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National EMS Week: Recognizing Fatigue as an Administrative Issue

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By Allison G. S. Knox
Edge Contributor

Fatigue is a major problem in healthcare services because of the problems it presents to patients and their overall safety.  Essentially, it is a problem when healthcare professionals are overworked and have not had enough sleep. More importantly, those that work in healthcare settings are dealing with people’s lives and providing them adequate care. In essence, fatigued personnel are not only scary, but fatigue can be a dangerous issue. 

This issue is also at the forefront of the policy discussion because of how it impacts health care throughout the United States. Emergency Medical Services is a 24-hour, 7 day a week healthcare service, and also particularly underpaid. Thus, many Emergency Medical Technicians and Paramedics work multiple jobs to make ends meet. In essence, fatigue is a serious issue and plagues EMS agencies throughout the country.  Where policy considerations are concerned, fatigue is an administrative issue that should be managed by local and state government policies.

Fatigue Is an Administrative Issue

 Hospitals, for example, do a nice job of managing employee fatigue. They schedule employees for part time and full time hours, respectively, and then pay them relatively well in exchange for their work. Other industries also do a nice job managing employee fatigue because they do not put their employees into situations where being tired would really become a life and death situation.

Ambulances, however, do not always have this luxury. Because ambulances need to be staffed 24 hours, 7 days a week, personnel are needed throughout the night. Some EMTs and Paramedics will take night shifts because they can sleep while on duty waiting for calls. But, there are nights when they may run all night and as such, they may not get a good night’s sleep.

While staffing can be difficult for ambulance agencies, putting people on different shifts should be an administrative issue.  Whether their personnel are getting enough sleep is a serious issue and thus, should be a managerial and administrative function. People will work multiple jobs if they are not getting paid enough.

Pulling this into perspective though, administrative staffing issues are complex and it can’t just reside with an agency to simply pay their personnel more money. If anything, the complexity touches on numerous pieces in society stemming from billing practices, to resource management issues, to budgetary issues in the local government.  It is a complex web of programs that contribute to wages.

Fatigue Should be a Policy Issue

While fatigue is absolutely an administrative issue, it should also be considered a policy issue.  Of course it is difficult to regulate the decisions departments need to make, but in this case, creating more regulations for staffing in this regard may help to prevent serious fatigue on the ambulance. In essence, Policies can be created to lessen fatigue for EMS personnel. 

Policy initiatives like this, however, are particularly complex and create other issues within society. Many scholars note that issues like this are referred to as “wicked problems” because of the complexity of the problem. It just isn’t a simple solution

What Can Be Done?

For National EMS week, those in leadership positions should consider how fatigue is plaguing their department. From there, they should create policies in the department designed to limit personnel fatigue.  Conversations between departments and with lawmakers need to take place to limit this issue. These conversations need to focus on answering the question, “What policies can agencies create to help combat this issue and what can they recommend to local and state level government officials?” 

Allison G. S. Knox teaches in the fire science and emergency management departments at American Military University and American Public University. Focusing on emergency management and emergency medical services policy, she often writes and advocates about these issues. Allison serves as the At-Large Director of the National Association of Emergency Medical Technicians, Secretary & Chair of the TEMS Committee with the International Public Safety Association and as Chancellor of the Southeast Region on the Board of Trustees with Pi Gamma Mu International Honor Society in Social Sciences. Prior to teaching, she worked for a Member of Congress in Washington, D.C. and in a Level One trauma center emergency department. Passionate about the policy issues surrounding emergency management and emergency medical services, Allison often researches, writes and advocates about these issues. Allison is an emergency medical technician and holds four master’s degrees.

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