The Shift Length, Fatigue, and Safety Conundrum in EMS

Shift work is inevitable given the constantneed for EMS, but the ideal length of shifts and restintervals is uncertain. Are eight-hour shifts that ro-tate every 30 days (e.g., 0700–1500 transitioning to1500–2300) really superior to a 24-hours-on, 48-hours-off schedule? Is a 24-hour shift with low call volumeworse than an eight- or 12-hour shift with high callvolume? How are we to address providers who workconsecutive shifts at more than one EMS agency?Many in EMS view these questions from differentperspectives. Some point to longer shifts as necessaryto achieve lower operating costs related to staffing,a compressed workweek, and the flexibility to havemore time with family or on a second job. Others maypresume that longer shifts can lead to poor care or poorprovider health. There is limited support for or againstthe different perspectives because of a lack of data gen-erated from studies of EMS clinicians.We seek to form a common frame of referencefor debate and decision making at all levels towards