Sleepy Heads

It's 4 o'clock in the morning and you have been running all night with back-to-back calls. This time, you do not spend much time at the hospital. You drop off the patient, give a quick report to the nurse, do a quick cleanup and you're racing back to the station, maybe to get a little shuteye. Quite frankly, you are exhausted. Your partner who is driving also is exhausted.

You pull up to the station and everything is dark. The engine company has been snug in their beds all night. You jump out to spot the ambulance backing into the fire station and before the ambulance gets through the door, the tones go off. Your heart sinks! You're going on another run.

For those of you who work in a busy system, this is not an uncommon experience. The problem - how mentally fit are you and your partner to drive the ambulance and make life-and-death decisions about a patient?

Probably, the most famous sleep-deprivation story occurred when the supertanker Exxon Valdez crashed into a reef in Alaska in 1989. Approximately 11 million gallons of crude oil was spilled into the Prince William Sound, creating an environmental disaster. Even though the captain was drinking and was blamed for the crash, he was not on the bridge at the time and some fault the third mate who was at the helm and had only six hours sleep in 48 hours. Other disasters partially attributed to sleep deprivation include the blowing up of the Space Shuttle Challenger in 1986, the nuclear accident at Three Mile Island in 1979, the gas leak in Bhopal, India, in 1984 and the Chernobyl nuclear meltdown in 1986.

Between 1989 and 1993, there was an estimated 56,000 vehicle accidents in which drowsiness/fatigue was listed as the cause on the police reports. In those accidents, there were 1,544 fatalities.

In 2006, the National Sleep Foundation released a study on lack of sleep called "Sleep-Wake Cycle: Its Physiology and Impact on Health." The study found that people who were awake 19 hours or more scored significantly lower on performance and alertness tests. Essentially, your ability to perform certain functions and make decisions is not at the level they should be.

Unfortunately, I have found myself sleep deprived. I have vivid memories of driving and thinking the road was moving up and down. I could not judge a car's headlights coming at me from the opposite direction. I kept thinking the other car was in my lane, which forced me to swerve right each time. Later, I knew I was tired, but I did not think my judgment was that impaired until I really could think about it after getting some sleep. Thankfully, I did not hurt anybody.

But each day in this country, firefighter-EMTs and firefighter-paramedics find themselves in the same situation. They have been running all day and are 19-plus hours into their shift running on another call. They have to drive to the scene and maybe to the hospital. They may have to make some life-altering decision for a patient - all while being sleep deprived.

Other studies have equated a sleep-deprived person to a functional level equivalent to certain alcohol levels in the blood. One study said a person who was awake for 24 hours or more had reduced hand and eye coordination that would be equivalent to a blood-alcohol level of 0.1.

Many firefighters and medics have adjusted to sleep deprivation. Some live with their coffee cups, while others who do not drink coffee find some other caffeinated drink to help sustain them. Others find more creative ways of getting some sleep in busy EMS systems. One method calls for one medic to take the patient into a hospital alone while the other medic remains back at the ambulance, sleeping in the front seat or jumping into the back of the ambulance to get some sleep. On the next call, the partners swap sleeping positions. I am not advocating this; just reporting what I know happens when innovative medics get together and solve a problem.

There are no easy answers for this problem. If possible, shift commanders need to monitor their personnel and look for signs of sleep deprivation that can lead to some terrible mistakes. Shift commanders should also look at rotating personnel in the middle of the shift for busy ambulances and, in some cities, busy engine and truck companies.

Busy departments have addressed this issue with 10/14-hour shifts while other busy departments that work the 48/96-hour shifts have come into question. Soon, the International Association of Fire Chiefs (IAFC) in partnership with Oregon Health & Science University will release the results of a study on the impact of sleep deprivation on human performance and other suggestions on how to minimize the impact on fire and emergency service personnel.

The National Sleep Foundation recommends eight hours of sleep a day for the average adult. Anything less, it contends, can lead to sleep deprivation and also can have an adverse impact on the immune and endocrine systems and lead to obesity, diabetes and hypertension.

The issue of sleep deprivation is something the fire service has faced for years. Unfortunately, it seems to get little attention. Regrettably, when it does get attention, it will be as a result of one of our own dying or a civilian getting killed because someone was sleep deprived.