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Daniel Patterson, PhD., NRP, Assistant Professor, Department of Emergency Medicine, University of Pittsburg, presented on Evidence-Based Strategies for Fatigue Risk Management in EMS.

Noting that fatigue can have devastating effects on the EMS provider and become a serious risk management issue for an EMS service, Dr. Patterson pointed out how fatigue can adversely affect the worker’s ability to work, as well as the safety and health of patients under the fatigued worker’s care. He showed several ambulance cab videos that showed fatigued drivers dozing off and crashing. 

Fatigue = Overwhelming tiredness

Defined as “unpleasant symptom incorporating feelings of tiredness to exhaustion creating mental and physical conditions that interfere with the ability to function in a normal capacity” (Ream & Richardson, 1996)

He presented compelling statistics:

  • 50% of EMS personnel report they do not achieve 7-8 hours of sleep as recommended by nationaand therefore have poor sleep quality.

  • 50% do not get the 16 hours of “recovery” required in between shifts

Daniel Patterson, PhD, NRP, addresses attendees at the National EMS Safety Summit during his presentation on fatigue in EMS providers. Photo A.J. Heightman

There is presently no clear standard for how we manage this threat in EMS. However, the National EMS Advisory Council has important research underway that will present evidence-based guidelines for fatigue management that Dr. Patterson believes may present significant results and recommendations that could impact and improve EMS delivery and equally important, positively affect the health and well-being of emergency responders that are shift workers. 

The ‘PICO” questions being addressed in this important study:

(PICO stands for Population; Intervention; Comparisons and Outcomes)

  1. Are there reliable and valid instruments for measuring fatigue among EMS providers

  2. In EMS, do shift-scheduling interventions mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?

  3. Does the worker’s use of fatigue countermeasures mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?

  4. Does the use of sleep or rest strategies and/or interventions mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?

  5. Does fatigue training and education mitigate fatigue-related risks, and/or improve sleep?

  6. Does implementation of model-based fatigue risk management mitigate fatigue, fatigue-related risks, and/or improve sleep?

  7. In EMS, do task load interventions mitigate fatigue mitigate fatigue, mitigate fatigue-related risks, and/or improve sleep?


Each PICO will produce a document and report that will be presented on the NHTSA website, with follow-up presentations in peer-reviewed journals, in JEMS and at the EMS TODAY Conference.

Dr. Patterson, a seasoned Pennsylvania paramedic provider at two EMS System, one a high-performance system, enthusiastically concluded his presentation stating: “I can’t wait to find out what we find out!”

Go to to participate by providing comments or questions to assist in this important research. Go to Federal Docket NHTSA-2015-0121.  You can also download tips for Submitting Effective Comments.

Written by A.J. Heightman, MPA, EMT-P Editor-in-Chief, JEMS
Editor-in-chief of JEMS, A.J. Heightman is a former EMS director and EMS operations director who has researched and specialized in MCI management training for 30 years.

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