Fatigue Management

For most of us the term “fatigue management” wasn’t around when we started in EMS. Providers worked until they went home and that was it. But as we see the number of transports increase and staffing stagnant or even drop, we are asking more of our providers today than we have in the past. Couple this with an increased emphasis on safety and patient satisfaction, and here we are talking about managing fatigue in our workforce.

Regardless of what we call it, we have an obligation to ensure that our providers are operating in a safe manner, that means when they are operating an ambulance they have the physical and mental capacity to do so. A fatigued driver is dangerous to themselves, their partner, their patient and the public. There are steps we can take to ensure safety when it comes to fatigue.

Like many other problems we face, technology can be an ally here. There is technology that can track eye movements and sense when the driver is drowsy or they close their eyes. This can alert the crew before there is an incident. Vehicles now can come equipped with sensors that detect when a driver is drifting lanes and alerts them before there is a collision.

Technology is expensive and takes time to implement, but there are policy changes we can make to help. We can take a page from our friends in the Aeromedical services, you will find policies for HEMS providers which require them to put their crew down if any member of the crew feels like they are not fully prepared to continue to work, including feeling fatigued.

This policy should specifically lay out the procedure to request down time; who to contact, whether they are sent home or just on a break, do they get paid and how this time is monitored. By addressing these issues upfront providers won’t feel punished if you send them home without pay, because one of the keys to making this successful is not making it punitive. They should be required to contact someone about fatigue issues before a call comes in. If a provider is too tired to continue they should know this immediately after a call, not wait until a call comes in. This is not a policy that allows crews to refuse calls, it allows them to take themselves out of the rotation.

One of the fears in a program like this is abuse, what happens if someone continues to use it. First, if your culture is such that people look for ways to get out of work, in some ways you already lost. But there are ways to avoid abuse. If someone continues to use fatigue as a way to get out of work they may need to be terminated simply because they can’t perform the job duties as needed.

Regardless of whether this is an official policy or accepted practice, we shouldn’t be punishing providers who recognize a safety issue and report it. In this case the safety issue is the fatigue of the provider and reporting it means they may not be able to take that next call, but we have helped to improve the safety for all.

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