# Phoenix SouthWest Medics Concerned Over Lack Of Sleep



## MMiz

*Valley Medics Concerned Over Lack Of Sleep*
_Paramedics With Southwest Ambulance Voice Safety Fears_

PHOENIX -- A four-month investigation by 5 Investigates revealed that some Valley medics are so exhausted on the job, they are afraid they will make a dangerous mistake.

Some of the medics with Southwest Ambulance told investigative reporter Tammy Leitner that they work on little or no sleep at all. They say Southwest Ambulance has ignored their concerns.

*Read more!*


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## WolfmanHarris

Why 24 hour shifts are allowed in any moderate to high call volume service are beyond me. Aside from VERY rural (remote) services in the North of the Province (1 call every couple of days) we have no 24 hour shifts, only 12's with some services doing 8 hour peak coverage shifts. 24 hour shifts are outright dangerous.

Where I work, moderately busy, mainly suburban service (pop. 1.1 million) we work 12's. If you get a late call that takes you into over time once that call is clear you return to base OOS for all but cardiac arrest calls. If a major call results in so much OT that you have less than 8 hours until your next shift, you are booked off with pay for that entire shift. 

The unfortunate downside to our shift structure is we're not entitled to beds so have to make do bedding down on the couches in the crew rooms. Commercial grade couches suck.

I don't understand how these long shifts are still allowed, let alone common place.


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## BEorP

WolfmanHarris said:


> Why 24 hour shifts are allowed in any moderate to high call volume service are beyond me. Aside from VERY rural (remote) services in the North of the Province (1 call every couple of days) we have no 24 hour shifts, only 12's with some services doing 8 hour peak coverage shifts. 24 hour shifts are outright dangerous.



FYI Huron County has 24 hour shifts.


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## triemal04

WolfmanHarris said:


> Why 24 hour shifts are allowed in any moderate to high call volume service are beyond me. Aside from VERY rural (remote) services in the North of the Province (1 call every couple of days) we have no 24 hour shifts, only 12's with some services doing 8 hour peak coverage shifts. 24 hour shifts are outright dangerous.


Part of the reason is that it's cheaper; 24 hour shifts, despite the many ways they can be scheduled almost always break down to a 56 hour work week.  So with that type of schedule it's possible to have fewer people working for the service thus saving money.

Another part is the time off; even at the basic 24/48 schedule it gives the employee 2 days off for every day worked, and there are others out there than sometimes give the employee up to 4 days off several times a month.

Of course, neither of these reasons makes up for the fact that, in a high volume service 24's are a bad idea, and can be horribly dangerous.  But, for slower areas they aren't a bad idea and do have some benefits.  It'll all depend on whether or not the employee can maintain an appropriate level of readiness (read not be sleep deprived) during the shift.


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## Onceamedic

I work 48 hour shifts and personally run an average of 20 calls per 48.  I don't know how long I will be able to do that.


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## Seaglass

24s can be a lot more convenient if staff are commuting over long distances. My station recently went to 12s, and you can only get 24s if you live beyond a certain distance away. If you're on a 24, you're encouraged not to drive or be the primary care provider on serious calls. Makes for some confusing crew rosters, and the restrictions on the second half of the shift can't always be followed, but it generally works well enough. Our medical director really pushed for this after hearing too many cases of people making stupid mistakes. Luckily, the new policies were put into place before anything serious actually happened.


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## redcrossemt

We do 24 hour shifts on our dedicated 911 cars. Our call volume is typically less than 6 calls in 24 hours. There are days when we are pushed, obviously; but the norm includes a good amount of downtime. We also stagger our shifts so that there is almost always someone working their first 12-hours.


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## VentMedic

Seaglass said:


> 24s can be a lot more convenient if staff are *commuting over long distances.*


 
That is truly the most dangerous.  If you read some of the articles on this, it is from sleepy workers driving home that cause many MVCs.


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## redcrossemt

VentMedic said:


> That is truly the most dangerous.  If you read some of the articles on this, it is from sleepy workers driving home that cause many MVCs.



Good point.

Of interest to me lately is what is called "sleep inertia". This is the grogginess and loss of some level of motor and thought functions when suddenly awoken. It worries me that during periods of sleep, we are immediately waking up for emergency calls, driving a dangerous vehicle, and then caring for someone who deserves our full attention.

Obviously we can't significantly lengthen our times to on-air... so the only solution I see is to go to shifts shorter than 12 hours, with no sleeping allowed. Of course, there are other things to consider then, like sleep debt, especially when accompanied by the fact that EMS providers are notorious for overtime and second jobs.

In the mean time, we do what we can to decrease the sleep inertia and danger to us and others... Tones are on real loud. Lights go up as soon as the call is received. We walk around the ambulance once before responding. My partner and I talk and if either one of us is feeling sleepy, or appears that way, the other drives.


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## Seaglass

VentMedic said:


> That is truly the most dangerous.  If you read some of the articles on this, it is from sleepy workers driving home that cause many MVCs.



Everyone is aware of that, but we don't have a choice. The cost of living near the station is going up pretty badly as the suburbs expand, and we're not going to get the commuters to move closer. New hires aren't being signed on for 24s. Rumor has it that there are some contractual things that keep us from forcing the older people to swap. 

So we do what we can. You can sleep in after a shift as long as you need--we've even set up a tone-free bunkroom, although we're still working on getting enough beds to host entire shifts. If there's some reason you can't go home until your next shift and we're out of room at the station, you can crash on someone's couch... it's not that uncommon, especially during severe storms. We can't force people to stay over, but most people seem to take advantage of it.


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## WolfmanHarris

BEorP said:


> FYI Huron County has 24 hour shifts.



8564 annual calls
5 24/7 Ambulances (increased to 7 at night)
23.5 calls per day
4.7 calls per 24 hours per truck (only counting the day cars) OR
3.4 calls per 24 hours per truck (7 cars)

Sure it doesn't actually work out that way, but with that sort of volume I'd say a 24 hours shift may be workable. 

So I probably overstated the VERY rural thing, but we're not talking 24's of being run of their feet.


As for the rest of the debate, the fact that convenience and logistics (commute times, recruitment, etc) is allowed to trump provider and patient safety is entirely unacceptable. Especially in the face of both anecdotal (as started this discussion) and more scientific evidence that thoroughly and conclusively proves the dangers of these shift schedules.

I will be far blunter and less diplomatic than I tend to prefer, and for the offense I'm sure this will cause, I apologize. I don't know any of you as individuals and this isn't directed at anyone in particular. That being said: if a service can't make safe operation a priority and a reality then it is time to take a very close look at how it's being managed or what service is providing it. Perhaps contracts need to be cancelled or managers replaced until someone is willing to look outside the box or make the tough decisions. Anything else, is just excuses and medical mistakes, dangerous driving and deaths will be the result.


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## Seaglass

WolfmanHarris said:


> As for the rest of the debate, the fact that convenience and logistics (commute times, recruitment, etc) is allowed to trump provider and patient safety is entirely unacceptable. Especially in the face of both anecdotal (as started this discussion) and more scientific evidence that thoroughly and conclusively proves the dangers of these shift schedules.
> 
> I will be far blunter and less diplomatic than I tend to prefer, and for the offense I'm sure this will cause, I apologize. I don't know any of you as individuals and this isn't directed at anyone in particular. That being said: if a service can't make safe operation a priority and a reality then it is time to take a very close look at how it's being managed or what service is providing it. Perhaps contracts need to be cancelled or managers replaced until someone is willing to look outside the box or make the tough decisions. Anything else, is just excuses and medical mistakes, dangerous driving and deaths will be the result.



I'm not sure where the debate is... academically, I agree, but reality doesn't always line up. I think my service has done everything realistically possible, and I applaud it for being one of the few in the area that has actively promoted 12s, rather than kicking and screaming. 

Canceling contracts isn't feasible without inviting lawsuits... particularly when the service is doing everything possible to discourage those on 24s from driving tired. Besides, we need the staff, period. 

If you want to get into the reality further, PM me; it's rather convoluted, and I'd rather not post too many details publicly.


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## Kevin1990

I work for a company in northeast ohio, and we work 24's. But are call volume is high during the day, and not so much at night. we dont have a high call volume so our medics and emt are normally fine. Some days were running back to back for 24 hrs. I worked 10 emergency is a 24 hr period, but may not seem alot but were in the country and sometimes the closest hospitals is 20-30 mins away. We have a alot of transfers from a hospital to cleveland clinic, which is a 3-4 hr round trip. If youre company has a high call volume, i think they shoud make 12 hr shifts.. if the medics are so tired and think they are going to make a mistake.. what good does the pt get out of this. Its not the medics fault... there tired, and you get tired


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## Outbac1

12 vs 24 is a topic of concern here as well. Our more urban areas do 12s and the rural towns do 24s. If we work at a 12 hr ste we can do a double shift(24hrs) and the 24s max out at 36.  The 24hr sites work one on and 3 days off.  

  Besides the sleep depravation issues already mentioned there is another issue. 

  The problem comes when dispatch pulls the 24s to town to do long hauls. As they don't have to be back in 12 for a shift change they often get several calls dumped on them. They often run 18 -20 hrs straight. Besides them being tired there is the matter of coverage for their area. This usually means the next amb. over is pulled part way into their terrortory for coverage. Now one amb. is covering twice the area, several hundred sq. kms. When they get a call their response time is quite long and now there is no one for coverage for the second call. The next amb. is probably an hour away. 

  Long hours even without doing a lot of calls is tiring. I don't do very many 24s anymore. Especially what we call a backward 24. Where you do the night portion of the shift first, then the day portion. They are just too hard on you. Even if you spend most of the night on the couch. 

 Eventually with enough mistakes the comapnies will have to change their shift structure. Its sad that it will have to be mistakes that cause them to do it.


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## TgerFoxMark

no offense, even in a "high" call volume area, i prefer 24's. it keeps us on the same shift as FD, and in a 24/48 i get to spend more time with my family during hours that matter in the real world. we are encouraged to go OOS if someone is too tired to get a rest period. i actually find that 12's are more damaging, due to the lack of time for family, and like i was (when i was on a 12 service) SOL of ever having time to do normal stuff. 0700 -1900 is killer if you ever have a life to deal with.


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## triemal04

TgerFoxMark said:


> no offense, even in a "high" call volume area, i prefer 24's. it keeps us on the same shift as FD, and in a 24/48 i get to spend more time with my family during hours that matter in the real world. *we are encouraged to go OOS if someone is too tired to get a rest period.* i actually find that 12's are more damaging, due to the lack of time for family, and like i was (when i was on a 12 service) SOL of ever having time to do normal stuff. 0700 -1900 is killer if you ever have a life to deal with.


If, and that's a big if sometimes, that's really accurate, then that wouldn't be an issue (working 24's).  But, if you go out of service every night for 6 hours, will that create a problem for you?  How much are you really encouraged to do it, and how much is lipservice?


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## JonTullos

I work a 48 hour shift but it's only once a week.  Typically we get to sleep most of the night but sometimes we get called out... normally it's an in-town call but sometimes we'll have an IFT at night.  I prefer it because the service I work at is about 45 minutes from my house so I'd rather work a longer shift.  Plus as long as we're up and around by the time the director gets in to the office (typically 0800 or 0830) we're good plus they'll let us sleep in if we have a really late call.  It's not bad in my situation.  Just because it doesn't work out well at one service doesn't mean that it doesn't work at all services.

Jon


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## ceej

70,000+ per year on my service
191 runs per day
Divided by 15 trucks (13 911 trucks and two supporting IFT trucks)
~13 runs per truck per 24hr shift

Those are last years stats, we're set to break 100,000 runs this year with our new 911 contracts.

We don't complain, guess we're used to it


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## firemedic1563

We work a 24/72 schedule, in a large county that goes from bordering a major metropolitan city, to much more suburban farm land. The good news in the much busier areas (10-15 avg calls per shift) the transport times are 10 minutes or less. The slower companies (3-5 calls per shift avg) have up to 30+ minute transports, but generally get much more sleep.

I agree that driving while tired can be very dangerous. For us, it is a fine balance however. A huge portion of our department lives outside the area, many (more than a whole shift of workers) outside the state. In an metro are where the median home price is more than $250k, it is hard to attract a local workforce for less than $40k a year to start. So workers are attracted from outside areas, and employess are enticed to move to other areas as well. For instance, one could chose to commute just over an hour to a neighboring state where the median home price is over $100k less. Additionally, our salaries(though still inferior to neighboring jurisdictions) are much higher than those in the far outlying areas.

So, while the safety is an obviously important component, one must take into account the effects of altering that schedule. Shorter shifts (14's/10's, 4off etc) may not decrease the needed workforce, but may cause a mass exodus of a quarter or more of the workforce.


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## VentMedic

TgerFoxMark said:


> i actually find that 12's are more damaging, due to the lack of time for family, and like i was (when i was on a 12 service) SOL of ever having time to do normal stuff. 0700 -1900 is killer if you ever have a life to deal with.


 
Yeah it must be rough if you actually could be home every night to tuck your kids into bed or to say good-bye to them in the morning before you went work. 

I love 12s. That is what I did on CCT and Flight as well as now in the hospital. I have not missed doing 24+ calls in 24 hours with the FD. Those who enjoy the 24 and 48 hour shifts the most probably don't have a family life. 

If anything has ruined marriages in the FD/EMS it is the 24 hour shifts and jealousy. Those working don't have any control over what their spouses are doing at home "alone" and those at home want to know who their spouses are doing at work. From the threads on the EMS forums, it there little doubt how something like that could have crossed their mind.


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## 46Young

VentMedic said:


> Yeah it must be rough if you actually could be home every night to tuck your kids into bed or to say good-bye to them in the morning before you went work.
> 
> I love 12s. That is what I did on CCT and Flight as well as now in the hospital. I have not missed doing 24+ calls in 24 hours with the FD. Those who enjoy the 24 and 48 hour shifts the most probably don't have a family life.
> 
> If anything has ruined marriages in the FD/EMS it is the 24 hour shifts and jealousy. Those working don't have any control over what their spouses are doing at home "alone" and those at home want to know who their spouses are doing at work. From the threads on the EMS forums, it there little doubt how something like that could have crossed their mind.



What if you work an 0700-1900 or an 0800-2000? All you'll be able to do is say good morning to your kids or tuck them in to bed. When you work 24's you can actually take them to school in the morning, pick them up after school, take them to the park in the afternoon, or to practice if they're older. If you need to be off for a function, you can do an exchange for 5, 8, 12 hours or whatever. I'll take a few days a week where I can spend hours with the family rather than see them for a few moments when I come home at 2100 hours or so.

When I worked all nights for hosp based EMS, my wife's complaint was that I was never home in the evenings, and why couldn't I work a 9-5? When I went through the fire academy her complaint was that I was gone all day every day and she only saw me for a couple of hours in the evening. Now that I'm working 24's, there's no issue with us.

Anyway, if you have to worry about your spouse double dipping and vice versa, what kind of person did you marry? Jealousy and insecurity is something you need to pick up on much earlier in the relationship. I've dumped many a bunny boiler or high maintenance control freak/princess.

BTW, LA City has used the 48/96 with general satisfaction per their report:

http://www.uflac.org/files/UFLAC 48-96 Color Primo v1.3.pdf


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## VentMedic

46Young said:


> What if you work an 0700-1900 or an 0800-2000? All you'll be able to do is say good morning to your kids or tuck them in to bed. When you work 24's you can actually take them to school in the morning, pick them up after school, take them to the park in the afternoon, or to practice if they're older. If you need to be off for a function, you can do an exchange for 5, 8, 12 hours or whatever. I'll take a few days a week where I can spend hours with the family rather than see them for a few moments when I come home at 2100 hours or so.
> 
> When I worked all nights for hosp based EMS, my wife's complaint was that I was never home in the evenings, and why couldn't I work a 9-5? When I went through the fire academy her complaint was that I was gone all day every day and she only saw me for a couple of hours in the evening. Now that I'm working 24's, there's no issue with us.
> 
> Anyway, if you have to worry about your spouse double dipping and vice versa, what kind of person did you marry? Jealousy and insecurity is something you need to pick up on much earlier in the relationship. I've dumped many a bunny boiler or high maintenance control freak/princess.
> 
> BTW, LA City has used the 48/96 with general satisfaction per their report:
> 
> http://www.uflac.org/files/UFLAC 48-96 Color Primo v1.3.pdf


 

You can't work 3 12 hour shifts a week to see your kids in the morning and in the evening?

What if you married someone else in EMS or the FD?  One of you would either have to give up their job or you would be working opposite shifts to take care of the kids. That only you with your spouse every 3rd day.  I have known couples who have done this for many years because they didn't have a live in nanny and didn't want their kids sleeping away from home 2 -3 nights per week. 

Did you say you and your wife almost divorced?  Of course she's now happy with your 24s.  If she's smart she'll wait till you brag a little more about all the money you have and go straight for the bank account once it gets to a desirable level.


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## 46Young

VentMedic said:


> You can't work 3 12 hour shifts a week to see your kids in the morning and in the evening?
> 
> What if you married someone else in EMS or the FD?  One of you would either have to give up their job or you would be working opposite shifts to take care of the kids. That only you with your spouse every 3rd day.  I have known couples who have done this for many years because they didn't have a live in nanny and didn't want their kids sleeping away from home 2 -3 nights per week.
> 
> Did you say you and your wife almost divorced?  Of course she's now happy with your 24s.  If she's smart she'll wait till you brag a little more about all the money you have and go straight for the bank account once it gets to a desirable level.



Really, who's only working 3-4 12 hour shifts per week in this line of work? Some do 3 12's and an extra every third week, and others do 2 12/s and 2 8's per week. Add in the all too common late job and you may not get home until after your kids are asleep. Many in EMS also work side jobs and/or OT. At least if you're working 24's you can still do OT and be home 50% of the time give or take.

When my wife met me I didn't have much in the way of money or possessions. It would be highly unlikely for her to agree to move down here with me for this job, express her satisfaction with the neighborhood, job schedule, pay, pension, etc. etc. just to bide her time until our nest egg grows. She's expressed interest in having more children with me, is excited to go house shopping here, and her parents are currently planning to move down here. But maybe you're right, this is one huge convoluted plan straight out of a Lifetime movie where she planned this from like 5 years ago and is waiting for just the right time to take me for a ride. If anything, the relationship was way more stressful when we were broke. The reason we almost divorced was because I went to medic school and basically left her lonely for over a year. Good thing I didn't go to college FT, 2-3 years of virtual abandonment would have sealed the deal. It'd be hard to complete school when you need to work two jobs to cover alimony and child support. 

State law dictates that she can't legally take my daughter out of state for permanent residence anyway. With my earning potential I could weather a divorce and still be okay financially. Maybe I could just marry a nurse or something and solve any divorce induced cash flow problems. See, I can make ridiculous statements too.


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## exodus

When I did 12's, I did 3 one week, and 4 the next.

Now I do a 24, a 5 (CCT Dedicated), and an 11.


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## 46Young

exodus said:


> When I did 12's, I did 3 one week, and 4 the next.
> 
> Now I do a 24, a 5 (CCT Dedicated), and an 11.



That's pretty cool. I also like the Alexandria Fire and EMS' EMS Division (single role) schedule: 24 hour shifts - WOOWOOOO. That's the best schedule I've seen yet.


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## reaper

I would never work a 24hr again. I love 12's and being home every day. We work 3 on, 2off, 3 off, 2 on. Works out to having 3 day weekends every other week, which works great with the kids.

Home before they get up and leave after home from school.


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## Jeffrey_169

I was a truck driver in the oilfield for most of my adult life, and I volunteered on FD's on my days off, and one thing I learned quickly is that sleep deprivation is a dangerous game to play. I have never understood why there are not laws pertaining to EMS regarding hours of service similar to those enforced on truck drivers. It is difficult to be proficient when you are fighting a losing battle against fatigue.


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## DrParasite

24 hour shifts are great for slow stations.  They are DANGEROUS in busy urban and suburban areas.  If your agency works 24s and you are running for most of the shift, time to tell management to switch to 12s.

my agency works 12s.  we can get between 7 calls on a slow day and 20 calls on a busy day per truck.  24s are not a good idea.   if you are doing less than 10 calls in a 24 hour shift, you might be olk.  bu if you are doing 12+, then when are you sleeping?

remember, would you want to be the patient who was really sick on a medic who was up and working for the past 22 hours?  who is falling asleep and can barely sleep straight?

The other thing to keep in mind is that a medic needs to sleep.  FFs get away with 24s because they are significantly slower than EMS in terms of call volume.  24s are not good for busy EMS systems, despite what some people will try to claim


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## fire_911medic

There are very valid concerns for this.  I have serious concerns with 24 hour shifts busy, or non busy departments be it in flight or ground services.  I have lost 2 former coworkers due to accidents resulting from falling asleep at the wheel following 24 hour shifts.  The truth is, in this job, many work more than one job.  Often one goes from a 24 hour shift at one job to another where perhaps he will get no sleep, or very little as well.  There are a few options to reduce crew fatigue.

1.  Utilize more trucks - yes this is more money for the service, but if a rotation of several trucks is used rotating the frontline truck for so many hours, it usually (except in rare nights) guarantees the crew will get at least some uninterrupted sleep.  For example, we had 6 crews on during the day and 4 on at night at one station (which was our busiest).  The two trucks were overtime trucks and staffed from 8 a - 8p.  The other four were 24 hour trucks that rotated who was first out for six hours a piece.  After they were front line, they were rotated to the back working their way back up the the front truck.  Also, if 24 hour shifts, they were prohibited working anywhere else for 8 hours prior or 8 hours after shift.

2.  Utilize crews in either 12, 10, or 8 hour rotations with time on not exceeding 16 hours.  Very similar to pilot's rules to prevent exhaustion.

3.  Allow crews to reject taking a call (transfer not 911) if they feel it will affect their safety.  Alot no more than a 2 hour "safety break" for the crew, but have no penalty for them turning down due to safety reasons (similar to flight rules as well).  However, it should be because they were running steady all day, not because they just don't want to take the transfer.

4.  Limit long distance transfers to reduce road fatigue.  When you're going long distance, it's easier to doze off as the scenery is much the same for miles.

Let's keep it safe out there !


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## medic01

*alot of complaining*

I have been in the system and maybee I am a rare breed. I have never had a problem with the 24 hour shifts and exhaustion. In fact I have had the opposite. When running day cars (10-12hours) 3-4days a week I spent more time trying to play catch up. Always getting held over and always being asked to pick up calls for the 24 hour units. Most people in that system who are complaing are the ones who need to take a look at why they do what they do. If you are tired and feel like you cant take a call. DONT man up and call for a secondary unit. First thing we learn is crew saftey. I have sent many partners home for being to tired. Oh and from personal experience these are the same people usally who stay up all night and play x-box. Or they dont get sleep the night  before. Personally I sleep when ever I can. Day or night. And if you are worried about your bosses punishing you than make sure they put it in paper than you can take it the news.


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## 04_edge

Ive been on a 24 hour crew for a few months now.  It didnt affect me until recently when we havent started getting busy until around 6 or 7 in the evening and running back to back  the entire night with no sleep, every shift.  The hardest part for me is driving when im that tired with no one to talk to to keep me awake.  I only have 2 more 24 hour shifts left before i start my new gig and ill only be working 10's there.

I will never go back to 24 hour shift that does not have a station in which we can sleep at during the day if we are going to have to run all night.  Its dangerous, and not worth it at all IMO.


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## Tigger

04_edge said:


> Ive been on a 24 hour crew for a few months now.  It didnt affect me until recently when we havent started getting busy until around 6 or 7 in the evening and running back to back  the entire night with no sleep, every shift.  The hardest part for me is driving when im that tired with no one to talk to to keep me awake.  I only have 2 more 24 hour shifts left before i start my new gig and ill only be working 10's there.
> 
> I will never go back to 24 hour shift that does not have a station in which we can sleep at during the day if we are going to have to run all night.  Its dangerous, and not worth it at all IMO.



Having the station is a must for 24 hour shifts. I think they work fine if the overnight call volume is low. Our medics work 2 24s a week and love them. Our 911 contract is usually slow at night and the city ALS IFT truck is even slower, so they probably make it from midnight to shift change without a call every third shift or so.

But staying in the truck for that long sucks, plain and simple. I worked a few 23s (13 hour day, 2 hours of stocking, 8 hour overnight) this summer and they were downright awful, no matter how slow we were on the overnight. It's too long to be in the cab.


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## Fish

24/48 is what we do.

Our busiest trucks average 8-12

Our slow ones 1-3

I am a big fan of 24hr shifts, even when I worked in a busier system and ran 10-20 calls a 24hr shift. The days off are invauleable(did I spell that right?)


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