EMS Napping on the Job

Commentary in the August 2020 issue of the  American Journal of Industrial Medicine asks: Should public safety shift workers be allowed to nap while on duty?

After weighing pros and cons, they conclude: 

“Where feasible, administrators of EMS agencies and others with influence over policy and safety should consider novel (yet safe) applications of an intra‐shift napping strategy and be attentive to assessing impact.”

While many EMS organizations prohibit sleeping on the job and others allow it only in designated areas, a 2018 safety panel empowered by the National Association of State EMS Officials also issued recommendations that included encouraging napping as a way to mitigate the adverse effects of fatigue.

Recommendation 4: Recommend that EMS personnel have the opportunity to nap while on duty to mitigate fatigue.

The panel determined that current evidence supports the use of naps while on duty as an effective strategy to positively impact fatigue-related outcomes. Naps improve alertness, reduce sleepiness, and improve personnel performance (e.g., reaction time).

A couple years ago, I posted about a picture put up on our employees only Facebook site where a crew was blasted for being photographed while sitting in their ambulance, the driver with eyes closed, and the passenger slouching in his seat.

Down Time

 I found some links to fatigue on the job, but did not get around to reading them in their entirety until later. I was surprised and pleased to find the pro-napping recommendations. In the document they directly address the issue of public misunderstanding of sleeping EMTs.

The general public may perceive EMS personnel napping on duty as unacceptable. The panel concluded that the benefits of improved alertness on duty, and ultimately improved patient and personnel safety, are a commonsense justification to this anticipated undesirable effect. Additionally, it is common knowledge that many EMS personnel and other first responders work long duration shifts requiring nighttime sleep when not on a response. Policies and protocols that clearly describe the appropriate use, structure, and benefits of naps on duty may be useful toward educating the public and reducing potential negative opinion.

I have been working EMS for almost 30 years, and have worked all types of shifts, overnights, 24s, 16s, 12s, and have never had a shift, where I did not occasionally on some days catch some rest with my eyes shut.  It could be in a designated bed with my cheek on a pillow and the blanket pulled up to my neck, in a comfy armchair with my feet up, on the stretcher or bench seat with my legs stretched out, or simply in the front seat with my head against the window and my mouth, hopefully closed.

I have always found the power nap restorative.  The only issue I have ever had with sleeping on the job was when I did overnights in places where you could sleep in a bed, and I would get a call in between the hours of 3:00 AM and 4:30 when I would wake and find myself driving down the road having no idea where I was or where I was going.

The Industrial Medicine Journal recommends caffeine either before a short nap or immediately after awaking to counter effects of sleep inertia.

EMS conditions most responders to listen for their number and hear it even in a sound sleep.  I have never failed to respond to a call for my number when I was dozing on the job. I have had partners however who have fallen asleep so deeply that they needed a shake.

Many, many years ago when I was on overnights (and EMS was still the wild west), I did a call for a patient on a street corner who wanted to go to detox.  While my partner slept soundly in the back (he was logging 100 hour plus weeks), I had the man sit in the front seat and we drove the half mile down the road to the detox facility.  My partner was still asleep when I came back out.

It has been years since I have done an overnight.  Today I work 12 hour day city shifts and my only napping is of the head against the window power variety (or the head nodding forward and jerking me awake as just happened while writing).

The safety panel recommends for those services that use dynamic deployment that napping should only be done in the front passenger seat or the patient compartment, that the sleeper be seat belted, and the driver never engage to prevent him from waking up with sleep inertia, leading to impaired driving.

Makes sense to me.  It’s nice to know napping has the sanction of the experts.

Read the full report here.

Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services


1 Comment

  • jon says:

    for me working nights, it can be tough staying up all night especially when you’ve been up the whole day as well. the only problem i find is waking and having to drive when you’re drowsy and hardly awake. Stop, take a couple breaths and make sure you’re able to not crash.

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