Shore EMS Conference 2010

1. Shore 10th Annual EMS Conference
Sleep
Deprivation
Christiana Fire Company
Christiana, DE
February 7, 2010

2. Outline
Sleep Deprivation-Chronic Sleep Loss
Physiologic Effects
Risk Factors
Potential Legal Liability
Options

3. EMS Work Hours

4. Sleep Deprivation
Sleep Deprivation
linked to
increased errors
in tasks
involving:
Alertness
Vigilance
Quick decision-
making

5. Long Work Hours
Decreased ability
to think clearly
Feelings of
depression
Feelings of stress
Irritability

6. Chronic Sleep Loss
Decreased ability to think
clearly
Decreased ability to handle
complex mental tasks
Decreased ability to form new
memories
Decreased ability to solve
problems
Increase in health complaints
Musculoskeletal problems
Higher body weights
Greater risk of obstructive sleep
apnea
Increased cardiovascular
disease
Increased cancer

7. Crashes
Fatigue is a major factor in
motor vehicle crashes
Drivers at high risk for sleep-
related crashes, including:
1. Younger drivers lacking
sleep due to demands of
school, jobs, late socializing
and poor sleep habits
2. Shift workers
3. Drivers using alcohol or other
drugs
4. Those with sleep disorders

8. EMS Work Hours

9. EMS Work Hours
Fewer than 6 hours of sleep
during one sleep-wake cycle
affects:
Coordination
Judgment
Reaction time

10. EMS Work Hours
“People with 24 hours of sustained wakefulness
performed tasks that involve tracking at a level
comparable to those with a BAC of 0.10%”
New England Journal of Medicine (2002)
In all 50 states, it is illegal to drive with a
BAC of 0.08% or higher

11. EMS Work Hours
Driving an emergency vehicle under
sleep deprived conditions can
have devastating consequences

12. EMS Work Hours

13. EMS Work Hours
“People who drive after being awake for 17-19 hours
performed worse than those with a 0.05% BAC.”
Occupational and Environmental Medicine (2000)
Motor vehicle collisions are the leading
cause of on-the-job fatalities for EMS
personnel.
Annals of Emergency Medicine (2002)

14. EMS Work Hours
Criminal Consequences
New Jersey “Maggie’s Law”
Sleep deprived driver qualifies as a reckless driver who
can be convicted of vehicular homicide in NJ
A person commits vehicular homicide when he
causes the death of another by driving a motor
vehicle recklessly
Proof that the defendant fell asleep while driving or was
driving after having been without sleep for a period in
excess of 24 consecutive hours may give rise to the
inference that the defendant was driving recklessly

15. EMS Work Hours
NJ Vehicular Homicide
Second degree crime
Imprisonment of 5-10 years
Fine of up to $150,000
Or both

16. EMS Work Hours
Civil Liability
Faverty v. McDonald’s Restaurants of Oregon, Inc.
133 Or App 514, 892 P2d 703 (1995)
HS student asked to leave work because he was sleepy
Caused motor vehicle crash & was killed
Critically injured another driver

17. EMS Work Hours
Civil Liability
Faverty v. McDonald’s Restaurants of Oregon, Inc.
133 Or App 514, 892 P2d 703 (1995)
Critically injured driver files negligence claim
Employee scheduled for too many hours without adequate
time for rest
Employer should have foreseen employee working 3 shifts
in 24 hour period would pose risk to themselves and other
motorists

18. EMS Work Hours
Civil Liability
Faverty v. McDonald’s Restaurants of Oregon, Inc.
133 Or App 514, 892 P2d 703 (1995)
Court rejects McDonald’s claim that employee
volunteered to work additional shifts
Court equated management liability to bartender who
serves drink to “visibly intoxicated” person who
“volunteers” to pay for the drink

19. EMS Work Hours

20. EMS Work Hours
Sleep deprivation & fatigue
in the workplace
Poor concentration
Absenteeism
Accidents
Errors
Injuries and fatalities

21. EMS Work Hours
64% of ATCEMS medics
found it “difficult” or “very
difficult” to stay awake
during 24-hour shifts
61.8% felt their health would
improve with shorter shifts
44% of medics reported
nodding off several times a
month during their shifts

22. EMS Work Hours
29% said they provide less
than optimum care at end of
a 24-hour shift
50% had accidents or near-
misses due to fatigue
5% had fallen asleep while
driving an ambulance

23. EMS Work Hours
Shortened to 12-hour shifts at busiest EMS stations
Reduced work week from 56 hours to 48 hours
Requires 10 hours off between each shift

24. EMS Work Hours
Is this an issue within your organization?
What steps have you taken?

25. EMS Work Hours
Options
Maximum allowable consecutive work hours
Maximum amount of time an employee must have to
recuperate before returning to duty
Defined number of hours between last alcoholic beverage
and the start of a shift
Consideration of fitness to drive home following a shift

26. EMS Work Hours
May drive maximum of 11
hours after 10 consecutive
hours off duty
May not drive after 60/70
hours of duty in 7/8
consecutive days

27. EMS Work Hours
FAA Regulations limit
pilots to:
Minimum of 10 hours off-
duty every 24-hour period
Maximum scheduled duty
period of 14 hours
Flight limit of 8 hours
between rest periods

28. Work Hour Management
Those who work long duration shifts can improve
their well being by leading healthy lifestyles.
Chronic sleep deprivation may not be recognized,
and it is important for firefighters and EMS
personnel to acknowledge their need for and
maximize their ability to achieve adequate sleep.

29. Work Hour Management
Coping with long work hours may be facilitated by
identifying workers at higher risk for difficulties in
adjusting, such as those with sleep disorders.
Fatigue is a risk for motor vehicle crashes, and
commuting home following long duration shifts may
be an especially vulnerable time for workers.

30. Work Hour Management
Firefighters, EMS personnel, their families and
management need to work collaboratively to
structure work hours and circumstances to meet the
needs of professional excellence and the well being
of the employee.

31. Watching Each Other
Forgetful Fixated
Poor decisions Apathetic
Slowed reaction Lethargic
time Bad mood
Reduced Nodding off
Vigilance
Poor
Communication

32. Questions?
Chief Lawrence E. Tan
New Castle County EMS
Department of Public Safety
3601 North DuPont Highway
New Castle, DE 19720-6315
E-mail: LETan@nccde.org
Office: 302-395-8185
www.nccde.org/ems