Question all, I recently worked at a agency that was employee driven wanting 24 hr shifts with 72 interem off. What are the national ranking on 24 hr shifts and your personal thoughts on them.

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Like most things in EMS, there is no "National Standard" to shift lengths that I'm aware of.

For that matter, both agencies I work for have policies against personnel working beyond 16 straight hours without a minimum 9 hour rest period inbetween. Because of those policies, one agency only schedules 9 and 12 hour shifts because units can get stuck on long hauls putting them past that time limit if they were scheduled for more hours up front.

For both of those agencies, the decision was safety and patient risk driven.

There is no national standard.  There are issues, though, and ranges of what a reasonable person would call "acceptable."

A rural EMS unit that runs 1-2 calls per day, the vast majority of which occur during the day, can probably utilize 24 shifts with impunity.  The science that I've found says that anything less than 5 hours of uninterrupted sleep is dangerous.  So - you know your service and its call load.  If you can get 5 uninterrupted hours, say, 95% of the time, you're probably being objectively reasonable.

On the other hand, there are plenty of places where 24 hour shifts were institutionalized when things were not so busy (some EMS systems, or some FDs before they started running EMS calls).  Once there, employees become invested in the lifestyle, the many days off, and resist change - even if it may cost them their lives - or more likely some poor patient or poor citizen's life (who was unfortunate enough to encounter some dangerously tired emergency responders).

Then there is the issue of money.  It takes roughly 6 FTE (full time equivalent) employees to staff an ambulance on 24 on, 48 off, and 8 FTE to staff 24 x 72.  It takes 8 FTE to staff on 12 hour shifts (14-15 days per month).  It takes more (maybe 8.6 or 9.2) to staff 8 hour shifts.  If you're responsible for the budget, all of a sudden asking for an increase in personnel of 25% is a big deal - even if you know that it would be more safe.

I've heard that the latest trend in the west coast fire services is to go for 48 on, 96 off.  How safe is that?  Again, are those rural units that run a couple of calls per day, and can do that schedule safely?  Or are they asking for trouble?

Are we good, or are we content to be lucky?

When I worked in surburban EMS in Westchester, Rockland, and Orange Counties in NY; there were times I did 24hours. It was allowed but only as a last resort. Call volume was lower but I wouldn't say they were slow. Whether it was easy or not; doing too many 24hour shifts breaks you down. Sleep is important and working like that didn't make sleeping afterwards easy. I found it difficult to sleep well after a 24hour work day... No nationial standard; no standardized guideline will ever say working 24hours is standard...
European working time directive. A piece of law that had a massive impact on healthcare working, no more junior doctors doing 60+ hours a week. All healthcare staff can only be "forced" to work 37.5 hours per week averaged out across 13 week cycles. A maximum of 16 hours per day only.

All staff must have 11 hours rest before their next shift so if a crew on a 7am-7pm get a late Job and ends up finishing at 11pm the crew cannot report until 10am following day.

Resource nightmare but patient safe

Neil White said:

European working time directive. A piece of law that had a massive impact on healthcare working, no more junior doctors doing 60+ hours a week. All healthcare staff can only be "forced" to work 37.5 hours per week averaged out across 13 week cycles. A maximum of 16 hours per day only.


How on Earth do your doctors see enough patients in a residency, then, to get good at it? Or have they doubled the number of years it takes to become a consultant there?

I was watching Bizarre ER on TLC; this episode was video-documenting an ER in the UK... The staff saw some pretty interesting cases. A lot of trauma we entering the ER; walk-in and via EMS. In addition, they were very busy... The staff depicted were multi tasking and clearly overwhelmed but the chaos was controlled well...

http://www.foundationprogramme.nhs.uk/pages/home

The medical training programme was overhauled recently to reflect working hours changes. Last I heard it was taking on average 7 years to go from med school to registrar (attending??) and then the same to go from registrar to consultant (clinical director??)

dr-exmedic said:

Neil White said:

European working time directive. A piece of law that had a massive impact on healthcare working, no more junior doctors doing 60+ hours a week. All healthcare staff can only be "forced" to work 37.5 hours per week averaged out across 13 week cycles. A maximum of 16 hours per day only.


How on Earth do your doctors see enough patients in a residency, then, to get good at it? Or have they doubled the number of years it takes to become a consultant there?

Personally, from working in a busy system on 24's for 4 years, it's a terrible idea.  When you're running for 22 hours straight and then get a critical care call with 4 drips and ART, CVP, and a vent you realise just how hard it is to think critically when you're that tired.  Then there's the driving while being dead tired.  There are multiple studies online to show that driving tired is the same as driving drunk.  I switched about 2 years ago to 15 hr shifts, and I have to say that that is about as long as I feel truly safe working.

As Skip mentioned, Lower unit hour utilization is an important consideration. My systems runs  approx. 1 call per aircraft per 24 hr shift. Well within an acceptable range by anyone's standards. Obviously, a range of variance. but we do well. I wouldn't drive the distance to work more than twice a week. Loss of an experienced Flight Nurse/Medic because of an an hour mandate dicated nationally?

 

In the Greater Tampa Bay area of Florida the 24 hour-on/48 hour-off schedule is the most common in EMS-based fire services.  The agency from which I recently retired has ambulances that run 3 calls per shift to others that run 15 calls per shift.  Five hours of uninterrupted sleep for the busier units never happens.  Is this a safety issue?  In my opinion it is.  But as Skip pointed out, tradition, employee desire and FTEs (money or costs) keep this manning approach alive.

 

As Neil has demonstrated, the UK (and much of Europe) has made great strides in recognizing and acting on the productivity, performance, satisfaction and safety of employees and consumers as it relates to the hours they work; notably in health care occupations.

 

Employee scheduling and staffing of ambulances and fire apparatus in most systems still boils down to costs (FTEs) to those charged with providing a service within the confines of constricting budgetary resources.  It ain’t pretty, but it’s the truth.  Even systems like the famed Pinellas County/Sunstar system are now faced with the reality of budgetary short-falls after a decade of being one of the richest EMS systems in the country.  But I digress.

 

With the constant growth in the use of EMS by the general public and the evolution of the EMS role in the health care continuum, attention will have to become more focused on work hours.  The safety of our employees helps insure the safety of our patients.

 

 I do have a bit of advice to all you “consultants” out there.  When you figure FTEs, remember the call does not end when the ambulance arrives at its destination or when it comes in-service.  There is still a lot of work being done while en-route back to the stations and when the unit finally gets back in quarters.  Uninterrupted sleep hours must keep this latter point in mind.  Even on cancellations and dry runs.  Adrenalin is our savior and our assassin in this crazy world of emergency services.

For years I have worked 24 hour shifts, both on slow and very busy units. It can be tough. And in my case, I worked a lot of extra shifts. I now work 12 hour shifts, 0700-1900. I like this better, from the workload standpoint. But I still have to maintain a certain amount of extra income, even more so with rising gas prices and the loss of income in my household over the past three years. Where I used to have 20 days off to work and extra 10 days each month, I now have 14 days off, but I still have to work those extra 10 days, either on an ambulance, QRV, or teaching. It’s tough. I see both sides. If things had worked out differently, I would rather work the 24s and have the usable time off. But they haven’t so it is what it is.

24 hour shifts are,  for the most part,  fire department tradition based bullS%^T  that should have been removed along time ago from EMS...24 hour shifts are dangerous, don't match the workloads of EMS, and are hazardous to busy MICU or BLS transport trucks. Sleep deprivation kills

 

sorry to be blunt ...... but it's true we all know it

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