# Ambulance crashes into disabled vehicle on I5 median after falling asleep, with video



## exodus (Jul 1, 2014)

http://losangeles.cbslocal.com/2014...r-nods-off-before-crash/#.U7JV9CxVqtI.twitter



> LOS ANGELES (CBSLA.com) — Jeff Johnson was on his way to work when his car broke down on I-5 near Griffith Park.
> Stranded along the median, his car was slammed into by an ambulance.


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## BASICallyEMT (Jul 1, 2014)

There goes 24hrs shifts in LACo. When I was doing IFT in LA, our 24hr unit averaged 5 hours of sleep if any.


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## 46Young (Jul 1, 2014)

BASICallyEMT said:


> There goes 24hrs shifts in LACo. When I was doing IFT in LA, our 24hr unit averaged 5 hours of sleep if any.



Five hours is more than most semi-busy units get on a 24 hour shift. I'm lucky to get three hours. It was worse when I worked in Charleston SC - when we did have the chance to get an hour or two, we would get a call to post on some street corner for an hour or 45 minutes, usually once or twice a night


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## Angel (Jul 1, 2014)

I hope somewhere they do make a law regarding this. I won't work 24 hour shifts (IFT) due to some terrible experiences I've had.


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## 46Young (Jul 1, 2014)

Angel said:


> I hope somewhere they do make a law regarding this. I won't work 24 hour shifts (IFT) due to some terrible experiences I've had.



Some fire departments have gone the other way, opting for a 48/96. Here's some info on that:

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


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## Angel (Jul 1, 2014)

46Young said:


> Some fire departments have gone the other way, opting for a 48/96. Here's some info on that:
> 
> http://www.uflac.org/files/UFLAC 48-96 Color Primo v1.3.pdf



that's "different" I did my internship at a fire house with a 48/96 schedule and even on our busiest days sleep and managing calls was never an issue. the way the calls are dispersed at least gave us a couple hours of downtime/rest. when I was private ift the calls were stacked day and night. we MIGHT get 2 hours of uninterrupted rest, but in between that we were driving 75-100 mile trips 1 way. THAT is the exhausting part. dispatchers/supervisors would threaten our jobs if we ever tried to 'fatigue' ie too tired to drive.

I don't think it works for IFT, fire/ems calls I think its perfectly fine, in fact I enjoyed it. but it also depends on where you are.


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## MMiz (Jul 2, 2014)

If the public knew that medics worked 24+ hours straight, often behind the wheel of a car, there would be immediate reform.  I don't care how you frame it, it's just not safe.

Pilot fatigue is often the cause of incidents and accidents.  It was the case in the Colgan Air crash in New Work, the Asiana Airlines Crash in SFO, and several other recent crashes. As a result, pilots are now limited to how many hours they can be "on duty" in a day (between 9-14 hours).

It used to be the norm that doctors in residency would work 36 hour shifts, but public outcry got rid of the 36 hour shifts.

If a pilot and doctor can't be "on the clock" for 24+ hours, why can EMS?


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## PotatoMedic (Jul 2, 2014)

Because were replaceable.


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## Tigger (Jul 2, 2014)

46Young said:


> Some fire departments have gone the other way, opting for a 48/96. Here's some info on that:
> 
> http://www.uflac.org/files/UFLAC 48-96 Color Primo v1.3.pdf



Yup. I can work hours on end so long as I get back to the station. 

However if they're truly stacking calls on 24 hour cars, I don't think I'd be able to do that.


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## Chimpie (Jul 2, 2014)

Both the anchor and the person hit referred to the medic/emt driving as an 'ambulance driver'. Okay, that gets some people upset, but let's look at the bigger picture. Besides being a driver, they also make patient care decisions. 

How different would pt care be when ems personnel work 12 hours instead of 24?


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## chaz90 (Jul 2, 2014)

Chimpie said:


> Both the anchor and the person hit referred to the medic/emt driving as an 'ambulance driver'. Okay, that gets some people upset, but let's look at the bigger picture. Besides being a driver, they also make patient care decisions.
> 
> How different would pt care be when ems personnel work 12 hours instead of 24?


In this case, I think "ambulance driver" is an appropriate description. Driving the ambulance was the activity that caused the problem and what they were engaged in at the time of the incident. I guess it's kind of arguing semantics, but to me, anything involving patient care on the EMS side should mention the provider as an EMT/paramedic, while if it's a driving issue it doesn't bother me if they're described as an "ambulance driver."

Hopefully that doesn't come across too convoluted...


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## Tigger (Jul 2, 2014)

Chimpie said:


> Both the anchor and the person hit referred to the medic/emt driving as an 'ambulance driver'. Okay, that gets some people upset, but let's look at the bigger picture. Besides being a driver, they also make patient care decisions.
> 
> How different would pt care be when ems personnel work 12 hours instead of 24?



I can and have run calls for 24 hours where I attended nearly all of them. Franky that was much easier than driving for long stretches. Driving on a freeway is often monotonous and while IFTs can be as well, there is more to "distract" yourself to remain awake and functioning. I don't think the quality of my (basic) level of care suffered at all though I would not want to do that for any greater length of time.


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## MMiz (Jul 2, 2014)

You should have seen some of the stuff that went down when medics were allowed to work 24+ hour shifts in a service with street corner posts.  Some picked up overtime creating shifts 48+ hours long.

After a few incidents providers were limited to 24 hour shifts with a 12 hour rest period before one could work again.

At the end of a 12 hour shift I'm exhausted.  I can't imagine regularly working 24 hours in busy systems.


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## Tigger (Jul 2, 2014)

MMiz said:


> You should have seen some of the stuff that went down when medics were allowed to work 24+ hour shifts in a service with street corner posts.  Some picked up overtime creating shifts 48+ hours long.
> 
> After a few incidents providers were limited to 24 hour shifts with a 12 hour rest period before one could work again.
> 
> At the end of a 12 hour shift I'm exhausted.  I can't imagine regularly working 24 hours in busy systems.



I work part time in a city with a handful of a 48 hour cars. Though they are assigned to a fire station, they rarely make it there during the day. As of yet there haven't been issues but it's been made clear that you need to show up to work adequately rested or you will not work those cars. 

There are more than a few busy systems that do this and so long as some protections are in place (sleep any time you like, rotating crews out of busier areas), it's not the end of the world.


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## NomadicMedic (Jul 2, 2014)

My old job in eastern Washington had us on 48s and we would frequently run all 48 of those hours. Sleep? What sleep? I'm amazed nobody's been killed there.


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## emtkia (Jul 3, 2014)

Ditto this.



MMiz said:


> If the public knew that medics worked 24+ hours straight, often behind the wheel of a car, there would be immediate reform.  I don't care how you frame it, it's just not safe.
> 
> Pilot fatigue is often the cause of incidents and accidents.  It was the case in the Colgan Air crash in New Work, the Asiana Airlines Crash in SFO, and several other recent crashes. As a result, pilots are now limited to how many hours they can be "on duty" in a day (between 9-14 hours).
> 
> ...


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## Flight-LP (Jul 3, 2014)

Fatigue mitigation is a hot topic in many safety cultures currently. I expect it to become even more popular as insurance agencies are starting to scrutinize untrained overworked drivers that are causing preventable accidents and their agencies by not having a fatigue mitigation oversight policy. 

There's a reason accreditation agencies have their recommended practices when it comes to shift length and crew quarters.

Sad situation  here, but completely the driver's and company's fault.


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## CentralCalEMT (Jul 3, 2014)

This is a complex problem that does not have a 1 size fits all solution. There is always a knee jerk reaction after a media event like this, and in this case, it seems to be against 24 hour shifts. The video is dramatic and food for thought.

 I do agree that 24 hour IFT is ridiculous and downright dangerous. 24 hour shifts in a high volume 911 system can be as well. On the other hand, if you only had 12 hour shifts, some agencies flat out would not be able to staff many units and put them on the road due to a lack of available paramedics willing to commute. Some extremely rural lower call volume systems use 48 or longer shifts and thus longer time off periods to get anyone to work there because of their remote location. With 48s you only have to get them to make the drive to work about 5 times a month versus 15 times with 12 hour shifts. I have worked stations where 4 calls in a 24 is a busy day and 6-10 hours of sleep a night was fairly common. 

 In larger states such as CA, there are multiple outlying areas that primarily consist of dirty, gang and drug infested, run down small towns with nothing to offer with regards to nice housing, shopping, good schools, etc. There are also desert and mountain towns with a lack of available, decent housing as well. Those towns are oftentimes more than an hour from any desirable/available area to live. If you went to 12 hour shifts, it will be even harder to find paramedics willing to make that commute. Fortunately those areas also usually have a lower call volume. 

I think the solution is to improve staffing models. If the 24 hour car is running 20 plus calls a shift, then the solution is to add additional units so the crew gets rest. Even if you go to a day and night 12 hour shift, you still run the crew into the ground.

Another elephant in the room, is the irresponsible lifestyle of certain EMS providers. It is on us to come to work well rested. All too often EMS providers come to work expecting to at least be able to rest so they may stay up too late before their shift and not sleep enough. I, for one, work 48 hour shifts. I make sure I get a full 8 hours of sleep the night before I work. I have a hard time believing a EMS provider who parties all night and gets 3 hours of sleep before his 12 hour shift is safer than me when providing patient care. Again, there is not one simple answer to this problem.


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## Angel (Jul 4, 2014)

And that's poor call management. Where I was at we were one of the busiest stations in the district but still (most of the time) got at or close to 6 hours each night. The guys would sleep when they wanted during the day (as an intern I could not) but we always made it to the station often enough to grab some food or rest. The captain would put us out of service if he had too. Areas that busy need more crews or to dispatch the calls more evenly. Bring on an extra short car to help lighten the load but its painfully obvious running nonstop for 24 or even 48 is going to lead to serious injury or death. The frustrating part is that's almost what it takes before some of these companies reconsider. 

And like centralcalemt stated we also have to do our part and actually rest BEFORE our shift. 
I like the 48s but only if done "right" and safely. 






Tigger said:


> I work part time in a city with a handful of a 48 hour cars. Though they are assigned to a fire station, they rarely make it there during the day. As of yet there haven't been issues but it's been made clear that you need to show up to work adequately rested or you will not work those cars.
> 
> There are more than a few busy systems that do this and so long as some protections are in place (sleep any time you like, rotating crews out of busier areas), it's not the end of the world.


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## DrParasite (Jul 5, 2014)

DEmedic said:


> My old job in eastern Washington had us on 48s and we would frequently run all 48 of those hours. Sleep? What sleep? I'm amazed nobody's been killed there.


how??? I know my body starts to shut down after being up for 20 hours straight.  I become grossly diaphragmatic, my joints ache, I feel cold and start to shiver, and if it's really bad, I start having uncontrollable muscle twitches (which freaked out my ex, who wanted to drag me to the ER because I couldn't stop twitching).

I work 12s in a busy system (well, two systems).  been doing that for almost 10 years now.  24s in our system are dangerous.  48s would be insane. 

The human body isn't designed to be awake for 48 straight hours.  I would argue that doing more than 24 is detrimental to your health, and long term 24s (where you are running all shift) WILL have long term health consequences.

I've said it before and I will say it again: 48s are great for slow stations, when you average 6+ hours of sleep a night.  24s are great for slow stations, and ok with medium stations (3-6 hours of sleep time, preferably in a bed).  12s are ideal for busy stations, but staff needs to remember to sleep before and after work, and realize they are expected to work at 100% functioning for 12 hours straight and shouldn't expect to get any sleep.  8s just suck for EMS, who wants to go to work 5 days a week anyway?


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## Rialaigh (Jul 5, 2014)

DrParasite said:


> I've said it before and I will say it again: 48s are great for slow stations, when you average 6+ hours of sleep a night.  24s are great for slow stations, and ok with medium stations (3-6 hours of sleep time, preferably in a bed).  12s are ideal for busy stations, but staff needs to remember to sleep before and after work, and realize they are expected to work at 100% functioning for 12 hours straight and shouldn't expect to get any sleep.  8s just suck for EMS, who wants to go to work 5 days a week anyway?



Basically this

One of the stations at the service I work at averages 3 calls a shift. You can go to bed whenever you like, we dont post, and its easy to work a 48 or 72. You have a full kitchen, showers, laundry facility....if you are "slammed" you might run 6 calls in a 24 hour period...


There is no fix it all solution. If providers are miserable at their job the problem will fix its self, I see no reason to regulate it. We flat out aren't killing a crazy number of people in ambulance wrecks or with poor provider care due to sleep that would be fixed by shortening shifts.


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