The Nature of Shift Work in Paramedicine
Healthcare is a 24/7 operation and paramedics must respond to emergencies at all hours. Rotating shifts ensure that emergency medical services (EMS) are available around the clock to respond to critical situations and protect the public. However, these shifts take a significant toll on the paramedics themselves.
Constant schedule changes disrupt sleep, leading to chronic fatigue, stress, and a range of other health issues. This not only impacts the well-being of EMS, but also impacts their ability to provide care in emergency situations.
How Shift Work Disrupts Sleep
The body’s circadian rhythm (the internal “clock” that regulates sleep) is designed to align with the day-night cycle. It helps us feel awake during the day and sleep at night. Irregular work hours interrupts this important system leading to several sleep-related problems:
- Difficulty Falling Asleep: Exposure to daylight (which signals the body to stay awake), can make sleeping during the day after a night shift challenging. Stressful work events and calls can also contribute to this issue.
- Poor Sleep Quality: Daytime sleep is often lighter and shorter than night-time sleep, which can lead to interrupted and less restorative sleep. Inconsistent sleep patterns also increases time spent awake in bed and lowers sleep quality.
- Sleep Deprivation: Frequent night shifts and irregular schedules lead to sleep loss that affects overall health and performance on the job.
Health Consequences of Sleep Disruption
This impact is widespread and can significantly affect paramedic’s health and job performance:
- Higher Risk of Chronic Health Conditions: Long-term, this is linked to higher risk of health issues such as heart disease, hypertension, and diabetes.
- For example, shift workers are up to 40% more likely to develop cardiovascular problems compared to those with regular schedules 1.
- Cognitive Impairment: Sleep is crucial for cognitive functions such as memory, concentration, and decision-making. Disrupted sleep impairs these functions, decreasing job performance and increasing the risk of vehicle collisions and errors.
- Mental Health Issues: Poor sleep combined with the often stressful nature of paramedic work can worsen mental health problems and negatively influence wellbeing.
- Paramedics are at a higher risk of developing conditions such as depression, anxiety, and PTSD than the general population 1.
- Impaired Immune Function: Chronic sleep deprivation can weaken the immune system, making paramedics more susceptible to infections/illnesses (which they are already frequently exposed to). This leads to more work absences and increased strain on colleagues.
The Challenge of Sleep Hygiene for Paramedics
Sleep Hygiene is the term used to describe habits, behaviors, and environmental factors that can be adjusted to promote a good nights sleep. Paramedics face additional challenges that can make implementing these changes difficult.
To learn more about sleep hygiene:
Sleep Hygiene Recommendations |
| Challenges for Paramedics |
Follow a consistent sleep schedule
| → | Inconsistent Shift- EMS needs staff 24/7
|
Sleep in cool, quiet, dark room
| → | Need to sleep during when there is daylight and the majority of people are active (more light and noise) |
Avoid stimulating activities (physical and mental) before bed
| → | Emergency calls are unpredictable
|
Relatively consistent energy use
| → | Energy demands are determined by emergency calls- unpredictable and variable between shifts
|
Why the Sleep Problem will Continue to Grow
Emergency Medical Services (EMS) across the country and internationally are facing complex challenges that further contribute to difficulties with sleep and energy management for paramedics.
- Demands on EMS are higher than the healthcare system can currently support. The strenuous working conditions have led many to leave the profession.
- Not enough paramedics to deal with the amount of emergency calls
- Higher call volume since the COVID-19 pandemic leading to minimal (if any) downtime and frequent overtime
- Employees face pressure to work with efficiency at the cost of their wellbeing, rarely getting a single break in a 12 hour shift
- In Alberta, emergency call volume has increased 30% per year since 2020
- Longer response times are leading to more serious health consequences
- I.e., an overdose becoming a cardiac arrest (heart stops) in the time between calling 911 and getting help
- Public health issues getting worse:
- Climate change: Weather impacts response times, employee safety, and resource allocation. More extreme weather is leading to an increase in heat/cold-related emergencies
- Opioid use is growing: as well as related deaths and EMS resources needed to manage these calls
- Homeless individuals (compared to housed) have a disproportionately high use of EMS. This population is continuing to grow
- Increased non-emergency use of EMS
- More and more calls that do not require EMS
- Some people knowingly take advantage of EMS
These examples all contribute to the issue by:
A: Reducing the capacity of paramedics by adding stress, and decreasing downtime
- This contributes to rates of burnout/health issues and people leaving the profession
- Overall, less people available to respond to emergency calls
AND/OR
B: Adding to the demands to the system (i.e., more calls)
These aspects have a two-way relationship, each adding to the other and ultimately putting everyone at higher risk.
Addressing the impact of shift work on sleep for paramedics requires multiple changes. Paramedics can use sleep hygiene strategies to get better sleep and minimize the negative impacts of shift work, but systemic changes must also be made to lessen this issue. Sacrificing the health of people working in public services (such as EMS) puts everyone’s health and safety at risk. The following are examples of changes that in the long term, benefit everyone:
- Advocating for policies that will ensure EMS workers get breaks and adequate recovery time between shifts
- EMS Awareness and education for sleep and energy management
- Public education programs on the appropriate use of emergency resources
- Providing support and resources to address mental health concerns and promote a healthier workplace culture
Conclusion
For paramedics, sleep and its impacts are complex. Poor sleep patterns, long term sleep loss, and the related health risks pose significant challenges for those in EMS
Amid ongoing contract discussions with Alberta Health Services (AHS) and the current restructuring of the Alberta health care system, it is uncertain how EMS will change in upcoming years. As we continue to explore solutions to this issue, it’s important to prioritize both individual and organizational efforts in supporting EMS. By encouraging a better understanding of sleep health and applying practical measures, we can promote a healthier, more resilient workforce of emergency responders and improve their ability to perform critical duties.
References
Huang, G., Lee, T. Y., Banda, K. J., Pien, L. C., Jen, H. J., Chen, R., Liu, D., Hsiao, S. T. S., & Chou, K. R. (2022). Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis. Journal of Global Health, 12. https://doi.org/10.7189/JOGH.12.04092
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