Should EMS Clinicians Be Allowed to Nap on the Job?

Editor's note: Phase 2 recruitment for Dr. Patterson's fatigue study launched on Sept. 10, 2020. If you are the administrator/manager of a 9-1-1 EMS agency that staffs between 50–300 paid clinicians and support personnel, please contact principal investigator Daniel Patterson, PhD, NRP, at pdp3@pitt.edu or 412-864-3830. Study participation will be administered completely online and will begin in January 2021.

Are EMS clinicians who nap at work during downtimes maximizing their effectiveness on calls? Or are they pilfering the public purse by dozing when they are being paid to be awake?

It’s a tricky question, and one that is sometimes debated on emotional and political grounds rather than rational terms.

In an attempt to bring reason to the ‘sleeping on shift’ debate, Drs. P. Daniel Patterson, Matthew D. Weaver, Francis X. Guyette and Christian Martin-Gill published a commentary in the American Journal of Industrial Medicine titled, ‘Should public safety shift workers be allowed to nap while on duty?’ (aka the ‘Napping Commentary’). Available for free at the Wiley Online Library (and easily found using a Google search), this commentary explores the pros and cons of workplace napping.

Why They Wrote It

P. Daniel Patterson, PhD, NRP is the James O. Page professor of emergency healthcare worker safety in the University of Pittsburgh’s Department of Emergency Medicine. He is also a practicing paramedic who works night shifts on a regular basis. “These night shifts take a toll on my mind, body, well-being, health and my family,” Patterson tells EMS World.

During the course of his EMS career, Patterson has worked for agencies who discourage intra-shift napping and others who allow it. But none of these agencies has ever set formal napping policies either way. It’s more like a ‘don’t ask, don’t tell’ situation for their EMTs and paramedics.

The absence of intra-shift napping policy is underlaid by an unwillingness by EMS administrators to discuss the topic in public. At a time when EMTs and paramedics are under more strain than ever due to the COVID-19 pandemic, Patterson and his co-authors find this taboo disturbing and counterproductive.

“If we in the EMS profession want to sincerely address the health, well-being and safety of our workforce—and the patients we care for—then all of us in public safety must openly and frequently discuss strategies that can help EMS clinicians endure the challenges of a shift work lifestyle,” says Patterson. “We need to talk about napping during shifts and discuss the evidence that supports it, as well as the dangers.”           

“My colleagues and I recognized that the 2018 ‘Evidence-Based Guideline for Fatigue Risk Management in EMS’ provides a substantial amount of documentation on the best available evidence related to intra-shift napping and other strategies," he adds. "However, many may not read these documents and miss an opportunity to discuss how these strategies—all supported by evidence—can help their workforce."

"We understand that the full Guideline document is about 1,000 pages long and packed with detailed information, which many readers may find overwhelming or difficult to digest," Patterson says. "Papers like the one we just published in the American Journal of Industrial Medicine may help. These papers can offer a pointed discussion on individual strategies like napping. They effectively provide a complement to the Guideline documents and illuminate concerns and other issues of importance to EMS administrators and clinicians."

Examining the Stigma

The fact that intra-shift napping is a taboo subject in EMS is a major theme in the Napping Commentary. According to Patterson, there are actually many reasons for this stigma.

“Many in public safety may have a negative view of intra-shift napping as a way to pay someone to sleep on the job,” he says. “Some may feel it violates the very essence of readiness, which is a hallmark of EMS and public safety. Still others may feel it comes at some financial cost.”

“Those of us in public safety, as clinicians and administrators, simply do not like the idea that the public may think of us in a negative light. Thus, if napping has a negative label, then let’s not avoid discussing it.”

Pros and Cons

In a bid to ground the intra-napping debate in rational terms, the Napping Commentary considered the pros and cons of sleeping on the job.

On the pro side, intra-shift napping can provide EMS clinicians with momentary relief from sleepiness and fatigue. It can also stop the decay in human performance associated with sleep deprivation often documented in the EMS workforce.

Napping during shift work can also reduce feelings of anxiety, stress and burnout among EMS clinicians. It can help them experience improved mental and emotional recovery between shifts or after a series of shifts.

Moreover, “our recent synthesis of the evidence, combined with our own research, shows that naps of a certain duration can actually provide benefit to the EMS clinicians’ cardiovascular health. This is very important data that shows a health benefit for EMS clinicians!” says Patterson.

The Napping Commentary also found some cons associated with intra-shift napping. The most notable is the public's negative perception of sleeping on the job, which translates into ‘people getting paid for sleeping.’ This may cause some people to feel resentful of EMTs and paramedics who have this option, which EMS professionals would prefer to avoid if possible.

“The next most notable con or negative is sleep inertia; it is that groggy feeling we experience when waking from a nap or sleep episode,” Patterson says. “Sleep inertia can have a negative impact on performance within the first 15 minutes after waking from a nap.” Other cons include reduced readiness or increased costs that may be related to adding personnel, trucks or other resources to help maintain rapid response and readiness while allowing staff to recover from sleep.

An Open-Ended Debate

The fact that intra-shift napping is an EMS taboo makes it difficult to tackle this subject openly and rationally, and to ensure that whatever policies are adopted (openly or covertly) maximize the health and safety of EMS clinicians and the patients they serve.

The body of varied research analyzed by the Napping Commentary authors offers support for intra-shift napping as an intelligent and effective workplace practice. “When you start to weed out the research that is not applicable, we are still left with a sizable body of studies that suggest napping on duty—especially during night shifts and long duration shifts—will benefit the EMS clinician in terms of health, well-being and performance,” Patterson concludes.

James Careless is a freelance writer and frequent contributor to EMS World.