Fatigue in EMS
With the way the world of emergency medicine is today, unfortunately those two words are almost synonymous. Fatigue and EMS.
Fatigue- "Extreme tiredness resulting from mental or physical exertion or illness."
EMS- "Extreme willingness to perform life saving efforts of a physical or mental illness of a completely random stranger."
Coming into EMS and experiencing the first year of being a licensed provider, it is hard to understand what your body is telling you, and what your mind is telling you. To move further from my first statement, fatigue is a good adjective to describe the effects of EMS on the body.
However in your first year, it's hard to understand that—when you’re working all the overtime shifts you can manage, because the money is like a magnet to a young and motivated EMT. There will be days where you NEED a day off, but the incentive bonus for the shift is so tempting you decide to work anyways. How many of us can say within that first year of working that they stepped back and saw what it was doing to their body?
The Journal of Emergency Medical Services (JEMS) published an article in February of 2018 regarding “Evidence-Based Guidelines for Combatting Fatigue in EMS”. The “hook, line, and sinker” of this journal is simply the first section of the article. Three separate cases, where three different EMS workers in the northern half of the United States were so exhausted they all crashed their rigs, and fatally wounded their patients they were transporting. One of the EMT’s was criminally charged in the death of their patient. Is this what it must come to make a living in such a dangerous business as EMS?
Why is this job so enthralling?
When I first got my license from the state, I could not begin to describe my thoughts on what I thought I was getting myself into. In school you learned about CPR, treating sick patients, the best way to treat different pathologies of diseases, and all in all how to save a life. From learning how to drive the ambulance with lights and sirens going, your heart is racing, your body has no clue how to contain its feeling in the moment of possibly going to save someone from their worst day ever.
That first feeling of getting a pulse back on the grandfather having dinner with his grandkids after he went unresponsive at the dinner table, and then flying to the hospital to figure out he was having a massive heart attack, and that had we not have performed the way we did. That patient would not have made it out of the hospital. That feeling becomes an addiction–you become so drawn to the adrenaline rush of the high intensity calls, you don’t ever want to stop, but at what cost?
The Cost of Saving Lives
The National Sleep Foundation recommends that in a 24 hour period an average human being needs 7-9 hours of sleep in that period. Unfortunately most EMS workers admit to only getting 6 hours of sleep, with over half of the population stating they get less than adequate sleep.
One thing we as providers need to understand is what is the cause of these numbers. In the service I work for, the first year of my employment I was able to “pick up” as many shifts as I wanted, with incentive bonus after incentive bonus. Getting messages every day telling all the employees “We are throwing extra money at you to work for us today" —there’s not many people that are going to turn down that deal.
While the extra money going into your pocket may seem great, nobody is able to realize the effects of working that much has on your body. With regards to the amount of sleep the average human needs, you are not going to get that allotted amount of sleep when working that many hours in the week. You may get off late the day before, and you picked up the next day to work, and by that point your body already starts to wear down due to lack of sleep.
Not only with the lack of sleep, but let’s also take into consideration the diet of an EMS worker. Working 2pm-2am on a Saturday night during a local college football game, you’re not going to have any options of getting a good quality meal. Between taking patients to the hospital, and moving around from post to post, the only option that is quick is either that drive-thru fast food joint or some quick snacks from the gas station, which is more than likely a roller dog or some potato chips. None of this is beneficial to you or your patients.
How to Combat it
Yes, it may be hard to turn down a little extra dough during the holidays, but your family and body will thank you by taking an extra day off that you would have normally worked. There’s no denying that spending time with your family–whether it be your dogs, or with your child and significant other, and having a relaxing day on the couch is much better for your body.
On the days you have off, take time to yourself, sleep in, maybe watch a movie or two, the key in all of this is to relax. Nobody can deny that working in a 911 system is stressful, whether you’ve worked in EMS for 20 years or 20 minutes, this job can break you down.
Finding ways to unwind and let your brain slow down is the best thing you can do for yourself. Whether it’s going for a walk, playing an instrument, or as simple as laying on the couch and binge watching your favorite TV show. Take these times and cherish the days off, it will save you and your job.
Now that may cover the sleep portion, but what else can we do?
While it may seem like a pain, try and pack your lunch the day before you work. The quick 20 minute task of packing your lunch box and thermos may save you the stress of hoping you don’t catch a call while in the line at Taco Bell! Find some foods that are filling, but don’t take much prep time prior to the meal!
One simple trick would be to bring some protein powder and a shaker bottle, not only at that point do you only need water (or milk if you’re feeling fancy), but you would have a quick and easy “meal” that you can drink driving down the road, and it would be enough protein and nutrients to be able to make up for the calories we burn during a 12 hour shift.
To end this on a happy note, there are many pros to working in EMS: hearing the stories of the WWII vet, or holding the newborn baby the first time mother just gave birth in the back of the truck. While there are cons, such as fatigue, poor sleep and eating habits, and the big one being those rough calls everyone runs. While all of those are valid points, there are ways to combat many of these issues within yourself.
Sadly, the state that EMS is in now, we will not be able to fix the systematic issues within private agencies and county organizations, but we as first line workers can help change our habits. With hope that when we start to change at the bottom of the pyramid, things might change on the upper side of the chain as well. Don’t let the money bring you in and bring you down. Be able to show what your limits are.
We preach to patients about how their bad habits can hurt them. When are we going to exercise those practices?
(P. Daniel Patterson, Evidence-based guidelines for combatting fatigue in Ems - JEMS: EMS, emergency medical services - training, paramedic, EMT News 2021)