EMS Shift Lengths And Overnights At Private Ambulance Companies

[x635 4,066]

I know it may be a little too soon to be talking about this, but I believe that from tragedy should come lessons. While this is fresh in my mind, I'm going to write about it.

We all know that working for a private ambulance company doing transports sucks. Many of us here started out our careers this way, myself included. I've known many EMT's who work the overnight and go to school, care for a child, or work another job during the day. Many companies don't have quarters for the crews to sleep, or appropriate ones at that, or crews even have to sleep in the bus.

Now, 5AM is not a natural hour to be up. I've worked overnights my entire adult life, and the time period between 4AMish-6AMish is always a time period where people lag, no matter how used to it you are or how much of a "night person" you are. Your body struggles. No matter how much caffeine's there.

There have been several incidents across the country of EMS workers falling asleep at the wheel on overnights. Put all the afformentioned factors into play here, and is there something we can do to prevent this happening in the future?

I beleive so. First, I think each company should be required to have appropriate places for the crews to rest inbetween jobs. Second, I think that all non-emergency transports, and pseudo private emergencies, should be extremly limited from Midnight-7AM.

For busy agencies that run all night, there should be enough personel to rotate drivers if someone gets tired. After doing back-to-back jobs on the overnight, many times being the only bus, and coming back to base at 5AM, I know the feeling. You just want to rest your eyes, but some nursing home on the other side of the county doesn't want to deal with a patient, so they send them to the ER, and you're on your way out again. This scenario repeats itself day after day, night after night.

EMT's and Paramedics for private comapnies work very hard for very little money. The health and safety of the employees is often overlooked and put below making a profit.

Sure, there are other professions that run all night, but the transport sector of EMS is very different, IMO.

Burnout Reason #100,001

[x129K 1,393]

I have to say...after working YEARS of doing 24's at Empress...I was very glad to see DOT put "rumble strips" on the Taconic.....made the ride home THAT much safer.

[JTF429 37]

I hope you choose not to delete my reply. It is way to early to even think about talking about this. The poor guy has'nt even been waked yet. The facts have not come out, and one can only imagine how bad the driver is beating himself up. I don't know how long you have been in EMS, but after 20 years I can assure you that the companies main concern is not how much sleep you get. They have a bussiness and we are employees. I am sorry to say I was not lucky enough to know this guy. I am pretty sure he was like the rest of us working, going to school, serving his community and planning a life. I am on the job in CT which means I have 3 side jobs to afford my house in NY. I try to maximize my hours to see my kids. It is what it is. When you work EMS that is how it will be. I don't know anything about Empire other than they have a station in Fishkill. I would not want to be the boss who took that phone call that day, or would I want to read speculation on my companies health and safety policies. You are entilted to your opion but at least wait until the guy is waked, buried, and remembered for the man he is. IMO

[xfirefighter484x 234]

I think it is a bit too soon to be bringing this subject up (or too late, depending on how you look at it). I recommend putting it to the side for at least a week, let things settle down a bit.

Just my 2 cents.

[Engfire 0]

Its not to early and Seth has a point Private ambulance companies work their employees to death and want the most out of thier employees for the least cost. It is a business and the owners are out to make a profit. I mean no disrespect to this guy or his family.

[STAT213 332]

I have no issue talking about this now. Its not like we are holding up signs at Mr. Lamb's funeral, or standing outside someone's door accusing them. It is the web, and it is what it is. That being said, I guess I'll offer my thoughts.

Commercial EMS overnights blow. I am lucky to be alive right now, having either woken up just in time, or stopping somewhere to catch those ZZZs. I feel for the kid who was driving.

Seth, your points about mandating sleep quarters are interesting. If we were CDL drivers, we would have to log our driving and rest periods. Might be a place to start. Unfortunately, the calls have to be done and in the cut throat world we operate in now, someone will pick up the transport. Management could usually care less how tired you are, or the hours you have to put in to make ends meet. (In saying this, I am not accusing Empire management - just stating corporate reality.) I have done the polyester shuffle all too much myself, praying to have an easy night or day shift somewhere so the back half of a 24 would be merciful on my system. I know we're supposed to be rested, but it doesn't work out that way, does it? I can remember shifts where I don't know how I got home. I think the cars I have had knew the way.

I don't think there are any easy answers other than what each of us can do ourselves. Wear your seat belts - even if sleeping on the rack/cot. Know the signs of being exhausted and unable to keep driving. Stop, walk around the rig. Have (another) coffee. Watch out for each other, be good to each other.

It is a sad day for the EMS world, for sure. To the EMT who was driving...keep your chin up, it could have been me.

[x635 4,066]

It is what it is.

And it's that complacency why nothing changes.

The reason why I posted this was in no means to disrespect or speculate, it was to bring attention to a GENERAL issue (NOT COMPANY SPECIFIC) that could possibly prevent this from happening in the future. This isn't the first incident where an overnight EMS crew has fallen asleep at the wheel, but I surely hope it's the last. While it's fresh in peoples minds, as it is mine, it's my opinion that they'll feel stronger about the issue, like wanting to go after the terrorists on the evening of 9/11. Did we disrespect the deceased at the WTC by wanting to correct the situation so it doesn't happen again?

My heart goes out to the EMT who was driving- and that's one of the reasons, again, why I wrote this...because I don't wan't it to happen to anyone else.

BTW, STAT, excellent points.

[ny10570 745]

I did my stint for Transports and still have to work an insane schedule to make ends meet. Too often I wake up with my heart in my throat after narrowly missing the concrete divider on whatever highway I'm on. It scares the crap out of me. I hate to play devils advocate, but at what point does the employer become responsible for an employee's schedule outside of work. Yes the pay forces you to have to work more hours and often multiple jobs, but we chose these careers and these jobs. STAT made an interesting point about over the road truckers but the traditional 8 hour day and I believe 12 hour days would be acceptable even under those standards.

[redmack 0]

This is an insult to the deceased, his family, and every emergency service provider! The results of the investigation are not even complete, and as an accident investigator myself it sometimes takes months to accurately complete an accident investigation of this nature. How can we state that from this itradegy should come lessons. There is a time and place for everything, and to point fault at anyone at this time is a disgrace!

Why not honor and pay tribute to the gentleman involved in this tragedy and save the monday morning quarterbacking for the average layperson not the professionals that I believe are part of this forum!

I extend my prayers to the deceased and his family in this difficult time.

[x635 4,066]

I'm NOT "Monday Morning Quarterbacking" the Empire incident at all. Nor am I accusing anybody of anything. It just stirred some thoughts in my head, and I wrote about it. I strongly believe that private EMS providers get the short end of the stick when it comes to health and safety, and whether it's a back that's damaged for life as a result of lifting a patient with no assistance because you couldn't get any in a timely manner, or an MVA, it's critical that EMS providers get the protection they deserve, like Firefighters or Police would. The press quickly forgets or ignores EMS providers who get injured or killed, and so will many of us, until incidents repeat themselves again or hit closer to home.

[Goose 188]

Seth, great post. It's easy to say, "yeah! Put this aside for a week, lets not talk about it, its to early." Well, unless I've missed a beat, the world hasn't stopped and EMS professionals continue to work. There will be hundreds of near misses tonight and it will continue, as it has for years. I'm not sure how many of you have tried to sleep in the front seat of a F-350 with the engine going, the base radio up and your portable next to your ear, lets just say at that point a concrete floor looks awful tempting. The fact of the matter is, as Seth articulated, we are run into the ground for a a few bucks above minimum wage. Shuck here, shuck there, 911 job, another shuck, backfill this, bring these supplies down to such and such a station. Even on a full days worth of sleep its hard to stay awake for that 12 hour night tour. It's simply unnatural for humans to be awake during the night, case in point. Whats the solution? I'm not sure if i have that answer. Better accommodations would be nice, rotating calls amongst units if possible is great. But, at the end of the day, EMS is like a box of chocolates (sorry Forest) you really never know what your going to come across during your tour. So, while there may be no way to avoid waking crews or having people up at 5am, i surely think crews need to be honest with themselves and their partner and companies should make concerted efforts to make overnights as safe as possible. If we don't ask ourselves the hard questions, little will ever change.

Edited November 9, 2007 by Goose

[CPAGE 2]

Back in the late 80's I worked for Empress and the hard time in the shift was 4am to 6am like Seth said after working all day and the 4x12 you are done but you hang in for the overnight. The body just can not do it. You need to get your rest. I do feel that no one should have to do this but we do it is our way of life. I do feel that 16 hours should be the max if you do not a building to sleep in and respond out of (such as the fd has) to drive around all night is not normal. EMS/Transport needs to have a better set up to have the members more alert and safe.

This is just my 2 cents.................... and may our brother RIP and our other brother recover and be at peice with himself....as this was an accident.

[RescueKujo 130]

This is an interesting subject, and I can give you both sides. I have been in dispatch now for almost 7 years, with 12 before that as an EMT. I have worked 12 hour night shifts and 24s in the field.

That said, I, like many of you have worked way too many hours in one stretch. I remember a 100 hour stretch one time (driving the Children's Hospital response unit). It is insane the hours that we have to put in to make ends meet. Something has to be done in regards to crew safety. First thing I think should be the abolishment of the 24 hour shift. We have a couple units that run 15-17 runs a shift, and I'm sure you can't be at your best at 4 a.m. if you haven't had much rest. Adequate staffing is also a must. But these days, when your crews don't understand the needs of the business, how can you mantain that?

On the other hand, in San Diego business is very competitive. We have 8 agencies trying to make a profit with the interfacility transfer business. If you can't/don't give an adequate ETA (most ERs want a 30 minute or less), another company will, just to get the business. And we as dispatchers are questioned if we "lose" a call, unless we're short staffed. But as a dispatcher you better have your ducks in a row and able to explain your decision making process.

It's a delicate balance that must be looked at to achieve what is best in the end. But what usually ends up happening is the crews, in the effort to take care of the customer/patients, gets the short end of the stick.

[irishfire2491 24]

I AGREE with you seth I know personally I used to work a 36 hours straight tour and held overtime for a couple of hours and I felt so tired that I refused to drive but it does a big wear and tare on you body and drains you out of EMS. I have been burnt out 3-4 time in the pass 3 years from riding ems calls and getting tired fast

[Remember585 815]

Been doing it for almost 16 years, I don't feel burnt out. At one point I volunteered at two EMS agencies, an FD and worked two EMS jobs in addition to another job as a FD Dispatcher.

"Burnout" in many cases is short for "inability to multi-task." No reason anyone can't step up and say to their EMS bosses that they can't perform their duties safely and feel as though they are a risk to the crew, patients and public. I said it and it got me off of my 36's and 24's.

Edited November 9, 2007 by Remember585

[trauma74 111]

Seth,

I agree 100% with what you said. I did many overnight shifts at Empress back in the day and I can tell you that I am lucky. Why do I say that I am lucky?......because time and time again I fell asleep at the wheel while driving home. I woke up to being in the oncoming lane, going head on with a snowplow, on an Easter Sunday I fell asleep at the while, my foot came off the gas and my car came to a complete stop........in the middle lane of the NYS T-way!

It got to the point where used to drive half way home, pull off into a rest area, sleep for about 30 min and drive the rest of the way home.

[20y2 43]

We're 'bashing' private companies, but the country's biggest public on also is the same exact way. FDNY EMS is stuck inside the bus with inadequate facilites to rest between jobs.

On the flip side, your at a JOB, and as such do not have any rights to get any sort of 'rest'. What it the point of mandating rest periods at a job that is usually only 8 hours long? Should the other 2 tours be given the same benefit?

Edited November 9, 2007 by 20y2

[20y2 43]

Seth,

I agree 100% with what you said. I did many overnight shifts at Empress back in the day and I can tell you that I am lucky. Why do I say that I am lucky?......because time and time again I fell asleep at the wheel while driving home. I woke up to being in the oncoming lane, going head on with a snowplow, on an Easter Sunday I fell asleep at the while, my foot came off the gas and my car came to a complete stop........in the middle lane of the NYS T-way!

It got to the point where used to drive half way home, pull off into a rest area, sleep for about 30 min and drive the rest of the way home.

That's mighty irresponsible and dangerous of you. If you were that tired when you got off, you should have slept in the parking lot before you left, there is no reason to endanger innocent peoples lives just so that you can get home earlier.

Personal responsibility people, personal responsibility. If you know that you are working an overnight, get adequate rest before your tour. If you are 'dead tired' during the tour, tell your partner to drive or notify a supervisor. There is not a supervisor in the world that will tell you to just 'deal with it'. And definitely don't drive home 'dead tired', you might just end up that way permanantly.

[shac 7313 0]

to jtf-429. i think you are wrong !! it sounds like your bashing the guy ?? it an very sad thing it could

happen to enyone.like everybody i worked 3 jobs too. i happen to know the driver in accident on rt-9

and he is an realey good kid . but lets not forget his emt/parter who died/ rip. and for the driver he

will be in my prayers.

[EFFDCO4 0]

Rest in Peace Matt! The debate will continue. Is it the appropriate time to bring all this up - probably not, it's already been started. What we should at least consider, is the 'shift'. If you are working the graveyard shift then you had better get some rest before you come to work - just like I sleep at night before coming to work in the morning. If I didn't - I'd probably fall asleep on the way to/from work or maybe even at my desk. Can't possibly ask my boss if I can crash in the conference room for an hour or so. Sleep is a necessity and you need to prepare your body for work. Rest in between shifts is always a nice thing - but, like FDNY, sometimes there are very few rest periods in between calls. That said, sleep before you come to work and you won't be as tired, no matter what line of work it is. If you work more than one 8 hour shift - well, that opens up a whole different can of worms.

[JTF429 37]

to jtf-429. i think you are wrong !! it sounds like your bashing the guy ?? it an very sad thing it could

happen to enyone.like everybody i worked 3 jobs too. i happen to know the driver in accident on rt-9

and he is an realey good kid . but lets not forget his emt/parter who died/ rip. and for the driver he

will be in my prayers.

IN RESPONSE TO MY QUOTE. I AM SORRY IF ANYONE THINGS I AM BASHING THE GUY. I AM NOT I WISH I HAD THE PRIVLEGE TO KNOW HIM. MY RESPONE WAS TO THE POSTING ON OVERNIGHTS AND EMS. I FELT IT WAS TO EARLY TO POST THAT THREAD OUT OF RESPECT TO THOSE INVOLVED. IN LIGHT OF THE REPLIES I GUESS I WAS WRONG. SURE LESSONS LEARNED MIGHT CHANGE THINGS, BUT IMO GIVE IT SOMETIME. AS FAR AS PEPOLES OPION'S YOUR ENTILTED TO THEM. IF YOU MISUNDERSTOOD ME AND THINK I AM TRYING TO BASH THE CREW OR THE COMPANY I AM SORRY BUT YOU ARE WRONG. :angry:

[SmokeAndFlames 2]

Its up to you to make sure you are properly rested if you are working a overnight. YOU ARE RESPONSIBLE FOR YOURSELF! If you can't handle a overnight DONT WORK. There is no way around it. YOU put peoples lives at risk, And why do we need a thread on everything to pick at every little piece?

[x635 4,066]

What about when you come in for a 3P-11P, and get held over on the overnight and sometimes the following day? I worked 48 hours straight at one company because they were so short staffed, there was no one to relieve me....and if I was to go home, not only would I have been fired, but I would have cost people's lives by not giving them ALS coverage (I actually did have a CPR save that day) I've been told by a supervisor(s) to "just deal with it". Do you think firefighters would be happy if they had to stay in the engine on some streetcorner, in a confined area, or cruddy crewroom for their entire shift, or they were mandated to stay awake all night? As for driving home drowsy, I think everyone wants to go home at the end of the shift.

Sure, Cops have to stay up the entire night, and so do some dispatchers. The difference is, in EMS we are often driving longer distances with sick patients in cramped ambulances. The monotony of routine transports makes it difficult to get that "adreanaline rush" that firefighters or cops have when called out on a real incident.

There is a difference between the employer being responsible and the employee being responsible.....health and safety should be something addressed by the employer, but EMS personel in private companies are often disposable. You wouldn't tell a firefighter he was on his own regarding his safety, would you?

And, with housing costs around here, EMS providers are living farther and farther from where they work, increasing commute times.

[SmokeAndFlames 2]

Well then the person needs to grow some.... and stand up for yourselves then

Edited November 9, 2007 by SmokeAndFlames

[x635 4,066]

People need to calm down, everybody is so defensive. Open your minds and listen. Don't degrade this thread by bickering or throwing one liners. Everybody is entitled to their opinion, and the respect of others to listen, comprehend, and then reply. These threads exist, like it or not, because the issues exist. If people want to wimp out and keep pretending these issues don't exist, or they aren't our employers problems, then nothing is going to change.

[Guest mediconpatrol]

I usually have a different take on most issues..

Let me start by saying that I do not believe in 24 hour shifts and frankly I thought they were illegal and against labor laws...but in doing some research before I wrote this I am finding I am just naive and cannot find any such ruling.....

BUT...that being said...I don't get 24 hour shifts..no one can work 24 hours straight without loss of quality in your performance and judgement. I am talking definately from personal experience where I would work my 12 hour shift and then volunteer for another 12 hour shift...eventually your body gets tired and needs down time no matter how hard you try to stay "on top".

We all like to think we are superman and that we can do it...especially when need arises...either a shift is short or we need the money....but we are doing a disservice to the agency...patients/clients and especially to ourselves....

On a management perspective....supervising an overnight shift....(not an ambulance service)...

yes..we all hope that it will be a slow night and we may be able to get breaks or some rest but..we are there and getting paid to work and not sleep...and it cannot be assumed you will be able to "sleep" at work.

Pleas all understand..these comments are in regard to the subject and has nothing to do with the accident and tragedy that occurred.....I truly do no the "specifics" of the accident or issues leading up to it...

[ONEEYEDMIC 68]

If you can't do a midnight without falling asleep then you need help. For my WHOLE PROFFESIONAL CAREER whether it be EMS or LE I have done midnights. I acutally switch out of Days now to do Midnights. Yeah some of them suck and some are good. I don't know the facts of the case at all but I do know that the EMT DRIVER has to live with this for the REST OF HIS LIFE. You knew what business you were getting into whether it be LE, EMS, or FD. You knew that you would have to work 12's, 24's 36's and even 48's hours. In that time you can't tell me that you didn't shut your eyes though. NO JOB CAN DO THAT. We are not allowed to go more than 16hrs now without 8hrs off. Unless there is an emergency.

Please let this guy get in the ground before you MONDAY MORNING QUARTERBACK.

[x635 4,066]

I'd be curious to know, let's say there was an emergency vehicle fatal MOS accident, and it was due to a defect in the apparatus. There were similar vehicles in the fleet that could be prone to the same thing happening. Do we wait on taking action until a few weeks after the funeral, or do we correct the issue as soon as possible so it doesn't happen again.

I know not all the facts are out on Wednesday's incident, and I am in no way speculating or quarterbacking that incident. This has been something on my mind for a long time, and Wednesday's incident did spark some thoughts, regardless of what happened. I know when people die, my immediate reaction, besides mourning, is to do something to fix it ASAP so it doesn't happen again. EMS goes on, and doesn't stop, and neither should our quest to make EMS better....at least those of us who actually care about our coworkers and the EMS profession in general.

Maybe if EMS was compensated/paid what they should be paid, then they wouldn't have to work so many hours, or second and third jobs.

Why do many police agencies have caps on the amount of time they can work in a row??

[20y2 43]

What about when you come in for a 3P-11P, and get held over on the overnight and sometimes the following day? I worked 48 hours straight at one company because they were so short staffed, there was no one to relieve me....and if I was to go home, not only would I have been fired, but I would have cost people's lives by not giving them ALS coverage (I actually did have a CPR save that day) I've been told by a supervisor(s) to "just deal with it". Do you think firefighters would be happy if they had to stay in the engine on some streetcorner, in a confined area, or cruddy crewroom for their entire shift, or they were mandated to stay awake all night? As for driving home drowsy, I think everyone wants to go home at the end of the shift.

Sure, Cops have to stay up the entire night, and so do some dispatchers. The difference is, in EMS we are often driving longer distances with sick patients in cramped ambulances. The monotony of routine transports makes it difficult to get that "adreanaline rush" that firefighters or cops have when called out on a real incident.

There is a difference between the employer being responsible and the employee being responsible.....health and safety should be something addressed by the employer, but EMS personel in private companies are often disposable. You wouldn't tell a firefighter he was on his own regarding his safety, would you?

And, with housing costs around here, EMS providers are living farther and farther from where they work, increasing commute times.

I in no way aim to flame you, but who in the heck stays 48 hours at any job? There is no rule ANYWHERE in either any guide or operations manual authorizing anyone to be held over more than a maximum of 16 hours, relieved or not. YOUR health and safety is ALWAYS number one. You are doing no one a service if, after being at work for 20 hours, YOU crash or YOU give the wrond dose of a drug to someone.

I really can't believe that you just took the 'deal with it' and went with it.

[Guest stephentyler20]

Does anyone know if Empire has 24 hour shifts? If not, what length