Managing Fatigue in EMS

Fatigue is a fact of life in modern society.  Fatigue in EMS is constant and, sadly, all too accepted by both employers and employees.  I taught a class recently and easily half of the soon-to-be instructors (who had to try and retain a lot of new information) survived the class on an endless stream of coffee and energy drinks. I still wonder how much of the key information was retained.

This is a constant theme in all my classes. I still remember being on the other side of the table: in uniform struggling to stay awake.

Leading EMS organizations are finally addressing the problems of fatigue and shift work, so change is coming.  In the meantime, we still have to take care of ourselves. We know that chronic fatigue will suppress the immune system, making it easier to get sick, stay sick and suffer from chronic illness.1  Plus, fatigued humans are more likely to over eat when compared to non-fatigued counterparts.2 These mechanisms alone explain why chronically fatigued first responders will miss work due to illness and stress and also have a higher likelihood of obesity and injury.

Sleep Hygeine

Sleep hygiene is a major component of learning to survive and thrive in EMS.  To keep it simple and actionable, the following six recommendations will set you on the path to rest, rejuvenation, healing and health.

1. Get your blood work done annually.  This is the most important part of the process.  How do we know what we need to treat if we’re guessing?  Make sure to ask your MD to test for things outside the normal blood panel.  Shift work, fatigue and chronic stress will upset cortisol levels, testosterone, blood sugar and even vitamin D levels.

The normal blood panel does not test for T. The cortisol screen, if done, is a snapshot, not a 24-hour profile. The test can also miss vital markers like calcium, magnesium and zinc.  If you don’t ask, it probably won’t get done. Especially the T and cortisol.

2. Calcium-magnesium supplements.  Most Americans are deficient in both minerals. Taken at bed time, the combination of calcium-magnesium promotes a calming effect and can help to promote sleep.  You can get it in a pill or a powder. The formulations vary and we have seen the average dose at around 400/400mg of each.  These usually come as a citrate which can promote bowel function as well.

3. Zinc & magnesium supplements. If you’re starting to see a trend here with magnesium, you’re right.  The next sleep-promoting supplement is called ZMA.  It’s a zinc-magnesium supplement that studies have suggested can enhance muscle size, muscle strength, and fat loss–not to mention overall health and well-being.  Taken at bedtime, magnesium can also promote sleep.  Zinc is also known to be cardio-protective. As always, see what your blood work says before starting a new regimen.

4. 5-HTP supplements. 5-HTP works in the brain and central nervous system by increasing the production of the chemical serotonin. Serotonin can affect sleep, appetite, temperature and pain sensation. Since 5-HTP increases the synthesis of serotonin, it’s used for several diseases where serotonin is believed to play an important role including depression, insomnia and obesity.

5-HTP taken the night after your last shift will really help to get your body back on a normal sleep-wake cycle.  It can be taken as needed, but most responders report to me that taken the night after a 24-hour shift or three 12s, it does an amazing job of promoting sleep without that ‘hangover’ feeling the next day.  Dosages can vary, so titrate to effect.

5. Hydration.  We all know the importance of staying hydrated, yet few of us do it enough.  Fatigue, mentation, concentration and pain are all effected by dehydration.  Muscles move poorly and disks absorb load badly when dehydrated.  The bottom line: Drink more water.

6. Eliminate blue light. Study after study has linked working the night shift and exposure to light at night to several types of cancer (breast, prostate), diabetes, heart disease and obesity. Exposure to light at night suppresses the secretion of melatonin, a hormone that influences circadian rhythms, and there’s some evidence that lower melatonin levels might explain the association with cancer.3

Creating the Right Environment

Take it a step further: You’e home and off duty, watching TV. Your phone/tablet/computer is on and in your hand.  You take one of the sleep hygiene supplements above and nothing happens. You have to promote an environment for sleep for any of this to work!

  • Turn the screen off or use a blue shade filter on your device.
  • Turn the room lights down and turn the TV off.
  • Take your sleep hygiene supplement and make sure all outside light is blocked.  Avoid alcohol.
  • Turn on a fan or use a white noise app (make sure the device is on silent and screen down).
  • Read a book and drift off to sleep.

Sleeping well requires some forethought and a little planning.  Throw in a consistent exercise routine (not near bedtime), eat clean and stay hydrated.  With some determination and diligence, you’ll start sleeping well again.


1. University of Washington Health Sciences/UW Medicine. (January 27, 2017.) Chronic sleep deprivation suppresses immune system: Study one of first conducted outside of sleep lab. ScienceDaily. Retrieved July 31, 2017, from www.sciencedaily.com/releases/2017/01/170127113010.htm.

2. American Academy of Sleep Medicine. (July 1, 2012.) Sleep deprivation effect on the immune system mirrors physical stress. ScienceDaily. Retrieved July 31, 2017, from www.sciencedaily.com/releases/2012/07/120701191638.htm.

3. Harvard Health Publications. (September 2, 2015.) Blue light has a dark side: Exposure to blue light at night, emitted by electronics and energy-efficient lightbulbs, harmful to your health. Harvard Health Letter. Retrieved July 31, 2017, from www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side.