System Status Management

[Tigger]

I'm not sure I would survive 24 hours containment in an ambulance no matter the call volume. I would go nuts plus I hate having half an ear tuned to the radio. In quarters we get a phone call instead.

Our satellite base crews have recently been ordered to post in quarters and it is lovely. Management wants to save fuel and sitting outside of the base with the truck running was finally deemed wasteful. Well duh.

Also there is no reason a system of 40 units needs 40 stations, it's a fairy common practice in the emergency services to have double company houses. It might raise response times a tidbit but it will reduce costs. I can think of a few municipal EMS crews doing this already.

 

[Shishkabob]

Also there is no reason a system of 40 units needs 40 stations, it's a fairy common practice in the emergency services to have double company houses. It might raise response times a tidbit but it will reduce costs. I can think of a few municipal EMS crews doing this already.

While agreed 40 is a bit much, again, 20 is still VERY expensive and you will likely hardly ever see the station to begin with.


I'm perfectly content with my employer putting funds towards employees and new EMS programs like they currently are, over a station I'd hardly be at.

 

[NomadicMedic]

There were some very interesting EMS systems I looked at before I accepted my current position and system status management was the reason that I didn't pursue several of those job opportunities.

Let's face it, as long as EMTs and medics will put up with system status management, companies will continue to do it. Long shifts without downtime have been proven to be not safe for providers. And anyone that uses the excuse that fire departments run and don't see their bunks… When was the last time you saw a fire engine posting on a street corner or in the parking lot of a 7-11? Engine companies may be busy, but they still have a place to go and take off their boots for a couple of minutes and go to the bathroom… And eat a hot meal. The little creature comforts that make a 24 hour shift bearable.

I've worked in system status management systems and it blows. Never again.

 

[shfd739]

While agreed 40 is a bit much, again, 20 is still VERY expensive and you will likely hardly ever see the station to begin with.


I'm perfectly content with my employer putting funds towards employees and new EMS programs like they currently are, over a station I'd hardly be at.

Same here.

We have a handful of stations in the county and medics always whine about not getting to go to them between calls. At the same time we are almost always busy so then the complaints would be they dont get to spend enough time there.

If you work for 12hours and are busy it really isnt worth going to a station.

24s are different and you need to be going back for that downtime. Our 24s do that and a 12hr unit will run before a 24hr unit if they are at the same place. Once a 24hr unit gets that busy they need to be converted.

 

[medicdan]

There were some very interesting EMS systems I looked at before I accepted my current position and system status management was the reason that I didn't pursue several of those job opportunities.

Let's face it, as long as EMTs and medics will put up with system status management, companies will continue to do it. Long shifts without downtime have been proven to be not safe for providers. And anyone that uses the excuse that fire departments run and don't see their bunks… When was the last time you saw a fire engine posting on a street corner or in the parking lot of a 7-11? Engine companies may be busy, but they still have a place to go and take off their boots for a couple of minutes and go to the bathroom… And eat a hot meal. The little creature comforts that make a 24 hour shift bearable.

I've worked in system status management systems and it blows. Never again.

Ya know... I don't think I would have agreed 3 or 4 years ago... But there is a lot of comfort in having a couch to sit on even if just for a few minutes. A bathroom I don't need to search for, or buy something to use. A fridge to keep some healthy food and microwave to heat a homemade meal makes a 24 hour shift so much more bearable.

SSM sucks. A lot. But I'm an enabler

 

[Shishkabob]

Ya know... I don't think I would have agreed 3 or 4 years ago... But there is a lot of comfort in having a couch to sit on even if just for a few minutes. A bathroom I don't need to search for, or buy something to use. A fridge to keep some healthy food and microwave to heat a homemade meal makes a 24 hour shift so much more bearable.

Most of my local hospitals have all that in EMS rooms for us, and provide said drinks and food, too. But as stated, 24 hours is too long for SSM (and I'd argue for most of 'busy' systems in general).

 

[DrParasite]

anyone who deals with SSM should read this article

http://www.emsworld.com/article/103...wers-response-times-and-enhances-patient-care

It sucks, and I hate it. I work in a busy system, and we post our trucks. it sucks. At least we only post them to an area usually once a shift, not changing location every time a new calls enters the system.

Every EMS system should have stations. If you have 40 trucks, than having 40 stations isn't unreasonable (if you cover a 400 sq mile area). If you have a city that all 40 trucks, typically having 5 stations is acceptable. one in the center of the city, one in the north, south, east and west. you don't need one station for every unit. posting in a truck that is constantly in motion (and not due to assignments) sucks, and would make me never want to work there.

24 hour shifts are only acceptable if you have a place where you can sleep (hence why FD's have both firehouses and BEDS TO SLEEP IN). you aren't just napping on the couch or recliner, they have actual beds. Even a 12 hour shift sucks with SSM; if you are slow, be in a station, if you are too busy, maybe your system needs more units to allow proper downtime where they can complete paperwork, pee, eat, change clothes, etc. If nothing else, it saves gas and prevents injuries to employees.

But as Vene said, companies, especially many privates, don't give a crap about their employees because EMS orkers are a dime a dozen and they are there to make money, so I don't see this changing until we refuse to tolerate this practice.

 

[leoemt]

It isn't safe for providers.

It will continue because providers let it happen.

I got no problems with it. I feel its very safe. What makes it more dangerous than a fire fighter who has a station? Yes they get a comfy bed, but they still get woken up at all hours. I know some firefighters who work at busy stations and they don't get more than a 30 - 60 minutes of sleep in a shift.

When you work SSM you learn how to adapt. Sleep when you can and where you can. I know many a EMT and Medic who has napped on the cot between calls.

Sleep deprivation is a problem in all of emergency services, not just in SSM systems.

 

[Veneficus]

I got no problems with it. I feel its very safe. What makes it more dangerous than a fire fighter who has a station? Yes they get a comfy bed, but they still get woken up at all hours. I know some firefighters who work at busy stations and they don't get more than a 30 - 60 minutes of sleep in a shift.

When you work SSM you learn how to adapt. Sleep when you can and where you can. I know many a EMT and Medic who has napped on the cot between calls.

Sleep deprivation is a problem in all of emergency services, not just in SSM systems.

given the documented negative effects of sleep deprivation in every industry from the airlines to medicine, too many to cite here, that is like an alcoholic saying they have adapted to drunk driving.

Only instead of just driving, EMS is also making medical decisions and performing interventions as well.

Some light reading:

http://www.ncbi.nlm.nih.gov/pubmed/21226780

http://www.ncbi.nlm.nih.gov/pubmed/11462875

http://www.ncbi.nlm.nih.gov/pubmed/9248505

http://www.medscape.com/viewarticle/768414

 

[Veneficus]

a few more:

http://www.ncbi.nlm.nih.gov/pubmed/22785637

"Among all residents, the mean amount of daily sleep was 5.3 hours. Overall, residents' fatigue levels were predicted to increase the risk of medical error by 22% compared with well-rested historical control subjects."

http://www.ncbi.nlm.nih.gov/pubmed/11453317

http://www.ncbi.nlm.nih.gov/pubmed/19805768

effects of caffeine
http://www.ncbi.nlm.nih.gov/pubmed/20970177

 

[Tigger]

I got no problems with it. I feel its very safe. What makes it more dangerous than a fire fighter who has a station? Yes they get a comfy bed, but they still get woken up at all hours. I know some firefighters who work at busy stations and they don't get more than a 30 - 60 minutes of sleep in a shift.

When you work SSM you learn how to adapt. Sleep when you can and where you can. I know many a EMT and Medic who has napped on the cot between calls.

Sleep deprivation is a problem in all of emergency services, not just in SSM systems.

Your body is not adapting all that well. It's not possible. Yes everyone has to wake up for calls not matter what model they work in, but don't even try and tell me that sleeping sitting up in a barely reclining Ford E-Series seat is somehow equatable to a bed. It it is not. You do not rest as well having to tune an ear to the radio (and it has to be on, possibly waking you incidentally), having the homeless bang on your windows, or moving posting assignments. SSM is "safe" for 13 hour shifts and not much more. Eight would be ideal but I do not have a problem working 13 hour days so as to only work three days a week.

 

[NomadicMedic]

Even sleeping in my comfy bunk, I know I'm not my very best at 2:30 in the morning, when I'm awakened from a sound sleep.

Having to calculate drug dosages and perform invasive medical procedures after trying to sleep in a cramped ambulance wouldn't be doing my patients any favors.

 

[usalsfyre]

There's one private around here that does that. The thought of it scares me.

 

[WestMetroMedic]

Here is a little background, which I will use as a basis for my opinion.

I work in a Major metropolitan service that provides services to 14 different municipalities that have a resident population of about 800,000 and a weekday population of 1.2 mil. Our 135 full time paramedics operate 7 to 18 Dual Medic trucks in a dynamic deployment model. We don't use true SSM, but we have a modified version of it. We are a profitable County Based Hospital owned system. Paramedics are scheduled either 2 twelve hour shifts and 2 right hour shift weekly, or 4 ten hour shifts weekly. If we are short crews, Paramedics can be held up to a total shift length of 16 hours, but your carriage turns back into a pumpkin at 16:01 (it's the law).

I believe SSM is the right choice for my service area and I don't mind that. I also believe that a cookie cutter approach is not appropriate. SSM isn't beneficial everywhere, but it can be in many places. I know that if we didn't use that approach, my agency could not afford to pay me what I make right now.

We eliminated our final street corner station 2 years ago and now post at fire stations, police substations and properties that we lease throughout our service area. That was a god send.

If you are concerned about catching some sleep, perhaps you should sleep during your time off. I do my best to not sleep at work because I know I am capable of sleeping through tones, and I really think bed head and creases in your face from sleeping make you look slouchy.

I firmly believe that 24 shifts are unsafe. We [EMS Providers] love the convenience of them, but I feel we are doing our customers a disservice. I haven't done a 24 in 5 years, but I can tell you that I am fully capable of falling asleep driving emergent, Making errors and having a poor demeanor during the course of those 24's.

 

[shfd739]

I still fail to see how 24s are convenient. You spend the first day off recovering and the second day off resting cuz you go back the next day. Even my guys that work a slower 24 hr unit complained about this- they do 3-5 calls on average in 24hrs and are at the station when not on calls. For them we've adjusted the schedule to allow 3 days off every couple weeks.

We ask/policy that our employees get a minimum 6hrs sleep prior to their shift and we work mainly 8-12 hour shifts(except for 3, 24hr units in slooow counties). Being in a vehicle and up for 12 hours is not that hard and does not require a station to go back to.

You can get out of the unit and businesses or just walk around. A former partner and I used to stash 2 folding camp chairs in a compartment and chill in those when posted. Here we can do that most of the year on night shift.

Personally when Im at work I get no down time. Im either in the station/office working, driving(at minimum 225miles a shift) by myself, interacting with crews or running calls. Im away from the office about 10hours a shift. Its not that hard.

 

[RocketMedic]

There's one private around here that does that. The thought of it scares me.

I think I know who you're talking about. We have the same problem here in New Mexico- Superior Ambulance in Roswell runs 2-3 crews concurrently on 72-hour shifts in a relatively steady-fast system, and it's dangerous.

 

[MMiz]

I was on a 24 hour shift in a Type II rig and we were busy running from post to post all shift. We'd get to one, park, and then just a minute later were sent to another.

Eighteen hours in I called the supervisor and said we couldn't do it anymore. He agreed and let both of us go home.

SSM can be dangerous on a 24 hour shift.

Good luck!