**8. Fatigue**

A simple internet search for motor vehicle accidents involving drivers who fell asleep at the wheel yields multiple results of devastating incidents, also populating numerous articles related to first responders being found sleeping on the job. When identifying risks to patient safety, the first things to come to mind are medication errors, high-risk procedures, and equipment malfunctions-issues, which can be mitigated with medication cross-checks, education, safety checklists, and preventive maintenance checks and services. However, according to the World Health Organization, healthcare worker fatigue is the largest contributing factor to both patient injury and medical errors [35]. Fatigue, whether physical or mental, can lead to many threats to patient safety, including delayed judgment making, medication administration errors, slow response to threats or obstacles, and failure to adhere to written protocol. Though inherent to the nature of the job, creation of evidence-based fatigue mitigation programs should be prioritized for both patient and prehospital clinician safety. A strong program should consider the needs of the community, available resources, and clinician feedback, while also incorporating formal education on effects of fatigue and strategies to reduce risk.
