Phoenix SouthWest Medics Concerned Over Lack Of Sleep

[MMiz]

Valley Medics Concerned Over Lack Of Sleep
Paramedics With Southwest Ambulance Voice Safety Fears

PHOENIX -- A four-month investigation by 5 Investigates revealed that some Valley medics are so exhausted on the job, they are afraid they will make a dangerous mistake.

Some of the medics with Southwest Ambulance told investigative reporter Tammy Leitner that they work on little or no sleep at all. They say Southwest Ambulance has ignored their concerns.

Read more!

 

[WolfmanHarris]

Why 24 hour shifts are allowed in any moderate to high call volume service are beyond me. Aside from VERY rural (remote) services in the North of the Province (1 call every couple of days) we have no 24 hour shifts, only 12's with some services doing 8 hour peak coverage shifts. 24 hour shifts are outright dangerous.

Where I work, moderately busy, mainly suburban service (pop. 1.1 million) we work 12's. If you get a late call that takes you into over time once that call is clear you return to base OOS for all but cardiac arrest calls. If a major call results in so much OT that you have less than 8 hours until your next shift, you are booked off with pay for that entire shift.

The unfortunate downside to our shift structure is we're not entitled to beds so have to make do bedding down on the couches in the crew rooms. Commercial grade couches suck.

I don't understand how these long shifts are still allowed, let alone common place.

 

[BEorP]

Why 24 hour shifts are allowed in any moderate to high call volume service are beyond me. Aside from VERY rural (remote) services in the North of the Province (1 call every couple of days) we have no 24 hour shifts, only 12's with some services doing 8 hour peak coverage shifts. 24 hour shifts are outright dangerous.

FYI Huron County has 24 hour shifts.

 

[triemal04]

Why 24 hour shifts are allowed in any moderate to high call volume service are beyond me. Aside from VERY rural (remote) services in the North of the Province (1 call every couple of days) we have no 24 hour shifts, only 12's with some services doing 8 hour peak coverage shifts. 24 hour shifts are outright dangerous.

Part of the reason is that it's cheaper; 24 hour shifts, despite the many ways they can be scheduled almost always break down to a 56 hour work week. So with that type of schedule it's possible to have fewer people working for the service thus saving money.

Another part is the time off; even at the basic 24/48 schedule it gives the employee 2 days off for every day worked, and there are others out there than sometimes give the employee up to 4 days off several times a month.

Of course, neither of these reasons makes up for the fact that, in a high volume service 24's are a bad idea, and can be horribly dangerous. But, for slower areas they aren't a bad idea and do have some benefits. It'll all depend on whether or not the employee can maintain an appropriate level of readiness (read not be sleep deprived) during the shift.

 

[Onceamedic]

I work 48 hour shifts and personally run an average of 20 calls per 48. I don't know how long I will be able to do that.

 

[Seaglass]

24s can be a lot more convenient if staff are commuting over long distances. My station recently went to 12s, and you can only get 24s if you live beyond a certain distance away. If you're on a 24, you're encouraged not to drive or be the primary care provider on serious calls. Makes for some confusing crew rosters, and the restrictions on the second half of the shift can't always be followed, but it generally works well enough. Our medical director really pushed for this after hearing too many cases of people making stupid mistakes. Luckily, the new policies were put into place before anything serious actually happened.

 

[redcrossemt]

We do 24 hour shifts on our dedicated 911 cars. Our call volume is typically less than 6 calls in 24 hours. There are days when we are pushed, obviously; but the norm includes a good amount of downtime. We also stagger our shifts so that there is almost always someone working their first 12-hours.

 

[VentMedic]

24s can be a lot more convenient if staff are commuting over long distances.

That is truly the most dangerous. If you read some of the articles on this, it is from sleepy workers driving home that cause many MVCs.

 

[redcrossemt]

That is truly the most dangerous. If you read some of the articles on this, it is from sleepy workers driving home that cause many MVCs.

Good point.

Of interest to me lately is what is called "sleep inertia". This is the grogginess and loss of some level of motor and thought functions when suddenly awoken. It worries me that during periods of sleep, we are immediately waking up for emergency calls, driving a dangerous vehicle, and then caring for someone who deserves our full attention.

Obviously we can't significantly lengthen our times to on-air... so the only solution I see is to go to shifts shorter than 12 hours, with no sleeping allowed. Of course, there are other things to consider then, like sleep debt, especially when accompanied by the fact that EMS providers are notorious for overtime and second jobs.

In the mean time, we do what we can to decrease the sleep inertia and danger to us and others... Tones are on real loud. Lights go up as soon as the call is received. We walk around the ambulance once before responding. My partner and I talk and if either one of us is feeling sleepy, or appears that way, the other drives.

 

[Seaglass]

That is truly the most dangerous. If you read some of the articles on this, it is from sleepy workers driving home that cause many MVCs.

Everyone is aware of that, but we don't have a choice. The cost of living near the station is going up pretty badly as the suburbs expand, and we're not going to get the commuters to move closer. New hires aren't being signed on for 24s. Rumor has it that there are some contractual things that keep us from forcing the older people to swap.

So we do what we can. You can sleep in after a shift as long as you need--we've even set up a tone-free bunkroom, although we're still working on getting enough beds to host entire shifts. If there's some reason you can't go home until your next shift and we're out of room at the station, you can crash on someone's couch... it's not that uncommon, especially during severe storms. We can't force people to stay over, but most people seem to take advantage of it.

 

[WolfmanHarris]

FYI Huron County has 24 hour shifts.

8564 annual calls
5 24/7 Ambulances (increased to 7 at night)
23.5 calls per day
4.7 calls per 24 hours per truck (only counting the day cars) OR
3.4 calls per 24 hours per truck (7 cars)

Sure it doesn't actually work out that way, but with that sort of volume I'd say a 24 hours shift may be workable.

So I probably overstated the VERY rural thing, but we're not talking 24's of being run of their feet.


As for the rest of the debate, the fact that convenience and logistics (commute times, recruitment, etc) is allowed to trump provider and patient safety is entirely unacceptable. Especially in the face of both anecdotal (as started this discussion) and more scientific evidence that thoroughly and conclusively proves the dangers of these shift schedules.

I will be far blunter and less diplomatic than I tend to prefer, and for the offense I'm sure this will cause, I apologize. I don't know any of you as individuals and this isn't directed at anyone in particular. That being said: if a service can't make safe operation a priority and a reality then it is time to take a very close look at how it's being managed or what service is providing it. Perhaps contracts need to be cancelled or managers replaced until someone is willing to look outside the box or make the tough decisions. Anything else, is just excuses and medical mistakes, dangerous driving and deaths will be the result.

 

[Seaglass]

As for the rest of the debate, the fact that convenience and logistics (commute times, recruitment, etc) is allowed to trump provider and patient safety is entirely unacceptable. Especially in the face of both anecdotal (as started this discussion) and more scientific evidence that thoroughly and conclusively proves the dangers of these shift schedules.

I will be far blunter and less diplomatic than I tend to prefer, and for the offense I'm sure this will cause, I apologize. I don't know any of you as individuals and this isn't directed at anyone in particular. That being said: if a service can't make safe operation a priority and a reality then it is time to take a very close look at how it's being managed or what service is providing it. Perhaps contracts need to be cancelled or managers replaced until someone is willing to look outside the box or make the tough decisions. Anything else, is just excuses and medical mistakes, dangerous driving and deaths will be the result.

I'm not sure where the debate is... academically, I agree, but reality doesn't always line up. I think my service has done everything realistically possible, and I applaud it for being one of the few in the area that has actively promoted 12s, rather than kicking and screaming.

Canceling contracts isn't feasible without inviting lawsuits... particularly when the service is doing everything possible to discourage those on 24s from driving tired. Besides, we need the staff, period.

If you want to get into the reality further, PM me; it's rather convoluted, and I'd rather not post too many details publicly.

 

[Kevin1990]

I work for a company in northeast ohio, and we work 24's. But are call volume is high during the day, and not so much at night. we dont have a high call volume so our medics and emt are normally fine. Some days were running back to back for 24 hrs. I worked 10 emergency is a 24 hr period, but may not seem alot but were in the country and sometimes the closest hospitals is 20-30 mins away. We have a alot of transfers from a hospital to cleveland clinic, which is a 3-4 hr round trip. If youre company has a high call volume, i think they shoud make 12 hr shifts.. if the medics are so tired and think they are going to make a mistake.. what good does the pt get out of this. Its not the medics fault... there tired, and you get tired

 

[Outbac1]

12 vs 24 is a topic of concern here as well. Our more urban areas do 12s and the rural towns do 24s. If we work at a 12 hr ste we can do a double shift(24hrs) and the 24s max out at 36. The 24hr sites work one on and 3 days off.

Besides the sleep depravation issues already mentioned there is another issue.

The problem comes when dispatch pulls the 24s to town to do long hauls. As they don't have to be back in 12 for a shift change they often get several calls dumped on them. They often run 18 -20 hrs straight. Besides them being tired there is the matter of coverage for their area. This usually means the next amb. over is pulled part way into their terrortory for coverage. Now one amb. is covering twice the area, several hundred sq. kms. When they get a call their response time is quite long and now there is no one for coverage for the second call. The next amb. is probably an hour away.

Long hours even without doing a lot of calls is tiring. I don't do very many 24s anymore. Especially what we call a backward 24. Where you do the night portion of the shift first, then the day portion. They are just too hard on you. Even if you spend most of the night on the couch.

Eventually with enough mistakes the comapnies will have to change their shift structure. Its sad that it will have to be mistakes that cause them to do it.

 

[TgerFoxMark]

no offense, even in a "high" call volume area, i prefer 24's. it keeps us on the same shift as FD, and in a 24/48 i get to spend more time with my family during hours that matter in the real world. we are encouraged to go OOS if someone is too tired to get a rest period. i actually find that 12's are more damaging, due to the lack of time for family, and like i was (when i was on a 12 service) SOL of ever having time to do normal stuff. 0700 -1900 is killer if you ever have a life to deal with.

 

[triemal04]

no offense, even in a "high" call volume area, i prefer 24's. it keeps us on the same shift as FD, and in a 24/48 i get to spend more time with my family during hours that matter in the real world. we are encouraged to go OOS if someone is too tired to get a rest period. i actually find that 12's are more damaging, due to the lack of time for family, and like i was (when i was on a 12 service) SOL of ever having time to do normal stuff. 0700 -1900 is killer if you ever have a life to deal with.

If, and that's a big if sometimes, that's really accurate, then that wouldn't be an issue (working 24's). But, if you go out of service every night for 6 hours, will that create a problem for you? How much are you really encouraged to do it, and how much is lipservice?

 

[JonTullos]

I work a 48 hour shift but it's only once a week. Typically we get to sleep most of the night but sometimes we get called out... normally it's an in-town call but sometimes we'll have an IFT at night. I prefer it because the service I work at is about 45 minutes from my house so I'd rather work a longer shift. Plus as long as we're up and around by the time the director gets in to the office (typically 0800 or 0830) we're good plus they'll let us sleep in if we have a really late call. It's not bad in my situation. Just because it doesn't work out well at one service doesn't mean that it doesn't work at all services.

Jon

 

[ceej]

70,000+ per year on my service
191 runs per day
Divided by 15 trucks (13 911 trucks and two supporting IFT trucks)
~13 runs per truck per 24hr shift

Those are last years stats, we're set to break 100,000 runs this year with our new 911 contracts.

We don't complain, guess we're used to it

 

[firemedic1563]

We work a 24/72 schedule, in a large county that goes from bordering a major metropolitan city, to much more suburban farm land. The good news in the much busier areas (10-15 avg calls per shift) the transport times are 10 minutes or less. The slower companies (3-5 calls per shift avg) have up to 30+ minute transports, but generally get much more sleep.

I agree that driving while tired can be very dangerous. For us, it is a fine balance however. A huge portion of our department lives outside the area, many (more than a whole shift of workers) outside the state. In an metro are where the median home price is more than $250k, it is hard to attract a local workforce for less than $40k a year to start. So workers are attracted from outside areas, and employess are enticed to move to other areas as well. For instance, one could chose to commute just over an hour to a neighboring state where the median home price is over $100k less. Additionally, our salaries(though still inferior to neighboring jurisdictions) are much higher than those in the far outlying areas.

So, while the safety is an obviously important component, one must take into account the effects of altering that schedule. Shorter shifts (14's/10's, 4off etc) may not decrease the needed workforce, but may cause a mass exodus of a quarter or more of the workforce.

 

[VentMedic]

i actually find that 12's are more damaging, due to the lack of time for family, and like i was (when i was on a 12 service) SOL of ever having time to do normal stuff. 0700 -1900 is killer if you ever have a life to deal with.

Yeah it must be rough if you actually could be home every night to tuck your kids into bed or to say good-bye to them in the morning before you went work.

I love 12s. That is what I did on CCT and Flight as well as now in the hospital. I have not missed doing 24+ calls in 24 hours with the FD. Those who enjoy the 24 and 48 hour shifts the most probably don't have a family life.

If anything has ruined marriages in the FD/EMS it is the 24 hour shifts and jealousy. Those working don't have any control over what their spouses are doing at home "alone" and those at home want to know who their spouses are doing at work. From the threads on the EMS forums, it there little doubt how something like that could have crossed their mind.