Administration and Leadership, Columns

Pro Bono: Fatigue and Sleep Deprivation in EMS

Issue 2 and Volume 43.

Managing the risks & liability of sleep deprivation in EMS

Fatigue brought on by sleep deprivation can lead to serious and even tragic mistakes for EMS practitioners.

The U.S. Department of Transportation identifies fatigue as the number one safety problem in transportation operations, costing more than $12 billion a year. Sleepy drivers can be as dangerous as alcohol-impaired drivers, and the U.S. National Highway Traffic Safety Administration (NHTSA) estimates that in 2015, more than 72,000 police reported crashes involved drowsy drivers. These crashes led to 41,000 injuries and more than 800 deaths.1

P. Daniel Patterson, PhD, MPH, MS, NRP, has a well-researched article in the February issue, which will be the seminal article on this subject into the future. Dan and his research team have developed practical solutions and strategies—including evidence-based guidelines for fatigue risk management—to help address this serious problem in EMS.2

A Major Risk

EMS agencies are at great risk for liability if this problem isn’t addressed effectively. Liability to the EMS agency for the mistakes of fatigued employees arises from the simple legal principle of respondeat superior: The employer is responsible for the actions of its agents, who are acting on the employer’s behalf.

Claims of negligence can be successfully brought against healthcare employers for mistakes made due to provider fatigue. This is especially the case if the employer knew or should have known of the risk that a fatigued healthcare provider posed to himself or others, yet did nothing about it.

EMS agencies have a legal responsibility to supervise their personnel and prevent negligent acts from happening. Claims of “negligent supervision” are becoming more common, and are likely to be found in a lawsuit against an employer when the fatigued employee harms a third party. Employers may also have workers’ compensation liability if the fatigued employee harmed himself or co-workers on the job.

The individual provider can be sued in civil court for negligence, and can also be held criminally liable if the individual fell asleep at the wheel and others were harmed or killed as a result.


EMS agencies must implement a comprehensive risk management program to deal with this increasingly serious problem. Risk management is mostly about prevention: Addressing the problem before a serious incident occurs.

Awareness of the problem is the first step, and EMS leaders should candidly discuss and address the issue head-on with field providers, dispatchers and others who may be prone to fatigue that can affect job performance or decision-making.

The old policies of “reporting to work well-rested,” “no sleeping on duty,” and “no moonlighting” need to be re-evaluated and retooled in an environment where EMS personnel are working increasingly long shifts and multiple jobs just to make ends meet.

If an employer is aware of staff members not functioning up to par because of fatigue or lack of sleep, simply put, the employer has a legal (and ethical) responsibility to do something about it. That’s why more EMS agencies are implementing “time out” protocols, allowing brief naps and establishing a “quiet room” or “sleeping room” where staff members can get refreshed if they’re too fatigued or too tired to function.

Agencies must develop policies to manage this evolving and serious issue and include those who will be affected in their development.

The culture of the organization must allow for a staff member to call him or herself “out of service” in specific situations if fatigue would pose a risk to themselves, their co-workers or their patients.

EMS practitioners have a professional responsibility. We need to be our best for every patient and every family, every time. You’re only one call away from a $10 million jury verdict. Making a fatal error because you didn’t get adequate rest is a sure-fire way to get one!

Providers shouldn’t take improper advantage of time out or rest protocols, but they should let their supervisor know if they don’t feel that they’re physically capable of safely performing their job duties. Furthermore, supervisors shouldn’t view this as a negative mark against the employee.

The bottom line is that workplace safety programs must include a process for addressing the fatigued staff member to ensure that we “do no harm” when we provide high-quality EMS for our communities.

The consequences are too great if we don’t address these critical issues.


1. United States Department of Transportation. (n.d.) Drowsy driving. National Highway Traffic Safety Administration. Retrieved Feb. 3, 2018, from

2. National Association of State EMS Officials. (Nov. 8, 2017.) Fatigue in EMS. NASEMSO. Retrieved Jan. 3, 2018, from