a little over 100 years since we found an effective way to produce artificial light, and now there are more than 24 million Americans working either shift work or straight nights. That just hasn’t been long enough for us to break our genetic code. Even though we have people who work nights, night hours do not equal day hours.”
CIRCADIAN works with a number of industries that deal with fatigue, including EMS, but it was the transportation industry that really was the pioneer in finding ways to combat fatigue, Davis says. For industries like trucking, the U.S. Department of Transportation implemented hours-of-service (HOS) regulations. The intent behind those regulations is good, according to Davis, but sometimes the models themselves are too simplistic.
“The more you work or the longer you’re awake, the more fatigued you become,” Davis explains, “and then the longer you’re at rest—and particularly at sleep—the more you’re able to burn off that fatigue. That does make some sense. It’s kind of an hourglass design. As you’re awake the sands go from the top to the bottom. You deplete your body, you start to increase your fatigue, and then when you get to that point, you turn the hourglass over, and now you’re getting your rest again.”
But HOS regulations don’t account for the circadian factor, which goes back to not all hours of the day being equal when it comes to fatigue. Davis says studies show there’s a specific period of time, for most people around 2 a.m. to 6 a.m., where our ability to respond is decreased. It’s called the window of circadian low, or WOCL. And the studies indicate when talking about fatigue in 24/7 operations, it’s important to be very mindful of the time of day, as well as the number of hours of service.
Davis notes the second thing HOS regulations don’t adequately cover is schedule regularity—or, more simply, if the hours spent working plus the hours of time off don’t equal 24. An example would be with passenger carrier drivers. Under DOT regulations, they can drive a maximum of 10 hours after having eight hours off duty. On the first day a driver starts at 8 a.m., works for 10 hours and gets off at 6 p.m. After taking the minimum eight hours of rest, the driver can start to drive again at 2 a.m.
“What we normally find is that schedules that cause you to start your next day earlier than you started today—called a backward rotating schedule—are more fatiguing,” explains Davis.