When is enough, enough?

[Tigger]

There are significantly more variations to how municipalities contract. For starters, these contracts/RFPs don't have to specify any sort of set staffing. If the contract says you need to provide a paramedic ambulance in less than 8 minutes to 90% of calls, it is up to the contractor to choose how to do that. Also, franchise fees are becoming more and more common, which is when a contractor pays for exclusive rights to a territory. In such arrangements it is rare for municipalities to stipulate actual resource numbers. It is hard enough to get companies to "bid" on paying money to operate, much less also require them to do anything besides meet response time guidelines.

 

[Tigger]

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.
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.

I could really care less about war stories, I still pick up in a system that routinely runs cars at 0.7UHU. I know exactly what the suck looks like. The point is that this was not some retirement house station. Busy, urban EMS, yet somehow they still figure out a way to get their people scheduled breaks and not hold them over. Too often I hear "well there's nothing we can do, it's private EMS." Sure there is, we could have some standards. I sit here, at my regular job that is only funded at 60% by taxes, in a station, with two ambulance crews, alternating calls. We don't have defined breaks, though our call volume probably does not warrant it given our staffing. We are not special, we just do the right thing. When things got bad, we increased staffing, and we'll do it again. Put up with crap conditions for long enough and they become the conditions. Not everyone has the ability to make change, I get that. But just immediately dismissing the idea of being treated decently is awful.

 

[Tigger]

Misery loves company?

I guess so. I see it all the time when I work my shifts in the city and it's just depressing.

 

[n00bmedic]

I could really care less about war stories, I still pick up in a system that routinely runs cars at 0.7UHU. I know exactly what the suck looks like. The point is that this was not some retirement house station. Busy, urban EMS, yet somehow they still figure out a way to get their people scheduled breaks and not hold them over. Too often I hear "well there's nothing we can do, it's private EMS." Sure there is, we could have some standards. I sit here, at my regular job that is only funded at 60% by taxes, in a station, with two ambulance crews, alternating calls. We don't have defined breaks, though our call volume probably does not warrant it giving our staffing. We are not special, we just do the right thing. When things got bad, we increased staffing, and we'll do it again. Put up with crap conditions for long enough and they become the conditions. Not everyone has the ability to make change, I get that. But just immediately dismissing the idea of being treated decently is awful.

I can not agree with you more.

The only way to change this kind of thing is for providers to vote with their feet. It happened at my last company. The place went from literally telling EMTs they were a dime a dozen and easily replaced, to raising wages by $2.50 across the board for basics and changing a whole slew of their more antagonistic employee policies. That change came about because so many people left that they couldn't meet their contractual obligations to the large city fire department that they performed BLS transports for. That is the kind of change that needs to happen at many (most?) ambulance providers. Unfortunately, people seem to have this concept that the more hardship and sacrifice they go through in EMS, the more "worthy" they are, or something.

This job is hard enough; having sh!tty working conditions doesn't need to be one more thing to deal with.

 

[n00bmedic]

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."
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.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)

Of course the municipality has the option of dictating what they will staff. At the same time, the company wanting the contract can also decline. Obviously, this doesn't mean the municipality will see the error of their ways: another company or provider will likely be happy to swoop in and take the contract anyway. Ultimately, the problem is the unscrupulous administrators that agree to provide insanely low staffing levels when they know exactly what it will mean. People like this need to be run out of this field.

I was a manager once (not in health care). I had roughly 20 direct reports, and an additional 40 indirect reports. I worked in contract security at a large electric utility, so I'm aware of contract negotiations and how the process goes, at least in private business. I never once abused my staff, or expected something from them that I wouldn't do myself. For this, I was rewarded with an extremely hardworking and loyal workforce who would do anything I needed them to. However, I was met with open hostility by my superiors, and was never promoted further. The moral of the story is that just because people are spineless, or go along to get along, doesn't mean the system in place is the right way of doing things. Stop coming down on those voices who point out the obvious, glaring flaws with the system and start going after those who created the mess in the first place. The expectation of being treated like any other human being in any other job IS NOT some insane request, and treating it as such is one of the big reasons why this profession does not have the respect or recognition it deserves.

 

[KnightRider]

Of course the municipality has the option of dictating what they will staff. At the same time, the company wanting the contract can also decline. Obviously, this doesn't mean the municipality will see the error of their ways: another company or provider will likely be happy to swoop in and take the contract anyway. Ultimately, the problem is the unscrupulous administrators that agree to provide insanely low staffing levels when they know exactly what it will mean. People like this need to be run out of this field.

I was a manager once (not in health care). I had roughly 20 direct reports, and an additional 40 indirect reports. I worked in contract security at a large electric utility, so I'm aware of contract negotiations and how the process goes, at least in private business. I never once abused my staff, or expected something from them that I wouldn't do myself. For this, I was rewarded with an extremely hardworking and loyal workforce who would do anything I needed them to. However, I was met with open hostility by my superiors, and was never promoted further. The moral of the story is that just because people are spineless, or go along to get along, doesn't mean the system in place is the right way of doing things. Stop coming down on those voices who point out the obvious, glaring flaws with the system and start going after those who created the mess in the first place. The expectation of being treated like any other human being in any other job IS NOT some insane request, and treating it as such is one of the big reasons why this profession does not have the respect or recognition it deserves.

Our company founder was about the employees as well as the customer. He cared about people. He passed away last year and his daughter is now in charge and she respects nobody, but they issue a memo asking for respect among other things. We are run hard for crappy pay and she and management could care less about improving life while we live there for 24 hours.

 

[Chimpie]

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

It was changed to 60 minutes back in June.

 

[DrParasite]

I could really care less about war stories, I still pick up in a system that routinely runs cars at 0.7UHU.

UHU of 0.7? ha, I wish. IIRC our peak load units had a UHU of around 1.2. But your right, that is a sucky situation.

Busy, urban EMS, yet somehow they still figure out a way to get their people scheduled breaks and not hold them over.

you didn't answer my question. What do you mean by busy? my small city has 1 BLS ambulances assigned to it 24/7. It was busy, and definitely urban EMS. If you added a second or third ambulance, it was no less urban, but was less busy. With more trucks, you can provide uninterrupted breaks, but overall runs per shifts affects what you define as "busy." So I ask you again, what did you mean by "they were busy"?

Too often I hear "well there's nothing we can do, it's private EMS." Sure there is, we could have some standards. I sit here, at my regular job that is only funded at 60% by taxes, in a station, with two ambulance crews, alternating calls. We don't have defined breaks, though our call volume probably does not warrant it given our staffing. We are not special, we just do the right thing. When things got bad, we increased staffing, and we'll do it again. Put up with crap conditions for long enough and they become the conditions. Not everyone has the ability to make change, I get that. But just immediately dismissing the idea of being treated decently is awful.

I never said anything of the such... and if your funded 60% by taxes, then i'm guessing you make up the other 40% from bills for services, which probably have a high return of payment. Many of these places have a 90% self pay or write off, so they can't afford it. The money needs to come from somewhere, which is why they are tax supported

There are significantly more variations to how municipalities contract.

you right, I was trying to break it down to the bare basics.

For starters, these contracts/RFPs don't have to specify any sort of set staffing. If the contract says you need to provide a paramedic ambulance in less than 8 minutes to 90% of calls, it is up to the contractor to choose how to do that. Also, franchise fees are becoming more and more common, which is when a contractor pays for exclusive rights to a territory. In such arrangements it is rare for municipalities to stipulate actual resource numbers. It is hard enough to get companies to "bid" on paying money to operate, much less also require them to do anything besides meet response time guidelines.

Wait, so your telling me that companies are paying for rights to an area, the municipality pay nothing at all, and they expect to make a profit simply based on billing returns? no wonder private EMS gets paid peanuts and ran into the grounds. i'm also glad i have never worked in a system like that; it seems like crappy place to work from the get go, based on the simple economics.

Of course the municipality has the option of dictating what they will staff. At the same time, the company wanting the contract can also decline. Obviously, this doesn't mean the municipality will see the error of their ways: another company or provider will likely be happy to swoop in and take the contract anyway. Ultimately, the problem is the unscrupulous administrators that agree to provide insanely low staffing levels when they know exactly what it will mean. People like this need to be run out of this field.

as you said, people like should be run out of the field, but once you run one out, two more will take their place. It's similarly bad with private EMS companies, throw one out and an even worse one will take the contact and take it's place.

For this, I was rewarded with an extremely hardworking and loyal workforce who would do anything I needed them to. However, I was met with open hostility by my superiors, and was never promoted further.

sounds like you experienced what I said before:

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.

The only way to change this kind of thing is for providers to vote with their feet. It happened at my last company. The place went from literally telling EMTs they were a dime a dozen and easily replaced, to raising wages by $2.50 across the board for basics and changing a whole slew of their more antagonistic employee policies. That change came about because so many people left that they couldn't meet their contractual obligations to the large city fire department that they performed BLS transports for. That is the kind of change that needs to happen at many (most?) ambulance providers.

Truer words were never spoken.

 

[Tigger]

UHU of 0.7? ha, I wish. IIRC our peak load units had a UHU of around 1.2. But your right, that is a sucky situation.you didn't answer my question. What do you mean by busy? my small city has 1 BLS ambulances assigned to it 24/7. It was busy, and definitely urban EMS. If you added a second or third ambulance, it was no less urban, but was less busy. With more trucks, you can provide uninterrupted breaks, but overall runs per shifts affects what you define as "busy." So I ask you again, what did you mean by "they were busy"?
I never said anything of the such... and if your funded 60% by taxes, then i'm guessing you make up the other 40% from bills for services, which probably have a high return of payment. Many of these places have a 90% self pay or write off, so they can't afford it. The money needs to come from somewhere, which is why they are tax supported

you right, I was trying to break it down to the bare basics. Wait, so your telling me that companies are paying for rights to an area, the municipality pay nothing at all, and they expect to make a profit simply based on billing returns? no wonder private EMS gets paid peanuts and ran into the grounds. i'm also glad i have never worked in a system like that; it seems like crappy place to work from the get go, based on the simple economics.

It. does. not. matter. how. busy. the. crews. are. They could be running a UHU of a thousand, and they would still get a lunch break. Lower priority calls hold until a unit is available. It is a government mandate. None of this eight minute for emergent and 12 for non-emergent calls crap that so many municipalities choose based on literally nothing.

We have a miserable collection rate, as do nearly all EMS services doing 911. There's a variety of ways to break it down but the simplest is that we get back around 30% of the total that we bill out. That is a common number for all population densities. CMS reimbursements are awful no matter where you are, and with the ACA most payor mixes will be majority CMS and the state Medicaid equivalent. It beats self pay which was the norm in most areas before, however.

Yes, franchise fees are a thing. AMR has more than a few operations that they do this, as did RM and I believe Falck as well.

 

[RocketMedic]

Here's my take on this:

1) Part of the issue is productivity vs coverage.

If you're looking at producing something, be it burgers, cars or profits on the stock market, you're looking for employees who spend as much of their time as possible working as productively as possible. Breaks and incentives are tools to maximize productivity within that time spent at work and are dictated by psychology and physiology more than anything- if you really care to dig, that's why most schools used to have "recess" periods at set times and why shift work generally has accepted mid-morning and mid-afternoon breaks. Productivity and performance improve when people are able to 'reset', but they're not really vital if the pace of the work is reasonably intermittent. Ideally, you as a manager actually leave the timing of breaks to your field personnel (supervisor) and allow them the discretion to adjust timing to real-time needs- this is how it works in pretty much every industry, where a fairly informal process capably handles who is on-break and who is 'covering' for them. In EMS, the 'production' model really only works in environments that are consistently busy enough to reasonably assure that there will be calls within the shift and area the unit is assigned to- this is the gateway to SSM and 'dynamic posting' and all that those models entail. You're not necessarily covering an area, you're offering X amount of transports and trying to increase that number X with operational controls (like caps on time-at-hospital, no breaks, drop policies, etc) and eventually adding additional units. The provider tries to push through twin goals- service for each individual call and throughput to allow for the most calls possible to cycle through the system, not dissimilar to a clerk working their way through a queue. This might sound abusive, but in a true productivity-oriented (the EMS term is 'high-performance') organization, the staffing is usually adjusted to keep each individual unit at a busy, yet reasonable UHU, and the shift lengths are generally capped at 12 hours. This usually means 8, 10, or 12 hours in a truck, running calls, but as a paramedic who has done exactly that for years, you can pretty reasonably work, relax, eat and function on busy shifts. Adding an extra few minutes for a break at the end of a call doesn't really have any affect on the system as a whole, nor does even a supervisor- or dispatch-controlled break system. There's downsides to this approach- burnout, fatigue, the perception of being 'but a cog in the wheel', lack of opportunities for other work or pursuits due to frequent shifts, a poor work/life balance, etc), but it's also a faster pace for EMS work, and although a busy 12 can certainly tire you, I don't think it's as inherently dangerous as a 24. Obviously (and sadly) many providers of all kinds view the productivity approach as the best one and staff/deploy to make it fit a 24-hour coverage model. In the productivity model, the overall objective is to answer as many calls for service as is efficiently possible. Questions of coverage area, staffing, response/deployment, etc are controls on that to define what and where those calls might be. The classic productivity question is anything SSM- the model itself is defined by how productive it can be in comparison to less-efficient coverage systems.

On the other hand, there's the coverage model. These aren't necessarily 24s, but in EMS/Fire, they are almost always 24s. The coverage model isn't so much concerned with productivity as it is 'covering' defined regions and/or populations with assets deemed to be reasonably necessary and accessible within a defined period of time. Whether or not those services are required in a defined period of time is a secondary concern to whether or not they are available from the perspective of management. Coverage-oriented models don't necessarily prioritize the productivity of a unit assignment; the coverage model emphasizes the coverage of an area and productivity concerns are secondary (or even tertiary). In the coverage model, human limitations like fatigue, breaks, etc and call volume are used to determine how many resources need to be stationed in an area to fulfill the mission of coverage as defined by contract, management, the public, etc.

Obviously, no matter which philosophy we are following, both are important. EMSA/AMR would make a lot more money for its shareholders if it only ran IFTs, but part of its mission and mandate is to provide 911 coverage; Houston Fire Department's core mandate is to provide 911 EMS and Fire coverage for the city of Houston, but is aware that human and physical limitations dictate how productive a particular unit can be and thus must consider productivity in its staffing solutions.

It sounds like the company you're working for, @KnightRider , is a coverage-oriented organization that is trying to maximize productivity. This isn't necessarily wrong, but it does bring out some issues.

2. SAFETY
Safety is EMS, in many other fields, would be considered criminally negligent. We lack even rudimentary fatigue controls, have an industrial culture of willful, wanton disregard for fatigue and human limitations, and build entire systems around responding in degraded conditions. We do it in aging, unsafe vehicles, with subpar restraints and lift systems, and without adequate training in many cases. Worse, our leadership on all levels is often either ignorant or unconcerned about these issues to the point of inaction, to the point where you have woefully-disconnected leadership who doesn't seem to respect or care about these concerns or that only offer platitudes. Luckily, this usually doesn't affect us directly in a significant manner, but it is a concern that you are feeling directly. I wouldn't go so far as to say that long-hour shifts are always wrong, but choosing to deploy people in long-hour shifts is introducing a lot of direct (fatigue-related) and indirect risks (increased exposure to harassment/fraternization claims, family stress, etc). In a perfect world, leadership would thoughtfully examine workload, expectations and anticipations to determine what mix of schedules is ideal, but most places aren't that thoughtful.

3. Pay, Work-Life Balance, and Income:
As other posters have commented, you're at one of the low points of EMS right now- BLS transfer. There's a lot of demand for your service and very little of it is particularly exciting, fun or even what you want to be doing. Whether or not you are able to leave that role is entirely dependent on you, but it's not going to realistically change. You're the steward of your own career, and although you've pointed out that you're not in a position to go to 12s currently, there may be other options for you, even if you are going to school or even paramedic school. From the sound of it, your organization kind of sucks- you should look at moving somewhere better if this is something you want to do.

 

[TheEleventhHour]

I could only suggest switching to a Company that provides 12-Hour Shifts. It would be more days than you want (possibly due to schooling schedule) but at least you won't be risking your own mental well-being as well as patient well-being from exhaustion.

 

[KnightRider]

Here's my take on this:

1) Part of the issue is productivity vs coverage.

If you're looking at producing something, be it burgers, cars or profits on the stock market, you're looking for employees who spend as much of their time as possible working as productively as possible. Breaks and incentives are tools to maximize productivity within that time spent at work and are dictated by psychology and physiology more than anything- if you really care to dig, that's why most schools used to have "recess" periods at set times and why shift work generally has accepted mid-morning and mid-afternoon breaks. Productivity and performance improve when people are able to 'reset', but they're not really vital if the pace of the work is reasonably intermittent. Ideally, you as a manager actually leave the timing of breaks to your field personnel (supervisor) and allow them the discretion to adjust timing to real-time needs- this is how it works in pretty much every industry, where a fairly informal process capably handles who is on-break and who is 'covering' for them. In EMS, the 'production' model really only works in environments that are consistently busy enough to reasonably assure that there will be calls within the shift and area the unit is assigned to- this is the gateway to SSM and 'dynamic posting' and all that those models entail. You're not necessarily covering an area, you're offering X amount of transports and trying to increase that number X with operational controls (like caps on time-at-hospital, no breaks, drop policies, etc) and eventually adding additional units. The provider tries to push through twin goals- service for each individual call and throughput to allow for the most calls possible to cycle through the system, not dissimilar to a clerk working their way through a queue. This might sound abusive, but in a true productivity-oriented (the EMS term is 'high-performance') organization, the staffing is usually adjusted to keep each individual unit at a busy, yet reasonable UHU, and the shift lengths are generally capped at 12 hours. This usually means 8, 10, or 12 hours in a truck, running calls, but as a paramedic who has done exactly that for years, you can pretty reasonably work, relax, eat and function on busy shifts. Adding an extra few minutes for a break at the end of a call doesn't really have any affect on the system as a whole, nor does even a supervisor- or dispatch-controlled break system. There's downsides to this approach- burnout, fatigue, the perception of being 'but a cog in the wheel', lack of opportunities for other work or pursuits due to frequent shifts, a poor work/life balance, etc), but it's also a faster pace for EMS work, and although a busy 12 can certainly tire you, I don't think it's as inherently dangerous as a 24. Obviously (and sadly) many providers of all kinds view the productivity approach as the best one and staff/deploy to make it fit a 24-hour coverage model. In the productivity model, the overall objective is to answer as many calls for service as is efficiently possible. Questions of coverage area, staffing, response/deployment, etc are controls on that to define what and where those calls might be. The classic productivity question is anything SSM- the model itself is defined by how productive it can be in comparison to less-efficient coverage systems.

On the other hand, there's the coverage model. These aren't necessarily 24s, but in EMS/Fire, they are almost always 24s. The coverage model isn't so much concerned with productivity as it is 'covering' defined regions and/or populations with assets deemed to be reasonably necessary and accessible within a defined period of time. Whether or not those services are required in a defined period of time is a secondary concern to whether or not they are available from the perspective of management. Coverage-oriented models don't necessarily prioritize the productivity of a unit assignment; the coverage model emphasizes the coverage of an area and productivity concerns are secondary (or even tertiary). In the coverage model, human limitations like fatigue, breaks, etc and call volume are used to determine how many resources need to be stationed in an area to fulfill the mission of coverage as defined by contract, management, the public, etc.

Obviously, no matter which philosophy we are following, both are important. EMSA/AMR would make a lot more money for its shareholders if it only ran IFTs, but part of its mission and mandate is to provide 911 coverage; Houston Fire Department's core mandate is to provide 911 EMS and Fire coverage for the city of Houston, but is aware that human and physical limitations dictate how productive a particular unit can be and thus must consider productivity in its staffing solutions.

It sounds like the company you're working for, @KnightRider , is a coverage-oriented organization that is trying to maximize productivity. This isn't necessarily wrong, but it does bring out some issues.

2. SAFETY
Safety is EMS, in many other fields, would be considered criminally negligent. We lack even rudimentary fatigue controls, have an industrial culture of willful, wanton disregard for fatigue and human limitations, and build entire systems around responding in degraded conditions. We do it in aging, unsafe vehicles, with subpar restraints and lift systems, and without adequate training in many cases. Worse, our leadership on all levels is often either ignorant or unconcerned about these issues to the point of inaction, to the point where you have woefully-disconnected leadership who doesn't seem to respect or care about these concerns or that only offer platitudes. Luckily, this usually doesn't affect us directly in a significant manner, but it is a concern that you are feeling directly. I wouldn't go so far as to say that long-hour shifts are always wrong, but choosing to deploy people in long-hour shifts is introducing a lot of direct (fatigue-related) and indirect risks (increased exposure to harassment/fraternization claims, family stress, etc). In a perfect world, leadership would thoughtfully examine workload, expectations and anticipations to determine what mix of schedules is ideal, but most places aren't that thoughtful.

3. Pay, Work-Life Balance, and Income:
As other posters have commented, you're at one of the low points of EMS right now- BLS transfer. There's a lot of demand for your service and very little of it is particularly exciting, fun or even what you want to be doing. Whether or not you are able to leave that role is entirely dependent on you, but it's not going to realistically change. You're the steward of your own career, and although you've pointed out that you're not in a position to go to 12s currently, there may be other options for you, even if you are going to school or even paramedic school. From the sound of it, your organization kind of sucks- you should look at moving somewhere better if this is something you want to do.

I think this is the best post yet and really nails it head on. They will even call us on a status check because they want to drop the next run on us. They take all these runs and dont think that maybe we just cant get to them all but will be upset that we cant and when clients cancel because we took too long. They will call other services and take their overflow and dont care if we run all the time. One of our Paramedics said that he doesnt care what the call volume is and he will pull over on the side of the road for 45 mins and catch a nap if his truck has been running all night. My BLS partner can be kinda flighty and she doesnt see things like that, though she will equally complain how overworked we are. So, we had to devised our own shortcuts and disappear from the grid for a while until they figure out that they havent heard from us in a while, especially when it comes to lunch breaks. We figure if its a discharge or an IFT, it can wait a few minutes since staff never has the patient or paperwork ready to go anyway so we mark enroute, swing through a drive-thru along the way, mark out at the hospital and eat there as quick as we can and then go deal with the patient. The whole sleeping thing we havent figured out yet because of the cameras in the bays and day room that Dispatch can see. I know some may disagree with the "shortcuts" but if dispatch is never going to let us have a meal break for 12 hours, we have little other choice.

 

[Bullets]

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.

You are right, there are proven safety concern with doing 24hr shifts. OP should provide this proof to his employer. Then there is documentation that he expressed his concern and when an incident occurs, there will be a record that he spoke to his management and it was ignored, or not, depending on what they do.

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.

I work in a system like this, SSM is a joke and i refuse to work for an agency that operates with it. It is the #1 way to kill morale, and when they discussed starting it where i run, i told them i would quit if they wanted my staff to start posting.

We have a miserable collection rate, as do nearly all EMS services doing 911. There's a variety of ways to break it down but the simplest is that we get back around 30% of the total that we bill out.

I mean, that's really really terrible. Im getting like 70% return on billing and i only do 911. While we do have a good payer base and a good demographic, i still couldn't imagine anything less then like 50%

The biggest problem OP has is that for the most part, EMTs are a dime a dozen. Unless you have a regional upheaval in the providers, i can replace any EMT tomorrow with another body. We are talking about a job that requires no high school diploma and 150ish hours of vo-tec education. I have hundreds of applications on my desk for 15 open spots. Hopefully you can find a place with scrupulous management who actually cares, but i know many an IFT company this is far from it. Look how long it took nursing to get where they are. Only just now are 4 year degrees becoming standard, safe ratios are being instituted and we see that they are willing to strike to get what the want.

Unless you are working for once of those rare agencies that provides additional services beyond BLS care, youre going to have a hard time exerting leverage because being an EMT just isnt valuable. But if those special agencies exist i am sure you know about them. And the applicant list is a mile long

I try to get my guys breaks, i try to get them to eat their meals hot, ill jump on a truck at lunchtime if they get a call, but with a .04UHU, they have plenty of down time during their shifts that its not generally an issue. Op needs to ask around and find a place. What you may not understand is that i know down to the cent how much it cost me to run an ambulance every day. I know how much i get in billing. i know when and where our calls occur. So i know exactly how i need to staff to make a profit. You as a line staff may not understand or be privy to this as i doubt your company has a quarterley staff meeting. So saying that a company needs more trucks may sound great, but based on call volumes, it just doesnt make sense.

We have 2 trucks, my staff wants them to both be 12hr trucks. Problem is that we dont have the call volume between 1800-0800 to justify having 2 trucks on. So we have a shorter shift trucks that cover our busiest times, 1000-1800. I try and explain that to my staff so they understand.

 

[RocketMedic]

If your employer needs you to bring evidence showing that 24s are dangerous, they really don't care and don't want change.

 

[Carlos Danger]

The biggest problem OP has is that for the most part, EMTs are a dime a dozen. Unless you have a regional upheaval in the providers, i can replace any EMT tomorrow with another body. We are talking about a job that requires no high school diploma and 150ish hours of vo-tec education. I have hundreds of applications on my desk for 15 open spots. Hopefully you can find a place with scrupulous management who actually cares, but i know many an IFT company this is far from it. Look how long it took nursing to get where they are. Only just now are 4 year degrees becoming standard, safe ratios are being instituted and we see that they are willing to strike to get what the want.

This IS the whole issue, right here. As long as a company can quickly, easily, and cheaply replace employees, they have little incentive to go out of their way to keep those employees happy. It's the same reason why fast food workers rarely make more than $10/hr or so.

FWIW, I think any improvements in working conditions for nurses really has less to do with anything the nursing workforce has done, and more to do with the fact that the ramifications of nurses being overworked is visible and somewhat easily quantified. For example, it doesn't take too many cases of patients missing important med administrations or assessments before physicians become irate and get administration to force nursing management to figure out why it happens and fix it. Also it is fairly easy to research the influence of nursing ratios on patient outcomes - much harder to do that kind of study in EMS. And lastly, many folks in leadership positions within hospitals are nurses or at least have worked closely with them and are familiar with the problem of being overworked and stretched too thin. The threat of strike is probably a minor contributor as fewer than 20% of RN's are unionized and in some states they can't strike anyway.

If your employer needs you to bring evidence showing that 24s are dangerous, they really don't care and don't want change.

Not caring and not wanting to change are two very different things. An employer can care a lot and either no be aware of simply not be convinced that a proposed change is necessary or that it would alleviate the problem.

It may seem obvious to us that working for 24 hours presents potential safety issues, but you might be surprised by the types of things that are obvious to everyone except management. And right or wrong, when you are busy running a business or operation and there are many things competing for your attention and your limited resources, it is easy to dismiss concerns that are only occasionally raised, or only raised by a small percentage of your employees. Ever see Undercover Boss? "These guys have been running the same way for years, and we've never had a problem and no one has ever complained except a few people here and there and they didn't stay around anyway. We will look into the issue more, when we have time" is the way they view these things.

It's also hard to imagine an employer having a flippant attitude towards the safety of their employees, even if for no reason other than the potential legal and financial ramifications.

 

[DrParasite]

It. does. not. matter. how. busy. the. crews. are.

just because you say it does not matter, still doesn't make it true. I asked a simple question, one you are either unwilling to answer out of ignorance, or refusing to answer because you know it will undermine your statement about this "super busy EMS station." Your crew might consider 3 calls in the urban area a busy day.... I don't know, hence why I asked.

The truth is, many EMS units in the US (especially inner city units) run more calls in a shift than they should. They are busy. Your crew in Australia might say they are busy, and it might be for them. A buddy of mine used to work for FDNY EMS.... he said, during an 8 hour shift, that he was got slammed one day; he ran 5 calls in 8 hours in Manhattan.... does anyone else consider 5 calls in 8 hours getting slammed? So it's all region specific. Which is why i keep asking for an actual number

They could be running a UHU of a thousand, and they would still get a lunch break. Lower priority calls hold until a unit is available. It is a government mandate. None of this eight minute for emergent and 12 for non-emergent calls crap that so many municipalities choose based on literally nothing.

I guess their tax payers accept it and their agency's budget for enough units to allow for that one hour lunch break. I know I have never had the pleasure of being able to do so.

And as a random aside, I wish more agencies held low priority calls, but do you think then people would be complaining that once they cleared one job, they had another low priority call waiting for them? and they were again, too busy?

Yes, franchise fees are a thing. AMR has more than a few operations that they do this, as did RM and I believe Falck as well.

Ah, that explains it. I briefly worked for RM back in 2001, and since then refused to work for a for profit EMS system. It still sounds like a recipe for disaster (especially taking into account what you said about miserable collection rate for 911 systems). The money for the profit needs to come from somewhere.... employee pay rates, equipment, staffing levels.....

They will even call us on a status check because they want to drop the next run on us.

that's their job....... once you are available, give you your next assignment. You would be surprised (or, rather, might not be) by how many crews will not call available once they clear a job because they are intentionally avoiding getting their next assignment).

They take all these runs and dont think that maybe we just cant get to them all but will be upset that we cant and when clients cancel because we took too long. They will call other services and take their overflow and dont care if we run all the time.

again, at its most basic level, your job is to make money for the company..... why are you complaining about having to do your job? that's why your employers gives you $$$ to come to work, so you can make them $$$$

One of our Paramedics said that he doesnt care what the call volume is and he will pull over on the side of the road for 45 mins and catch a nap if his truck has been running all night.

that's awesome..... what does your company management think of that? if he can do it, why don't you?

My BLS partner can be kinda flighty and she doesnt see things like that, though she will equally complain how overworked we are. So, we had to devised our own shortcuts and disappear from the grid for a while until they figure out that they havent heard from us in a while, especially when it comes to lunch breaks. We figure if its a discharge or an IFT, it can wait a few minutes since staff never has the patient or paperwork ready to go anyway so we mark enroute, swing through a drive-thru along the way, mark out at the hospital and eat there as quick as we can and then go deal with the patient.

nothing wrong with getting food from the drive through on the way to your next run. it's not like you are stopping and spending 45 minutes eating in the restaurant.. You ever stop and wonder that the reason you get status checked to get the next run is because you disappear from the grid so frequently?

You know, most dispatchers either started out on a truck, or spent years on a truck before accepting a position in dispatch. if you call them and ask if you can get a bite on the way, they will usually work with you, and tell the receiving facility that you will need an extra 10 minutes, provided it's not an emergency run. I know I did that frequently for my units.

The whole sleeping thing we havent figured out yet because of the cameras in the bays and day room that Dispatch can see. I know some may disagree with the "shortcuts" but if dispatch is never going to let us have a meal break for 12 hours, we have little other choice.

You have never slept in the truck?

You know, I think I have a solution for you..... transfer into dispatch. It's a great gig, totally climate controlled, you RARELY get stuck on a late job, and you have unlimited access to power (to charge cell phones, laptops, etc), and often internet. Maybe even TV. You can usually bring your lunch (so you don't go hungry), and you can actually make the schedule better for your field crews, instead of simply complaining about all those mean dispatchers. If you really think you can do it better, what's stopping you?

 

[KnightRider]

just because you say it does not matter, still doesn't make it true. I asked a simple question, one you are either unwilling to answer out of ignorance, or refusing to answer because you know it will undermine your statement about this "super busy EMS station." Your crew might consider 3 calls in the urban area a busy day.... I don't know, hence why I asked.

The truth is, many EMS units in the US (especially inner city units) run more calls in a shift than they should. They are busy. Your crew in Australia might say they are busy, and it might be for them. A buddy of mine used to work for FDNY EMS.... he said, during an 8 hour shift, that he was got slammed one day; he ran 5 calls in 8 hours in Manhattan.... does anyone else consider 5 calls in 8 hours getting slammed? So it's all region specific. Which is why i keep asking for an actual number
I guess their tax payers accept it and their agency's budget for enough units to allow for that one hour lunch break. I know I have never had the pleasure of being able to do so.

And as a random aside, I wish more agencies held low priority calls, but do you think then people would be complaining that once they cleared one job, they had another low priority call waiting for them? and they were again, too busy?
Ah, that explains it. I briefly worked for RM back in 2001, and since then refused to work for a for profit EMS system. It still sounds like a recipe for disaster (especially taking into account what you said about miserable collection rate for 911 systems). The money for the profit needs to come from somewhere.... employee pay rates, equipment, staffing levels.....
that's their job....... once you are available, give you your next assignment. You would be surprised (or, rather, might not be) by how many crews will not call available once they clear a job because they are intentionally avoiding getting their next assignment).
again, at its most basic level, your job is to make money for the company..... why are you complaining about having to do your job? that's why your employers gives you $$$ to come to work, so you can make them $$$$ that's awesome..... what does your company management think of that? if he can do it, why don't you?nothing wrong with getting food from the drive through on the way to your next run. it's not like you are stopping and spending 45 minutes eating in the restaurant.. You ever stop and wonder that the reason you get status checked to get the next run is because you disappear from the grid so frequently?

You know, most dispatchers either started out on a truck, or spent years on a truck before accepting a position in dispatch. if you call them and ask if you can get a bite on the way, they will usually work with you, and tell the receiving facility that you will need an extra 10 minutes, provided it's not an emergency run. I know I did that frequently for my units.You have never slept in the truck?

You know, I think I have a solution for you..... transfer into dispatch. It's a great gig, totally climate controlled, you RARELY get stuck on a late job, and you have unlimited access to power (to charge cell phones, laptops, etc), and often internet. Maybe even TV. You can usually bring your lunch (so you don't go hungry), and you can actually make the schedule better for your field crews, instead of simply complaining about all those mean dispatchers. If you really think you can do it better, what's stopping you?

Our dispatchers really have no medical background. I think one was a wheelchair van driver once. Sometimes we get sent on calls that should be ALS. I cant tell you how many times I showed up somewhere and they ask for our IV pump or a heart monitor. Now I have to go in service and get an ALS truck coming and nobody knows when that will get there. I have been a dispatcher elsewhere. At our company, Dispatchers make somewhere around $9/HR. No thanks. I dont need a cut in my pay any further.

I never said I "frequently" disappear. I said some do and I get why. Not all of them check up, maybe during a commercial or if they remember.

You sound like you are one of those slave-driver type managers. There is nothing I can say that will change your mind so we will have to agree to disagree.

 

[DrParasite]

Our dispatchers really have no medical background.

That might be part of the problem..... speak to your boss and suggest that if your dispatchers had some medical training, things might run better, and you could justify being paid more than $9 an hour. heck, I wouldn't even get out of bed for $9 an hour.

Sometimes we get sent on calls that should be ALS. I cant tell you how many times I showed up somewhere and they ask for our IV pump or a heart monitor. Now I have to go in service and get an ALS truck coming and nobody knows when that will get there.

did the facility request an ambulance, or a paramedic unit? I've been sent on numerous 911 runs to doctors offices, where the MD asked where my monitor was.... he called to request a transport for a sick person to the hospital.... I've also received requests for paramedics, when they just needed a comfy ride to the ER. If it happens frequently, why not file a complaint with your management over in appropriate dispatches?

I have been a dispatcher elsewhere. At our company, Dispatchers make somewhere around $9/HR. No thanks. I dont need a cut in my pay any further.

So why not go back to the other company where you were a dispatcher? You seem like it's horrible where you are now. If you are as good as you say you are (with all your experience and education and such), you should have no problems finding a better job elsewhere.

You sound like you are one of those slave-driver type managers. There is nothing I can say that will change your mind so we will have to agree to disagree.

If I'm a slave-driver manager, than you sound like a lazy slug who expects to get paid to sleep and doesn't want to do the job that you are being paid to do. And if you complain this much about having to do your job, the job you are being paid to do, then you probably wouldn't last a month at any place where I worked

The reason you can't change my mind is because I'm an adult and I have a pretty firm grasp on both economics and the laws of supply and demand. I understand that if you work for a for-profit entity, than profit is the bottom line, and your job (actually, anyones job really) is to make money for the company. I, as your boss, am paying you, my worker, to make me, the company, money. The more time I am paying you where you aren't making me money = the more money I am losing, which is why I would totally support picking up runs during your town time. that's simply economics, which you don't seem to understand. A truck that isn't on a run isn't making money, yet it is costing the company money.

And supply and demand means your working conditions (everything from call volume, to quarters, to pay) is all based on the supply of available workers, and what demands they make. As long as I have 10 applicants for every 1 position, there is no need for me to make less profit, even if it means firing some low performing employees (corporate america calls it downsizing, and some big name companies have annual layoffs).

I totally understand where you are coming from, and what you want to do..... but it's not how the real world works. Which is the part that you are failing to understand, despite several people trying to educate you otherwise.

Let me ask you this: can you name 3 jobs where you are paid to sleep while this is revenue generating or other job related work that could be completed?

Have you discussed your concerns with your management? Have you applied to other companies, to see if they have better working conditions? Or are you just complaining because you aren't getting your way, and your boss is making you work during the times that he is paying you to be working?

You mention that you are used to a fire-based system, and how you used to dispatch elsewhere..... so with all your experience, how are you stuck working for a private IFT service with crappy working conditions, where dispatch is run by minimally trained people, with (as you claim) glaring safety concerns? Why are you not working for a better company, in a better system?

I'll repeat the advice I gave you in the beginning of this topic, when you asked for 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.

 

[Tigger]

just because you say it does not matter, still doesn't make it true. I asked a simple question, one you are either unwilling to answer out of ignorance, or refusing to answer because you know it will undermine your statement about this "super busy EMS station." Your crew might consider 3 calls in the urban area a busy day.... I don't know, hence why I asked.

The truth is, many EMS units in the US (especially inner city units) run more calls in a shift than they should. They are busy. Your crew in Australia might say they are busy, and it might be for them. A buddy of mine used to work for FDNY EMS.... he said, during an 8 hour shift, that he was got slammed one day; he ran 5 calls in 8 hours in Manhattan.... does anyone else consider 5 calls in 8 hours getting slammed? So it's all region specific. Which is why i keep asking for an actual number
I guess their tax payers accept it and their agency's budget for enough units to allow for that one hour lunch break. I know I have never had the pleasure of being able to do so.

And as a random aside, I wish more agencies held low priority calls, but do you think then people would be complaining that once they cleared one job, they had another low priority call waiting for them? and they were again, too busy?

I do not understand what the disconnect here is. The point is no matter how many calls crews in New Zealand (not part of Australia incidentally) get, they are legally entitled to two breaks. The system makes provisions for this. I think we ran nine in 12 hours, if it really is that important. But again, we could have run over 12 in 12 hours (which they said they had done many times before), and they would still get two breaks. What does being busy (based on your discussion) have to do with this again?

 

[Tigger]

I mean, that's really really terrible. Im getting like 70% return on billing and i only do 911. While we do have a good payer base and a good demographic, i still couldn't imagine anything less then like 50%

The AAA says the industry average is well less than 50 but I do not recall the actual number. Our state average is right around 30%. More than 30% of people pay their bills I should add. Our self pay is almost non existent now, so we are getting insurance payments for almost every bill. But with Medicaid reimbursing 180 bucks and our ALS rate being over 2k, there is just no way to get any decent return. Can't balance bill CMS (Medicare, Medicaid, Tricare) and CMS is 79% of our payor mix. There is no money in patient billing for most of us, especially those in the middle of nowhere that somehow have a census designation of urban so we are not eligible for addon payments.