Living With the Night Shift

When I first entered EMS, I was like everyone else: I worked whenever they needed me. Everything was new and exciting and a learning experience, for good or for ill. As I got to know the system, eventually I gravitated toward nights. I liked the vibe, I preferred the logistics and clientele, and it’s where I made my home for the better part of 20 years. Even though I’ve moved to a day position for the last three years, I work part-time at another paramedic project—at night.

For me working nights was always a better fit. It put me against the flow of traffic, so rush hours were never an issue. Without the daytime traffic, responding to even distant jobs was less stressful. Office buildings and commercial areas are shut down, so you’re farther out of the public eye. Management across the board is absent; with less oversight there is the perception of less pressure. It seems like many true “night” people often demonstrate more independence and take things more in stride. With fewer resources available, you have to make your own solutions.

These benefits come at a cost. Not everyone can function at top speed at 4 a.m.; in fact, some folks are pretty much nonfunctional by midnight. Our system does not allow for any significant down time, so relying on it for sleep is a fool’s dream. Plus, working nights gives you one significant temptation: daytime availability. You’re off during the day, with plenty of time to go to appointments, shop, run errands—basically do everything but the one thing you really should be doing: sleeping. That’s what would really hurt me: not going to bed when I got home. I’d get a second wind, and the next thing I’d know, it was just three hours to get ready for another overnight.

When I had my kids it became even worse. Anyone who says “I will just sleep when the baby does” simply does not have a baby yet. Especially in the first few months, you sleep for an hour, get pulled awake, nod for 20 minutes, get cried awake, pass out in the chair, get screamed awake. I’m pretty sure it’s used as a template for torture in other countries. No downtime at work or home makes for one frazzled, short-tempered parent (and provider). I’ve driven home so tired that my depth perception would be way off; someone hitting the brakes hundreds of feet ahead would have me slamming mine. Or I would literally hallucinate—see things like branches or shopping carts in the middle of a highway that just weren’t there. I would find things hard to process: It would take much longer for my brain to make sense of what I was seeing or what was being said. It would be an utter lie to say my patient care was not compromised at some point.

How we learned to manage (my husband is a night guy too), both pre- and post-kids, simply was with routines and priorities. When we came home we went to bed, period. Even if it wasn’t a full day’s rest, we would dedicate the morning to letting ourselves sleep, even arranging child care around that purpose. The bedroom is quiet, cold and dark—we like our crypt. To this day there is an Army-issue OD green wool blanket covering our windows. You will not find a better shade. Nights gets harder on the body the older you get, and now I simply cannot go as long without rest. If that means cutting something short so I can go to bed early, so be it. It’s tough to admit you need to go to bed at the same time as your kids to be at your best the next day.

My best piece of advice for folks walking the edge of exhaustion most of the time? Pull over. Really. Find a rest area, lock your doors, set your alarm for 20 minutes and give in. Recognize when you are a danger to yourself and other people on the road—no destination is worth that price. I have very close friends who have suffered serious consequences because of fatigue, including one who broke their neck. Suck it up and accept that even heroes have limits.

Sleep Tips for the Night and Shift Workers

• You have to recognize when you’ve hit the point where you can’t function and need to address it. That makes you a danger to your patient and your crew. If you’re so tired you can’t operate the vehicle or make a critical decision, you need to know that and step away before you mess it up.

• Know what your sleep pattern is. Everybody has a full life, but the reality is, if you want to be functional at night, you must sleep during the day. Have a routine, and whether you’re going to be a morning sleeper or an afternoon sleeper, adhere to it.

• Create a cave—a sleeping space that can keep out the ambient noise, because that’s what’s going to prevent you from getting quality sleep.

• Invest in childcare if you need to. Even though we were home, my husband and I would have a baby-sitter come over to sit with the kids, so we could get three or four hours of sleep when we were working the same schedule. It’s just too critical.

• For people who commute, pull over. If you do nothing else, pull over. If you’re nodding at the wheel, pull over. Make a phone call, get out and walk around, or call in and say, ‘Listen, I just can’t get behind the wheel.’ Because you will die, you will break your neck, or you will kill somebody else.

Tracey A. Loscar, NREMT-P, is the training supervisor in charge of QA at University Hospital EMS in Newark, NJ. Contact her at taloscar@gmail.com. She is also a member of the EMS World editorial advisory board.