# EMS and 12 Hour Shifts



## Medic14 (Feb 2, 2017)

Good Morning brothers and sisters!

My job (911/transfer) just recently went from 24 hour shifts (24 on, 24 off, 24 on, five days off or aka Kelly schedule) to 12 hours shifts. The three 12 hour shifts are 6a-6p, 10a-10p, and 6p-6a with a single 24/72 truck. My chief went this direction to battle fatigue within EMS. The new schedule cut out 300+ hours but the crews were compensated to make sure there was no loss in wage/salary. Crews went from working 9 days a month to 15 days a month.

My question is, if your company has done this as well, how did the shifts work out for your coworkers? Are you currently still on this shift schedule? Any unforeseen issues?

Also, if you have not gone to 12's, would you like to and why?

Please leave any and all opinions. I am tasked with the job of writing a paper explaining why 12's do not work.

Thank you!


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## Summit (Feb 2, 2017)

"Battle fatigue"? You are pretty old to be a WWII vet (that is where the term originates).

Will you getting adequate rest off shift between the mortar barrages and snipers?


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## SpecialK (Feb 2, 2017)

The standard ambulance roster on a 24 hour station is two 12 hr days then two 12 hr nights followed by four days off.  There is some variation for specific vehicles such as 9 am to 9 pm (or slight variations thereof) in large urban centres for the second or third vehicle.  Some smaller stations which have a three or four person paid roster and use a volunteer for full crewing will operate, for example, 8 am to 5 pm.  

There is general dissatisfaction with 12 hour shifts because are too long given the very high workload, and even if that were reduced, many still believe a 12 hour shift is too long, and I agree.  Most people like the idea of 8 or 10 hours maximum.  Personally I think 10 hours is reasonable.


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## NysEms2117 (Feb 2, 2017)

I work part time in ems and do 1 12 hr shift every 2 ish weeks. And don't really mind it. I also work on a critical care rig, so we don't have the "call volume" that everybody else has. most of the time....


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## DrParasite (Feb 2, 2017)

24 hour shifts are great if you are slow.  they are great if you get downtime and time to sleep.  and the 5 days off are awesome.

24 hour shifts suck if you are busy.  can you imagine trying to intubate someone at 4am after you have ran 18 calls already?  or trying to calculate a dopamine drip?  

The fire service loves them because the majority of their calls finish in less than an hour, more often under 30 minutes.  yes, a big fire or extended operation call can take longer, but the majority of their calls (smells and bells and medical runs) are done in less than 30 minutes.  And that's not even counting the calls they get cancelled from without getting out of the truck.

Throughout my career, I have predominantly worked 12s, on a pittman schedule.. we typically worked 3 on 2 off, 2 on, 3 off, 2 on two off, or some variation, where every two weeks, you worked 7 days, an during that period, you had either one or two 3 day stretches, with a float day in the mix to cap you at 40 hours for the week (it's easier to show you than explain).







  +

I hated rotating days to nights, so my full time position was either day or night (at both my career city EMS positions), to prevent screwing up your circadian rhythm.  

comparing it to the kelly schedule, which rotates every 9 days:





if you look at the kelly schedule, for team 2, if you ran all night on day 1, and didn't get any sleep, you would spend much of your first day off sleeping, waking up aruond 4pm, and then trying to get to sleep at a normal hour to be up for the start of your next shift.  it gets rough.  now if you were able to sleep all night, than you are fine, you can go home and enjoy your day, being all rested.  

http://community.bmscentral.com/learnss/Tutorials/SchedulePlans/ has a bunch of schedules, with pictures.

on of the big logistical advantages to a 12 hour shift is you can easily switch everyone to a 24/72, without having to hire any additional staff. and the 72 hours off means you can sleep the entire day away following a busy shift, and still have two days off to do whatever you want.

in general, the shorter the shift, the more days you spend at work per week.  also, the length of your shift should be inversely proportional to the call volume, so the fewer calls you run, the longer the shift can be (so if you only run 2 calls in 24 hours, a 48 hours on / 96 hours off would be awesome).


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## Jim37F (Feb 2, 2017)

Only 2 shifts before a 5 day? Sounds like am awesome Kelley schedule to me. 

My previous dept Kelley was 24 on, 24 off, 24 on, 24 off, 24 on, then 4 days off (so 3 shifts then a 4 day or XOXOXOOOO). My current company's is a little different, 2 on, 2 days 9ff, 2 on, then the 4 day, or XOXOOXOXOOOO.

However, mixed in with that, one of the FDs we run with uses a 48-96 schedule, so the 2 stations that cover that city run the same 48-96. 

Also mixed in are "day cars" or units on either an 11 1/2 hour or even 12 hour schedule (don't ask me why they're not all either 11 1/2 or an even 12...I can't find a rhyme or reason just looking at the schedule..) They have a wide variety of start times all around the clock, and are either a Mon-Wed-Fri-every other Sat/Sun-Tue-Thurs-every other Sat, or Sun-Mon-Tues-every other Wed/every other Wed-Thurs-Fri-Sat schedule.

Base hourly rate is the same whether you're on a 12 or 24, except 12s get straight time for the first 8 hours, double time for hrs 8-12, then if you get held over, anything more than 12 is double time. 24s are a straight time for the first 40 hours in the week (Sun-Sat) then time and a half for the rest of the week after that first 40. 

It's considered better to have a 24hr station assignment, because now you have one set station you start/end out of, return to after calls etc vs the day cars start out of headquarters and while they may have an assigned geographical area, they end up going anywhere, and everywhere needed for coverage, they're considered first up for all calls and move ups, and are more likely to get a street corner post than the 24s, who will get move ups, but mostly to other stations, unless it's that busy that one unit now has to cover multiple stations, then they'll get the street corner post. However the flip side is a 12 hour shift can get destroyed, running non stop all shift...and then go home and sleep at the end, vs a 24, you're at the mercy of the EMS Gods if you get to sleep or not lol (if you have enough seniority to be assigned Malibu or Palos Verdes stations for example, it's awesome...if you're running Hawthorne or Compton...expect to be catching up on sleep at home the next day lol)


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## hometownmedic5 (Feb 2, 2017)

24's are awesome...until they're not and when they go bad they seem to go all the way bad.

I currently work 24's OOXOOOX. A normal shift I do 3-5. My busiest day in this system was 12 calls, but there were unusual circumstances. In the same system, the rip and run truck is good for 12+ calls a day on an average day and the retirement truck is truly surprised and offended when they have to do a call at all.

4 12's drastically reduces my overtime/second job potential, not to mention me time. From a company, risk management type of perspective I get it, but personally if you tried to take my 24's away, I'd be one of the angry villagers in the parking lot with a pitchfork and a torch.


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## TransportJockey (Feb 2, 2017)

We are getting set to go to 12s in the next four months. Going from 2 set 24s a week to 4x12. We have a lot of dissension in the ranks about it but we are getting a decent raise and not losing any hours. 
We are swapping for the same reasons y'all are. 
Our goal as crews is to get them to maybe increase hourly a bit more next fiscal year and make it a 36/48 pay period with a drop days in the middle somewhere that alternates between the two halves. 

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## VentMonkey (Feb 2, 2017)

I agree with DrP regarding 24's. They're doable if the workload is slower than average, or reasonable at best. Our current schedule is 1 on/ 1 off for a 4 day rotation followed by 4 days, come back repeat, then get a 6 day break:

XOXOXOXOOOOXOXOXOXOOOOOO

Again, this station makes it reasonable, others don't IMO/ IME. As far as 12's we have a variety of those from front half/ back half to rotating weekends which is a 3/2 schedule where you get every other Fri.-Sunday off. I liked that schedule personally, and while I miss night shifts for various reasons I don't miss the awful sleeping habits I developed. 

Nowadays pretty much all of my overtime is day shifts, that way I can still be with my family at night.


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## Nick15 (Feb 2, 2017)

I am part-time where I work and have a regularly scheduled 8 hour shift. It's nice because it goes by relatively quickly, but I am more of a fan of working 12's instead of a 24. Plus with our pay scale we have, after 8 hours it becomes double time. So in a 12 hour shift, 4 hours become double time. 24's are ok minus the fact that our pay goes down to minimum wage for the whole shift. The whole reason my company does that is so at the end of the year, a part-timer can make almost as much as a full-timer with their annual salary. It doesn't make much sense to me, because naturally if you're full-time you're going to make way more than a part-time employee ever will. 


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## STXmedic (Feb 2, 2017)

If the system is even remotely busy, it should move to 12s. If y'all are slow, I'd prefer 24/72s. I work 24/72 now and dread the 24hr shift. We make 16-20 runs per shift, and has made me start hating EMS. There are days I don't even remember driving home. It's not safe for the patient or myself to be making that many runs with little to no sleep.


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## Scott33 (Feb 4, 2017)

I work a set 12 hour 3/4 flex shift. In other words, 3 x 12 hours one week (Thursday, Friday, Saturday) and 4 x 12 hours the next (Wednesday, Thursday, Friday, Saturday). Overtime is built into every long week so it is guaranteed every pay check. I rotate to nights every 6 weeks for a period of six weeks, working the same days. The schedule is same throughout the year and allows me to plan ahead. I still prefer overnights but overall I am happy with the schedule. It's not too bad getting half the year off.


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## akflightmedic (Feb 4, 2017)

Pay adjusted so no loss of wages.
Shorter shifts.
Still have 15 days off a month (compare that to any career job).
Risk to your life reduced.
Risk to poor patient care reduced.
Risk to fatigue/burnout reduced.
More time with family or self because you are not tired and recovering after a long 24 or back to back 24 (48).
Plenty of time for that "needed second job" or schooling.

Why do 12s not work?

Is it they do not work or is it "we have always done it this way and I don't want to change"?


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## AtlasFlyer (Feb 4, 2017)

Our agency recently went to all 12s. It's fine. Really.


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## TransportJockey (Feb 4, 2017)

akflightmedic said:


> Pay adjusted so no loss of wages.
> Shorter shifts.
> Still have 15 days off a month (compare that to any career job).
> Risk to your life reduced.
> ...


At my agency the push back on 12s (which we haven't even started so they haven't given them a chance) is a combination of that it's new and unusual for the area and some of our people are living so far beyond their means that they need 36 hours of overtime every single week. 

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## hometownmedic5 (Feb 4, 2017)

akflightmedic said:


> Pay adjusted so no loss of wages.
> Shorter shifts.
> Still have 15 days off a month (compare that to any career job).
> Risk to your life reduced.
> ...




They work extremely well, which is why OSHA has been calling for an end to 24's for years.

That being said, i prefer my 24's. I don't kill myself or my patients, fairly low call volume and am usually not wasted enough the next day to prevent normal adult human activities. "My" 24's work for me and I only HAVE to come to work 8 times a month. I see how they can be a problem for others. As I said, a truck in the same system is good for at least a dozen hits a shift. That might be too much for 24's, but I don't see the logic in an across the board ban on them.


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## luke_31 (Feb 4, 2017)

Not all 24s are bad. Here we typically don't get a lot of calls after 10pm until 6pm, so there is a good period of downtime. Plus during the colder months we have few calls for service, so keeping 24hrs does work for us.


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## akflightmedic (Feb 4, 2017)

They work...until they don't. Any issue with not being ahead of the curve and proactively changing for a proven better outcome as opposed to waiting until an issue occurs and then being reactive?

I get it...yes there are stations that run 1 call per 24 and have done so for years and years...but this is a generally speaking approach and while not everyone will fit in the neat box (no one ever does), what is the harm in doing it and then saying "wow, look how safe and cutting edge we are"?


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## AtlasFlyer (Feb 4, 2017)

Our agency used to have a mix of 24s and 12s. For the most part, the busier trucks were the 12s and the lower call volume trucks were the 24s. Sometimes even the quiet 24-hour trucks could get busy though. It made for a long 24 hours when they did. The busier trucks that were already 12s, some of those trucks typically do 10-14 runs in a shift. That pace can't be kept up for 24 hours safely. It just can't. I'm not management so I wasn't involved in nor asked about why we went to all 12s... but it is now, and now that the dust has settled everyone seems to be dealing with it just fine.


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## NPO (Feb 4, 2017)

We have a variety of shifts available to suit the needs of the system and employees. I like having options. I'm currently on a 48 and I love it. Having 8 consecutive days off every few weeks is fantastic. Allows for significant overtime opportunity, and makes planning vacations easy, which I love doing. But to be honest, I do miss the hustle and bustle of the metro system, so I routinely pick up overtime there. 

On my 48 hour shift I have been running 4-6 calls per 48, where as in a 12 hour, I was running 8-12 on a busy day, which is most days. 

Metro System Shifts:
8 Hour
XXXXX OO

10 Hour
XXXX OOO

12 Hour
XXX OOOO
XXXX OOO
or
XX OO XXX
OO XX OOO

Station shifts:
24 hour (busier stations, CCT, and Medivac (@VentMonkey))
X O X O X O X OOOO X O X O X O X OOOOOO

48 hour
XX OO XX OO XX OOOOOOOO

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## CALEMT (Feb 4, 2017)

NPO said:


> 48 hour
> XX OO XX OO XX OOOOOOOO



I'm a fan of the 48/96 but this is just an amazing schedule.


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## VentMonkey (Feb 4, 2017)

The airport folks used to be on the county schedule as well, but it was voted off for some reason in favor of the BFD rotating Kelly with 4's and 6's.


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## DrParasite (Feb 4, 2017)

CALEMT said:


> I'm a fan of the 48/96 but this is just an amazing schedule.


24/72 is even better.....

As I (and many people) mentioned earlier, there is nothing inherently wrong with 24 hour shifts, nor are 12 hour shifts inherently better.  Where problem occur is when you don't have downtime to sleep, and you end up running 20 calls in 24 hours. 

If you are on a rural truck, and you only run 1 call in 24 hours, great.  what if that 1 call is at 10pm, and  you have been up all day chilling, doing HW, reading, watching TV, etc, and as you clear the local hospital, you get pulled into "the system", and are dispatched as the closest ambulance to 7 more calls in the city because every time you clear the hospital, the city is slammed and you are the "closest unit."  Then what happens?  you end up running the next few calls after being awake for 16 hours, 18 hours, maybe even 20 hours.....

The other issue is, in the real world (IE, not in EMS or in certain facets of public safety and healthcare), you are not paid to sleep, you are paid to work.  so if you are getting paid for 24 hours of work, it's not unreasonable to expect you to be working for 24 hours, since you are being paid to be there.  How hard is it to go to your boss and say you deserve a raise, when they say "you only run 1 call in 24 hours, so you only really 'worked' for 2 of those hours.... why should you get paid more than minimum wage, especially since you slept through most of your shift?

Also keep in mind, many places will pay you less if you are working 24s, on an hourly rate.  so if you do some OT on a 12 hour shift, you will get time and a half on that lower pay rate.  And if you don't get any sleep on your 24, you are still making that lower pay rate, despite working as hard as the 12 hour trucks for 24 straight hours.

BTW, my "dream shift" is either a 10am to 10pm or noon to midnight shift on 12s, 3/4 days a week (aside from 24/72s in a not too busy system).  yes, you will be busy, yes, you will often come online and immediately be put to work, but you can sleep late (don't need to wake up at 5am to make it to work on time), can still go out for a few drinks after work before the bars all close, and you don't have that tired feeling because you are awake and functioning for most of your normal day, so your days off will be awake at the same time.


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## DrParasite (Feb 4, 2017)

Wake EMS used to work a mix of 12s and 24s, but they are in the process of transitioning from the county fire schedule of 24s (XOXOXOOOO) to the pitman schedule or 12 hour shifts for all trucks.   They cited the same reasons as the OP, crew fatigue and safety, and units were just too busy to do 24s.  An EMS unit could go in service at 7am, get relocated or assigned a job, and that truck might not see their station again for another 12 to 18 hours.  

My FD still work 24s, but most of the county fire stations (and in reality, most of the city fire stations as well) aren't answering calls nearly as frequently a our EMS counter parts, at least not on a per unit basis.


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## CALEMT (Feb 4, 2017)

DrParasite said:


> If you are on a rural truck, and you only run 1 call in 24 hours, great. what if that 1 call is at 10pm, and you have been up all day chilling, doing HW, reading, watching TV, etc, and as you clear the local hospital, you get pulled into "the system", and are dispatched as the closest ambulance to 7 more calls in the city because every time you clear the hospital, the city is slammed and you are the "closest unit." Then what happens? you end up running the next few calls after being awake for 16 hours, 18 hours, maybe even 20 hours.....



I employ the safety nap. Take a hour or so long nap after lunch so when/ if you're up from 10 to who knows when you at least have the little bit of sleep going for you. I can't speak for everyone but me personally just laying down in bed and relaxing is enough for me. Maybe its because I take so long to fall asleep, but if I get a short break in between calls where I can dress down and lay down in bed I'm fine with that. I've been to that "zombie" point where I just do work. I've distinctly remember when I was up for 60 hours straight with oh maybe 5 hours of sleep and relaxation. Again, I can't speak for everyone on sleep habits and how you function on lack of sleep. But I still prefer a Kelly schedule or a 48/96, you do your shift and you're off for X amount of days.


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## Bullets (Feb 4, 2017)

DrParasite said:


> BTW, my "dream shift" is either a 10am to 10pm or noon to midnight shift on 12s, 3/4 days a week (aside from 24/72s in a not too busy system).  yes, you will be busy, yes, you will often come online and immediately be put to work, but you can sleep late (don't need to wake up at 5am to make it to work on time), can still go out for a few drinks after work before the bars all close, and you don't have that tired feeling because you are awake and functioning for most of your normal day, so your days off will be awake at the same time.



I do 11-11s every Saturday and i wish we had an 11-11 truck during the week. Its really quite amazing


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