Sleep Deprivation and 24 hour shifts

I am a silent member on the NEMSMA (National EMS Management Association) listserv. They have great & well informed discussions on topics related to our field, you should be part of that group and join the conversation.

The most recent topic is about shift duration. The discussion is mostly about safety, and sleep deprivation. Even the EMS Garage has touched on the topic recently, in their episode 109 Can We Take A Nap?

The one piece of statistical data that is used most frequently when talking about shift length is UHU (Unit Hour Utilization). This is expressed in a decimal (0.1-1.0), and the number represents a percentage of time that the ambulance or unit is being used (0.8 would be 80% of the time the unit is on a call, from dispatch to clearing from the hospital).

The regulations covering commercial motor vehicle drivers (CMV) are also used in comparison to the EMS field. This makes sense since EMS is regulated on the federal level by the National Highway Traffic Safety Administration (NHTSA), however being an emergency service, ambulances are except from the Federal DOT regulations. For comparison, the hours of service regulation (49 CFR Part 395) states:

For Passenger Carrying CMV drivers: They may not drive more than 10 hours after having 8 consecutive hours off duty.
May not drive after being on duty for 15 hours following 8 consecutive hours off duty (Off-duty time is not included in the 15-hour period)
May not drive after being on duty for 60 hours in 7 days or 70 hours in 8 days.

There is talk of the DOT reducing consecutive driving hours to only 8. This regulation is for drivers who are on the road, driving for the entire time period. Obviously EMS is a little different (even at busy services there is occasional downtime).

My full time job, working for a large national ambulance service, works me on two 24 hours shifts a week. I have one 24 hour period off between the two shifts. I do not have the UHU for my service. I do know we make a little more than 50,000 transports a year. During my shifts we make between 4-12 runs in a 24 hours period. My company does provide sleeping quarters, but we can only return to the station after 7pm. I average 3-4 hours of sleep per night while on shift. We are at our peak during the day averaging 5-6 runs in the first 12 hours. I have mentioned to my supervisors that we are tempting fate running 24 hours shifts in a busy service. There are two ALS ambulances per day that work 24 hour shifts. The remainder of the ambulances work 8, 10, 12, 14 hours shifts. Many nights, when we’ve been awake for 16+ hours I wonder if this is worth the risk to myself and my patients. I do not wish to place anyone in harms way, but the data shows that workers who are fatigued will make mistakes. I have personally found that sleep deprivation effects my ability to think and react rapidly. I have been told by several supervisors that we medics would leave this service if they switched to 12 hour shifts. I still think 12 hours shifts here would be safer for the crews and the patients.

One of my part time jobs with a rural 911 ambulance service schedules all personal in 12 hours shifts. I do not have the UHU for that service either, sorry. Many paramedics will work 24 hours, scheduling two shifts in a row. This service has 2 ambulances staffed with EMTs 24 hours a day, two paramedics in rapid response vehicles staffed 24 hours a day and one ALS ambulance staffed 24 hours a day. From my personal experience, the medics make 2-5 runs in a 24 hours period (some days we are lucky to make 1 run in 24 hours). The BLS ambulances make a few more runs then the paramedic cars, not many EMTs work more than their 12 hour shift in a 24 hour period, but it does happen. Like most 911 services the call volume varies from day to day, but for the most part the night shift can get 5 hours sleep. At this service we are also allowed to sleep during the day, provided all the house chores are completed. I have a bit of trouble with insomnia, but otherwise I am normally well rested at most hours when I work there.

The 911 EMS agency that works in the Metro area has a different scheduling dilemma. They are scheduled 12 hour shifts, can be held over for no more than 4 hours past their scheduled time (making for 16 hours maximum per shift). There are almost always people being held over for coverage, giving them only 8 hours until they have to be back at work for their next scheduled shift. They are still have open positions, so coverage becomes an issue when people call in sick. With only 8 hours to get home, eat, sleep and wake up in time to be ready for their next shift, I can only imagine that most employees are not getting adequate rest between shifts.

Sleep deprivation is a topic that needs to be addressed in all sectors of emergency services, not just EMS. Ambulance services are most susceptible to sleep deprivation due to the high call volume and the potential for harm to the patients. How does your service handle this issue? How can we make this the top safety priority for all ambulance companies?

I will not say that all 24 hour shifts are dangerous, but in high call volume services I think we should stay away from 24 hour shifts and limit the consecutive hours a person can work without rest. In the next post I will tackle the issue of people working multiple jobs.


About Joel

I am a paramedic, firefighter and I work for an organ procurement organization. All stories related to work have been altered to HIPPA standards and for the protection of those involved. The personal stories are different. Photography, flying, aviation, hiking, camping, travel, geocaching, amateur radio are a few of my hobbies.
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One Response to Sleep Deprivation and 24 hour shifts

  1. Pingback: EMS and Sleep Deprivation | Rescue Monkey

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