A car crash. A heart attack. A drug overdose. No matter what time of day, where you are, or what your problem is, emergency medical technicians (EMTs) will be on call and ready to come to your aid. These health care providers are charged with providing quality care to maintain or improve patient health in the field, and their efforts have saved the lives of many who could not otherwise find care on their own. While these EMTs deserve praise and respect for their line of work, what they deserve even more is consideration for the health issues that they themselves face. Emergency medical technicians suffer from a host of long-term health issues, including weight gain, burnout, and psychological changes.
The daily "schedule" of an EMT is probably most characterized by its variability and unpredictability. The entirety of their day is a summation of what everyone in their area is doing, those people's health issues, and the uncertainty of life itself. While there are start and end times to their shifts, even these are not hard and fast--shifts have the potential to start early or end late based on when people call 911. An EMT can spend their entire shift on the ambulance, without time to eat a proper meal or to get any sleep. These healthcare providers learn to catch a few minutes of sleep here and there when possible. Their yearly schedules are also unpredictable, with lottery systems in place to ensure that someone is working every day, at all hours of the day, while maintaining some fairness. Most services will have either 12 or 24 hour shifts, and this lottery system can result in EMTs having stacked shifts that are either back to back or at least within close proximity to one another. This only enhances the possibility of sleep disorders, with 70 percent of EMTs reporting having at least one sleep problem.1 While many people have experienced the effects of exhaustion and burnout due to a lack of sleep, few can say that their entire professional career has been characterized by these feelings. EMTs have been shown to be more than twice as likely than control groups to have moderate to high scores on the Epworth Sleepiness Scale (ESS), which is correlated with a greater likelihood of falling asleep during daily activities such as conversing, sitting in public places, and driving.1 The restriction and outright deprivation of sleep in EMTs has been shown to cause a large variety of health problems, and seems to be the main factor in the decline of both physical and mental health for EMTs.
A regular amount of sleep is essential in maintaining a healthy body. Reduced sleep has been associated with an increase in weight gain, cardiovascular disease, and weakened immune system functions. Studies have shown that, at least in men, short sleep durations are linked to weight gain and obesity, which is potentially due to alterations in hormones that regulate appetite.2,3 Due to this trend, it is no surprise that a 2009 study found that sleep durations that deviated from an ideal 7-8 hours, as well as frequent insomnia, increased the risk of cardiovascular disease. The fact that EMTs often have poor diets compounds that risk. An EMT needs to be ready around the clock to respond, which means there really isn’t any time to sit down and have a proper meal. Fast food becomes the meal of choice due to its convenience, both in availability and speed. Some hospitals have attempted to improve upon this shortcoming in the emergency medical service (EMS) world by providing some snacks and drinks at the hospital. This, however, creates a different issue due to the high calorie nature of these snacks. The body generally knows when it is full by detecting stretch in the stomach, and signaling the brain that enough food has been consumed. In a balanced diet, a lot of this space should be filled with fruits, vegetables, and overall low calorie items unless you are an athlete who uses a lot more energy. By eating smaller, high calorie items, an EMT will need to eat more in order to feel full, but this will result in the person exceeding their recommended daily calories. The extra energy will often get stored as fat, compounding the weight gain due to sleep deprivation. Studies involving the effects of restricted sleep on the immune system are less common, but one experiment demonstrated markers of systemic inflammation which could, again, lead to cardiovascular disease and obesity.2
Mental health is not spared from complications due to long waking periods with minimal sleep. A study was conducted to test the cognitive abilities of subjects experiencing varying amounts of sleep restriction;the results showed that less sleep led to cognitive deficits, and being awake for more than 16 hours led to deficits regardless of how much sleep the subject had gotten.4 This finding affects both the EMTs, who can injure themselves, and the patients, who may suffer due to more errors being made in the field. First year physicians, who similarly can work over 24 hour shifts, are subject to an increased risk of automobile crashes and percutaneous (skin) injuries when sleep deprived.5 These injuries often happen when leaving a shift. A typical EMT shift lasts from one morning to the next, and the EMT will leave his or her shift during rush hour on little to no sleep, increasing the dangerous possibility of falling asleep or dozing at the wheel. A similar study to the one on first year physicians mentioned prior studied extended duration work at critical-care units, and found that long shifts increased the risk of medical errors and lapses in attention.6 In addition to the more direct mental health problems posed by the continuous strain, EMTs and others in the healthcare field also face more personal issues, including burnout and changes in behavior. A study on pediatric residents, who face similar amounts of stress and workloads, established that 20% of participants were suffering from depression, and 75% met the criteria for burnout, both of which led to medical errors made during work.7 A separate study found that emergency physicians suffering from burnout also faced high emotional exhaustion, depersonalization, and a low sense of accomplishment.8 While many go into the healthcare field to help others, exhaustion and desensitization create a sort of cynicism in order to defend against the enormous emotional burden that comes with treating patients day in and day out.
Sleep deprivation, long work duration, and the stress that comes with the job contribute to a poor environment for the physical and mental health of emergency medical technicians and other healthcare providers. However, a recent study has shown that downtime, especially after dealing with critical patients, led to lower rates of depression and acute stress in EMTs.9 While this does not necessarily ameliorate post-traumatic stress or burnout, it is a start to addressing the situation. Other possible interventions would include providing more balanced meals at hospitals that are readily available to EMTs, as well as an improved scheduling system that prevents or limits back to back shifts. These concepts can apply to others facing high workloads with abnormal sleeping schedules as well, including college students, who are also at risk for mood disorders and a poorer quality of life due to the rigors of college life.10
- Pirrallo, R. G. et al. International Journal of the Science and Practice of Sleep Medicine. 2012, 16, 149-162.
- Banks, S. et al. J. Clin. Sleep Med. 2007, 3(5), 519-528.
- Watanabe, M. et al. Sleep 2010, 33(2), 161-167.
- Van Dongen, H. P. et al. Sleep 2004, 27(4), 117-126.
- Najib, T. A. et al. JAMA 2006, 296(9), 1055-1062.
- Barger, L. K. et al. PLoS Med. [Online] 2006, 3(12), e487. https://dx.doi.org/10.1371%2Fjournal.pmed.0030487 (accessed Oct. 3, 2016)
- Fahrenkopf, A. M. et al. BMJ [Online] 2008, 336, 488. http://dx.doi.org/10.1136/bmj.39469.763218.BE (accessed Oct. 3, 2016)
- Ben-Itzhak, S. et al. Clin. Exp. Emerg. Med. 2015, 2(4), 217-225.
- Halpern, J. et al. Biomed. Res. Int. [Online] 2014, 2014. http://dx.doi.org/10.1155/2014/483140 (accessed Oct. 3, 2016)
- Singh, R. et al. J. Clin. Diagn. Res. [Online] 2016, 10(5), JC01-JC05. https://dx.doi.org/10.7860%2FJCDR%2F2016%2F19140.7878 (accessed Oct 3, 2016)