Professional Fatigue Project: Research Release (Part 1)

The Impacts of Extended On-Call Hours on the Functioning of Paramedics

The Alberta Paramedic Association has been engaged in a collaborative review as part of our Professional Fatigue project, to assess the health and wellness effects of the 24 hour shift model currently being used in rural Alberta’s EMS delivery.

During this assessment which included current legislation, frontline consultation and research/literature review. Over the next few weeks, our members will be able to follow this project as we lobby for change and release more information by checking back here in the news feed frequently.

Here is an overview of some of the findings.

Legislation and Consultation

  • Shifts exist in rural Alberta using 24 hour, 48 hour and 96 hour scheduling in different variations that do not involve scheduled breaks.
  • There are -/+ 192 ambulances in Alberta using a variation of 24, 48 and 96 hour scheduling.
  • The Traffic Safety Act regarding hours of service regulation explicitly excludes Paramedics operating an ambulance.
  • Neither the Health Professions Act, Emergency Health Services Act, Commercial Vehicle Drivers legislation, nor the Occupational Health and Safety Act addresses limiting hours of work or ambulance operation.
  • “Recent changes to employment standards legislation did not amend or make changes to the standards for ambulance attendants.” Hon Christina Grey, Labour Minister

Paramedic Health and Safety Risk

  • Humans require 6-8 hours of uninterrupted rest in a 24 hour period to mitigate sleep starvation and sleep deprivation
  • With no rest periods scheduled, aforementioned paramedics are at risk of sleep starvation and sleep deprivation
  • Sleep starvation increases the risk of cancer, dementia, depression and PTSD
  • Sleep starvation exacerbates sleep pathology by increasing the length and pathophysiology of sleep apnea
  • Frontline paramedics are currently reporting using sick time to “catch up” on sleep.
  • Paramedics lacking scheduled breaks for extended periods have no access to personal psychological supports
  • Cognitive performance after 18 hours of wakefulness mimics blood alcohol levels of 0.10
  • Eye-hand coordination at 8 AM after being awake all night has been correlated with a blood alcohol level of 0.10

View or print the full report: The Impacts of Extended on-Call Hours on the Functioning of Paramedics (PDF Format)

Alberta College of Paramedics Renewal Season Begins

It is that time of year again, registration renewals are underway with the Alberta College of Paramedics. We are pleased to announce to our members that professional liability certificate numbers are ready to be issued for the registration process with the college. Members will find our 2019 Insurance Certificate tool available for use November 1, 2018.

We encourage all members to ensure their contact and billing information is updated with the association to ensure your continued membership and insurance coverage.

Statement and action relating to recent media reports related to mental health

Mental Health Committee update;

The APA has received numerous requests for statement and action relating to recent media reports related to mental health. We would like to respond to those requests from practitioners as best we can with this summary.

The APA has an active Mental Health Committee that is currently working on developing an online registry of therapists specific to meet the unique needs of Alberta’s Paramedics. This includes; (1) conducting a literature search to identify common diagnosis facing Paramedics; (2) identify minimum certification levels competent and authorized to diagnose those conditions; (3) conduct a literature search to identify supported treatment modalities for those diagnosis; (4) identify minimum certification levels authorized to use those treatment modalities. Once those certification levels are identified, the therapists meeting those credentials may apply to be added to our registry at which time their practice will be reviewed by the committee to ensure they meet the criteria. Concurrently the Mental Health Committee is creating an ‘EMS Awareness Program’ for therapists to complete prior to being placed on the registry, and is officially recognized by the APA as an approved resource for paramedics seeking help.

As you can imagine, this has been a monumental undertaking, however, we have been able to attract a registered Psychologist to the committee, as well as build a team of Psychologist peers to review the work they are doing. We also have a neuroscientist student in their final year, who is involving a Ph.D. Psychiatrist for quality control purposes, as well as follow-up research. These Alberta registered Psychologists are all working voluntarily, and are key in the development of a provincial strategy. The mental health committee has learned many things along the way, and we want to share some of those with you.

Currently, in Alberta, the term ‘therapist’ covers many certification levels. These levels may include Behavioral therapist, Pastoral counselor, addictions therapist, Registered Social Worker, Registered Nurse, Occupational therapist, Registered Psychologist, Provisional Psychologist, Psychiatrist, plus much more. Further to those, there are subsets within those specialties, an example may be a registered Psychologist specializing in PTSD vs a registered Psychologist specializing in child behavior therapy who has never assessed/treated a patient with PTSD. If a Paramedic presents to their local doctor with symptoms of mental stress, that Paramedic may be referred to any one of these certification levels (it should be noted that referral is not necessary). This has been noted in quite a few cases lately, as the APA is being contacted by practitioners who have been referred to inappropriate therapists, and are dissatisfied with the results.

The mental health committee has identified that there is a subset of therapists who are more proficient in diagnosing and treating Paramedics suffering from mental trauma. There are also indicators that some therapists are not adequately educated and/or experienced to treat Paramedics suffering from mental trauma.

If a diagnosis of PTSD is made there are recognized treatment regimens that therapists must be trained in beyond their basic education. This is an important component of building the resource database for practitioners.

Scenario loosely based on actual cases handled by APA;
Currently, a family physician may remove a Paramedic from the workplace citing mental health. That Paramedic may be referred to a mental health practitioner who is inadequately trained to treat the mental health issue. After an extended treatment regimen, the therapist may feel the Paramedic may return to work, and provide a letter of support to the physician. The physician may then advise the employer and/or WCB that this Paramedic may return to work, although this particular Paramedic has not had proper treatment as defined by the Canadian Mental Health Association. This Paramedic is now at risk of being further injured by sustaining the continued mental trauma we are all exposed to in our profession. The mental health committee has seen this scenario play out multiple times over the last few months.

With this scenario in mind, it is obvious and time sensitive that we work together as a profession to demand better for our practitioners. Once a Paramedic asks for help, there should be no barriers in receiving the kind of specialized therapy we deserve, to address the mental injuries we sustain from our unique workplace. Furthermore, once a Paramedic has completed treatment, we need to have a standardized return to work process that ensures the practitioner has indeed received the proper treatment and is fit to return to full duties. This kind of work is the mandate of an association.

Your mental health committee’s first goal is to complete the literature searches and build the provincial resource database for all practitioners seeking help. Once that database is completed, the committee can get to work on the next goals of creating an entry to practice pre-screening, formalizing a re-entry to practice strategy for those restricted from regular duties, as well as lobby the family physicians to ensure Paramedics get the right referral the first time.

The recent controversy regarding paramedicine and mental health highlights the need for a strong unified association. The work the mental health committee is doing is 100% voluntary outside our full-time jobs. We strive to expedite our work to reach our goals faster and respond to practitioners needs immediately, however, work such as literature searches, and limited volunteer hours by allied health professionals puts limits on how quickly we can reach our goals. With more support, and increased membership we can expedite this time-sensitive work by employing individuals on a short-term temporary basis to do complete some of these time-consuming tasks.

Please contact us with any questions or comments

Together we are stronger.
Alberta Paramedic Association
Mental Health Committee