News, Patient Care, Training

Federal Aviation Adminstration Releases Fatigue Guidelines

Issue 2 and Volume 37.

The Federal Aviation Administration (FAA) is requiring pilots to get 10 hours of rest between flights before going airborne, and some EMS experts say the emergency medical profession should do the same.

“When we’re talking about sleep deprivation, we’re talking about the Achilles’ heel of EMS,” says Chris Nollette, MD, NREMT-P and director of the EMS education at Moreno Valley (Calif.) College. “It’s underreported, and it’s the No. 1 problem we have to deal with in terms of the profession.”

The FAA’s new rules, announced in December, were created after some accidents were attributed to tired pilots. The old rules required eight hours of rest between flights, which experts said wasn’t enough.

However, no such national rules regulate EMS workers, and the field is fraught with tension and danger. The nature of prehospital medicine exposes paramedics and EMTs to traumatic events on a daily basis, which can lead to post-traumatic stress issues. EMS professionals work long shifts. They’re often overworked and underpaid, requiring second or third jobs.

Making matters worse is an air of “machismo,” as Nollette describes it, of those who work in public safety. Employees in those fields pride themselves on working harder and longer; although they often suffer the occasional consequences of that lifestyle in silence.

In fact, survey researchers at the University of Pittsburgh linked fatigue and poor sleep patterns of EMS professionals to increased injuries, medical errors and safety compromising behaviors.

Researchers for the study, published in the January–March 2012 edition of Prehospital Emergency Care, reported the rate of injury was 1.9 times higher for fatigued workers when compared with non-fatigued staffers. The odds of medical errors were 2.2 times larger for fatigued EMS providers, according to the report by P. Daniel Patterson, PhD, EMT-B, an assistant professor in the Department of Emergency Medicine at the University of Pittsburgh School of Medicine.

EMS is different from other fields, says Peter Dworsky, corporate director of support services at the Monmouth Ocean Hospital Service Corporation, a consortium that provides ALS services in New Jersey. Unlike factory workers who do eight hours and leave, “here, there is no whistle,” he says.

“The risk is medical errors, critical judgment issues and driving issues,” Dworsky says.

MONOC rules limit staffers to working no more than 24 hours straight, which would be a double shift.

“The concern we’ve always had has been where did that person come from,” Dworsky says, noting that 50–60% of the paramedics at MONOC work second jobs. “Unfortunately, it’s a very large problem. Nobody makes a lot of money anymore, and the economy forces everyone in EMS to have a job and a half, maybe two.”

Companies may monitor how long their employees work in one place, but the EMS industry doesn’t have regulations that require specific amounts of downtime an employee must have between jobs or shifts. 

A third of the 511 respondents in the University of Pittsburgh survey reported working at more than one EMS agency.

Dworsky also notes that volunteer providers are just as susceptible to fatigue issues as those at career services.

“What we have to do is recognize it’s a real problem,” says Nollette. “It’s affecting the health, the welfare and the safety of people in EMS.”

And the public, Nollette says, are at risk if overtired EMS staffers are behind the wheel of a 14,000-lb. ambulance.

“All the safety experts tell you, change starts from the top down, and every agency should have a safety committee,” Dworsky says. “In order to correct or change this, there needs to be a cultural change in EMS.”
—Richard Huff, NREMT-B

Pro Bono: Searching for Patients
EMS providers want to provide the best care to their patients, but sometimes they’re hampered by inadequate access to patient medical information.

Imagine you’re presented with a patient who’s unconscious or otherwise unable to communicate due to their condition, and no one familiar with the patient’s medical history is immediately available to answer questions—to provide the patient’s medical information you so desperately seek. The patient isn’t wearing a medical ID bracelet that would alert you to a medical condition that would be important to know.

Should you search the individual’s personal effects—the patient’s clothing or wallet or purse—for information that might help you assess the patient and administer appropriate medical assistance? If you do, are you improperly infringing on the patient’s privacy?

If money or some other item of value is later found to be missing, is the finger going to point to you? Should these concerns deter you from conducting the search? No. They should not if the circumstances warrant the search, but take appropriate measures to protect yourself and your interests.

When providing care to a patient as an EMS provider, your primary responsibility to your patient is to assess their condition as well as you can under the circumstances by securing the available patient medical information that best indicates the care needed. Then, provide that care as directed by your medical protocols or a physician authorized to provide you with patient care direction.

A search of the patient’s personal effects for important patient information is appropriate under some circumstances and inappropriate under others. Invading a patient’s privacy, whether legal or not, isn’t to be taken lightly. You’re responsible for exercising sound professional judgment. If circumstances dictate that you or your partner search a patient’s personal effects for critical information, you should do so. However, you should also ensure, if possible, that your partner or a bystander observes your search and that a record of the search and the objects and information obtained are documented and signed by both you and any available witness or witnesses.

You should also take appropriate precautions when conducting the search to avoid injury to yourself, such as might be caused by a needle stick or other sharp. Also, you should be extremely careful in ensuring the information you secure pertains to the patient and not someone else.

The key is to only search a patient’s personal effects when it’s needed to effectively treat the patient. Never search just because you have access. You need a legitimate, defensible reason. Take the appropriate precautions, but the bottom line is that it’s better to face the consequences of potentially violating a patient’s privacy than to forego a search for important medical information in the situation in which it may be essential in your treatment of the patient.

You don’t want to regret not having provided the care to a patient that could have saved their life had you obtained the critical patient information that was inches from your fingertips.

When in doubt, ask yourself this question: What would another reasonable EMT or medic do if faced with the same situation? JEMS

Pro Bono is written by attorneys Doug Wolfberg, Steve Wirth and Ken Brody of Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s website at for more EMS law information.

This article originally appeared in February 2012 JEMS as “Sleepy Time: FAA releases new guidelines about fatigue.”
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