When is enough, enough?

[Akulahawk]

Nobody is in a hurry for a discharge from the hospital to your nursing home/rehab center.

When the hospital is full and the ED is holding patients because there's no beds available in the hospital... yeah, there can be a hurry to discharge patients from hospital to skilled nursing. I have had the distinct pleasure of taking care of Med/Tele patients (and ICU, occasionally too) for HOURS because there's no beds available in the hospital. I'm an ED nurse, not a Med/Surg/Tele, not an ICU nurse.

I've mostly been a field guy too. Once I promoted to supervisor, I had to cross-train to dispatch. I know that BLS can only run BLS, ALS can run both. I try to keep the ALS units available to run ALS calls, but I also will send them on BLS calls if the call is going to be a short duration and with the understanding that I can peel that ALS unit off a BLS call right up to the point where they've made patient contact. So that ALS car is never going to be stuck doing a 40 mile d/c run. I'll bring a BLS car 30 miles over to do that run while I'll happily send that ALS car to d/c a patient from a hospital to a SNF that's 5 or 10 minutes down the road, knowing that the ALS crew is going to be rather speedy in getting that call done so they can be available and I'll even give the sending facility as accurate an ETA as I can.

Where things really get "interesting" is when you have contracts with facilities for "private emergency" runs. Those are basically 911-avoidance contracts. If my company had an availability contract like this, then I'll keep the ALS crew available and let the BLS crews run all the BLS calls. The dispatchers likely won't know the specifics of a contract, but will be told what they must do because of it, like literally: Keep an ALS crew available over in this area at all times unless they're running an ALS call from X facility. BLS units are to take all BLS calls in that area, ALS is not to take those, even if they ask to.

 

[VentMonkey]

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.

Um, pretty sure this is the goal of every 24-hour shift in existence ever, fire-based or private.

The private EMS system is just horrible.

And what makes an over taxed, over worked fire-based system such as LAFD, Chicago, Philadelphia, or New York so much better or efficient?

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.

It’s certainly nice to have refreshments provided, and to be able to take even just a little break. Also, I’m pretty sure fire-based providers get just as hungry being ran an entire 24-plus hours as well. Do you do this much complaining at work?

Again, the options have been laid out for you, but perhaps a different outlook on life might not be a bad idea either //shrugging//.

Oh, and as another former supervisor like @Akulahawk, and others who are on here have pointed out, you really do not know what you do not know...good luck.

 

[KnightRider]

Wow, here I am asking a safety-related question out of concern for my patients and the crew and I’m getting attacked. Incredible!

 

[akflightmedic]

I think you have been given some very solid advice from multiple individuals who have extensive experience and knowledge within EMS. If all you see are attacks, I suggest you go back and read again...especially the posts which were chock full of advice....which is what you posted for and sought.

I did notice at no time did you expand the conversation on any of the nuggets of wisdom, instead you countered with more complaints or non-solution input.

Just saying, if you truly want to change it, then snatch up some of the advice and let's digest it some more or you can go do some of the advice and report back on how it went.

 

[DrParasite]

I get it, some of you are seeing it in terms of money. I am seeing it in terms of safety.

No, you are looking at it from a microscopic point of view, focused only from your ambulance, while many of us are trying to explain how things work from a macroscopic point of view, explaining how there are more stakeholders here that just you. these stakeholders include the facilities, management, dispatchers, and hospital. It's not money vs safety, it's what you want to do vs how the real world operates.

I guess I am just used to the fire-based EMS rather then the private-EMS system.

So why are you not with a fire-based EMS system? If that is what you are used to (and I'm assuming that's because you have experience working a a system like that), and that is what you want, I would think you would have no problems returning to the fire based system.

I've learned to try and sleep in the passenger seat on the way to pick up someone from 50+ mins out.

I've actually slept on the bench seat (secured with three buckles) as my partner drove 50 minutes to get to the pickup. and I've dozed off in the passenger seat too.

Wow, here I am asking a safety-related question out of concern for my patients and the crew and I’m getting attacked. Incredible!

Calm down, cool your butthurt, you're not getting attacked.... What is happening is you came here expecting one answer, and several experienced EMS providers (who have worked in systems both similar and dissimilar to yours) explained to you how, while your point of view was valid, it wasn't the only point of view, and there are several other factors that are contributing to why the system is what it is.

Here is my suggestion: next time you are working, and are too tired to continue working (which I agree, is a serious safety concern). notify dispatch that you are too tired to operate the vehicle safely, and will be returning to base. Go inside, give the keys to the dispatcher (or whomever keeps them), and go home sick. If you are that adamant that it's a safety issue concerning your patient and crew, than YOU have a responsibility to prevent said issue from risking the lives of your crew and patient. You can't control what runs you get sent on, you can't control when the facilities call, and you can't control the schedule that management has imposed on the you. What you can control is how you operate, and if you think it's a legitimate and serious safety concern, than you have an obligation to take your truck out of service, and go home, out of concern for your crew and patients. You might get called into the boss's office the next day to explain your actions; but if you think it's a valid safety concern, than you should should have no problem justifying what you did and why.

 

[n00bmedic]

No, you are looking at it from a microscopic point of view, focused only from your ambulance, while many of us are trying to explain how things work from a macroscopic point of view, explaining how there are more stakeholders here that just you. these stakeholders include the facilities, management, dispatchers, and hospital. It's not money vs safety, it's what you want to do vs how the real world operates.

While I certainly understand what you're saying, and I agree to some extent (private ambulance companies can't pay providers if they aren't making money), making excuses for owners of ambulance companies is, IMO, a BS excuse. There are proven safety concerns with running a stand-up 24, and to dismiss them and essentially treat someone as a complainer because of concerns is ridiculous.

Part of the problem in EMS, and a major contributor to the current staffing/turnover problem, is labor practices such as expecting someone to run a stand up 24 without complaining. In fact, I don't think it's unreasonable to expect regular breaks just as any other normal job. Sure, we all know what we're getting into, but that isn't a license to run minimal staffing and abuse crews. Personally, I have no problem running late calls or being busy, if the city I work in is busy. However, when dispatch pulls some BS like they did to me just this morning (I was dispatched to a call 5 minutes before the end of my shift, and passed another in-service unit to get to said call), I get a little pissy.

 

[luke_31]

While I certainly understand what you're saying, and I agree to some extent (private ambulance companies can't pay providers if they aren't making money), making excuses for owners of ambulance companies is, IMO, a BS excuse. There are proven safety concerns with running a stand-up 24, and to dismiss them and essentially treat someone as a complainer because of concerns is ridiculous.

Part of the problem in EMS, and a major contributor to the current staffing/turnover problem, is labor practices such as expecting someone to run a stand up 24 without complaining. In fact, I don't think it's unreasonable to expect regular breaks just as any other normal job. Sure, we all know what we're getting into, but that isn't a license to run minimal staffing and abuse crews. Personally, I have no problem running late calls or being busy, if the city I work in is busy. However, when dispatch pulls some BS like they did to me just this morning (I was dispatched to a call 5 minutes before the end of my shift, and passed another in-service unit to get to said call), I get a little pissy.

You want regular breaks and no stand up 24hrs, it's time to get out of EMS. It is the nature of the job. Regular breaks are something that is not a part of the job, some days you may be running all day and others you can be sitting in the ambulance for an hour or two waiting for your next call. We've already told you that if you don't like running 24hr shifts because you're getting run for most of the shift to find a company that has 12hr shifts or other non 24 options. Welcome to the job I can't count how many calls I've run in the last five minutes of my shift or how many crews I've waved to as I pass them by heading to a call. You're not in dispatch, so you don't know what is going on up there. Crews can be standing by locations for a call that is getting ready to be run, contracted posting location requiring said crew to be there for specific reasons, and just normal mistakes of seeing one unit is available and sending them on a call when they forget that they posted a unit in the area earlier. All that happens, it's the nature of the job. I don't go to work expecting to sit down and not work for any hours of my shift. I've worked 26hrs or more without seeing my bunk or station, and in the same token have started my shift checking the ambulance and then never turned the wheel again for the rest of the shift. As much as you don't want to hear it, all you are doing is complaining and getting upset that much more experienced providers then you are not being all sympathetic to your gripes. Maybe you should reevaluate your desire to be in EMS as you seem to have serious issues with the basics of how this job works, it's not for everyone, and sometimes you have to be working the job to find that out.

 

[DrParasite]

making excuses for owners of ambulance companies is, IMO, a BS excuse.

I wasn't making excuses, I was explaining how the less than ideal situation the OP occurs. I never said it was ideal, or a good idea.

There are proven safety concerns with running a stand-up 24, and to dismiss them and essentially treat someone as a complainer because of concerns is ridiculous.

There absolutely are safety concerns with running a stand-up 24, and I didn't treat the OP as a complainer simply because of his concerns. Personally, I would never work for a company that ran stand-up 24s on a regular basis. Once in a while, sure, disasters happen. but if it's a regular thing, than my health and safety come first, and i will gladly seem employment elsewhere. No point in complaining about it, no one really wants to hear your complaints anyway.

Part of the problem in EMS, and a major contributor to the current staffing/turnover problem, is labor practices such as expecting someone to run a stand up 24 without complaining. In fact, I don't think it's unreasonable to expect regular breaks just as any other normal job. Sure, we all know what we're getting into, but that isn't a license to run minimal staffing and abuse crews.

hahah regular breaks in EMS? "I'm sorry Mr tax payers, i know your mother isn't breathing, but the ambulance crew is on their lunch break, once they have paid the check, they will gladly go and help your mom." or is it "sorry mr tax payer it's nap time for the EMS crew.... yes, i know they are being paid to be at work, but they need their nap too. I know your son just got hit by a car. don't worry, once they wake up, i'll be sure to send them right over."

Apparently you need this education too: you are paid to work. you aren't paid to sleep, you aren't paid to eat, you aren't paid to do HW for school, you aren't paid to watch TV. from the moment you clock in, until the moment you clock out, you are expected to work. whether you work 8s, 12s, 24s, or 48s, it does not matter. from the moment you clock in, until the moment you clock out, you are expected to work. Can you sleep, eat, and watch TV, if you have no other work to do? sure, and I will say I have done it too. But my job, what my employer is paying me to do, is to do the job that they hired me to do, for the duration of my shift.

Now you want breaks? That's not unreasonable. In fact, it's legally required according to the department of labor. Your agency should have a policy for how breaks are handled. maybe you should ask them?

I worked for one busy 911 agency that said any crew that was not on an assignment (IE, before you were dispatched to one) could request and be granted a 10 minute break. During that 10 minutes, by written policy, they could not be dispatched to an assignment, regardless of what else was happening in the system. After 10 minutes, they were immediately put back into the rotation.

I also worked at a transport company, in dispatch, and gave a crew a run at 11:30am. They hadn't done anything for 2 hours. when they were assigned the run, they actually told me "can we get lunch first?" They didn't do anything for 2 hours, and now that they have a run, they want a lunch break?

If you think your company is not giving you the legally required breaks, then you should ask your management why they aren't happening. If you don't like the answer, you can always contact the state DOL or the federal DOL and have them investigate. They will do so gladly. Or you can quit and find a slower agency, or one that only runs 12s at the max. See, that's not complaining, that's being proactive and actually working on solving the problem, or removing yourself from the "dangerous situation."

Personally, I have no problem running late calls or being busy, if the city I work in is busy. However, when dispatch pulls some BS like they did to me just this morning (I was dispatched to a call 5 minutes before the end of my shift, and passed another in-service unit to get to said call), I get a little pissy.

You sure they were in service? why didn't that crew contact dispatch and offer to take the job for you? Would it have put them outside of their contracted response area? Personally, I'd be more pissed at the other crew who knew they were closer, than the dispatchers who are in a windowless room and don't always get told where all the units are.

Remember what I said earlier? "from the moment you clock in, until the moment you clock out, you are expected to work." I hate late calls as much as the next guy, especially if I had plans after work, but I also know until my shift ends (and even then, if I'm still the closest unit, until I get back to my station), I can get sent on another call.

Did you contact the supervisor and ask why the situation happened? maybe dispatch screwed up. maybe the crew was only an assignment. maybe you just pissed off dispatch, and they weren't looking to help you out. or did you just say "dispatch is being mean to me, I'm going to be pissy even though I don't know the entire situation." Have you ever worked in dispatch, and seen how easy it is? I mean, it's really easy to complain about dispatch from the road, it's a lot harder to actually do the job.

 

[KnightRider]

[DELETED]

 

[KnightRider]

[DELETED]

 

[DrParasite]

[DELETED]

Now I'm curious what was deleted, especially since you quoted my response.... Hey @Chimpie , wasn't the edit time capped at 10 minutes?

@KnightRider , if you want to PM me about anything I said, feel free too. It's very likely that I've been in your position, and can help enlighten you based on my experience as to how you can make things better

 

[KnightRider]

Now I'm curious what was deleted, especially since you quoted my response.... Hey @Chimpie , wasn't the edit time capped at 10 minutes?

@KnightRider , if you want to PM me about anything I said, feel free too. It's very likely that I've been in your position, and can help enlighten you based on my experience as to how you can make things better

Wasnt anything bad really but I didnt want it to seem like I was stirring the pot. I didnt see an option to delete a post so I did that instead.

 

[n00bmedic]

You want regular breaks and no stand up 24hrs, it's time to get out of EMS. It is the nature of the job. Regular breaks are something that is not a part of the job, some days you may be running all day and others you can be sitting in the ambulance for an hour or two waiting for your next call. We've already told you that if you don't like running 24hr shifts because you're getting run for most of the shift to find a company that has 12hr shifts or other non 24 options. Welcome to the job I can't count how many calls I've run in the last five minutes of my shift or how many crews I've waved to as I pass them by heading to a call. You're not in dispatch, so you don't know what is going on up there. Crews can be standing by locations for a call that is getting ready to be run, contracted posting location requiring said crew to be there for specific reasons, and just normal mistakes of seeing one unit is available and sending them on a call when they forget that they posted a unit in the area earlier. All that happens, it's the nature of the job. I don't go to work expecting to sit down and not work for any hours of my shift. I've worked 26hrs or more without seeing my bunk or station, and in the same token have started my shift checking the ambulance and then never turned the wheel again for the rest of the shift. As much as you don't want to hear it, all you are doing is complaining and getting upset that much more experienced providers then you are not being all sympathetic to your gripes. Maybe you should reevaluate your desire to be in EMS as you seem to have serious issues with the basics of how this job works, it's not for everyone, and sometimes you have to be working the job to find that out.

You've got me confused with the thread starter.

I've been doing this job for a little over 5 years, so I certainly know what it's all about. Like I said, it's not unreasonable to expect to be treated like a human being. You're not special for running 26 hours straight without a break; nobody in any other industry or any other job would do such a thing or tolerate those conditions on a regular basis. Sure, as DrParasite said, disasters happen. When they do, that's fine, and I wouldn't even consider grousing about extended work and/or no breaks in those circumstances. However, everyday call volume is decidedly NOT a disaster. If an agency is not staffing enough units appropriately to handle that call volume and still give their employees a break, that's wrong.

 

[luke_31]

You've got me confused with the thread starter.

I've been doing this job for a little over 5 years, so I certainly know what it's all about. Like I said, it's not unreasonable to expect to be treated like a human being. You're not special for running 26 hours straight without a break; nobody in any other industry or any other job would do such a thing or tolerate those conditions on a regular basis. Sure, as DrParasite said, disasters happen. When they do, that's fine, and I wouldn't even consider grousing about extended work and/or no breaks in those circumstances. However, everyday call volume is decidedly NOT a disaster. If an agency is not staffing enough units appropriately to handle that call volume and still give their employees a break, that's wrong.

Initially though you were the OP and was responding to some of that. But stuff does happen and it wasn't planned to run a 26hr shift, but when it's a busy day and then the hospital you work for sends someone 200miles away, it's not like you can say no I've only had a few minutes rest today. You and your partner get in the rig and the one in back tries to rest while the other drives, so you have at least something resembling rest to stay awake for driving back.

 

[n00bmedic]

hahah regular breaks in EMS? "I'm sorry Mr tax payers, i know your mother isn't breathing, but the ambulance crew is on their lunch break, once they have paid the check, they will gladly go and help your mom." or is it "sorry mr tax payer it's nap time for the EMS crew.... yes, i know they are being paid to be at work, but they need their nap too. I know your son just got hit by a car. don't worry, once they wake up, i'll be sure to send them right over."

Like I said in my reply above to luke_31, it is the agency's responsibility to staff an appropriate number of units for the call volume of their area. If they don't, I absolutely do not think it's unreasonable to demand a break or refuse a call. Fortunately, I've never been in that situation because the places I've worked don't suck that much. Although I have refused late calls, as in, I got dispatched after my shift ended but I was still on the road. F that, dispatch somebody else.

Apparently you need this education too: you are paid to work. you aren't paid to sleep, you aren't paid to eat, you aren't paid to do HW for school, you aren't paid to watch TV. from the moment you clock in, until the moment you clock out, you are expected to work. whether you work 8s, 12s, 24s, or 48s, it does not matter. from the moment you clock in, until the moment you clock out, you are expected to work. Can you sleep, eat, and watch TV, if you have no other work to do? sure, and I will say I have done it too. But my job, what my employer is paying me to do, is to do the job that they hired me to do, for the duration of my shift.

Now you want breaks? That's not unreasonable. In fact, it's legally required according to the department of labor. Your agency should have a policy for how breaks are handled. maybe you should ask them?

I worked for one busy 911 agency that said any crew that was not on an assignment (IE, before you were dispatched to one) could request and be granted a 10 minute break. During that 10 minutes, by written policy, they could not be dispatched to an assignment, regardless of what else was happening in the system. After 10 minutes, they were immediately put back into the rotation.

I also worked at a transport company, in dispatch, and gave a crew a run at 11:30am. They hadn't done anything for 2 hours. when they were assigned the run, they actually told me "can we get lunch first?" They didn't do anything for 2 hours, and now that they have a run, they want a lunch break?

If you think your company is not giving you the legally required breaks, then you should ask your management why they aren't happening. If you don't like the answer, you can always contact the state DOL or the federal DOL and have them investigate. They will do so gladly. Or you can quit and find a slower agency, or one that only runs 12s at the max. See, that's not complaining, that's being proactive and actually working on solving the problem, or removing yourself from the "dangerous situation."

I'm not saying there aren't lazy people out there. They exist in every job. Hell, I don't even have any complaints about my current workload; a busy shift for me is 7 calls in 12 hours. I usually run 4 or 5. The entire point of my argument is that, at a certain point, the call load becomes too much. I wouldn't have thought that would be a controversial opinion with other EMS providers, but maybe more are dense or drink that "Hero EMT kool-aid" a bit too much than I thought.

You sure they were in service? why didn't that crew contact dispatch and offer to take the job for you? Would it have put them outside of their contracted response area? Personally, I'd be more pissed at the other crew who knew they were closer, than the dispatchers who are in a windowless room and don't always get told where all the units are.

Remember what I said earlier? "from the moment you clock in, until the moment you clock out, you are expected to work." I hate late calls as much as the next guy, especially if I had plans after work, but I also know until my shift ends (and even then, if I'm still the closest unit, until I get back to my station), I can get sent on another call.

Did you contact the supervisor and ask why the situation happened? maybe dispatch screwed up. maybe the crew was only an assignment. maybe you just pissed off dispatch, and they weren't looking to help you out. or did you just say "dispatch is being mean to me, I'm going to be pissy even though I don't know the entire situation." Have you ever worked in dispatch, and seen how easy it is? I mean, it's really easy to complain about dispatch from the road, it's a lot harder to actually do the job.

Yeah, I'm sure they were in service. They were posted in the city the call dropped in, then got sent to the post I was at until I got dispatched. It was a dispatch screw up. Which is less excusable considering we are SSM and have functioning GPS on all of our trucks. Even if the GPS wasn't working on the other truck, they were posted in the city we were sent to, while we were about 5 miles outside of it. It's a small town; there is no way they were further than the 7 1/2 miles away that we were.

And yes, I have worked in dispatch. It doesn't take a genius. In fact, in my system, the CAD program essentially does everything but answer the phone and make the final dispatch decision on who to send. Everything else is assigned automatically (call priority, what questions to ask the caller, any dispatch instructions, etc). It even tells the dispatcher what the closest unit is, along with every other available unit.

 

[Tigger]

hahah regular breaks in EMS? "I'm sorry Mr tax payers, i know your mother isn't breathing, but the ambulance crew is on their lunch break, once they have paid the check, they will gladly go and help your mom." or is it "sorry mr tax payer it's nap time for the EMS crew.... yes, i know they are being paid to be at work, but they need their nap too. I know your son just got hit by a car. don't worry, once they wake up, i'll be sure to send them right over."

Meanwhile, in the rest of the world, EMS often does have scheduled breaks. When I lived in New Zealand I did a ride with busiest station in Auckland (1.4mil). We were pretty busy, but not stacked. I was amazed to find that the crew got an hour for lunch. Between (I think) 1100 and 1400 they were to get an uninterrupted hour break, unless they were the closest unit to an echo level call. The crew informed me this hardly happened (multiple ambulances in the station), but if it did, they'd run the call and then get an even longer break. They also got an afternoon 30 minute break with same conditions. Tax and charity supported, very modern system. I don't understand why US EMS is proud that we don't enjoy such working conditions.

Their busier stations worked 12 hour shifts. They could work up to 16 hours at time before needing 12 hours of rest. Seems pretty solid. I work 24s now but if we were any busier we'd need more staff to make it reasonable.

 

[n00bmedic]

Meanwhile, in the rest of the world, EMS often does have scheduled breaks. When I lived in New Zealand I did a ride with busiest station in Auckland (1.4mil). We were pretty busy, but not stacked. I was amazed to find that the crew got an hour for lunch. Between (I think) 1100 and 1400 they were to get an uninterrupted hour break, unless they were the closest unit to an echo level call. The crew informed me this hardly happened (multiple ambulances in the station), but if it did, they'd run the call and then get an even longer break. They also got an afternoon 30 minute break with same conditions. Tax and charity supported, very modern system. I don't understand why US EMS is proud that we don't enjoy such working conditions.

Their busier stations worked 12 hour shifts. They could work up to 16 hours at time before needing 12 hours of rest. Seems pretty solid. I work 24s now but if we were any busier we'd need more staff to make it reasonable.

Misery loves company?

 

[DrParasite]

Like I said in my reply above to luke_31, it is the agency's responsibility to staff an appropriate number of units for the call volume of their area. If they don't, I absolutely do not think it's unreasonable to demand a break or refuse a call.

Actually, no, it's not.

It's the Authority Having Jurisdiction that staffs and appropriate number of units. They are the ones who provide the funding that allows the agency to staff so many units. So if the town/county/region/political people who make and approve budgets only provides enough funding for X units, it's not like the agency can provide more, at least not without an additional funding source. And all too often, they barely provide enough funding to staff appropriately.

When the AHJ contracts with a third party provider, they often determine how many units are required, and fund that many. if they wanted more, they could always pay for more, but all too often that doesn't happen.

I'm curious, what would happen to you at your employer if you refused a call, because you were demanded a break? Inquiring minds want to know

Yeah, I'm sure they were in service. They were posted in the city the call dropped in, then got sent to the post I was at until I got dispatched. It was a dispatch screw up. Which is less excusable considering we are SSM and have functioning GPS on all of our trucks. Even if the GPS wasn't working on the other truck, they were posted in the city we were sent to, while we were about 5 miles outside of it. It's a small town; there is no way they were further than the 7 1/2 miles away that we were.

And yes, I have worked in dispatch. It doesn't take a genius. In fact, in my system, the CAD program essentially does everything but answer the phone and make the final dispatch decision on who to send. Everything else is assigned automatically (call priority, what questions to ask the caller, any dispatch instructions, etc). It even tells the dispatcher what the closest unit is, along with every other available unit.

Based on what you just said, it sounds like it was more of a CAD screw up than anything else, or failure of the GPS system, as well as a screw up on the other crew for not offering to take the call since they were closer. I won't say dispatchers don't make mistakes, but it seems like there were multiple contributing failures in the system.

Meanwhile, in the rest of the world, EMS often does have scheduled breaks. When I lived in New Zealand I did a ride with busiest station in Auckland (1.4mil). We were pretty busy, but not stacked.

Please define busy..... the busiest units at my old job in NJ did 18 calls in 12 hours during the summer months..... Now I will openly admit that their system is woefully understaffed, and urban EMS/Taxi service at its worst, but they were busy.

My personal busiest 12 hour shift ever involved doing 11 calls, two of which were mutual aid into other counties, and one was a transport of a trauma to a trauma center in another county. And we broke into my apartment at 2am (which was in the same town at the trauma center) because my drunk girlfriend and her friend got themselves locked out after a night of drinking.

So being the busiest can be a relative term.

I was amazed to find that the crew got an hour for lunch. Between (I think) 1100 and 1400 they were to get an uninterrupted hour break, unless they were the closest unit to an echo level call. The crew informed me this hardly happened (multiple ambulances in the station), but if it did, they'd run the call and then get an even longer break. They also got an afternoon 30 minute break with same conditions. Tax and charity supported, very modern system. I don't understand why US EMS is proud that we don't enjoy such working conditions.

wait... multiple ambulances... in a station? tax funded? So no street corner posting, no SSM, and enough units to actually give units appropriate downtime so they can eat a meal in peace? It sounds like the ideal EMS system.

BTW, I don't know of many in EMS that are "proud that we don't enjoy such working conditions," but with the outsourcing of many well funded and well staffed EMS systems to the lowest bidder (often a crappy private company), all in the name of saving money, I think you can see why many US agencies aren't budgeted for such luxuries. Although I totally wish they were.

 

[n00bmedic]

Actually, no, it's not.

It's the Authority Having Jurisdiction that staffs and appropriate number of units. They are the ones who provide the funding that allows the agency to staff so many units. So if the town/county/region/political people who make and approve budgets only provides enough funding for X units, it's not like the agency can provide more, at least not without an additional funding source. And all too often, they barely provide enough funding to staff appropriately.

When the AHJ contracts with a third party provider, they often determine how many units are required, and fund that many. if they wanted more, they could always pay for more, but all too often that doesn't happen.

I'm curious, what would happen to you at your employer if you refused a call, because you were demanded a break? Inquiring minds want to know

That's fine, but if a company (in my case, a hospital) entertains a contract with a municipality, would you disagree that they have a responsibility to tell said municipality how many units are needed? After all, the agency providing the ambulance is obviously the subject matter expert and is in a position to know what is required.

As for refusing a call, I'm not sure. The first time, I'd probably get told not to do it again. Subsequent instances would get successive discipline, I would assume. But that's fine...I can find another job. I have a career in public safety spanning 12 years, the past 5 of which are in EMS. Like I said, I can find another job. However, the complaints I have with my hospital system don't involve dispatching, staffing levels, or call volume, so it's a moot point. I can say that my last employer stated flatly that crews refusing calls would get fired, but I did it twice there and was never even talked to. Both times I was "just" an EMT, so it wasn't like they were trying to hold onto a medic.

Based on what you just said, it sounds like it was more of a CAD screw up than anything else, or failure of the GPS system, as well as a screw up on the other crew for not offering to take the call since they were closer. I won't say dispatchers don't make mistakes, but it seems like there were multiple contributing failures in the system.

Sure, the other crew were being ****s. They knew they would have been closer, and the call was a "sick person", which is the catch-all category for BS calls that we use. The dispatchers, however, have a map of the county with all units on it. Regardless of what the computer says, a competent dispatcher would check the map. Especially when that same dispatcher spoke to the unit in question posting them in the city where the call came in less than a half hour later.

 

[DrParasite]

That's fine, but if a company (in my case, a hospital) entertains a contract with a municipality, would you disagree that they have a responsibility to tell said municipality how many units are needed? After all, the agency providing the ambulance is obviously the subject matter expert and is in a position to know what is required.

5 years in EMS, I'm guessing entirely as a field provider right? never a supervisor or more accurately, never management right? no worries, let me explain how things work, because your mostly wrong.

There are typically two way a "contract" is decided upon (and in this case, I'm using the term contract to include agency exclusive systems too): an RFP, and a budgetary allocation. With an RFP (request for proposal), the municipality states what they want (# ambulances, response times, etc,) and agencies reply with proposals for how much it will cost. The idea is to create a bidding war, often with the lowest bidder getting the contract. Sometimes an entity (such as the hospital you work for) will provide the service for free to the municipality, offering to just bill the patient, because they figure they will get good PR out of the deal and it will help drive more patients to their facility. So even if your hospital has the contract this year, once it's up, they might not keep it

The other method, budgetary allocation, is more common with government and quasi government agencies. In these cases, the agency IS the provider, and the head of the agency (fire chief, EMS director, whatever), writes up a budget, which is then submitted to the AHJ. It calls for # ambulances and all the support staff, and the AHJ can either approve it, deny it, or deny it with the direction that it needs to be trimmed down, because the AHJ budget only wants to allocate so much to EMS. So while the director can ask for 100 ambulances, and can even demonstrate that their is a need, but if the AHJ says they will only provide them funding for 75 ambulances, guess what happens? Even if you are a quasi governmental (typically volunteer EMS agencies or formerly volunteer EMS agencies that are technically not part of the municipal government, but have been providing the service for decades), you typically get some type of funding, however the actual amount is decided by the town; there is no guarantee that if you ask for it that they have to provide it.

I used to work for two hospitals, which were the contracted EMS providers for their respective cities. in the first, the city paid us 0 a year to have 1 dedicated BLS ambulance available 24/7. This was in a city that could get as many as 5 EMS calls at once, which were covered by non-contract mandated ambulances whose primary assignment was not to run 911 calls in the municipality. But the city contact called for 1 ambulance, and that was what was dedicated to them. The other city was contracted to provide 4 BLS ambulances 24/7. The hospital funded an additional 4 ambulances, on a 12 hour peak load schedule, and even then we still had calls stacked frequently. If someone complained about a long wait, they were more than welcome to speak to hospital administration, but we met the requirements of the contract; they could complain to the city, but the city only paid for 4 ambulances..... so at the end of the day, who do you think would ultimately be held accountable? That's right, the person who actually provided the funding. at those two hospitals, ALS was a regional thing, and I have no clue how that was funded (other than from the hospital's budgets).

So your absolutely, 100% right, your agency is the SME on how many ambulances are needed, and how many you would like..... but directors who request too many resources typically have relatively short careers, and at the end of the day, even though you need so many ambulances to do the job right, there is no guarantee you will actually be granted the funding for it.

It's not as simple as saying "as the SME on EMS in your town, we need 10 ambulances to do the job properly, to not run our crews into the ground, and to ensure rapid response 24/7, so please cut us a check for everything we are asking for."

I can say that my last employer stated flatly that crews refusing calls would get fired, but I did it twice there and was never even talked to. Both times I was "just" an EMT, so it wasn't like they were trying to hold onto a medic.

sounds like you had good reasons to, at least from the point of view from someone above you... and I also bet others have been fired for doing so in the past. it all depends on if management agrees with you or not.

Sure, the other crew were being ****s. They knew they would have been closer, and the call was a "sick person", which is the catch-all category for BS calls that we use. The dispatchers, however, have a map of the county with all units on it. Regardless of what the computer says, a competent dispatcher would check the map. Especially when that same dispatcher spoke to the unit in question posting them in the city where the call came in less than a half hour later.

fair enough. file a written complaint with management, and maybe they will fix the issue. As I said earlier, dispatching is easy, doing it well, not so much. and there are plenty of people who shouldn't be in dispatch, for various reasons (lack of competency is definatly one of them)