Help for going strong through 24h-48h paramedic shifts
November 15, 2015 6:40 AM Subscribe
Hello MeFi!
I am doing a 5-month internship at my local rescue center and I will have twelve 24h shifts every month. I'm located in a dense district with the highest number of operations in my city. On average, I will have around 15 interventions scattered in a day. It means that I'll have small chunks of sleep on my shifts, it is especially painful when they are 48h shifts.
Sleeping is forbidden before midnight and getting two hours of sleep a night would be an achievement. I can sometime go into complete zombie mode on my second day. The worse is when I get to sleep 30 minutes at 4am and getting a call, adrenaline at times fails to kick in immediately and I arrive at the intervention scene not fully awake. It is usual practice for new recruits to go through this regimen and it is hard for everybody.
People who do 24h shifts from Mefi, I need your help! Do you have any tips for reducing fatigue during and between shifts? I have a day to recover after a 24h shift and two days to recover a 48 hours sleep.
Sleeping is forbidden before midnight and getting two hours of sleep a night would be an achievement. I can sometime go into complete zombie mode on my second day. The worse is when I get to sleep 30 minutes at 4am and getting a call, adrenaline at times fails to kick in immediately and I arrive at the intervention scene not fully awake. It is usual practice for new recruits to go through this regimen and it is hard for everybody.
People who do 24h shifts from Mefi, I need your help! Do you have any tips for reducing fatigue during and between shifts? I have a day to recover after a 24h shift and two days to recover a 48 hours sleep.
I used to do overnight or what were effectively 24hr shifts in theatre and corporate events. Some things that helped me cope were:
*Limit things like alcohol or other chemical assistants. I found alcohol particularly really unhelpful in the long run, even if it helps you get to sleep after a shift.
*Wind down before bed when you finish your shift. About an hour worked for me. Going to bed immediately upon arriving home generally led to poor sleep.
*Go to bed on a full stomach. I'm pretty certain this won't work for everyone though.
*Eat well and regularly. If you are staying up that long 3 meals a day will not do. I used to get to about 5.
*Avoid excess caffeine. Caffeine is just a way of borrowing time from your future self. You have to give it back.
Sleep and health are super important. Honestly though, doing this kind of work regularly will fuck you up. Not may. Will. Your physical health will suffer and your mental health is likely to. In the long term you are almost certainly shortening your life.
As someone who told those kind of hours to go jump I would urge you (and your employer) to consider this.
posted by deadwax at 7:24 AM on November 15, 2015 [3 favorites]
*Limit things like alcohol or other chemical assistants. I found alcohol particularly really unhelpful in the long run, even if it helps you get to sleep after a shift.
*Wind down before bed when you finish your shift. About an hour worked for me. Going to bed immediately upon arriving home generally led to poor sleep.
*Go to bed on a full stomach. I'm pretty certain this won't work for everyone though.
*Eat well and regularly. If you are staying up that long 3 meals a day will not do. I used to get to about 5.
*Avoid excess caffeine. Caffeine is just a way of borrowing time from your future self. You have to give it back.
Sleep and health are super important. Honestly though, doing this kind of work regularly will fuck you up. Not may. Will. Your physical health will suffer and your mental health is likely to. In the long term you are almost certainly shortening your life.
As someone who told those kind of hours to go jump I would urge you (and your employer) to consider this.
posted by deadwax at 7:24 AM on November 15, 2015 [3 favorites]
I almost never do a full 24-hr day, but 16-20 hour days on not much sleep are fairly common in my line of work.
You sound like you're fairly fresh to this - over time I developed the ability to cat-nap (doze off for 15-20 minutes), one of these somewhere in the middle of the shift is usually enough to revive me for the rest of the gig.
Speaking of which, this - "Sleeping is forbidden before midnight" - sounds like a bunch of "prove yer tough" bullshit. Hopefully this is just some kind of temporary thing for interns (so they get a taste of the worst scenario), and not a part of the regular job. If it is, you should definitely not stick with this rescue center after the internship - I know several firefighters/EMTs, and they all agree that due to the uncertain nature of the work you take naps when you can, if you don't have anything else to do. Far better for a paramedic to take a nap at 2 in the afternoon so they'll be alert for the rest of the shift than to have them do dumb busywork just so they don't go to sleep during daylight hours. And this is totally known and agreed to by their bosses and co-workers. If everyone at your rescue center has to stay awake pretty much all the time that's bad management.
A big part of reducing fatigue for me is not fucking up my sleep schedule on days off - like, if I get home at four a.m. after a 20-hour day, it's really tempting to sleep for 8 hours and then take another 2 or 3 hour nap at 7 p.m. But then that means that I'm awake until 4 a.m. again, which then means that I'm starting the next day of work with not enough sleep. So I find it's better to actually use alarms on my days off, sleep for like 6 hours at first, then take a one-hour maximum nap in the late afternoon, and then go to bed for real early enough so I start the next work day with a full night's sleep. That way I'm awake and alert enough during "real person" hours on my days off to get the things done I have to (and maybe do some socializing), and I'm not starting my next day of work too groggy to function.
posted by soundguy99 at 9:18 AM on November 15, 2015 [7 favorites]
You sound like you're fairly fresh to this - over time I developed the ability to cat-nap (doze off for 15-20 minutes), one of these somewhere in the middle of the shift is usually enough to revive me for the rest of the gig.
Speaking of which, this - "Sleeping is forbidden before midnight" - sounds like a bunch of "prove yer tough" bullshit. Hopefully this is just some kind of temporary thing for interns (so they get a taste of the worst scenario), and not a part of the regular job. If it is, you should definitely not stick with this rescue center after the internship - I know several firefighters/EMTs, and they all agree that due to the uncertain nature of the work you take naps when you can, if you don't have anything else to do. Far better for a paramedic to take a nap at 2 in the afternoon so they'll be alert for the rest of the shift than to have them do dumb busywork just so they don't go to sleep during daylight hours. And this is totally known and agreed to by their bosses and co-workers. If everyone at your rescue center has to stay awake pretty much all the time that's bad management.
A big part of reducing fatigue for me is not fucking up my sleep schedule on days off - like, if I get home at four a.m. after a 20-hour day, it's really tempting to sleep for 8 hours and then take another 2 or 3 hour nap at 7 p.m. But then that means that I'm awake until 4 a.m. again, which then means that I'm starting the next day of work with not enough sleep. So I find it's better to actually use alarms on my days off, sleep for like 6 hours at first, then take a one-hour maximum nap in the late afternoon, and then go to bed for real early enough so I start the next work day with a full night's sleep. That way I'm awake and alert enough during "real person" hours on my days off to get the things done I have to (and maybe do some socializing), and I'm not starting my next day of work too groggy to function.
posted by soundguy99 at 9:18 AM on November 15, 2015 [7 favorites]
The wildland firefighting community has enforced policies for work/rest cycles in response to fatal accidents, dangerous decisions and impaired sense making due to fatigue and inadequate rest. Do all you can to take care of yourself but please try to get management to think about the liabilities of working such extended hours.
posted by X4ster at 9:28 AM on November 15, 2015 [4 favorites]
posted by X4ster at 9:28 AM on November 15, 2015 [4 favorites]
Wait, when you say rescue center, do you mean like you're a paramedic on an ambulance? Like you are driving and performing medical care after more than a day with little or no rest? Because that sounds incredibly dangerous, both for you and for the people you're supposed to be helping. And if there are not laws prohibiting this, there should be. Perhaps you could speak up, both within your own unit, and within your community, about how dangerous this is. I know that it doesn't answer your immediate question, but I'm really worried that you or one of your colleagues are going to unintentionally kill someone, and I think that you should be trying to figure out a way to put a stop to this practice.
posted by decathecting at 11:48 AM on November 15, 2015 [7 favorites]
posted by decathecting at 11:48 AM on November 15, 2015 [7 favorites]
It's not clear where you are working or what you are doing, but when I was in my surgical training- long before there was any of this work-hours nonsense- the adage was "never stand when you can sit, never sit when you can lie down, eat when you can, sleep when you can, and don't fuck with the pancreas." This silliness that sleep before midnight is forbidden is exactly that.
ETA: oops, your title says paramedic, the idea that you can never sleep before midnight is bad policy.
posted by karlos at 5:36 PM on November 15, 2015
ETA: oops, your title says paramedic, the idea that you can never sleep before midnight is bad policy.
posted by karlos at 5:36 PM on November 15, 2015
Take a look at chapter four of U.S. Army Field Manual 22.5, which discusses sleep deprivation. pdf. There are specific dosing schedules for caffeine, as well as instructions for how to stop caffeine to allow for sleep.
Less scientifically: Nap when you can, using earplugs and blindfold to get as good rest as possible. Eat lots of low glycemic index calories (nuts and dried fruit, whole-wheat bread, cheese, butter). Stare into a bright white lamp, like a fluorescent ceiling fixture or something. If you can take a hot shower, do that; otherwise, wash your face with hot water and peppermint soap. (I have no idea why the last one works, but it helps me.)
During your off days, maintain a consistent sleep schedule. Wear red or amber tinted lenses for several hours before you intend to sleep. This reduces your exposure to blue light, which is what your brain uses to decide when the sun is up. Some people also swear by melatonin. As usual, strive to sleep in total darkness and quiet.
posted by d. z. wang at 6:04 PM on November 15, 2015 [1 favorite]
Less scientifically: Nap when you can, using earplugs and blindfold to get as good rest as possible. Eat lots of low glycemic index calories (nuts and dried fruit, whole-wheat bread, cheese, butter). Stare into a bright white lamp, like a fluorescent ceiling fixture or something. If you can take a hot shower, do that; otherwise, wash your face with hot water and peppermint soap. (I have no idea why the last one works, but it helps me.)
During your off days, maintain a consistent sleep schedule. Wear red or amber tinted lenses for several hours before you intend to sleep. This reduces your exposure to blue light, which is what your brain uses to decide when the sun is up. Some people also swear by melatonin. As usual, strive to sleep in total darkness and quiet.
posted by d. z. wang at 6:04 PM on November 15, 2015 [1 favorite]
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Source: my last 8.5 years as a full-time, paid firefighter and EMT-Intermediate at several fire departments in NC. I can't imagine riding a bus for 48 hours; our medics work 12s, but they can run around 20 calls in that amount of time due to our county's small size and the amount of bullshit they have to put up with.
posted by sara is disenchanted at 7:21 AM on November 15, 2015 [6 favorites]