Fighting Sleep Deprivation in EMS

  • Fighting Sleep Deprivation in EMS

    BY MARK LAMPLUGH ON NOV 20, 2015

    It’s 3 a.m. and the tones go off again. You just tried to lay your head down for a few minutes and get some rest. You throw on your boots and run out the door.

    At times, the cycle seems never-ending. You keep pushing because there is no other choice. Besides, you can sleep when you get off work, right? Wrong! You barely get home in time to have breakfast with the kids before hustling everybody in the car and running to school, daycare, etc.

    Then you have to run by the grocery, pay bills and walk the dog. Back home you catch a few winks before you are on the go again.

    Sound familiar? You are not alone. This scenario plays out on a daily basis across the nation.

    Whether you are on a 10, 12, 16, 24, or 48 hour shift schedule, one thing is certain in EMS: you could use more sleep.

    You are in one of the most physically, mentally, and emotionally draining jobs around. Compound that with little outside time to eat right, exercise and have free time and you are headed for potential disaster.

    Sleep deprivation is a hot term over the past couple of years. Scientists are stressing the massive impact that sleep has on our overall physical well-being.

    Sleep deprivation goes way beyond just having a couple of shifts that are busier than normal. It is a serious state to be in, and it leaves you vulnerable to a host of problems.

    Sleep deprivation is defined as: a sufficient lack of restorative sleep over a cumulative period so as to cause physical or psychiatric symptoms and affect routine performances of tasks¹.

    The very definition of sleep deprivation should be cause for concern. Restorative sleep is not relaxing in the station recliner with the TV on in the background and radio noise blaring occasionally overhead.

    The direct consequence is a decline in the quality of what you have to offer in your everyday activities including driving, checking off equipment, assessing patients, administering medications, starting IV’s, inserting airways, applying splints and documenting important legal information. Do you really want a decline in your level of performance on any of these tasks? Can you or your patient afford that change?

    What other effects will you see? Let’s start with the physical.

    Sleep deprivation has been related to obesity, cardiovascular disease, diabetes and alcohol dependency².

    On the surface, you may think this is all due to poor eating choices, lack of regular exercise and dealing with stressful situations. While these do play a big part in our health, adequate and restorative sleep actually allows the body to operate in a manner where all systems reset and are primed to function as intended.

    If you short-circuit that process those systems never have a chance to reboot.

    Mental effects are just as prevalent. Loss of cognitive function, slower response time, anxiety and overall feeling of sluggishness can occur.

    Emotional effects are seen in a shorter fuse, quick swings of emotions, and depression.

    So let’s throw out another scenario: You are sleep deprived but just shrug it off. You encounter a belligerent patient that you normally would treat quietly and move on. Instead, you engage in a yelling match. Your partner tells you to cool off, but that just makes you angrier. The shift ends, and you go home. Your spouse asks you a mundane question and you verbally bite their head off. Everything irritates you to an irrational level.


    The next day at work you nearly miss an obvious sign of distress your patient is showing. Your partner mentions it, and you honestly are oblivious. Driving back to the station, you pull out in front of a truck which barely swerves in time to avoid a collision. You simply can’t shake the feeling like you are stuck in fog and operating at a much slower speed.

    Statistics have shown some frightening trends. EMS responders who are sleep deprived are more likely to have an accident, commit a patient care error, take shortcuts, become injured on the job or exhibit the same mental impairment as being intoxicated³.

    So what does this mean for you, the EMT that is due to report for work in a few hours?

    Think back to how you prepared for your board exams. You studied, you armed yourself with information. Learn the difference between just being tired to actual sleep deprivation. Ask your coworkers. They know you and your normal behavior. Ask your loved ones if they think you are changing. A great barometer to how you truly are doing is to read those in your environment. Is your spouse tiptoeing around? Are your kids walking on egg shells, afraid they will say the wrong thing? Are people at work refusing to ride with you? Do you consistently seem to be forgetting minor things or simply not caring about your daily events?

    Maybe it isn’t you that is the concern. Maybe your partner is showing these signs. Maybe they are having frequent stress headaches, mental lapses or showing a loss of interest in the job. Maybe you are an employer and have had an increase in legitimate complaints on an employee who never had any.

    What is the answer? Long term changes need to be put in place. Shorter shifts, limited OT and rotations of busiest crews would provide relief. Employers need to be aware of the signs and symptoms, and need to act quickly if they have an employee showing them.

    Many employers have anonymous programs in place that provide counseling.

    As for personal responsibility, make sure to take time to rest. If that means you skip that OT shift, do it. Try to make changes in your financial situation so you might not have to work extra. If that isn’t possible, see if you can rotate to a slower station or area for a time.  Enlist the help of family with chores around the house.

    Don’t ignore the situation and pass it off as life in EMS. This is a demanding field, and always will be. We will most likely be underpaid and overworked. But it is an important job and few do it well. Don’t shortchange yourself, your career, family and patients.

    Be honest with yourself and others. You owe it to yourself, your partner and especially your patient.

    References

    1. Farlex Partner Medical Dictionary. Sleep Deprivation. www.medical-dictionary.thefreedictionary.com/sleep+deprivation.

    2. Altevogt BM, Colten HR. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press, 2006. 

    3. McCallion, T. Study Measures Effect of Sleep Deprivation on EMS Providers. J Emerg Med Serv, 2012. 


    About the author:
     Mark Lamplugh is a fourth-generation firefighter and former captain with the Lower Chichester (PA) Fire Company. He is the Chief Executive Officer with 360 Wellness Inc. (www.360wellness.org) and a Executive Director with Sprout Health Group (www.sprouthealthgroup.com).

    Lamplugh is also nationally recognized in Crisis Stress Intervention through the American Academy of Experts in Traumatic Stress. He has helped hundreds of firefighters, police officers, veterans, EMS personnel, and civilians nationwide find help for addiction, alcoholism, PTSD, and mental health support.

    He can be reached for comment at mark@360wellness.org.