**8.1 Needs of the community and available resources**

When thinking about factors contributing to fatigue, shift length and call volume immediately come to mind. Though it would make sense that the longer an employee works, the more likely they are to be fatigued, available literature suggests that there is no statistically significant difference in the number of unfavorable events, which occur in shifts of varying lengths as long as they are 24 hours or less in duration [35]. This may not make sense at first glance, but it is thought that this could be attributed to the ability to rest between calls and longer periods of time between shifts for those who work 24-hour shifts, which reduces the risk of adverse events. In other healthcare fields, higher individual workload has also been shown to contribute to increased adverse patient events due to effects of fatigue, however, no prehospital studies have been conducted [35, 36]. Regardless, factors such as call volume, transport times, and call acuity should be taken into account prior to determining appropriate shift length to remedy fatigue. However, adjustments to shift structure may not be possible in all response areas given increased costs of additional equipment and lack of available EMS professionals, therefore, other mitigation techniques may be more feasible.
