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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Another point on studying small groups - like an EMS system with only 10 employees.  There is always the ability to study several small groups at a time to create an adequate study population, as well as to lengthen the study time.

 

Just another way to give us the ability to conduct our own research and to do it for more than just the urban EMS providers...

Ben is correct on both points.

I doubt that there is a correlation between 24 hour shifts and high UHU (except in the most insane systems).  If you had a UHU (dispatched, adjusted for time on task), or a traditional UHU (transports per hour) of 1.00, it would mean that you did 24 transports (which probably means 32 calls) in 24 hours.  I know that there are some out there who are real powerhouses, and some that think they are, but the average medic would be a total zombie at the end of that shift - and so fatigued that he or she would have to go sleep about 12 hours right after, thereby negating the "quality of life" argument for the 24 hour shift.

In mixed systems (like mine), we start seeking the funding and FTE to convert from a 24 hour schedule to a 12 hour scheduled when the UHU (adjusted total) approaches 0.40.  Based on observation and internal data, we know that when we get close to the 0.40 mark, people appear fatigued when going off shift, and the likelihood of their getting 5 uninterrupted hours of sleep is unlikely.  So the busier the unit, the more likely it is to have 12 hour shifts.

Interestingly, 7 years ago there was zero interest in anything except 24s.  Today, we are half-way converted and there is a long waiting list of people wanting to move to 12s as soon as it can happen.  New generation?  Different expectations?  Busier system?  Who knows - but probably is worthy of being part of our unique body of knowledge.

Interestingly, 7 years ago there was zero interest in anything except 24s.  Today, we are half-way converted and there is a long waiting list of people wanting to move to 12s as soon as it can happen.  New generation?  Different expectations?  Busier system?  Who knows - but probably is worthy of being part of our unique body of knowledge.



I think this is a fair point, now as our call volume rockets upwards and our crew levels remain static, there is a long line of people that would sooner have an 8 hour shift rather than 12 even. The notion of receiving a late call and the 12 hour shift turns into 14 or even 16 hours really has a knock on effect, particularly if the crew is due back the next day. 

I think the perspective over this side of the pond is that the days are long gone where you could plan to do anything other than sleep after a dayshift.

I applaud Austin/Travis County EMS for hiring a sleep consulting company to design a more sleep friendly shift.  We have EMS-specific research about how dangerous lack of sleep is thanks to Dan Patterson.  We can't pretent to be ignorant about this anymore.

This goes beyond 24 hour shifts.  One service I am familiar with works on a rotation with 10 hours off between 14 hour night shifts each week.  How much rest can people be expected to get after getting off late and coming in a little early for shift change? For people who can't fall asleep during the day, they end up being zombies the next night.

 

While I haven't read all of the posts presented, most of these posts revolve around the UHU as a measure of "productivity". The measured UHU reflects the revenue generating (or possibly revenue generating) activity. It in no way adjusts for randomly driving around in circles to satisfy your system status plan or other non responding activity. As a true measure of shift activity or workload, it's a false measure.

On the other hand, fomenting the destruction of the Fire Service's beloved 24 hour shift would make it much easier to truly compare the cost structure of fire based EMS, and be a potential wedge against the difference in exempt work hours..... 

Johnson,

While there is a classic definition of UHU promulgated by Jack Stout, the term has been adopted throughout the industry as a measure of busy-ness of a crew.  In our system, we ignore classic UHU (because transports/hour doesn't measure anything that we are concerned about), but we are interested in dispatches/hour (UHUd), and total time on task (UHUat).  You need to measure what you are concerned about.  If your system does dynamic deployment, you need to count that too.  But dispatches/hour, adjusted for the time it takes to run a complete call, including paperwork) is a very effective measure of busy-ness.  And our personnel have shortened that to simply UHU - they know what is measured, 'cause we teach 'em in the academy.

Skip, once again, you show that your agency is more enlightened than most I've been affiliated with. Your agency probably declines to engage in the time honored "performance" EMS practices of juking the stats with definition games and other tactics to play with the numbers. Your agency probably also does not assume that units are 'in service' if they are at the hospital for 20 minutes. 

It might just be me, but I don't know of a single agency that measures or includes non call activities in determining activity. While infrequent, I do recall many shifts in dynamic SSM systems that resulted in very few responses, yet I spent the entire shift running in circles because calls dropped in every area other than my post. 

We try and call it straight.  I've never liked the "exceptions" game, like "train delay" or bad weather - we know those things happen and we should ethically plan for and around them.  It's also too difficult to play those games when you have 6,000 dispatches per month.  The only thing that I can't capture in call-based productivity measurements is station chores, truck checkoffs, trading trucks for repairs, and stuff like that - so we just have to allow for it.  And no, trucks are not in service until the patient has been transferred, the report written, and the truck restored and restocked.  There are days when we try to shorten that interval, but no "back in service" whether you're ready or not.  Doesn't make any sense.

It's not that hard to be ethical in those areas.  Much of EMS response performance is simple math (distance = rate x time), and you can't alter that.  You either have enough units or you don't, and you either meet your goals or you don't.  If you want to improve your (mostly meaningless) response performance, you add units.  If you want to improve cardiac arrest survival (or most of the other time-dependent stuff), put your money in to the first response services.

It's about the patients - not about us.

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