Paramedics in rural Manitoba are calling for a mandatory limit on the number of consecutive hours they can work, as they say fatigue is jeopardizing their safety.
"Lack of sleep can be very scary for paramedics," says Wayne Chacun, a paramedic based in Virden, Man., and a representative with the Manitoba Government Employees Union's paramedic unit.
In an interview with CBC News, Chacun said the longest shift he has worked continuously was 20 hours long.
On-call duty makes the work schedules even more grueling, he added — in one day in January, Chacun said he worked a 12-hour shift, went home for a bite to eat, then was called back for another nine hours.
Chacun said paramedics don't like to admit it, but fatigue often jeopardizes the safety of patients, paramedics and the public.
"You hear of people hitting the gravel on the side of the road, but thankfully being able to correct before they hit the ditch," he said.
"You hear of the occasional accident that's happened. You hear of people that were exhausted and may have made a medication error with the patient. These are the extreme cases you hear about."
Chacun said he has seen some improvements, but some paramedics have still been told to work even after they have alerted supervisors that their call would amount to more than 16 hours of work.
Chacun said he would like to see a cap of 16 consecutive hours as an absolute maximum for paramedics to work.
However, even that is longer than what is allowed in other sectors, such as trucking, which imposes a 13-hour limit on consecutive hours behind the wheel, among other restrictions.
Researchers like Blair Bigham, an associate scientist with St. Michael's Hospital in Toronto, have been studying the effects of fatigue among paramedics.
"We know from the research that when paramedics work greater than 12 hours they have an increased chance of making a mistake," Bigham told CBC News.
Bigham said policy-makers in Canada may want to consider regulating the hours of service for paramedics, but he conceded that the solutions would not be easy to find.
"To say that you're going to limit your paramedics to 12 hours might reduce some safety problems. But at the same time, you could find yourself with staffing shortages — that's not going to serve anybody," he said.
"I think this is a very difficult question for us to answer."
Province willing to listen
The Manitoba government says it is discussing the possibility of limiting the length of time paramedics can work.
"If paramedics say this is something that they want, then I would suggest that we would listen to them and do something about those types of things," said Gerry Delorme, the province's director of emergency preparedness and response.
Ambulance services review
For years, the paramedics' union in Manitoba has been demanding a provincial review of ambulance services.
Provincial government officials recently told CBC News they are still determining the scope of that review.
Delorme said the province receives very few reports of incidents involving ambulances.
Chacun agreed, saying he wants to reassure Manitobans that "we are doing everything we can to provide them with the best care we can.
"Sometimes we are working in extreme situations, and that the medics themselves would like to see this changed," he said.
Chacun added that rural ambulance services can have trouble retaining staff because paramedic salaries are higher in Winnipeg, which can result in a heavier workload for the other workers.
Chacun said the current collective bargaining process, which is addressing that issue, will take seven years before salaries are comparable.
The Assiniboine Regional Health Authority, which includes the ambulance service where Chacun works, says it doesn't want tired employees on the road, either.
"All of our supervisors have very explicit directions that if the paramedics say they cannot complete the call, or they're too tired, obviously we want what's in the best interest of the patient and the crew and the other people on the road," said Neil Gamey, the health authority's manager of operations for emergency medical services.
"So if they feel they cannot do the call, then they shouldn't be doing the call."