Fighting Fatigue in EMS

Cartoon image of person falling asleep behind a steering wheel with text that says “Developing evidence based fatigue risk management guidelines”

The dangers of fatigue among EMS providers are well known, but not well understood. The Fatigue in EMS initiative conducted extensive literature reviews and developed voluntary, evidence-based fatigue risk management guidelines and resources for agencies and communities to ensure the health and safety of providers and the public.


The Fatigue in EMS initiative kicked off in February 2016. The project aims to address the potential dangers of drowsiness and fatigue among EMS workers, including the risk of traffic crashes, injuries to providers and patients, and medical errors. Researchers have found that half of EMS personnel obtain less than 6 hours of sleep per day and report severe mental and physical fatigue while working, a lack of recovery between shifts, and poor sleep quality.

What’s Happening Now

After an extensive review of more than 30,000 published research articles, the project team released its evidence-based guidelines for fatigue risk management, along with companion materials and expert commentaries online. The guidelines intend to combat the effects of fatigue through strategies such as using caffeine and napping during shifts. As the project enters phase two, researchers will test the impact of one or more evidence-based recommendations. In the third phase, the project team will develop a biomathematical model tailored to EMS shift scheduling.

Who’s Involved

The Fatigue in EMS project is a collaboration between NHTSA, the National Association of State EMS Officials, and content experts from multiple institutions, including the University of Pittsburgh Department of Emergency Medicine and Carolinas HealthCare Department of Emergency Medicine. The University of Pittsburgh’s Daniel Patterson, PhD, a practicing paramedic and leading expert in EMS fatigue research, serves as the project's principal investigator. The project has also assembled an expert panel representing various sectors of the EMS profession as well as fatigue scientists to review the evidence and help steer the development of guidelines.

What You Can Do