Fatigue Questions

[Qulevrius]

...and when the Kool Aid finally runs out, comes the bitter disappointment and realization that you cannot run on pure enthusiasm for too long. This is what happens to young EMTs that the private ambulance companies in SoCal love so much to hire; they’d agree to anything because they bought the snake oil lock, stock & barrel and are hoping to make a difference. As long as the mindset of “this is what we signed up for” exists, this vicious circle will never get broken.

 

[MMohler]

Well, I dont plan on being an EMT long enough to let the kool aid run out. What did you sign up for then? A guaranteed amount of sleep every shift would sure be nice but from my standpoint its a business and cant feasibly provide this. I guess EMS should just take a break from 11pm to 6am in my area because I need a good sleep? Even if I were to propose an additional car that goes 8p-8a what happens when its a busy night? Add another? the cycle still doesnt end. Im open to any idea to bring to management from you guys but keep in mind small company, 3 cities, 4 (technically 5) dedicated fire rigs.

 

[VentMonkey]

Well, I dont plan on being an EMT long enough to let the kool aid run out. What did you sign up for then? A guaranteed amount of sleep every shift would sure be nice but from my standpoint its a business and cant feasibly provide this. I guess EMS should just take a break from 11pm to 6am in my area because I need a good sleep? Even if I were to propose an additional car that goes 8p-8a what happens when its a busy night? Add another? the cycle still doesnt end. I'm open to any idea to bring to management from you guys but keep in mind small company, 3 cities, 4 (technically 5) dedicated fire rigs.

Without directly speaking for @Qulevrius, he and I are (somewhat) cut from the same SoCal cloth. You seem ambitious, this is promising, keep at it.

I think perhaps had I still been in SoCal trying to pursue other career goals such as nursing, or RT all while still working at one of the more "reliable" privates as a source of income I too would be inundated by the legions of fresh new optimistic, and often completely unrealisitc new EMT's that are hired on; we have them at my service as well.

It's not to say I can't appreciate or value young, enthusiastic people (weren't we all once?), but a lot of the times they end up right where someone such as myself, or @Qulevrius can see them in the set time frame. It is sad, but very true. I do know first hand, many former partners who've I've seen turn into that burned out EMT; even worse are the ones who as he mentions, drink what I like to refer to as the "cultural Kool-Aid", but in all fairness this has been bred over many nauseating decades by the elders in the industry that came even before me.

In summary, old habits die hard. Literally, it's taken (taking) decades for the much needed intellectually driven cultural changes to occur.

Back on topic, @RocketMedic you are correct. This is management's issue, but in reality it is something pushed to the bottom of the pile for a multitude of reasons. Many of the reasons we may never fully understand. Is it acceptable? Absolutely not, and I hope leaders-to-be such as yourself and @NomadicMedic truly do provide the change that you seek. Even if it's initially in your respective services, the "butterfly effect" can certainly apply...even in this industry.

 

[Qulevrius]

What did you sign up for ?

I signed up for a paycheck.

 

[luke_31]

I've been through the burn out, getting four hours non consecutive sleep each night working a 48 and trying to get a little bit during the second day. It does wear on you after a while. Now I work where most nights I get at least five hours of sleep and it rarely is interrupted, it makes a big difference when you work a 24hr shift with a high UhU versus a low UhU. Even when it gets busy in the summertime and we are running calls all day, most nights we are still back at station by 10pm and generally don't start out till after 5am when morning PT begins.

 

[Tigger]

Yah, it certainly is but this does not happen frequently. I had one bad shift and now have 4 days off to catch up on sleep and recover. You dont have to bring more "education" on about it only takes one shift to get in an accident, injure a pt, etc. The system is already in shambles as far as private ambulance goes. Itd be all rainbow and butterflies if we were funded by government and state. We could staff as many cars out as we wanted to! it is just not possible in any way. In reference to . Youre right but I understand my position and know it isnt my end all. Might as well keep drinking my kool aid because better to be enthusiastic about carting people around then to pout and start this "burn out" process quicker.

If you are going to be obtuse and obstructionist, I'm done here. You came in and posted unsafe behaviors, you got called on them. Stop justifying it.

 

[MSDeltaFlt]

I'm curious. Why is your area staffed so poorly? Is it because of pay? Is it because of the company culture? Overall call volume? Crew culture? The lack of people willing to get in to the field in the first place?

The reason why I ask is this. I've worked in some counties in my state that have such a high call volume period that there are absolutely ZERO people in the state or in the adjacent state you can find to come in and work. There isn't enough money to pay them to come in. Like the punchline in the old Give Calhoun The Ball joke, "Calhoun say he don't want the ball."

I've been there. The county I got started in almost 20 years ago full time had seven trucks on 12hr shifts covering the county with a lower monthly call volume and night shift was steady. Now it's being covered with two to three 24hr shift trucks with a higher call volume. Getting more than 4 hours sleep in 48hrs is a rarity. I left for that reason. You couldn't pay me to work that county again. A cardiothoracic surgeon's annual salary isn't enough to get me to work there again. Which really breaks my heart because I consider that county my EMS home.

 

[MMohler]

Our county is divided into regions, private ambulance companies bid on these regions (excluding individual city departments). We have 3 cities that we serve 911 we are a small company and do not have the financial backing to staff a 6th or 7th rig. Minimum wage is the pay. each fire car is a 24 hr shift, each crew is working 2-3 shifts a week. Sort of like ABC shifts fire uses. Staffing isnt an issue, its the financial part of it. Being that we are small, management would like us to be run to the ground instead of getting quality rest (which I also understand because its a business they have to make money too). When we are level 0 (no fire rigs left) we call adjacent ambulance company to cover our area. I live in the area I work which makes a bit more enjoyable, can bite me in the a** one day as working on someone I know would be a nightmare.


Basically how I have come to figure it out is staff what they think is needed based off previous year call volume and research. Instead of playing the safe side and staffing extra rigs giving guys the opportunity to rest. We risk coverage and rest to maintain a profitable company. Now id say 95% of the time this does not happen we all can cover the cities pretty reliably and get good sleep but there are THOSE days where its just non stop. Thats where extra rigs would come in handy but it falls back to a money thing. Im sure if we could we'd have more rigs running around but it isnt possible.

 

[RocketMedic]

MSDeltaFlt, there is always enough money if the conditions are changed. Why did they transition away from 12s? Did they decide to stop recruiting, or did they opt for 24s for savings, or what?

There is not enough money to embrace current conditions, true.

@MMohler , we've been there too. Here's the reality of it (with 'I' as a manager).
EMS is a 24/7/365 operation. That does not mean that you schedule your employees like that. When you schedule employees for long-hour trucks, you are saving money on healthcare expenses and (potentially) payroll costs, because it's cheaper to pay 5x2 (shift) x3 (# of shift, assuming 24/48 or 48/96 scheduling) employees $40k a year (salary + health) for a total of $1.2 million a year than it is to pay 5x2 (shift) x 6 (12 hour day and night shifts) the same $40k it takes to convince them to work for you- literally twice as much. You're looking at 1.2 million dollars per year in payroll costs that you're saving. Realistically, I can buy a new rig to replace the one you wrecked driving tired, pay a higher insurance premium to shield myself from the mistake you made due to fatigue, and make a tidy profit that wouldn't be there if I worked 12s- and my only 'extra' expense is a few stations that I either rent or own and I save on fuel with stations because you're not SSM. That you're sleep-deprived, unhealthy, tired, irritable and eventually burned out are features for me- it lets me keep wages sort of low, eliminates the need for an expensive retirement plan, and lets me make an excuse to fire you when you start getting bigger aspirations than I want to feed.

Fatigue management, at its core, is only about the organization in terms of risk management. It is fundamentally about you. No company really cares about you the way that you care about you, so it's up to you to care about yourself.

 

[RocketMedic]

Our county is divided into regions, private ambulance companies bid on these regions due to the size of counties in CA, and the wildly variable needs and capabilities of each company and municipality. What Lancaster needs is not what Compton needs, etc. (excluding individual city departments). We have 3 cities that we serve 911 we are a small company so are most EMS agencies, of all sorts. County services tend to be about this size in most of the nation btw and do not have the financial backing to staff a 6th or 7th rig what kind of cars are your managers driving? Ambulances and people are cheap, and if they'll pay with IFTs, they will literally pay for themselves. That you're playing in the 911 market indicates that your owner(s) and managers have money coming in to burn on recruiting (911 work) and whatever they're getting from cities (likely not much). Minimum wage is the pay of course it is, you're new and work 24/48s. each fire car is a 24 hr shift, each crew is working 2-3 shifts a week. Sort of like ABC shifts fire uses selected because it gives the taxpayers the most 'coverage' at the lowest cost by making you work 33% of your life. Staffing isnt an issue 911 in SoCal, it won't be an issue until your checks bounce and the new wears off, its the financial part of it. Being that we are small, management would like us to be run to the ground instead of getting quality rest because they want a consistent ROI (which I also understand because its a business they have to make money too). When we are level 0 (no fire rigs left) we call adjacent ambulance company to cover our area so you don't lose your contract and have to raise wages to recruit for IFT employees. I live in the area I work which makes a bit more enjoyable, can bite me in the a** one day as working on someone I know would be a nightmare it's not that bad.


Basically how I have come to figure it out is staff what they think is needed based off previous year call volume and research no they just took the contractual minimums and will fill any gaping holes with overtime shifts they'll sucker you into with a trinket. Instead of playing the safe side and staffing extra rigs giving guys the opportunity to rest. We risk coverage and rest to maintain a profitable company great for the owners, how does that help you?. Now id say 95% of the time this does not happen we all can cover the cities pretty reliably and get good sleep but there are THOSE days where its just non stop same here, I empathize and want this to change.. Thats where extra rigs would come in handy but it falls back to a money thing. Im sure if we could we'd have more rigs running around of course, because that's extra IFT work and $$$ but it isnt possible because your company is competing for IFT contracts and additional fully-staffed trucks would be inefficient.

 

[MMohler]

Great points, so take away is that it is cheaper to staff 6 guys on 24s (Like I was saying about the ABC?) then 12 guys on 12 hour shifts? In my own opinion i still prefer the 24 because its 2-3 days each week vs 3-4 gives me ample time to pick up a second job to move on quicker. I would really like to see even a 6th fire car as a back up. And to clarify we have stations (3). We have set posts that are county mandated depending on which area we get a call. I assume because of the number of actual staffed rigs we have being low.

 

[RocketMedic]

Great points, so take away is that it is cheaper to staff 6 guys on 24s (Like I was saying about the ABC?) then 12 guys on 12 hour shifts? In my own opinion i still prefer the 24 because its 2-3 days each week vs 3-4 gives me ample time to pick up a second job to move on quicker. I would really like to see even a 6th fire car as a back up. And to clarify we have stations (3). We have set posts that are county mandated depending on which area we get a call. I assume because of the number of actual staffed rigs we have being low.

Your 911 contracts depend on that.

 

[MMohler]

Well im hoping to be long gone by then. Then meaning if they are lost

 

[RocketMedic]

Well what are your goals as a paramedic?

 

[Qulevrius]

Great points, so take away is that it is cheaper to staff 6 guys on 24s (Like I was saying about the ABC?) then 12 guys on 12 hour shifts? In my own opinion i still prefer the 24 because its 2-3 days each week vs 3-4 gives me ample time to pick up a second job to move on quicker. I would really like to see even a 6th fire car as a back up. And to clarify we have stations (3). We have set posts that are county mandated depending on which area we get a call. I assume because of the number of actual staffed rigs we have being low.

Your logic is off for the sole reason of that it takes significantly longer than a good night sleep to recover from a sleepless 24. Not to mention that the main problem with fatigue is that it’s cumulative. Based off your previous posts you are, indeed, working for Emergency; you cover a small corner of OC that calls in CARE for mutual aid when sh*t hits the fan, but Emergency’s fire contract is mostly for vanity and advertising, since the city’s reasoning goes along the lines of “fund FD to buy & staff ETs with AOs + fire medics” vs “outsource a private ambulance for medical transport only”. That alone creates a whole new dimension of operational issues, but that isn’t the subject of discussion here; what happens next, is what @RocketMedic has outlined, when the private company starts crunching #’s and calculate profits. And as the FD’s need for coverage increases, so does the company’s need to run IFTs, because the fire contract is a financial sinkhole that does not generate enough revenue.

 

[RocketMedic]

And any new shift lines are going to be very heavily focused at IFT work that is revenue-positive.

 

[DrParasite]

Was it calculated the same way as above?

I believe it was either transports / hour, or requests for service per hour (which actually reflects a more accurate level of utilization than simply transports).

 

[Qulevrius]

And any new shift lines are going to be very heavily focused at IFT work that is revenue-positive.

Or, add the IFT work to the existing load. Which is exactly what’s happening to us now.

 

[MMohler]

when the private company starts crunching #’s and calculate profits

I have been told that around 80% is made from fire calls, dont shoot the messenger, just what I have been told but I will stick to thread topic.

Well what are your goals as a paramedic?

Wont go into it much due to topic of this thread but goal is FF/Medic.

it takes significantly longer than a good night sleep to recover from a sleepless 24.

is there a study that gives a timeline as too how many days it takes to fully recover? Not arguing and trying to justify a faulted schedule, just curious.

Or, add the IFT work to the existing load. Which is exactly what’s happening to us now.

Existing load as in? 911 and IFT or?

 

[Qulevrius]

I have been told that around 80% is made from fire calls, dont shoot the messenger, just what I have been told but I will stick to thread topic.



Wont go into it much due to topic of this thread but goal is FF/Medic.



is there a study that gives a timeline as too how many days it takes to fully recover? Not arguing and trying to justify a faulted schedule, just curious.



Existing load as in? 911 and IFT or?

I’ve explained how it works in the previous post. The city outsources the ETs, meaning that they pay a flat rate for transports only. Whether it is for every call or just for actual transports, is outlined when the contract is signed. Everything else - such as crew salaries, rigs, equipment etc - is the ambulance company’s responsibility. So go ahead and tell me if what they’ve told you, makes any sense.

Just look up any study on REM sleep deprivation, or sleep deprivation in general. It is not difficult to find.

Adding to the existing load as in, covering for fire during the day (including occasional IFTs & rotating posts), and then getting slaughtered with IFTs during the night.