When is enough, enough?

[KnightRider]

This is for the 24 hour guys really.

I work 24 hour shifts for a private EMS company. We do not do alot of "emergency" runs, but rather inter-facility transfers, discharges, and doctors appointments. Lately, it's starting to anger me because of the disparity in dispatching runs. The ALS crews get a relatively easy shift, while the BLS crews run their butts off. Sometimes, you have more ALS then BLS. We even have a ALS crew in the city 40 miles away and they seldom see a run, because they are sending the BLS crew all the way to their area to take what should be their runs. There is a dispatcher who will rotate pretty evenly. However, I am not always fortunate enough to work with him. We will literally run nearly all of the 24 hours. I ahve spoken to the other dispatchers and they want to keep the ALS crews more available. I feel its becoming a safety issue as I can barely stay awake to drive sometimes long distances and sometimes can not think straight. After hours, the EMT-B's will also be wheelchair van drivers for discharges not needing a stretcher. No sooner do you get in your bunk and the phone rings again and you are up.

Any advice??

 

[Jim37F]

Unless your company is about to lose one of its contracts OR is actively hiring more EMTs to add more units on the road, then you have to make a change.

Is there a slower station you can go to? My last company had stations that would routinely see 12-15 calls per 24hr shift (and thus get little to no sleep on shift) but we had other stations that would get half that and had decent chances of sleeping thru the night (of course you needed seniority and someone to leave in order to get one of those spots).

Alternatively, go to a 12 hr shift, or 16 or 8 or whatever other non 24s you have. I've only ever heard of fire Depts having exclusive 24hr shifts (and I worked at one that had 12 hr shifts on a full third of its ambulances)....yours would be the first private company I've heard of that DIDN'T have 12hr shifts (most of the private companies in areas I worked didn't even staff up any 24hr units at all, 12s were the longest you could get on any single shift).

If none of those are options at all (your company only has 24s, every BLS unit gets ran all night, no hiring boom or pending contract losses).....well you're SOL at your current employer. In which case you can either a) apply for a Supervisor position (assuming you have the seniority and meet the other requirements) since they typically don't run calls all night and day.....b)switch to another employer with better call volume/work schedule options....c)change careers all together....or d) simply put up with it.

 

[DesertMedic66]

Unless your company is about to lose one of its contracts OR is actively hiring more EMTs to add more units on the road, then you have to make a change.

Is there a slower station you can go to? My last company had stations that would routinely see 12-15 calls per 24hr shift (and thus get little to no sleep on shift) but we had other stations that would get half that and had decent chances of sleeping thru the night (of course you needed seniority and someone to leave in order to get one of those spots).

Alternatively, go to a 12 hr shift, or 16 or 8 or whatever other non 24s you have. I've only ever heard of fire Depts having exclusive 24hr shifts (and I worked at one that had 12 hr shifts on a full third of its ambulances)....yours would be the first private company I've heard of that DIDN'T have 12hr shifts (most of the private companies in areas I worked didn't even staff up any 24hr units at all, 12s were the longest you could get on any single shift).

If none of those are options at all (your company only has 24s, every BLS unit gets ran all night, no hiring boom or pending contract losses).....well you're SOL at your current employer. In which case you can either a) apply for a Supervisor position (assuming you have the seniority and meet the other requirements) since they typically don't run calls all night and day.....b)switch to another employer with better call volume/work schedule options....c)change careers all together....or d) simply put up with it.

A lot of the smaller companies will be 24 hour only. Before we bought out a smaller company (only staff 2 units per day) they were working 48 hour shifts. Due to their location they are still doing 48 hour shifts but can transfer to our main deployment (about 2 hours away) where they can have 12 hour shifts.

There is another company close by to me that did 48 hour shifts only with 3-4 units per day.

 

[CALEMT]

Before we bought out a smaller company (only staff 2 units per day) they were working 48 hour shifts.

But with their call volume and how those rigs rotate between calls makes it quite nice. 48/96 is hands down my favorite shift.

 

[DesertMedic66]

But with their call volume and how those rigs rotate between calls makes it quite nice. 48/96 is hands down my favorite shift.

Until the normal prison doctor is out and the sub calls 911 every 10 minutes for transfers haha

 

[CALEMT]

Until the normal prison doctor is out and the sub calls 911 every 10 minutes for transfers haha

**** that place.

 

[akflightmedic]

How many ambulances does your company have on the road?
How many are ALS and how many are BLS?
How long have you worked for this company?

See below for more questions, comments, and advice...

When is enough, enough?

That is for you to decide, rest assured you are not the first to ever encounter or question ****ty practices, companies or expectations.

This is for the 24 hour guys really.

Why? Is safety across the spectrum not for everyone regardless of length of shift or cultural employment practice?

I work 24 hour shifts for a private EMS company. We do not do alot of "emergency" runs, but rather inter-facility transfers, discharges, and doctors appointments.

If the busy shifts were all 911 "emergency" runs, every single time you worked, would it negate your complaint or concern? Ask yourself that, seriously. Because if you would push through it and actually relish wearing the "badge of no sleep" and running 28 calls in a 24 hour shift all because it was 911 then the rest of your "argument/complaint" is completely moot.

I seriously want to highlight this not only for you but for everyone else who comes along and reads it. Are inter-facility transfers beneath you and not worthy of your sleepless nights? You did know the shift and the type of work when you interviewed right?

**During your interview did you ask call volume, shift rotations and how they (the employer) handle dispatching, rotation and what their policy is for crews who run continuously? Did you ask about their safety measures in place?

or

Did you just accept the job cause you needed the job and were happy to gobble up any scraps handed to you?

Lately, it's starting to anger me because of the disparity in dispatching runs.

How long have you worked there?
And why "lately" is this just now starting to bother you? Has the honeymoon phase ended?

The ALS crews get a relatively easy shift, while the BLS crews run their butts off. Sometimes, you have more ALS then BLS. We even have a ALS crew in the city 40 miles away and they seldom see a run, because they are sending the BLS crew all the way to their area to take what should be their runs.

Do they? Again, not knowing the structure and size of your company, do they really get an easy shift? Are you aware of every single call, every single pending transfer? Sometimes transfers pend and never go for dozens of reasons. I am just trying to present and provoke thought from the other side. Do you know the contract details of that posted ALS unit 40 miles away? Being an EMT and just a cog in the wheel, I will assume you do not know them. Even the ALS crew themselves might not know it as that is usually an executive level access. Therefore, on surface while it seems the BLS crew being sent 40 miles away is more costly and unfair, there may be contract requirements in play which necessitate that.

There is a dispatcher who will rotate pretty evenly. However, I am not always fortunate enough to work with him. We will literally run nearly all of the 24 hours. I ahve spoken to the other dispatchers and they want to keep the ALS crews more available.

Are these other dispatchers you have spoken to in your chain of command? Is this the process your company instructed you to follow for concerns? You are barking up the wrong tree. Getting the dispatchers to confirm your opinion does nothing for your complaint. You very well may have a legitimate complaint, however you are not presenting it to the right people AND you are out seeking support instead of just pushing it up the ladder. If your concerns are legit, you do not need a whole consortium standing behind you nodding their heads in agreement. Understand?

I feel its becoming a safety issue as I can barely stay awake to drive sometimes long distances and sometimes can not think straight. After hours, the EMT-B's will also be wheelchair van drivers for discharges not needing a stretcher. No sooner do you get in your bunk and the phone rings again and you are up.

Have you pulled yourself off the road in these situations?

You FEEL it is a safety issue. Instead of feeling, I suggest you KNOW it is a safety issue and you document it. By documenting it, my suggestion is you present examples, statistics (what you do know for fact) and you SHARE it with your supervisors and above...in WRITING, preferably EMAIL. You then follow up after giving them some time to digest it or you call a meeting to discuss it in your initial complaint submission. THIS is the grown up thing to do.

If you are this passionate about changing something, then it is now on YOU to accomplish that. Do not recruit others; instead, document, document, document and then SHARE. I cannot stress that enough. If you never present your concerns and give the powers that be a chance to change, then you have failed. Along with your concerns, also present some ideas or changes which may be beneficial. Do not come with a long list of problems and have zero input on the fixes.

Any advice??

Read above, read again and then ACT.

 

[DrParasite]

oh, where to start, where to start..... to begin, I have worked as a 911 dispatcher for several years, as well as an IFT dispatcher.

I work 24 hour shifts for a private EMS company.

24 hour shift are great if it's slow, they suck if it's busy. There are numerous issues in EMS with provider fatigue, including several reported ambulance crashes.

We do not do alot of "emergency" runs, but rather inter-facility transfers, discharges, and doctors appointments.

I see what he is saying. it's more of a scheduling thing. you can't control when an emergency run will come in, but a non-emergency has more flexibility. IE, if the facility requests a truck, and you say it will take two hour for the truck to get there, than it gives the truck time, vs needing to send the closest truck.

Lately, it's starting to anger me because of the disparity in dispatching runs. The ALS crews get a relatively easy shift, while the BLS crews run their butts off. Sometimes, you have more ALS then BLS. We even have a ALS crew in the city 40 miles away and they seldom see a run, because they are sending the BLS crew all the way to their area to take what should be their runs.

let me educate you on how this work. a BLS crew can take a BLS run. an ALS crew can take a BLS run or an ALS run. a BLS crew CAN'T take an ALS run. Do you understand why they won't send an ALS crew from 40 miles away to do a BLS run?

Now, if I have several ALS units available, and a BLS unit is coming from 40 miles away, and the ALS unit can handle the quick BLS IFT, then I might send them. but if they are coming from 40 mile away, than it's a waste of time, especially when I have a closer BLS unit who can handle the call.

There is a dispatcher who will rotate pretty evenly. However, I am not always fortunate enough to work with him.

sounds like your just unlucky then

We will literally run nearly all of the 24 hours.

wait; your actually complaining about having to work for every hour that you are being paid to be at work? You know an ambulance that isn't on a run doesn't make money for your employer right?

I ahve spoken to the other dispatchers and they want to keep the ALS crews more available.

see earlier comment as to why

I feel its becoming a safety issue as I can barely stay awake to drive sometimes long distances and sometimes can not think straight.

i agree.

After hours, the EMT-B's will also be wheelchair van drivers for discharges not needing a stretcher.

did the EMTs pick up an OT shift? or are they being forced as a condition of employment?

No sooner do you get in your bunk and the phone rings again and you are up.

you're lucky to have a bunk. If I was your management, and you were running for 24 straight hours, I wouldn't waste money on providing you a bunk that you never got to use.

Any advice??

1) get your paramedic certification, so you can work one of those cushy ALS trucks 2) speak to your management about your concerns, citing safety reasons; also provide documentation about how 24 hour shifts are becoming a liability to the organization, and if you are really that busy, than it's time to switch to 12s. Provide examples of ambulance crashes and ems fatigue. if they aren't looking to switch 3) go work for another EMS agency.

Like it or not, in may systems BLS crews get ran into the ground, and it's even worse in tiered 911 systems....BLS gets sent on every EMS calls, and ALS might be added if its a call that meets ALS criteria. Don't like it? find a job that doesn't put you on the BLS ambulance. Or think of it as incentive to go to paramedic school, transfer into dispatch, become a supervisor, accept an administrative position, or help with training. Only you can determine when enough is enough.

 

[mgr22]

KnightRider, I'm not a "24 hour guy," but as Akflightmedic suggested, that shouldn't disqualify me from offering advice.

You probably already know that getting angry at work isn't a good thing, particularly when you're dealing with customers face to face. What are you angry at, exactly? 24-hour shifts? ALS providers? Dispatchers? The reason that's important is there are different solutions, depending on your answer. If you're angry at 24-hour shifts, find a company that doesn't make you do them. If you're angry at ALS providers, try becoming one. If you're angry at dispatchers...well, it might be best for you to do something other than EMS. There's nothing wrong with that; lots of people discover EMS isn't a good fit, and go on to fulfilling careers in other fields.

I'm guessing one reason for your frustration is that you're still pretty low on the food chain in an industry that doesn't exactly specialize in nurturing its entry-level people. Even moving up a step or two isn't likely to make you much happier, unless you feel something special about EMS that helps you get out of bed and go to work.

I see you're 34 -- old enough for me to assume (hope?) you've already considered most of what I'm saying. Sometimes all we need is a little validation to take the next step.

 

[RocketMedic]

Akflightmedic, I would not necessarily say that BLS IFT isn't worthy, but I don't think its worthy of sleepless nights either. BLS IFT can wait for a safe, fresh crew.

 

[akflightmedic]

Rocket...you took it out of context from the sentences which precede it.

 

[DrParasite]

Akflightmedic, I would not necessarily say that BLS IFT isn't worthy, but I don't think its worthy of sleepless nights either. BLS IFT can wait for a safe, fresh crew.

so from a management perspective, you think it makes good financial sense to be paying a crew to sleep while a contracted facility requests a service, and has to pay the staff to watch this patient, until a fresh crew comes in?

wouldn't it make more sense to send that crew home that is tired and either have no available units (since the crew you are paying isn't available anyway because they are tired) or switch every one to 12s so you can run them for 12 hours straight, and then not have to pay them when they go home and sleep?

 

[KnightRider]

Unless your company is about to lose one of its contracts OR is actively hiring more EMTs to add more units on the road, then you have to make a change.

Is there a slower station you can go to? My last company had stations that would routinely see 12-15 calls per 24hr shift (and thus get little to no sleep on shift) but we had other stations that would get half that and had decent chances of sleeping thru the night (of course you needed seniority and someone to leave in order to get one of those spots).

Alternatively, go to a 12 hr shift, or 16 or 8 or whatever other non 24s you have. I've only ever heard of fire Depts having exclusive 24hr shifts (and I worked at one that had 12 hr shifts on a full third of its ambulances)....yours would be the first private company I've heard of that DIDN'T have 12hr shifts (most of the private companies in areas I worked didn't even staff up any 24hr units at all, 12s were the longest you could get on any single shift).

If none of those are options at all (your company only has 24s, every BLS unit gets ran all night, no hiring boom or pending contract losses).....well you're SOL at your current employer. In which case you can either a) apply for a Supervisor position (assuming you have the seniority and meet the other requirements) since they typically don't run calls all night and day.....b)switch to another employer with better call volume/work schedule options....c)change careers all together....or d) simply put up with it.

To answer some questions:

I stay on 24's because it provides me flexibility. With school coming up, this is most important

There are no Supervisor positions to be had here. Small company. There are 2 (Operations Manager, Operations Director) and they are filled.

There are no other stations to go to. We have 2, one of which may not always be manned. Sometimes that 2nd stations crew comes to Station 1 if there is low call volume in their area

How many trucks are on the road just depends. We have a fleet of about 8 Ambulances. Sometimes 3 are on the road, sometimes 6. Some mechanical issues have sidelined some of them

Guess I will just have to put up with it

 

[KnightRider]

I guess for some of this, you have to be here to better understand. IFT's are not beneath me, but when you are constantly sent to the hospital for things you think a hospital should take care of to transport them hours away, it's infuriating. I guess more so for the patient who just wants to be treated and go home, not accrue more bills.

As far as the wheelchair vans, its not an OT thing. You will get pulled off your truck to do it. It just places your truck out of service and they will stack calls for you until you come back or you do like some others and just milk the call for all its worth to force Dispatch's hand to send another crew who may have not turned a wheel at all, or does little else all day. We know who has done what so figuring it out isnt hard.

I didnt mean to discount/disqualify the non-24 hour guys. Sorry.

What I am angry at is Dispatchers not wanting to use any other trucks but BLS truck. So, the same truck get hammered all the time. Its not safe for driving nor patient care. What angers me is the facilities know we are coming as some are set up in advance and the patient isnt ready. A couple of weeks ago we were tied down to a nurses station for 2 hours (no joke) in the middle of the night because a doctor didnt sign a transfer order before he left and another doctor didnt wanna touch it. Dispatch would not let us back in-service. Finally the on-call doctor took care of it. I had a chat with management about that and they said after a 1/2 hour we should just leave and they can call back. Its bad for the patients all around when facilities arent ready and when the crews can barely function.

 

[luke_31]

Ok knightrider I read everything that you wrote and not a single thing you said is unusual or abnormal for what we do. Is it fair, no. But guess what everyone here has had happen everything you listed. I don't think you're going to be too happy with this job long term, until you realize how messed up it is and accept that .... happens. I've been on calls where the patient is said to be ready and waited hours because the shunt won't clot or paperwork isn't ready, it sucks but I just find something to entertain myself with and wait. You are just a cog in the wheel of the medical treatment of a patient and yes most hospitals can take care of the patient that you are transporting out of there, but chances are it's an insurance issue that is the reason for them being transferred. This job wears people down and spits them out with all the bs you run into and most of the schools sell you on the excitement of running lights and sirens. Our job is mostly about getting a person from a to b, and making them comfortable as possible. If you still enjoy your interactions with the patients, I'd say keep going and just focus on what you can do for them and accept that you're not going to change an industry built around inefficiency. Moving up to a paramedic doesn't change much unless you get onto a fire department that doesn't do transfers. Good luck.

 

[DrParasite]

I stay on 24's because it provides me flexibility. With school coming up, this is most important

I completely understand..... but it's also unfair to your company to have to pay you to sleep when you could be generating more revenue for them. It's one thing if there are no runs to take, than you are being paid in the even if a run should occur; but if you have a job to do, than you should be expected to do it.

I guess for some of this, you have to be here to better understand. IFT's are not beneath me, but when you are constantly sent to the hospital for things you think a hospital should take care of to transport them hours away, it's infuriating. I guess more so for the patient who just wants to be treated and go home, not accrue more bills.

you really want to go up against a doctor involving whether or not a patient needs something? Do you really think your EMT training can trump his years of education to get his MD? I'm not saying your wrong, only that you will lose ever time.

As far as the wheelchair vans, its not an OT thing. You will get pulled off your truck to do it. It just places your truck out of service and they will stack calls for you until you come back or you do like some others and just milk the call for all its worth to force Dispatch's hand to send another crew who may have not turned a wheel at all, or does little else all day. We know who has done what so figuring it out isnt hard.

So you aren't on an extended shift, it's just a long night. nothing really bad, other than the fact that you are expected to work while you are being paid.

sounds like a management issue about some trucks milking calls, but at the end of the day, you are paid to work (or be available in case work comes in), not sleep.

What I am angry at is Dispatchers not wanting to use any other trucks but BLS truck. So, the same truck get hammered all the time.

see earlier statement about being expected to work during the entire time you are being paid. And I have tried to explain why they send you instead of the ALS truck in an earlier post.

Its not safe for driving nor patient care. What angers me is the facilities know we are coming as some are set up in advance and the patient isnt ready. A couple of weeks ago we were tied down to a nurses station for 2 hours (no joke) in the middle of the night because a doctor didnt sign a transfer order before he left and another doctor didnt wanna touch it. Dispatch would not let us back in-service. Finally the on-call doctor took care of it. I had a chat with management about that and they said after a 1/2 hour we should just leave and they can call back. Its bad for the patients all around when facilities arent ready and when the crews can barely function.

While this sucks for all around, it's a very common practice. Their time is more valuable than yours. 2 hours at a nursing station is annoying; management should correct the actions of the dispatcher who told you to wait. But I've had to wait outside of a facility for over an hour until the staff would come out and accept the patient. it sucks, but it happens all the time, and part of the nature of the job.

Maybe if you get a job at a 911 service you won't have to deal with issues like this?

 

[Colt45]

The company I work for doesn't have 24 hour BLS shifts for that exact reason. They do 12's so you can run all shift. Our 24 hour shifts are reserved for ALS only.

 

[hometownmedic5]

In a perfect world, BLS trucks do BLS call, ALS trucks do ALS calls and theres enough of each to handle the volume without overloading the system or having too much inefficiency(down time or dead head time).

That’s a perfect world, which does not describe the world we live in. Expecting them to tie up a medic truck to do a BLS call when they have BLS truck available so the basics can sleep isnt reasonable; just like it wouldn’t be reasonable to downgrade an ALS call to BLS so the medics can sleep.

Picture this: the phone rings and a bls transfer is booked, D/C to SNF 25 miles away. You have an ALS truck 10 minutes away and a BLS truck 30 minutes away. The patient is stable, no urgency. You want them to burn their ALS truck on a call that will take lets say 90 minutes. What if ten minutes after they commit to the transport, a stat vent job comes in. We’re talking the full package; vent, monitor, meds. The golden ticket in ambulance billing, a license to print money. But wait, you just sent your ALS truck out of town and this is a stat transfer, so if you cant be there in 10 minutes, they give the call to the next company. That dispatcher just turned a call worth several thousand dollars into a 300 dollar Medicare bls call. Why, so your BLS truck could catch a nap, watch Netflix, etc? Come on...

You’re on the clock, you’re expected to earn your pay. If being up for 24hrs without sleep doing calls doesn’t work for you, you either need a job in a slower system or shorter shifts.

 

[VentMonkey]

I don’t think the OP is looking for an easy way out, or a slow BLS shift. He genuinely seems frustrated.

That said, @KnightRider you either need a different line of work, a different service, or a different shift. Oh, and there are certainly stand-up ALS cars in 911 systems. It is the sad reality of this industry that appears stuck in a perpetual rut.

Most of the tenured folks on here have found ways to make it work for them regardless of their particular system; some are even actively seeking to make changes themselves. But, your idle complaining on an EMS board goes absolutely nowhere within your respective service.

 

[KnightRider]

I get it, some of you are seeing it in terms of money. I am seeing it in terms of safety. Nobody wants to die because the driver fell asleep at the wheel and drove off the road. Nobody wants to make a mistake somewhere because someone couldnt think straight, either ALS or BLS.

I guess I am just used to the fire-based EMS rather then the private-EMS system. The tones drop, you respond, drop them off at the ER, and go back in service. The private EMS system is just horrible. I'm not saying I agree with "milking" any call but I now understand why the hospital EMS rooms are typically full or the food and snacks have been picked through quickly. Nobody is in a hurry for a discharge from the hospital to your nursing home/rehab center. I've learned to try and sleep in the passenger seat on the way to pick up someone from 50+ mins out.