# 24/48 hour shift



## Francisco (Sep 21, 2016)

To those that have worked a 24 or 48 hour shift, were you awake the entire shift or did get some sleep ? how did you manage to say awake for that many hours ? Isn't it dangerous for the safety of the crew to be awake for more than 24 hours and be driving an ambulance ? I'm a new EMT, just got hired by the way, I was advised that I will be working 24's and 48's so any piece of advice about working such shift I'll take into consideration thank you !


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## VentMonkey (Sep 21, 2016)

Francisco said:


> To those that have worked a 24 or 48 hour shift, were you awake the entire shift or did get some sleep ? how did you manage to say awake for that many hours ? Isn't it dangerous for the safety of the crew to be awake for more than 24 hours and be driving an ambulance ? I'm a new EMT, just got hired by the way, I was advised that I will be working 24's and 48's so any piece of advice about working such shift I'll take into consideration thank you !


This is very broad brush you painted. 
1. You can be awake the whole shift, sleep all night, or anything in between.

2. Rockstars been my friend since paramedic school. Lol, you find ways.

3. Yes, it is, and can be dangerous, so my last 24 I would take turns driving for my partners if they were too tired. Depending on the workload of your particular station(s) thag's hard to tell. The 24 I am at now can range from busy (for us 3-6 flights=busy), to a shut out, which is also not uncommon. 

4. Good luck, and congrats on your new job. I'm sure others will chime in soon enough with their experiences. Until then, have fun, and stay safe.


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## NomadicMedic (Sep 21, 2016)

I worked 48 hour shifts pretty often in Eastern Washington. We were a very busy service and it was not uncommon to run 25 or more ALS calls on each truck in those 2 days.  Or, if your 911 call volume had been low, you would get selected for the long distance transport to Seattle. 

 We usually managed to nap every few hours, it wasn't common to sleep through the night, but I never felt like I was exhausted. There was enough downtime that I could get some rest.


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## LanceCorpsman (Sep 22, 2016)

You sleep all the time. Thats what firefighters do.


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## VentMonkey (Sep 22, 2016)

LanceCorpsman said:


> You sleep all the time. Thats what firefighters do.


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## CALEMT (Sep 22, 2016)

Francisco said:


> To those that have worked a 24 or 48 hour shift, were you awake the entire shift or did get some sleep ? how did you manage to say awake for that many hours ? Isn't it dangerous for the safety of the crew to be awake for more than 24 hours and be driving an ambulance ? I'm a new EMT, just got hired by the way, I was advised that I will be working 24's and 48's so any piece of advice about working such shift I'll take into consideration thank you !



I've worked 24's, 48's, and 72's. All of which I've been ran and I've slept all night. When I've been ran all night I've always somehow managed to get a hour or two of sleep in the night. If I'm uber tired during the day I'll take a nap. I can stay up for 24 hours straight with no problem (perks of being a wild land firefighter) and I've cut out all energy drinks, just strictly coffee for me now. 

Mimicking what others have said if your on a 48+ naps during the day will help if you've been running all night. Caffeine is only temporary and its best not to rely on it solely to make it through the night. Most partners I've worked with if I'm too tired to drive we'll switch out driving. You'll get used to it after you've worked a busy 24, 48, or 72.


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## pogoemt (Sep 22, 2016)

I know a station by me takes 30+ calls in a 24 hour shift consistently from what I was told, they don't sleep, poor souls.

Shoutout to Tampa Fire Rescue Station 13


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## VentMonkey (Sep 22, 2016)

pogoemt said:


> I know a station by me takes 30+ calls in a 24 hour shift consistently from what I was told, they don't sleep, poor souls.
> 
> Shoutout to Tampa Fire Rescue Station 13


This is just foolishness. Talk about dangerous on so many levels.


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## pogoemt (Sep 22, 2016)

VentMonkey said:


> This is just foolishness. Talk about dangerous on so many levels.



I don't work for Tampa Fire so I could be completely wrong, but I heard they are building another station to split 13's response area because of how big an issue this is


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## VentMonkey (Sep 22, 2016)

pogoemt said:


> I don't work for Tampa Fire so I could be completely wrong, but I heard they are building another station to split 13's response area because of how big an issue this is


I completely understand. My statement was more of a generalized one. And it really isn't unheard of in larger metropolitan areas to have stations this busy. 

It always gets me when providers from stations such as this seem to almost view it as a "badge of honor". Again, I'm not insinuating that this was by any means what you were implying. 

I worked at a similar station when I was a brand new paramedic. It has since been disbanded, and there was no honor in functioning, or trying to, with virtually no sleep at all. 

It just tends to be debatable and sore subject for some, as EMS providers who have been doing this for any amount of time realize the problems we face, and this is a big one.


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## Jim37F (Sep 22, 2016)

I know that the LAFD stations that cover Watts (the area that neighbors our first in area) have 5 ambulances between 2 stations (2 ALS and a BLS out of Station 64 and 1 each ALS and BLS at Station 65) to share the call load, each station gets in the neighborhood of 30ish calls a shift so I've heard, but by adding more units in the same station, it cuts down the call volume for the individual crews to much more manageable levels....hopefully if Tampa Fire has a station with that much call volume they have multiple units running out if it as well....

Most of our own stations also have 2x 24-hour units, which can be hit or miss. Yesterday I ran 8 calls, and slept most all the night, except for a 1 am call and a 4 am post move to cover a neighboring city.....however the shift before, both ambulances out of my station ran 13-14 calls....busy days like that you basically come home and sleep all day....if you picked up some overtime and are on a 48 same thing, sleeping at station in between calls, even the busiest units always manage some down time. While most of our units are scheduled 24-hour shifts, we do have a few shifts on a 48-96 schedule (48 hours on, 96 off) mostly because that mirrors the FD in the city they are assigned....while that city does occasionally blow up, for the most part, it's somewhere you can expect to be able o sleep most of the night and be functional the next day of the shift.


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## VentMonkey (Sep 22, 2016)

Jim37F said:


> I know that the LAFD stations that cover Watts (the area that neighbors our first in area) have 5 ambulances between 2 stations (2 ALS and a BLS out of Station 64 and 1 each ALS and BLS at Station 65) to share the call load, each station gets in the neighborhood of 30ish calls a shift so I've heard, but by adding more units in the same station, it cuts down the call volume for the individual crews to much more manageable levels....


And hopefully the NP program LAFD rolled is, or will help augment this problem as well.

Yet another promising avenue that needs further acceptance, exploration, exploitation in our field. It works, it shows, and it needs to be accepted nationwide in every system. 

Community paramedicine is nothing short of a godsend, IMO.


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## CALEMT (Sep 22, 2016)

Jim37F said:


> I know that the LAFD stations that cover Watts (the area that neighbors our first in area) have 5 ambulances between 2 stations (2 ALS and a BLS out of Station 64 and 1 each ALS and BLS at Station 65) to share the call load, each station gets in the neighborhood of 30ish calls a shift so I've heard, but by adding more units in the same station, it cuts down the call volume for the individual crews to much more manageable levels



I've heard the horror stories from LAFD station 9 "skid row". Something like they're the busiest station in the nation.


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## VentMonkey (Sep 22, 2016)

CALEMT said:


> I've heard the horror stories from LAFD station 9 "skid row". Something like they're the busiest station in the nation.


Yes. It is (was) called "Whino Nine-o's". It's where my paramedic preceptor did _his _paramedic internship back in the 80's when they were still a third service.

It is a busy station. If you can get your hands on it, check out a doc called "Firestorm". It follows LAFD #65 around, as well as another station or two as they get pummeled day in and day out.

I believe that show "Risk Takers" followed LAFD #9 out, but it was very, um, "edited", and doctored so as not to show it in a negative light, understandably.


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## Jim37F (Sep 22, 2016)

VentMonkey said:


> And hopefully the NP program LAFD rolled is, or will help augment this problem as well.
> 
> Yet another promising avenue that needs further acceptance, exploration, exploitation in our field. It works, it shows, and it needs to be accepted nationwide in every system.
> 
> Community paramedicine is nothing short of a godsend, IMO.


Unfortunately all that I've heard about the NP program is what they've put out in press releases, but hopefully it'll expand, personally it sounds promising.



CALEMT said:


> I've heard the horror stories from LAFD station 9 "skid row". Something like they're the busiest station in the nation.


I've heard many of the same horror stories...cursory search shows that that station has 2 engine company's, a Light Force company (I know how popular that concept of a Truck with Pumper engine married together is around here  ) and 4 ambulances (looks like 2 each ALS and BLS)....def the most ambulances in any one of their stations....I'm not even aware of any LA Co stations with multiple squads (though there's at least one or two I can think of that could use an extra ha)


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## VentMonkey (Sep 22, 2016)

[QUOTE="Jim37F, post: 620350, member: 18895]....I'm not even aware of any LA Co stations with multiple squads (though there's at least one or two I can think of that could use an extra ha)[/QUOTE]
Off the top my head? Sqauds 16, 14, and 147 were all endlessly put to work when I was there.


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## CALEMT (Sep 22, 2016)

While I'll admit I know nothing of LA or LACo but I've heard the rumors of how busy skid row is. Haven't heard anything about LACoFD. As far as my turf goes (Riverside Co) I believe station 37 is the busiest in the county. We have a 24 hour rig up there that gets absolutely hammered. I don't think I've ever slept the night and got off on time up there.


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## WolfmanHarris (Sep 23, 2016)

We're on 12's almost exclusively in Ontario and definitely at my service (3rd service, municipal ALS, limited FD response. 1.1M served, 80K calls per year). I work at one of our busiest stations and have for 7 years. We have 2x 24 units plus our deployment moves us to stations (sometimes far from home) to cover off other stations. I run 5-6 per 12 plus redeployments. I like being busy and will try to stay in a busy station when I come back to Ops after school. 

That being said, these numbers being thrown around are not safe for the provider, the patient or the public unless they have some strong rest period policies. Non-stop for 24-48 for work is killing us as providers and probably killing patients. 

I'm fortunate to not get held over for OT very often these days (some novel policies to decrease this) but regardless I'm an legally not allowed to work longer than 16hrs without being provided sleep facilities and sleep time. Since we do 12's the translates to OOS drive back to base and have next shift start delayed with pay to ensure adequate rest before reporting in.


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## VentMonkey (Sep 23, 2016)

WolfmanHarris said:


> We're on 12's almost exclusively in Ontario and definitely at my service (3rd service, municipal ALS, limited FD response. 1.1M served, 80K calls per year). I work at one of our busiest stations and have for 7 years. We have 2x 24 units plus our deployment moves us to stations (sometimes far from home) to cover off other stations. I run 5-6 per 12 plus redeployments. I like being busy and will try to stay in a busy station when I come back to Ops after school.
> 
> That being said, these numbers being thrown around are not safe for the provider, the patient or the public unless they have some strong rest period policies. Non-stop for 24-48 for work is killing us as providers and probably killing patients.
> 
> I'm fortunate to not get held over for OT very often these days (some novel policies to decrease this) but regardless I'm an legally not allowed to work longer than 16hrs without being provided sleep facilities and sleep time. Since we do 12's the translates to OOS drive back to base and have next shift start delayed with pay to ensure adequate rest before reporting in.


Just curious Wolfman, what does fire typically respond to in Ontario Canada?


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## Generic (Sep 24, 2016)

CALEMT said:


> I've heard the horror stories from LAFD station 9 "skid row". Something like they're the busiest station in the nation.



Fort Lauderdale Fire station #2 is the busiest station in the country with over 33,000 calls last year among 8 units out of that station. LAFD FS9 was second with 27,000 calls and 6 units. LACoFD FS33 was third with 26,000 call and 3 units. 



Jim37F said:


> As far as my turf goes (Riverside Co) I believe station 37 is the busiest in the county. We have a 24 hour rig up there that gets absolutely hammered. I don't think I've ever slept the night and got off on time up there.



FS7 was the busiest last year with over 5,600 calls. FS37 is up there though.


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## Generic (Sep 24, 2016)

I am not sure why this wasn't posted in the post above. I even edited it and this text showed up but I am not seeing it posted in my last answer.

[QUOTE="Jim37F, post: 620350, member: 18895]I'm not even aware of any LA Co stations with multiple squads (though there's at least one or two I can think of that could use an extra ha)[/QUOTE]

I am not sure why they don't do that. It may be partly do to a lack of space at stations that need it. They did add squad 130 to help pick up the slack of squad 33 which ran over 10,000 calls last year. It's unusual that they put a squad at a neighboring station but with that call volume, it's understandable. Usually it's every other or 2 stations. (West Hollywood is a special case).


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## ExpatMedic0 (Sep 24, 2016)

I have never been on that exact schedule. However, I have worked day shift fulltime for years and night shift fulltime for years. Once you get a rythem on the same shift its not so bad. The worst was rotating shifts. The last couple contracts where terrible. First one was 2, 12 hour day shifts, followed by 2, 12 hour night shifts. The last on was one week of night shifts, followed by one week of days shifts. When you switch back and forth like that over months and years its not only terrible for your physical health, but your mental health as well. The worst of the worst was by far the day and night shifts in the same week. I use "black out curtains" a night mask and ear plugs when I get home.


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## CALEMT (Sep 24, 2016)

Generic said:


> FS7 was the busiest last year with over 5,600 calls. FS37 is up there though.



Now thats interesting, while I'm a east end guy I would've figured that 25 or 27 would be the busiest. Always hearing those stations pop off.


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## WolfmanHarris (Sep 24, 2016)

VentMonkey said:


> Just curious Wolfman, what does fire typically respond to in Ontario Canada?



Each service sets their own tiered response agreements with their local FD. Generally in areas served by paid FD they would respond  to cardiac arrest, unconscious, chest pain, SOB and obviously MVC/rescues. Areas served by volly FD about the same though some do less due to demands on volunteers. FF's only trained to FR or EMR.

Where it gets interesting is in a few major centres services are provided advocating for more evidence based tiering which has dropped FD response way down in my area. We send two transport Ambulances to every cardiac arrest. No FD response to LTC or other medical facilities. We've also stopped FD response to CP and SOB unless altered LOA. We have liberal policies for back-up and lift assist and aggressive RRU deployment during peak hours so I can get additional Paramedic help quickly.

**Edit: fixed some big thumb related issues. Sorry on my phone.


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## CALEMT (Sep 24, 2016)

WolfmanHarris said:


> Each service sets their own tiered response agreements with their local FD. Generally in areas served by paid FD they would respond  to cardiac arrest, unconscious, chest pain, SOB and obviously MVC/rescues. Areas served by volly FD about the same though some do less due to demands on volunteers. FF's only trained to FR or EMR.
> 
> Where it gets interesting is in a few major centres services are provided advocating for more evidence based tiering which has dropped FD response way down in my area. We send two transport Ambulances to every cardiac arrest. No FD response to LTC or other medical facilities. We've also stopped FD response to CP and SOB unless altered LOA. We have liberal policies for back-up and lift assist and aggressive RRU deployment during peak hours so I can get additional Paramedic help quickly.
> 
> **Edit: fixed some big thumb related issues. Sorry on my phone.



So just out of curiosity a typical medical aid where I'm at in So Cal gets a fire engine and a ambulance. Full arrests get 2 engines and a ambulance. Traffic collisions depending on if its a cut and rescue or how many vehicles involved can get just a engine and ambulance. If its multiple vehicles you can get 2+ engines and more than 1 ambulance (depending on how many people are injured). A cut and rescue traffic collision gets a truck, 2 engines, battalion chief, and depending on number of patients 1 or more ambulances. 

Is your typical medical aid response just a ambulance and you utilize fire for the more "serious" calls i.e. full arrests, tc's, etc?


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## WolfmanHarris (Sep 24, 2016)

CALEMT said:


> Is your typical medical aid response just a ambulance and you utilize fire for the more "serious" calls i.e. full arrests, tc's, etc?



All calls receive a Paramedic ambulance. During peak times (0600-2400) in higher density areas a RRU will also be sent if the call is in its zone. If FD is tiered they are often cancelled before scene or shortly after; or response times are similar throughout our region. 

If the call is clinically high acuity or dynamic and I want hands I will either take the RRU medic with me in the back or call for back-up. There are guidelines for when/how but essentially at my discretion. 

If the call is operationally challenging (MVC, MCI, rescue, etc) than a Captain or Superintendent will attend the scene to take operational command. They rarely provide any patient care. Depending on resource requirements we have pre planned responses that could include our Multi-Patient Unit (bus), Emergency Support Unit, (truck full of spare gear, scene lighting and command post), Special Response Units (single medic, tactical w/ additional lighting, spare bags, rescue support) and any additional Ambulances and RRU as necessary to manage the call.

The Incident Management Support Centre may be staffed at HQ to oversee system level issues like calling in/holding over staff, media inquiries, managing the usual call volume that's still coming in, mutual aid, etc. 

In my system FD is primarily used in non patient care roles even on the calls they do attend. If I haven't cancelled them they're likely running equipment to and from the truck for me, facilitating extrication from the house, etc while Paramedics handle patient care, even on cardiac arrests.


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## CALEMT (Sep 24, 2016)

Interesting. Also excuse my ignorance but RRU is what exactly?


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## Flying (Sep 24, 2016)

CALEMT said:


> Interesting. Also excuse my ignorance but RRU is what exactly?


Rapid Response Unit?


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## VentMonkey (Sep 24, 2016)

WolfmanHarris said:


> **Edit: fixed some big thumb related issues. Sorry on my phone.


No worries, I suffer the same affliction.

Very neat, cutting sounding system, btw, so thanks for that.


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## WolfmanHarris (Sep 24, 2016)

Flying said:


> Rapid Response Unit?



Yep. We staff 5 from 0600 to 1800 and another 4 that come on from 1200-2400. They cover an area of a few square kilometres in areas that are both high density for calls and due to traffic have higher than average response times. Single Primary Care Paramedic (BLS) that stay mobile in their zone (our Ambulances are all station based).

Beyond that we have one Captain or Superintendent in a response unit per district and one SRU (tactical) per district that can jump calls.

I'm extremely lucky to work in a system that is not only very well resourced (though we can always use more units) but has excellent professional leadership and is very progressive. Ontario has terrible directives and scope of practise compared to elsewhere, but within those provincial limits we're as evidence driven and patient centred as possible.

I realize I've hijacked this thread a bit; sorry about that.


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## VentMonkey (Sep 24, 2016)

WolfmanHarris said:


> Yep. We staff 5 from 0600 to 1800 and another 4 that come on from 1200-2400. They cover an area of a few square kilometres in areas that are both high density for calls and due to traffic have higher than average response times. Single Primary Care Paramedic (BLS) that stay mobile in their zone (our Ambulances are all station based).
> 
> Beyond that we have one Captain or Superintendent in a response unit per district and one SRU (tactical) per district that can jump calls.
> 
> ...


Not at all. I think it's safe to say I'm not the only one on here interested in learning how prehospital practitioners function in other parts of the world, and outside of the U.S.


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## CALEMT (Sep 24, 2016)

VentMonkey said:


> Not at all. I think it's safe to say I'm not the only one on here interested in learning how prehospital practitioners function in other parts of the world, and outside of the U.S.



I'm always intrigued by how other people especially our neighbors north of the border do things.


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## VentMonkey (Sep 24, 2016)

CALEMT said:


> I'm always intrigued by how other people especially our neighbors north of the border do things.


...the most efficient way


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## dutemplar (Sep 24, 2016)

VentMonkey said:


> Not at all. I think it's safe to say I'm not the only one on here interested in learning how prehospital practitioners function in other parts of the world, and outside of the U.S.



2 12 hour days, flip to 2 12 hour nights.  "Four" off, but the first day is wasted recovering and all.  Overall, most providers don't like that and would much prefer to do straight days or straight nights, and flip weekly or every other week.. instead of in the middle of each rotation.  16 shifts per month, so extras and OT are tossed in. But it makes scheduling easier.  Somehow.  

Every call gets an Alpha (two EMT-Is) started hot, may be calmed down as info comes in.
Step up gets a Delta, area EMT-I supervisor who's been here a while and can coordinate.
Next steup up gets a Charlie, (one EMT-I, one Critical Care Paramedic).
"Oh schnikies" may get an Oscar (Operations supervisor/manager, usually a CCP, they've been here a while)

Incident command system is styled off of the London Ambulance Service,... (sigh)

Remote areas will get a Lifeflight helicopter, and outside of the city may get a Lifeflight if there it's judged a better option than a ground Charlie to respond.  

Sadly, they use a US based system so it tends to overdispatch severely where the the tiers were designed for BLS cold, BLS hot, ALS as compared to Intermediate cold or hot, Intermediate and supervisor, Intermediate plus Supervisor and CCP.  But hey, it works.  Lucas on just about every unit (Deltas, Charlies, Oscars,...) so any priority call already starts with 5 providers.


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## ExpatMedic0 (Sep 25, 2016)

dutemplar said:


> 2 12 hour days, flip to 2 12 hour nights.  "Four" off, but the first day is wasted recovering and all.  Overall, most providers don't like that and would much prefer to do straight days or straight nights, and flip weekly or every other week.. instead of in the middle of each rotation.  16 shifts per month, so extras and OT are tossed in. But it makes scheduling easier.  Somehow.


 I absolutely hate this, Its defiantly the Brits and South Africans that love doing this.


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## NomadicMedic (Sep 25, 2016)

ExpatMedic0 said:


> I absolutely hate this, Its defiantly the Brits and South Africans that love doing this.



It's the Sussex county schedule too


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## ExpatMedic0 (Sep 25, 2016)

DEmedic said:


> It's the Sussex county schedule too


WOW! I actually had never seen a place do it in the U.S. ( on the west coast anyway). That's a bummer


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## DrParasite (Sep 25, 2016)

ExpatMedic0 said:


> WOW! I actually had never seen a place do it in the U.S. ( on the west coast anyway). That's a bummer


When I was in Central NY, all the fire departments did it.  I never could understand it, switching from days to nights on a regular basis sucks.


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## NomadicMedic (Sep 25, 2016)

4 platoons, 2 12 hour days. 2 12 hour nights. 4 days off. I actually didn't mind it until the second night. That was always bad.


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## WolfmanHarris (Sep 25, 2016)

I love our schedule. PD is on the 2D-2N-4Off and they always look wiped by the end. We're on 4N-4Off-3D-3N-4off-4D-6off. The split can be a challenge, but the 6 in a row off each month and the predictability of having two out of every four weekends off is nice. Plus using 48hrs vacation or lieu usually results in 2 weeks off. Thanks to some careful saving of my time I just took all of September off.


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## dutemplar (Sep 25, 2016)

DEmedic said:


> 4 platoons, 2 12 hour days. 2 12 hour nights. 4 days off. I actually didn't mind it until the second night. That was always bad.


Yea.  It's 0310 on my second night.  The communications manager is basically jogging in place to keep moving two more hours.  I'm stepping out of the room to pound coffee, karak/coffee and the occasional cigar.  2 hours until my relief should arrive.  Twenty minute drive outta here.  Unwind.  Nap.  Naaaaaaaaaap.

What's suprising is for a place that focuses very strongly on "effective" care and "best possible," they don't seem to take into account simple human exhaustion and the fact that tonight eeeeeveryone is dragging, hard, and not as effective as we could be.


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## phideux (Sep 29, 2016)

I did 24/48s on a dual medic ambulance. As soon as we got on shift we did our daily station duties, checked off the rig, then hit the lounge chairs in front of the TV. Napped in front of the TV all day between calls. After dark we went to bed and napped in bed between calls. You never know, sometimes you slept most of the shift, sometimes you didn't. Nap whenever you can.


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