Putting EMS crews and patients at risk?

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Permalink Reply by Joe P. on May 15, 2009 at 4:10pm

If your service is busy then it is unaccecptable to have 24 hour shifts. I don't think it's right to say "Well, we're too tired to run a non-emergent transfer, but we can still respond to emergency calls." Either you are too tired to run a call (any call) or you are not.

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Permalink Reply by Ben Waller on May 15, 2009 at 9:12pm

Joe,

Even slow services have an occasional busy shift. That doesn't make it "unacceptable" for them to work 24-hour shifts.

This situation can happen pretty much anywhere that runs transfers, regardless of the average daily call volume or typical UHUs.

The question here is sending the ambulance on a long call where fatigue is going to be a much bigger factor than running emergency responses close to the station with the endogenous catecholamine release that occurs when the siren starts.

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Permalink Reply by blair4630 on May 16, 2009 at 12:44am

I would have to say, if you're working for a service that runs 24 hour shifts, then you need to be prepared that any given shift you will be awake for the whole 24 hours. Are 24 hour shifts too long? That's a matter of everyone's personal opinion. I worked them for a short time at my previous service, then declined and went to 16's. I personally can be up for 24 hours, but don't feel completely comfortable with big decisions in pt. care at that point. That's why I dropped to 16's. But, not to sound like an ass, if your service runs only 24's and you're not comfortable with that shift duration, maybe it's time to look for another service down the road.

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Permalink Reply by Lady O. on May 16, 2009 at 12:57am

Well, now that the call has been completed, you should bring this concern to the attention of upper management. Common sense should suffice in answering that question, but lets look at the facts: Sleep is needed to regenerate certain parts of the body, especially the brain, so that it may continue to function optimally. After periods of extended wakefulness or reduced sleep neurons may begin to malfunction, visibly effecting a person's behavior. This inevitably translates into poor motor function, judgment, critical thinking...the list goes on. Anytime you feel you're putting yourself or the patient at risk, in my opinion, that action should not be taking place.

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Permalink Reply by Michael Hulsizer on May 16, 2009 at 5:34am

I work 12 hour shifts at my full time job, but I also work a part time position in which we do work 24 hours. My assigned base is a pretty steady bases and safety is always a priority!! We have a written policy that at any time we need to sleep we are able to contact the director and ask for a time out!! This time out is a 4 hour block for sleeping... period!!! We are not allowed to chart, and do any of the normal station duties while on the time out. We very rarely have to use this, but it is out there for those times when we feel that safety of the crew and or patient is compromised!! Our system is a large system and we can over lap coverage areas with other bases during these times. I agree with an earlier post...if you are a busy system and something like this is not available to you, then maybe you should consider a shorter shift, or consider something similar to management. Please be safe out there!!

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Permalink Reply by B Williams on May 17, 2009 at 8:25am

I would like to ask everyone to consider this piece from the original post I made: "Upon arriving at the ER, the crew is informed that they will be transporting a 46 year old female to another hospital 1 hour and 35 minutes away"

If you are transporting a patient that far, you are working RURAL EMS. 80% of the United States is rural (Alaska is 100% rural). It's not typical for shifts to be 12 hours long with rural services. I can tell you from my own experiences that most calls last 100 minutes sometimes if not a bit more. Running even 5 or 6 calls per shift that's 8-10 hours on the road that someone was operating an emergency vehicle.

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Permalink Reply by Skip Kirkwood on May 17, 2009 at 8:45am

This issue is something that we, as an industry, have to get our hands around.

My recollection is that the research shows performance degradation with fatigue, such that at the 19th hour performance is as though the person had a blood alcohol of 0.8, and that it doesn't improve without 5 hours of uninterrupted sleep. So Blair, it's not a matter of personal opinion - there's some science there too.

How do you spell COLGAN Airlines? (For those of you who don't follow the news, this is the regional airline that flew a loaded plane in to the ground and killed 50+ people outside Buffalo. The NTSB hearings are bringing out "crew fatigue" and "improper training" as the causes. Y'all need to read some of this.)

This is another part of putting the patient first - insuring that every crew works shifts that are short enough to be safe. Regular old truck drivers (not carrying humans in the back) are limited to 10 hours at a whack, yes? What is it about us that makes our biology different?

Patients first? Or profits first?

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Permalink Reply by Gul Dukat on May 17, 2009 at 11:25am

Before I can give you my thoughts on this issue I need to ask a couple of questions.

1. Were you the only crew available for the transfer?
2. was your ambulance service the only one available to do the transfer or is there another service that could have performed this?
3. Does the service you work for operate with government funding or are they only paid for the transports that they do?
4. What time was the last run you did prior to this transport?
5. What would be the repercussions for your service for refusing to do the run? In other words would they be in trouble with the local E.D.? This is not as simple as it sounds btw.

Now having asked all of that I want to say this. One thing that is being over looked in all of this, at least from the way I am reading it, is the fact that the E.R. requested an ALS truck for the transfer. When you say "resting comfortably with the assistance of a few pharmacological agents" do you mean that they were given the meds prior to transport or did you give some enroute or was there a drip hanging?

There are many questions to ask along this line of thinking as well, but at face value it looks like you might have been the victim of RN overkill. But before I assume that I guess I would want to know about the pain meds. this person received.

Oh well since I started this thought process going I'll go ahead and ask this as well.

A. Was this an actual ALS run that required you to actually perform any type of ALS intervention? Or did they want you in back, just in case?
B. Is your service an all ALS service so it would not make a difference?
C. Between the hospital that you transferred from and to are there any other Hospitals or EMS agency's that have Paramedics available?
D. By you leaving your service area did that leave another ALS truck available?

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Permalink Reply by ArcticKat on May 18, 2009 at 1:04pm

My service is a three unit rural ALS service that does 350 - 400 calls per year. Our shifts are also 24 hour rotations. I have the schedule set up so there is a primary crew, a secondary crew, and an on call crew. The primary crew takes all calls. The secondary takes anything when the primary crew is busy, and so on. If my primary crew is in the ambulance for more than 16 hours in a 24 hour period, they are rotated to on call crew status for 8 hours of down time and the other crews are rotated up.

A typical transfer for us is about 7 hours long and local 911 calls anywhere from an hour to 3 hours depending on severity and location.

Guld Dukat raises some relevant questions about your service that need to be answered. Basically, if I have a crew asking to sit out a trip, I know they must be tired and not lazy because a transfer means about $250.00 bucks in overtime they're giving up.

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Permalink Reply by dr-exmedic on May 18, 2009 at 2:16pm

Skip Kirkwood said:

Regular old truck drivers (not carrying humans in the back) are limited to 10 hours at a whack, yes? What is it about us that makes our biology different?

Patients first? Or profits first?

Days off first, obviously. How else is everybody in the industry supposed to work a second or third job if they don't have the 20 days off a month provided by a 24/48 schedule? ;)

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Permalink Reply by ArcticKat on May 18, 2009 at 2:43pm

dr-exmedic said:

Skip Kirkwood said:

Regular old truck drivers (not carrying humans in the back) are limited to 10 hours at a whack, yes? What is it about us that makes our biology different?

Patients first? Or profits first?

Days off first, obviously. How else is everybody in the industry supposed to work a second or third job if they don't have the 20 days off a month provided by a 24/48 schedule? ;)

Who's to say that every schedule is a 24/48? Ours is a 6 day on / 3 day off schedule. Oh, and truck drivers are limited to 13 hours of driving in the last 15 hours before requiring 8 hours of rest.

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