Fatigue impacts personal health as well as the ability of responders to perform key functions including patient care, incident command and vehicle operations. Studies have shown that 17 hours of sustained wakefulness is equivalent to a blood alcohol level of 0.05 percent and that after 24 hours, it is equivalent to 0.10 percent – more than the legal limit for driving. Despite this evidence, efforts to move to shorter shifts continue to face significant resistance and the number of EMS agencies using 24- and 48-hour shifts continues to rise