Fatigue: The Risk Hiding in Plain Sight

Why I’m Writing This?

If you’ve worked in the ambulance service for any length of time, you’ve experienced fatigue.

You don’t need a research paper to tell you what it feels like.

It’s the run of night shifts where your body clock feels completely out of sync.

It’s the meal break that never happened.

It’s the late finish that turns a 12-hour shift into a 14-hour shift.

It’s driving home with the window down and the radio turned up because you’re struggling to stay alert.

For many of us, fatigue has become so normal that we barely talk about it anymore.

But that raises an important question:

Have we become so used to fatigue that we’ve stopped seeing it as a workplace hazard?

Why Fatigue Matters

When people hear the word “fatigue”, they often think it simply means being tired.

In reality, fatigue is much more than that.

Research has shown that fatigue can affect:

• Concentration
• Memory
• Decision-making
• Reaction times
• Situational awareness
• Communication

In a safety-critical environment, these things matter.

Ambulance staff are expected to:

• Drive emergency vehicles
• Make complex clinical decisions
• Work in unpredictable environments
• Deal with emotionally challenging situations
• Perform under pressure

Nobody is suggesting that tired staff are incapable of doing their jobs.

The point is that fatigue can influence performance in ways that are not always obvious to the individual experiencing it.

This is why industries such as aviation, rail and offshore energy treat fatigue as a workplace risk that needs to be actively managed.

What I Wanted To Find Out

As a UNISON Health & Safety Representative, I wanted to understand how ambulance services are managing fatigue.

Rather than relying on assumptions, I submitted Freedom of Information requests to ambulance services across the United Kingdom.

I asked a number of questions, including:

• Do trusts have Fatigue Risk Management Systems?
• Do they carry out fatigue-specific risk assessments?
• Do they monitor fatigue-related incidents?
• Do they assess roster patterns for fatigue risk?
• Do they audit themselves against Health and Safety Executive (HSE) guidance on managing shift work?

The aim wasn’t to criticise anyone. It was simply to establish what systems currently exist.

What The Responses Showed

The responses were remarkably consistent. Every trust recognised that fatigue exists.

Most referred to controls such as:

• Working Time Regulations
• Occupational Health support
• Wellbeing services
• Stress management policies
• Reasonable adjustments for individual staff

These are all positive measures.

However, there was limited evidence of structured systems specifically designed to manage fatigue as a safety-critical risk.

Across the trusts that responded:

• No trust confirmed a formal Fatigue Risk Management System
• No trust provided evidence of fatigue-specific risk assessments
• No trust demonstrated active fatigue modelling of shift patterns
• Fatigue was generally not recorded as a specific contributory factor within incident reporting systems
• No trust provided evidence of formal auditing against HSE guidance on managing shift work and fatigue

The simplest way to summarise the findings is this:

Fatigue is recognised, but there is limited evidence that it is being systematically measured, monitored or managed.

What Does That Actually Mean?

This is where health and safety language can become confusing, so let’s keep it simple.

Most organisations already recognise fatigue.

They know staff get tired.

They provide support when people are struggling.

The issue isn’t whether fatigue is recognised.

The issue is whether fatigue is being managed in the same way as other workplace risks.

For example:

If we identify a manual handling risk, we assess it.

If we identify a vehicle risk, we assess it.

If we identify a violence and aggression risk, we assess it.

We don’t simply acknowledge the risk exists and hope people cope with it. We put systems in place to understand and control it.

The question this work raises is:

Should fatigue be treated in the same way?

What Does HSE Say?

The Health and Safety Executive recognises fatigue as an important workplace issue, particularly in organisations that rely on shift work, night work and long working hours.

HSE guidance highlights the need for employers to:

• Assess fatigue risks
• Review working patterns
• Monitor potential problems
• Put controls in place to reduce risk

Fatigue isn’t viewed as a personal failing. It’s viewed as something that can arise from the way work is organised.

That’s an important distinction.

Lessons From Other Safety-Critical Industries

Before joining the ambulance service, I worked within the railway industry. One of the biggest differences I noticed was how fatigue was treated.

It wasn’t viewed purely as a wellbeing issue.

It was treated as an operational risk.

Shift patterns were assessed.

Fatigue risks were monitored.

Organisations looked for trends and warning signs before incidents occurred.

That doesn’t mean the railway industry has all the answers. But it does show that fatigue can be managed proactively rather than simply reacted to when problems arise.

What Could Better Fatigue Management Look Like?

This isn’t about creating unnecessary bureaucracy. It’s about understanding risk.

Potential improvements could include:

• Better monitoring of fatigue-related concerns
• Fatigue-specific risk assessments
• Review of higher-risk shift patterns
• Improved reporting and learning from fatigue-related incidents
• Greater use of evidence when designing rosters

The aim would not be to eliminate fatigue entirely.

That’s unrealistic in a 24-hour emergency service.

The aim would be to understand and reduce unnecessary fatigue risk wherever possible.

Why This Matters To Members

At its heart, this is about safety. It’s about protecting staff who already work under significant pressure.

It’s about ensuring fatigue is viewed as a workplace issue rather than an individual weakness. And it’s about asking whether we can do more to understand and manage a risk that affects virtually everyone working in ambulance services.

The Conversation Starts Here

This work isn’t intended to point fingers or assign blame.

The evidence suggests that fatigue is recognised across ambulance services.

The question is whether we are doing enough to manage it.

“The evidence suggests that fatigue is recognised across ambulance services, but there is limited evidence that it is being systematically measured, monitored or managed.”

I’d be very interested to hear members’ experiences and views.

Have you experienced fatigue at work?

Do you think current systems go far enough?

What changes would make the biggest difference?

Because if we’re going to improve how fatigue is managed, the conversation has to start somewhere.