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For Sam Koenig, sleep is but a brief respite between saving lives. The 23-year-old EMT regularly pulls the eight-to-eight overnight shift.

While those hours may strike even the most hardened shift worker as crazy, they’re not uncommon among EMTs, who are called to the scene of car wrecks and other life-and-death medical situations. Between calls, technicians are allowed to nap in beds in the back of their ambulances or at the base. Those brief bouts of shut-eye, however, depend on the volume of accidents in which their services are required. When the siren sounds, sleep is a necessary casualty.

In his own words, here’s how Sam keeps his eyes open and head straight in one of the toughest jobs around.

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My agency currently has us on 24-hour shifts. I usually work two days a week, and then a third day every other week. Holidays rotate. Other departments may have 12-hour and/or 48-hours shifts. I work for a public ambulance service in Missouri, but this is the generic structure of an EMS work schedule: a few days on, followed by a few days off.

While working, I spend all 24 hours on base or on the ambulance. The base is nice: We get bedrooms, a kitchen, a gym and a living room. When we aren’t running a call, we’re usually filling out paperwork, doing training modules or completing chores around the base. Typically, you finish these chores by mid-afternoon, and then you can do whatever you like — usually napping, playing video games or just sitting around.

The 24-hour shift sounds daunting, but you pretty much spend the day like you would at home. I was a junior in college when I started, so it was not very hard to adjust to the sleep — or lack thereof — schedule. Staying alert isn’t necessarily very difficult but… coffee. Lots and lots of coffee.

The most exhausting thing we do are transfer calls. That’s when we take a person from one hospital to another. You end up having to drive three to six hours roundtrip, oftentimes at two or three in the morning.

To tell you the truth, 90 percent of 911 calls are incredibly boring. The reason burnout and turnover on the job tends to be high is the mundaneness, the repetition. After hundreds of calls about elderly people who fell down, people complaining about shortness of breath, you eventually want to move on...

Average healthy adults could save on healthcare costs if they found someone to drive them to the emergency room for non-life threatening issues. Just because you came in by ambulance doesn’t mean you’ll be seen by a doctor faster. The ER triages everyone — unless you’re bleeding out or in some sense about to die, you’re going to wait.

When I get off work, chances are I’m gonna sleep for 10 to 12 hours. If we didn’t have a busy night, I’ll spend my day off like any other person would. I always have to nap, though. I can’t go through a day without a one- to two-hour nap in the afternoon or evening.

The long hours don’t bother me, but the stress is harder to tackle. A lot of us handle it in different ways. When I started two years ago, I developed quite the drinking problem — not uncommon amongst first responders. I have since quit drinking altogether in favor of therapy, exercise and hobbies.

The patient was trying to commit suicide with a paper clip. When we arrived on scene, Law Enforcement Officers were trying to get the patient to put it down, but the person kept jabbing it in their forearm. Eventually, the person set the paper clip down and waddled their way out the house onto the back of the ambulance — then started hooking themselves up to all of our equipment.

Protocol usually dictates that they should be wheeled out on the stretcher, but it seemed that this patient was more aware than I was. This was one of my first 911 calls.

I never dream that I’m on the job, though sometimes I dream about saving someone heroically. But don’t we all?