Feature Story

Wake Up Call: The Consequences of Inadequate Rest for EMS Professionals

08/27/2024

By Nidhi Binoy

Background/Abstract:

EMS workers experience mental, physical, and emotional stresses which contribute to an increased risk of PTSD and job injuries₁. For this reason, physical, emotional, and mental well-being play critical roles in helping EMS workers cope with their careers₁. However, EMS professionals often have to work 18-36 hour shifts and 70+ hour weeks to continually staff ambulances. The average adult needs 7+ hours of uninterrupted sleep per 24 hours₂ and EMS providers are especially harmed by sleep deprivation.

Cognitive Consequences of Sleep Deprivation

Sleep is an evolutionary necessity and prolonged sleep deprivation and insomnia can result in negative consequences such as sleep intrusions (or microsleeps) and even death₃. As someone stays awake throughout the day, sleep pressure (the buildup of a chemical called adenosine in the brain) increases until feelings of drowsiness make sleep unavoidable irrespective of stimuli. Although a human can be motivated to remain awake, EEGs show that there is slower brain activity or microsleep even if a person seems to be awake (i.e. they are moving with open eyes)₃. Additionally, the short nature of a microsleep, which is generally no longer than a few seconds, may lead to people not even believing they’ve slept. Microsleeps are spontaneous results of sleep deprivation and they’re especially troubling considering that many sleep-deprived people are reported to involuntarily fall asleep in dangerous situations₃. Unsurprisingly, acute sleep deprivation and crash risk are correlated₄. Sleeping less than 5 hours a night leads to a car crash risk increase by threefold and sleeping a few hours a night makes a car crash 11.5 times more likely₄. These statistics are especially troubling when considering that EMS workers are responsible for driving large vehicles with important medical equipment and injured patients.

Furthermore, sleep deprivation is shown to harm cognitive functioning in humans₃. Sleep deprivation is shown to cause an impairment in visual attention tasks₅ which are very important to EMTs and Paramedics who have to do a lot of hands-on work and charting, which are all important for a patient's well-being. Another aspect of cognitive functioning that sleep impacts is memory processing, which is the ability of our brain to store, retrieve, and essentially remember information and events. During the NREM-2 cycle of sleep, our brain has sleep spindles that facilitate learning by consolidating memories6. EEGs have shown that post-learning sleep spindle lengths have correlated with participant-specific brain areas for learning₆. Other studies have shown that memory processing capabilities decrease after more hours of wakefulness₇. EMS workers have jobs that involve learning from hands-on experiences which are important to remember for growth. Memory processing is broader than just learning, and it can involve life experiences that people would probably like to remember. EMS professionals deserve, like others, to experience and remember their lives.

Sleep deprivation also strongly affects the brain’s ability to process emotions and react to stressors. Sleep deprivation significantly impairs the accurate judgment of human facial emotions, especially threat (anger) and reward-relevant (happy) categories₈. Understanding social cues and human emotion is very important for EMS clinicians to be able to understand, empathize with, and recognize the feelings of their patients—all of which are necessary for good patient care. If an EMS worker is unable to do this due to sleep deprivation, then their job performance will subsequently be impaired. Additionally, studies show that sleep-deprived people were more likely to report more stress, anxiety, and anger in low-stress conditions whereas a non-sleep-deprived person didn’t report similar feelings₉. Although all participants in the study (sleep-deprived or not) responded with anxiousness in high-stress situations, the sleep-deprived people were more reactive and negatively impacted by something that is low stakes. EMS professionals shouldn’t feel stressed about calls or situations that aren’t as stressful. Additionally, reacting to low-stress situations with more anger could negatively affect EMS job performance and bedside manners.

Sleep Deprivation and Chronic Illness/Behavioral Health Disorders

Sleep deprivation increases the risk of “innumerable and life-changing” diseases or worsens the symptoms or pathogenesis of those diseases₁₀. One study explored the blood pressure and heart rate of participants on two days and found that blood pressure and heart rate increased significantly after a night of insufficient sleep (compared to a normal night of sleep)₁₁. The study found that insufficient sleep increases the activity of the sympathetic nervous system₁₁—a network of nerves that help your body activate a fight or flight response by increasing your heart rate and blood pressure when you are stressed, in danger, or physically active. A hyperactive sympathetic nervous system means your body systems are also more active than they would be on a normal, healthy day. The sympathetic nervous system is also responsible for the production of cortisol, a stress hormone. Sleep deprivation increases the amount of cortisol produced in your body which high stress levels₁₂.

Sleep deprivation is further linked with chronic illnesses when analyzing type 2 diabetes. Sleeping less than 7 hours a night is associated with insulin resistance₁₃ and Impaired Fasting Glucose (IFG)₁₄, both of which are risk factors for type 2 diabetes. Sleeping a minimum of 7 hours a night helps prevent type 2 diabetes₁₃.

During sleep, the human body increases inflammation₁₃ which strengthens adaptive immunity (your immune system’s response to foreign substances)₁₅. Sleep deprivation robs you of these benefits by disrupting your body’s ability to regulate inflammation levels. Low levels of inflammation contribute to chronic and neurodegenerative diseases. On the other hand, persistent high inflammation levels are associated with depression and cancer₁₅. Furthermore, insufficient sleep after a vaccination reduces the effectiveness of the vaccine to the point where a person may even require a second dose₁₅ because sleep allows your immune system to develop immunological memory (a memory on how to respond to pathogens)₁₅. The importance of vaccine efficacy for first responders cannot be understated especially in the aftermath of the COVID-19 pandemic. Additionally, sleep deprivation increases the susceptibility to catching the cold/ flu₁₅. EMS professionals are exposed to a lot of different germs during every shift so they must have a healthy immune system. EMS professionals could also expose their patients to sickness if they have a weaker immune system.

Additionally, disturbed sleep patterns cause an increased energy intake, partly from snacking on foods high in fat and carbohydrates₁₆—and these nutritional choices lead to poor health outcomes₁₆.

Lastly, healthy sleep is correlated with better mental health₈. First responders are prone to mental illness. To manage their jobs, EMS workers need to practice self-care—which includes sleep. One study centered around night-time shift work to explore its impact on mental illness found that night-time shift work is linked with poor mental health outcomes₁₇. EMS workers need to be mentally stable and well-adjusted to cope with the traumatic nature of their jobs. Lastly, sleep disruptions could be harming many EMS clinicians regarding substance abuse. Sleep disturbances are a universal risk factor for relapse in addictions to psychoactive substances₁₈. Many EMS clinicians who are former addicts may relapse due to the stressful and traumatic nature of their jobs. The behavioral health of people who are serving the community should be protected for the safety and well-being of everyone.

Sleep is a powerful tool to prevent harmful diseases. EMS workers shouldn’t make significant health sacrifices to keep a job. I hope that this article can help facilitate a culture around EMS that discusses self-care and well-being for first responders. As a sequel to this article, I will be discussing legislative, employer, and systematic recommendations that could help alleviate sleep deprivation among EMS providers.

Annotated Bibliography:

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EMS World or HMP Global, their employees, and affiliates.

Wake Up Call: The Consequences of Inadequate Rest for EMS Professionals

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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EMS World or HMP Global, their employees, and affiliates.

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