hospital based EMS models

[emscoord]

All-

I am doing some research on hospital based EMS systems. First I'll give you some background of what we have now. The provider serves a small county with one on duty crew and one call crew. They have 4 ambulances (3 ALS on BLS). Our EMS staff currently work 12 hours on followed by 12 on call. They work in the ED (and are pulled to start IV's, EKG's etc throughout the hospital) when not on a call or transfer. The call back model is a 20 minute response time and is for out of town calls and transfers. Since they are based in a small rural community with long transport times call backs and long hours are not uncommon (especially if you work back to back days with call sandwiched between them).

I have worked in a model as described above and also worked 8 plus years on 24 hour shifts in a flight program. I liked the 24 hour shifts for a few reasons but that is not an option here (budget and personel). The other advantage we had flying was mandatory rest periods which is not feasible for a 911 service.

My questions are:

1. What staffing models do you have experience with in a hospital based system?

2. If you staff the ED also, what are your work expectations?

Anything else you can add or if you have any questions fire them my way.

Thanks for the help.

 

[46Young]

My experience is with a large hospital system in NYC/Long Island. They are a NYC 911 prehospital provider. They also do IFT and CCT. Shifts are either 911 only or IFT only. Each EMT or medic must have at least one IFT shift scheduled, since the 911 shifts are generally more popular than the IFT shifts.

Shifts are either 8 hours, 12 hours, or 16 hours. It is unlawful to work in excess of 16 consecutive hours, although a late call is allowed before the 16th hour is reached. All hospital employees were paid 37.5 hours out of 40 scheduled; a 30 min break on a 8 hour day, 45 mins on 12, and one hour on 16. In EMS, if the crew works straight through the entire shift, they are paid time and a half for that missed break.

911 shifts are contracted slots in the FDNY EMS 911 system. They only come in 8 hour or 12 hour tours. A 16 hour shift is simply "doing a double" with two back to back 911 shifts. Night differential in the form of 10% of hourly salary is given for both 911 and IFT.

IFT shifts are 8, 12, or 16 hour tours. Employees may typically have schedules such as two 12's in 911 and two 8's or a double in IFT; they may also do a double in the city and two 12's in IFT. The schedule is changed yearly or less, mainly due to the staffing needs and call volume changes in IFT, along with any additions to 911 spots. Tours are given on seniority basis. #1 picks their schedule, then #2, etc. The leftovers go to the newest employees. It's typical to have only one or two scheduled shifts and the rest being float days, wherever scheduling decides.

NYC 911 EMS is either double medic (ALS) or any other combination of cert level (BLS). ALS must have two medics. IFT is "one and one" unless another medic picked up OT in place of an EMT.

IFT was changed at one time to a version of system status management. Admin fell for that concept. After implementing SSM, they realized a few things. First, wear and tear on vehicles was significantly increased, as was fuel costs. There is no true way to predict call volume and general location, at least to the extent that a SSM model proves beneficial. Crew morale plummeted. SSM is intended to increase net utilization to the highest aamount possible. Crews were tired of high call volume, where working straight through a shift without a break was the norm. Crews were tired of being moved from place to place, ruining whatever small amount of downtime they might have on the overnights. A good number of valuable medics left for other hospitals or FDNY EMS due to disgust of SSM. There were still extended response times to emergent txps, since SSM doesn't allow for periodic call volume spikes.

Paid on call doesn't exist here; if you're on call, even if there is downtime, you're still working, since you're obligated to perform a function, or to be in a constant state of readiness. If you're working, you're compensated at your normal hourly rate.

IFT is busy in the health system. It is common to get no break, or exactly that 30/45/60 minute break, to the minute. The hospital hires ER techs for around $2/hr more than EMT top pay.

The paid on call system and utilizing the staff to assist in the hospital makes sense in a relatively slow, rural setting. It isn't appropriate for a large, busy hospital system with other area hospitals competing for quality employees.

 

[BLSBoy]

You are doing 911, IFT, or a mix of both?
General call volume?

I was a former FT hospital based MICU Paramedic in South Jersey, and I remain a part timer there now.