Dead Tired.

MedFlight participating in industrial field amputation training with the Kettering Health Network Surgical Emergency Response Team.

Dead Tired.
Amanda Osborne, MedFlight Outreach Coordinator

In my 18 years in EMS, I have never met a first responder who wasn’t unwaiveringly dedicated to their job and to serving others. Taking that extra 911 call, picking up that extra shift, waking up in the middle of the night when the tones drop, pouring that extra cup of coffee as to prepare for a long transport. I’ve been there myself. And I’ve come home to my family at the end of a long a strenuous shift, kissed my kids, and went to bed… exhausted.

Odd schedules, odd hours, odd circumstances innately lead to odd sleeping patterns. But what about fatigue? What is fatigue? “A subjective, unpleasant symptom, which incorporates total body feelings ranging from tiredness to exhaustion, creating an unrelenting overall condition which interferes with an individual’s ability to function to their normal capacity.” What this translates to: “You are so tired that you are not making great decisions.”

I had never heard of ‘fatigue management’ until I began my career in critical care transport 15 years ago. There were so many proactive measures and systems in place at MedFlight to respect and PREVENT fatigue that I lost count as I learned them all. Among those is a “Crew Rest” feature, where the team can take themselves out of service for a period of time to rest. We want healthy and alert clinicians taking care of the sick and injured. Listing every fatigue management system at MedFlight would make this article 4 pages long.

Let’s look at fatigue from a different angle:

A friend of mine, who does not work in this industry, just had his NORMAL work week increased to 72 hours a week, indefinitely. Six 12-hour shifts in a row, with one day off inbetween (and he is asked weekly to work that day as well). He works in an industrial setting working with very large machinery. As he talked about it, I found myself drawing a lot of parallels to OUR industry and how fatigue, burn out, and the drive to “get more done, place production over safety” can quickly threaten the well-being of medical transport crew members.

Talk with your teams: Could this lead to fatigued decision making? Could this lead to machinery failure? Could this lead to injury, or worse?

What would the potential risks be if we required our crews to work a similar schedule? What tools are in place at YOUR organization to mitigate against fatigue and burn-out? Which of those practices could proactively be placed in my friend’s work setting that would mitigate fatigue and potential errors?

Take time to review the safety measures at your organization that discuss fatigue and burn-out. In addition to having systems, practices, and beliefs in place that promote a safe working cultures, The Commission on Accreditation of Medical Transport Systems (CAMTS) recommends ongoing training on the topics of sleep deprivation, sleep inertia, circadian rhythms and recognizing signs of fatigue.

We work in an industry that needs us at our healthiest so we can help those who need us most. In addition to that, we have families at home who depend on us. Respect your fatigue level, and find a balance that maintains your health and well-being…it’s a matter of safety.

“Evidence-Based Guidelines for Combatting Fatigue in EMS”, Daniel Patterson, PhD, MPH, MS, NRP
“Fatigue: A concept analysis. Int J Nurs Stud.”, Ream E, Richardson
CAMTS Standards and Policies, 10th Edition.