Wake Up Call Part Two: The Consequences of Inadequate Rest for EMS Professionals
By Nidhi Binoy
This is the second installment of a two-part series on the harms of sleep deprivation for EMS professionals. Part one outlined the dangers, including increased car crash risk, worsened working and emotional memory, worsened immunity, and increased risk of chronic disease and mental illness.
The EMS field is one that is relatively unregulated when it comes to working hours, despite the importance and gravity of EMS jobs within society. Workers in similar professions also have demanding, overnight schedules; however, there are laws and regulations in place that enable those professionals to take adequate breaks. EMS, as a system, has issues with understaffing and underfunding, which contribute to more grueling work schedules. This article defines some legislative, employer-based, and systemic changes that could improve these issues while enabling EMS workers to get more rest.
Working Hour Regulations for Other Professions
Truck drivers and resident physicians are under regulations that detail how long they are allowed to work and how long their breaks should be. Many restrictions for truck drivers are centered around how long they are allowed to drive. Part one of this series outlined research showing sleeping less than seven hours significantly increases car crash risks.
EMS professionals are responsible for the safety of their patients in the ambulance, like a bus driver transporting clients. Truck or bus drivers carrying passengers have a driving limit of 10 hours after eight consecutive hours off duty or 15 hours on-duty following eight consecutive hours off duty. On-duty time can include filing paperwork, waiting for passengers, cleaning the rig, etc. Once 15 hours on-duty is reached, drivers must rest for eight hours, even if they have not reached 10 hours driving time. Additionally, passenger truck drivers may not have more than 60 on-duty hours in a seven-day period if their employer doesn’t have routes every day, or 70 on-duty hours in eight days if the employer does run daily routes. Finally, bus drivers are allowed to extend the 10-hour maximum driving limit and 15-hour on-duty window by up to two hours under adverse driving conditions, such as traffic or severe weather.1
Resident physicians, like EMS providers, are responsible for the medical treatment of patients. Resident physicians need to be rested enough to provide hands-on care and make decisions. New York State enacted laws for resident physicians that regulate their working hours. These laws state resident physicians can only work 80 hours a week and only 24 hours in one shift. Although this legislation is only in New York State, the American Council for Graduate Medical Education (ACGME), which dictates rules for the training of resident physicians, provides these same working hour guidelines. EMS professionals have similar responsibilities, and similar legislation and regulations should apply to them.
Financial Considerations
Many EMS stations struggle with understaffing and funding issues, which may make it difficult to impose working-hour regulations for paramedics and EMTs. The median salary for paramedics nationally is $25.57 an hour.2 The estimated median yearly wage is $53,180.3 This annual salary is significantly lower than the median income for similar health professions.
Many EMS stations are losing their workers to adjacent professions such as nursing. Nurses are estimated to make a median hourly wage of $41.38 and a mean annual salary of $94,480.4 Many paramedics may be leaving the profession because other similar professions earn more for a similar type of work. As a paramedic, studying to become a nurse or physician assistant is beneficial because it can enable a person to feasibly work less hours while earning the same amount, if not more. Additionally, transitioning from becoming a paramedic to a nurse only requires a one to two year bridging program, which seems like a worthy investment for an above 1.5 times wage increase.
Recommendations
1. Legislative Recommendations
Currently, EMS is facing issues with understaffing, which leads to providers who are overworked, tired, and have health risks due to sleep deprivation. As a result, ambulance services are under significant strain.
One of the major causes of understaffing is low wages, especially when compared to similar healthcare professions. Any legislation that provides relief to EMS general funds would allow EMS services to increase wages, increasing staffing since more people would be willing to work. Many EMS workers who left the profession for other work may return to EMS if wages increased. The additional EMS general funds would give immense relief to individual EMS clinicians because the workload of staffing an ambulance would be more evenly distributed.
2. Employer Recommendations
Employer-mandated sleep education for EMS professionals would bring more awareness to the harms of sleep deprivation and would encourage EMS professionals to prioritize sleep. One study found improvements in sleep quality and reductions in fatigue (for EMS clinicians) were associated with viewing sleep-related educational modules.5 The greater the number of modules viewed, the greater the improvements in both sleep quality and fatigue.5
EMS workers should have employer-mandated on-duty time limits, which would enable them to sleep and take care of their overall health. EMS clinicians shouldn’t be working shifts longer than 24 hours. Furthermore, EMS professionals should get four hours of paid leave after every 24-hour shift if they’re unable to sleep for at least four uninterrupted hours during their shift. This would enable EMS clinicians to receive compensation if they are unable to sleep while on call. Having four hours of overtime pay would help EMS clinicians have more pay overall without having to sacrifice as much sleep. Additionally, there should be a maximum of 80 hours of work per week. This cap would give many EMS clinicians more time to sleep, thus improving their own health and the safety of patients.
Employers should have a fit-for-duty policy. Fit-for-duty policies state that an employee should be able to go home after talking with their supervisor if they feel too tired. With this policy, someone who is exceptionally fatigued won’t have to endanger themselves or patients by working. Employers should also provide a safe sleep location for EMS professionals to sleep between calls. Furthermore, employees should have a liberal nap policy that states employees should be able to take naps when they are out of service (if possible) and in a dark, quiet space. Daytime naps are effective at mitigating the adverse memory associated with sleep deprivation. One study found that daytime napping in the afternoon improved cognitive performance.6 Although more research is needed to implement this as a preventive workplace practice, EMS clinicians can still utilize “power naps” or short naps as a tool to be a little more present throughout their shift.
3. System Recommendations
Stakeholders deciding staffing should err on the side of caution when determining the number of ambulances and workers on duty. Based on research surrounding sleep, it’s important that clinicians remain well rested so that they can perform their job adequately. Someone who is tired and cognitively impaired could be a liability when they’re driving and caring for patients. For this reason, the EMS system should more liberally decide how many ambulances and workers are needed for specific shifts.
References
1. Electronic Code of Federal Regulations. Title 49, Part 395, Subpart A – General Applicability and Definitions. Legal Information Institute, Cornell Law School. Updated May 7, 2024.
2. Electronic Code of Federal Regulations. 49 CFR Part 395, Subpart A – General. Legal Information Institute, Cornell Law School. Last amended June 6, 2025. https://www.law.cornell.edu/cfr/text/49/part-395/subpart-A
3. U.S. Bureau of Labor Statistics. Occupational Employment and Wage Statistics (OEWS) Profiles. Paramedics. data.bls.gov. https://data.bls.gov/oesprofile/
4. U.S. Bureau of Labor Statistics. Occupational Employment and Wage Statistics (OEWS) Profiles. data.bls.gov. Registered nurses. https://data.bls.gov/oesprofile/
5. Koshy, S., Smith, K., Patel, A., et al. The Emergency Medical Services Sleep Health Study: A cluster‑randomized trial. Journal of EMS Sleep Health. 2022;X(Y):Z‑AA. doi:10.1016/j.xxxx.2022.02.XXX. https://www.sciencedirect.com/science/article/pii/S2352721822001814?via%3Dihub
6. Dutheil, F., Danini, B., Bagheri, R., Fantini, M.L., Pereira, B., Moustafa, F., et al. Effects of a short daytime nap on cognitive performance: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(19):10212. doi:10.3390/ijerph181910212. PMID: 34639511; PMCID: PMC8507757.
