A culture change: Fatigue in emergency services


HAGERSTOWN, Maryland – Officials call it a culture change; changes that took effect October 1 to reduce provider fatigue and increase provider resilience at Austin-Travis County Emergency Medical Service, changes that are being met with smiles.

“We only turned the key Oct. 1,” Commander Mike Benavides of Austin-Travis County EMS said in a phone interview. “My communication with the field staff says there are a lot of happy faces. It doesn’t mean that we have fixed all the problems, but we are determined as an organization to not be stagnant and continue to reevaluate.”

“You always have to take care of (your) personnel. You can’t complete the mission without your personnel. Public safety has always been lax (in that aspect),” Commander Mike Benavides of Austin-Travis County EMS

A 2006 study found 44 percent of medics reported nodding off several times a month during their shifts, 29 percent said they provide less than optimal patient care near the end of a 24-hour shift, 50 percent had accidents or near misses due to fatigue, and 5 percent had fallen asleep while driving an ambulance.

Followed by a study performed in 2013 that found nearly 90 percent of ATCEMS employees said they “often experience fatigue.” The survey also showed around 50 percent of the respondents believed fatigue often impacts their quality of work.

A 2015 study performed by the National Highway Traffic and Safety Administration and published by EMSWorld.com reported that 50% of EMS employees reported fatigue on the job.

EMSWorld.com reports adequate sleep is vital to employee health and wellness. At least seven hours per night should be encouraged. Concerns of fatigue in EMS operations are consistently under-appreciated. Pre-hospital providers have alarming rates of illness, depression, PTSD, and suicide, yet the industry waits for additional studies to re-diagnose the known underlying issues.

The United States military have studied the effects of fatigue on fighter pilots.

According to EMSWORLD, a study from a recent article from the Association for Psychological Science, “F-117 pilots deprived of one night of sleep were tested on precision instruments. Not only did the pilot errors on those instruments double after one night of sleep loss, pilots reported feeling depressed and confused.”

Additionally, studies show that drivers who have been awake for 18 hours operate their vehicle similarly to drivers who have a blood alcohol concentration of 0.05 and drivers who have been awake for 24 hours operate their vehicles equivalent drivers who have a BAC of 0.10.

Fatigue has always been a concern that departments face, especially EMS. Our department elected to look at this at a more comprehensive level.

The Texas agency experienced two medic suicides less than a year apart, according to Benavides.

“I was reluctant to convey that, it is easy for the media to latch on to and make it provocative,” Benavides said. “We know that there are a thousand reasons to commit suicide. We know that there is not a singular reason that people commit suicide. We know that it is not solely job related, but it is in appropriate to combat this with facts.”

“Personally, it was probably the toughest thing I’ve ever had to endure…I don’t know that any chief of any organization could ever be prepared for that,” Chief Ernesto Rodriquez of Austin-Travis County EMS said during an interview with local media.

“PTSD is a fact verses a theory (in EMS)”, Benavides said.

“Unlike people that go into a war zone and have acute onset (PTSD), providers in the EMS industry can develop the same disorder as a cumulative effect of seeing death and destruction,” Benavides said.

Benavides said that supervisors using new software will monitor field units and if they notice a unit that is busy running back-to-back calls, they are to reach out to the crew, acknowledge that they have been busy, and ask if they need a break to eat, get a shower, or take a nap.

“It is our (new) culture that our supervisors will reach out to the units,” Benavides said. “It could be something as simple as giving the unit time to get back to the station to allow the medic to put dry socks on…whatever they want to do with that time.”

With the change, field providers have been given the ability to reach out to their commander if they are feeling fatigued and ask for a break, Benavides said.

Benavides admits that this idea may seem simple, but in real life is more challenging.

“(Medics) don’t want to sound like they can’t handle something. We will continue to push ourselves to the brink,” Benavides said. “We want to change the mindset and say it is okay for you to be tired and reach out for help.”

Another idea that Austin-Travis County EMS looked at was changing their shift start time from the typical 6 a.m. or 7 a.m. to an 8 p.m. start time to allow a more even flow with the provider’s life. This is currently being beta tested at several stations around the city and county.

“Starting at 8 p.m. allows the provider to eat dinner at home with their family and leave when their family is settling in for the night,” Benavides said. “We are trying to maximize the amount of family time.”

The idea for an 8 p.m. start time was suggested by a staff member to foster a better family, home, and work life.

“It makes sense theoretically and if it makes sense, we wanted to at least try it,” Benavides said. “We are still in the evaluation of this waiting for the feedback.”

“We are trying to create a happy and resilient medic,” Benavides said.

Austin-Travis County is now cutting edge in the area of fatigue management, according to Benavides.

“We hope that can make that change for systems across the country,” Benavides said.

Benavides said that in his 23-years with the agency it has improved every year.

“I have been there through (rough) times,” Benavides said. “I always take the standpoint in the 23-years that I have been here…things have gotten better every single year. That is something I really take pride in with my department.”

“We are tip of the spear on new advances in science, research and development…all things that make ATCEMS unique and special,” Benavides said. 

We have always prided our self as being the tip of the spear, Benavides said.


Todd Bowman is a local journalist and social media anchor. He has been a paramedic/firefighter in Western Maryland for more than 12 years. Todd is passionate about identifying problems within the EMS system and helping create solutions to improve the lives of today’s providers. Follow Todd on Twitter @todd_bowman87.


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