Paramedic Fatigue Management

Paramedic fatigue management is a vitally important aspect of the paramedic’s duty to themselves, their colleagues and their patients, as well as the responsibility of the Ambulance Service that employs them. Very little is scientifically known about paramedic fatigue and its effect on the paramedic’s health and the health outcomes of their patients. Anecdotally, stories relating to paramedic fatigue are rife within the profession of paramedics: the time I fell asleep at the wheel, made a massive medication error, left a patient at home because I was too tired to notice that he was having a silent heart attack. These are all too common stories amongst paramedics.

Given the amount of hours that paramedics work it is strange to think that paramedic fatigue management has been so overlooked until recently. The correlation between fatigue and work related accidents have been well documented and studied since the early 1980s. Even better documented is the correlation between driver fatigue and car accidents. In NSW sleep studies have shown a correlation between driver fatigue comparable alcohol intoxication. Persons forced to stay awake longer than 16 hours or have a cumulative loss of sleep of 2 hours each night over 3-4 days were found to have similar coordination with persons who had blood alcohol readings greater than 0.10.

In NSW it is illegal as a professional driver to drive longer than 10.5 hours in any given 24 hour period. Yet, paramedics across Australia work 12-14 hours shifts, which can easily extend to 16-18 or more with overtime.

Tips on Managing Paramedic Fatigue?

The following are tips on paramedic fatigue management:

1. Ensure that you have a good balance between work days and days off so that you are relatively refreshed by the time you start your set of days on and are not starting your working week already fatigued. Many paramedics make the mistake of taking on too much overtime or a second job on their days off and are consequently fatigued before they even start their working week!

2. Don’t take the job home with you. As a paramedic you deal with people in stressful positions every day it is important not to take this stress home with you. When you leave the job for the day, you need to leave the stress their too. This may be a little difficult if you are on call with work.

3. Ensure adequate meal breaks every 4-5 hours. A short 20 minute, uninterrupted meal break is usually sufficient. Many Ambulance Services fail in this respect by expecting their staff to work 12 -14 hours shifts without any break due to work demands.

4. Eat good food and long lasting food (such as foods rich in nutrients and carbohydrates). Try to avoid eating large amounts of food on night shift which then change your bowel system when you return to day shift or days off.

5. Few people are genetically predisposed to sleeping well during the day. Consequently, it is important that Ambulance Services avoid rostering systems that require the paramedic to work multiple night shifts in a row.

6. Avoid short change over shifts where you go from afternoon shift to early morning shift.

7. Sleep can be seen as a bank account. If you have plenty of sleep in the bank you are able to withdraw some of this saved up sleep during night shift. Without excess sleep in the bank account you enter negative sleep balances and this is when fatigue becomes detrimental to your health and your clinical judgement as a paramedic.

8. Avoid eating excessive amounts of sugar (lollies) or stimulants such as caffeine to get you by night shift. These may help on the occasional night shift, but become troublesome if used to regularly. It is abundantly clear that illegal stimulants have no place in managing a paramedic’s fatigue.

9. Take regular holidays (preferably at least once every 3-6 months) in order to manage the cumulative effect of fatigue.

10. Ensure that you are educated about the signs and symptoms of fatigue so that, as a paramedic, you are aware when you are experiencing fatigue and are better able to manage it. All paramedics are different and only you can identify your own fatigue and manage it correctly.