Fatigue

[RocketMedic]

Just got off of a 24 (rare for me, I normally work 12s but this was a favor that got me the Superbowl off) and I'm exhausted. Cumulative UHU of 0.6, but only about 2 hours of sleep total, interrupted three times. Caught myself with a tad of sleep inertia and possibly a micronap at a light this morning on some predawn posting action. Fine-motor skills definitely a bit less than average. Partner was worse off.

This isn't safe or appropriate.

 

[Carlos Danger]

This isn't safe or appropriate.

Then why did you do it?

FWIW, long hours and not enough sleep is a pretty common thing in healthcare. It's a problem at times where I work (doing anesthesia in a small, rural facility) as well as many other places, big and small. When I was in the military there were lots of times that sleep was very hard to come by, and I'm not talking about combat operations where at times it's simply unavoidable.

Not saying that makes it right; just saying it isn't at all unique to EMS.

 

[DrParasite]

Just got off of a 24 (rare for me, I normally work 12s but this was a favor that got me the Superbowl off) and I'm exhausted. Cumulative UHU of 0.6, but only about 2 hours of sleep total, interrupted three times. Caught myself with a tad of sleep inertia and possibly a micronap at a light this morning on some predawn posting action. Fine-motor skills definitely a bit less than average. Partner was worse off.

This isn't safe or appropriate.

Let me see if I had this right... you willingly asked to work 24 hours straight, so you could be off fro the superbowl, in a system that has a UHU of 0.6. and willingly decided to be driving while tried on the tail end of the double while you were being posted. Was your partner also on a double? Did you sleep during the day during your town time?

As Remi said, if it wasn't safe or appropriate, why did you willingly do it? the company didn't force you, you committed this unsafe act in order to be off today. You put yourself in danger so you could watch a ball game.

Maybe you should make smarter decisions in the future?

 

[NomadicMedic]

I think his system normally works 24s and Rocket was just filling in from his usual 12. from past conversations with him, I do not believe he was condoning the idea of a 24, but after working one, he simply reiterated what most of us think; that they're unsafe and ill-advised.

 

[Tigger]

24s in that kind of system are awful. 24s/48s in places where you aren't routinely getting up at night let us keep reasonable staffing.

 

[Jim37F]

Yeah, coming from a system that did primarily 24s where we routinely had 10-15 calls per shift at my station (each call could take up to 2 hours) it's exhausting...

The City&County EMS here only does 12s (12-12) and the units in town especially will hit double digits in calls in those 12hrs...theyre not even allowed to work a 24 straight because of fatigue issues

 

[VFlutter]

I think 24s are completely doable in a safe manner if the proper systems are in place. We can call a time out at any point in the shift if we feel unsafe. This usually consist of 2-4hrs of uninterrupted time (Base out of service, no calls). If you are flying a lot then take a nap when you get back and do the chart when you wake up or at the end of your shift. Be well rested before your shift. Eat and consume caffeine appropriately so you don't crash.

Everyone is different. Some people do not function well with little sleep, others can tolerate it much better to a point.

 

[NomadicMedic]

I think 24s are completely doable in a safe manner if the proper systems are in place. We can call a time out at any point in the shift if we feel unsafe. This usually consist of 2-4hrs of uninterrupted time (Base out of service, no calls). If you are flying a lot then take a nap when you get back and do the chart when you wake up or at the end of your shift. Be well rested before your shift. Eat and consume caffeine appropriately so you don't crash.

Everyone is different. Some people do not function well with little sleep, others can tolerate it much better to a point.

Flight is TOTALLY different than ground EMS. There is no "calling for a time out" in busy ground services.

 

[VFlutter]

Flight is TOTALLY different than ground EMS. There is no "calling for a time out" in busy ground services.

Understandle. Would it be impossible to have some system in place to dispatch the next closest ambulance? Or have a supervisor swap out with a crew member for a bit so they could rest? Just wondering. Never done ground 911 so I have no clue.

 

[DrParasite]

Yeah, coming from a system that did primarily 24s where we routinely had 10-15 calls per shift at my station (each call could take up to 2 hours) it's exhausting...

The City&County EMS here only does 12s (12-12) and the units in town especially will hit double digits in calls in those 12hrs...theyre not even allowed to work a 24 straight because of fatigue issues

I'm curious... once you graduate from the fire academy, will you be working 12s or 24s? I would imagine your call volume will rival hat of the city and county EMS, esp since fire goes on so many EMS calls....

24s can be exhausting, especially if you haven't prepared for them (as in a good night sleep before the start of the shift, pretty much waking up from that good sleep and going straight to work). In Wake County, county policy caps you at 36 hours straight (which is still insane). Most of the time if this happens it's because the employee requested it (OT, swaps, etc). some of the slower EMS crews still work 24s, so one and a half times isn't unreasonable.. the problem is when you work a busier area, which is normally 12 hours, and you do three back to back shifts.

When I was still working up north, our standard shift was 12 hours.... so our longest allowable period of work (either voluntary OT or force due to staffing requirements) was 18 hours. When I moved to a busier place, our standard was still 12 hours, but they allowed doubles. And you could run for almost 24 hours straight.

24s are great for slow areas; one agency near me runs 24/72s. They are awesome. it's not super busy, and you can sleep any time, day or night, until you are woken up for a call. you can also get hit hard, but the call volume is nowhere near as bad as it was up north.

 

[DrParasite]

Understandle. Would it be impossible to have some system in place to dispatch the next closest ambulance? Or have a supervisor swap out with a crew member for a bit so they could rest? Just wondering. Never done ground 911 so I have no clue.

What do you mean? in first paid EMS job I had, we had 1 ambulance covering the entire city. in the second, we have 1 ambulance dedicated to the entire city (we could find others, assuming they were available and not on non-emergency assignments). the next closest would be a mutual aid unit, and they often only had one truck for their coverage area. When I went to the big city, we routinely had calls stacked, so the next closest ambulance was likely already on a call.

So could it be done? sure, in theory. But with everyone focusing on response times, staffing with minimum possible levels,and most places are barely able to cover their call volumes with the resources they have.

Now if we had more units, enough to let crew get some rest, so they weren't running for 24 straight......

 

[DesertMedic66]

Flight is TOTALLY different than ground EMS. There is no "calling for a time out" in busy ground services.

In some ground systems there is. We are able to call for a safety nap which means we are out of service for all calls for 2 hours. The supervisors and dispatch are unable to tell us no and there is no disciplinary actions unless we start to use and abuse the policy on 12 hour shifts.

 

[Jim37F]

I'm curious... once you graduate from the fire academy, will you be working 12s or 24s? I would imagine your call volume will rival that of the city and county EMS, esp since fire goes on so many EMS calls....

Fire runs 24 hour shifts, EMS 12 hours. There's also a bit of a disparity here. First off Fire doesn't respond to 100% of medical calls. During my ride alongs we respond to a traffic collision a block away from one of the fire stations....and Fire was never dispatched (nor did the EMS crew decide they needed to call them even when we backboarded and transported two patients from that). I don't have the exact numbers but Fire only responds to maybe half as many medicals as EMS does....and HFD has 43 stations on the island (16 of those have 2 companies and 2 have 3 companies.....a total of 63 (43 Engines, 16 Ladders/Quints/Towers, 2 Rescue, and 2 HazMat) companies that can respond to calls.....vs 18 EMS units staffed 24hrs a day. 2 additional EMS units are scheduled daily but are only on noon to midnight, they're not staffed midnight to noon. And when the staffing is available they can plus up 2-3 additional units, but once again that's only noon to midnight....so yeah they run a hell of a lot more than we do. I think they said the busiest truck on the island runs 8-10 calls in a 24-hour shift.

 

[RocketMedic]

This was one of those "calculated risk to obtain both something I want (the Superbowl) and goodwill (always important) at a moderately-paced station after a shift on the peak truck to 'help the team out'. We don't get safety breaks or downtime here unfortunately. To be honest, I thought I could handle it easily. I was wrong, and it made me realize that even a 'moderate' 24 in our system is hazardous from my perspective.

After last night, I really don't want to do more 24s in this system. It's not safe, even at 'slow' stations, and although I was still functional, I certainly wasn't 100%- and that's despite 'proper' preparation.

 

[MSDeltaFlt]

Some folks can handle what you did. Some can't. Some can for only a short while. And still others no longer can. That being said we have all at some point in time been made to realize that sometimes it hurts being stupid. You were lucky your foot didn't slide off the break at the light. Count your blessings.

As far as the "goodwill" bit goes, be careful about falling on your sword. You might discover there won't be anyone to catch you.

Good luck

 

[DrParasite]

I don't have the exact numbers but Fire only responds to maybe half as many medicals as EMS does....and HFD has 43 stations on the island (16 of those have 2 companies and 2 have 3 companies.....a total of 63 (43 Engines, 16 Ladders/Quints/Towers, 2 Rescue, and 2 HazMat) companies that can respond to calls.....vs 18 EMS units staffed 24hrs a day. 2 additional EMS units are scheduled daily but are only on noon to midnight

I think I see why so many people are trying to get out of EMS.... those staffing numbers paint a very clear picture of where resources are being allocated, compared to where the call volume is. Glad you were able to make the switch.

To be honest, I thought I could handle it easily. I was wrong, and it made me realize that even a 'moderate' 24 in our system is hazardous from my perspective.

honest question: are the 24 hour trucks slower? Meaning, if you hadn't started our on the peak truck, would you have been more rested?

The worst decision I ever made was to do 36 hours straight; 3 twelve hour shifts, going from one job to the next and then back. Thankfully the job in the middle was pretty slow, so I was able to get some ZZZ, but I won't lie, at the end of the third shift, I was def hurting.

Now compare that to when I work a 24 at the fire house: I get to sleep in a bed, we aren't too busy (even the city station might run 8 calls in 24 hours on a super busy day, most of them EMS first responder runs, and that's usually all within a 2 mile first due radius with the occasional trip to a county area), and the county station is a total snooze. I know guys who work there and then go straight to their other job to work another 24. Can you run all night and be hurting in morning? sure, but it's not that common.

After last night, I really don't want to do more 24s in this system. It's not safe, even at 'slow' stations, and although I was still functional, I certainly wasn't 100%- and that's despite 'proper' preparation.

Before you totally write of 24s, why not work a planned 24 at your agency? it might be slower, so you can rest more. I bet one of the reasons you were hurting was because you started on the peak load truck. you were busy for the first 12, in a truck where sleep is not expected. so you weren't able to properly rest during the first half of the 24, which can be crucial when you are busy during the overnight.

24s aren't for everybody (as an individual, some people just can't handle them), and they aren't for every agency or coverage area (depending on call volume and such). Trying to fit a square peg into a round hole isn't going to work out for everyone.

 

[RocketMedic]

Our planned 24s are actually generally busier than the peak truck for "core stations". Outlying stations are not as busy, but will post frequently. Also, they start three hours earlier than my peak shift. Having done both planned and extra 24s in this system, I can safely say that the only thing keeping them from being a guaranteed stand up shift is pure luck and luck isn't a strategy.

 

[Tigger]

In some ground systems there is. We are able to call for a safety nap which means we are out of service for all calls for 2 hours. The supervisors and dispatch are unable to tell us no and there is no disciplinary actions unless we start to use and abuse the policy on 12 hour shifts.

We have a similar deal at a few of my jobs. The 12 hour ambulances cannot use it, but the crews on 24s who are in fire stations can go mostly out of service for four hours. They still run calls in the fire district that they are stationed at but those districts are slow.

Our planned 24s are actually generally busier than the peak truck for "core stations". Outlying stations are not as busy, but will post frequently. Also, they start three hours earlier than my peak shift. Having done both planned and extra 24s in this system, I can safely say that the only thing keeping them from being a guaranteed stand up shift is pure luck and luck isn't a strategy.

Posting 24 hour cars is a sure way to make those shifts miserable. Adding artificial busyness sucks.

There is a large fire based EMS agency west of denver that continues to run 48s. Their district varies from super dense urban areas to slow areas in the interface zone. If their busy ambulances get hammered have them switch stations to someplace slow during the second day of the 48. The slow station goes into the city for the daytime, the busy guys nap, and then they go back to their home stations at night.

 

[DrParasite]

Having done both planned and extra 24s in this system, I can safely say that the only thing keeping them from being a guaranteed stand up shift is pure luck and luck isn't a strategy.

Now that's scary.... and it will probably continue until the first fatigue related incident (crash, medical error, etc) occurs, and then the lawyers get involved.

Posting 24 hour cars is a sure way to make those shifts miserable. Adding artificial busyness sucks.

I'd like to add that posting for any length of shift is generally miserable. And coverage should be made to ensure proper coverage of a particular response area, especially when you have a major incident or a particular area where all assigned resources are on assignments.

But if you are posted to an area, and constantly getting relocations, than that makes your UHU increase (even if you aren't on a call, you are up and in your ambulance on a "assignment"). It's often managers don't consider when calculating UHU for how busy a truck is.

 

[NPO]

At my last job I was on a 48 hour shift in a rural town. Problem is, we would get sucked into the city if levels were low.

Everyone loved their 48 hour schedule, but you worked hard and got little sleep. But sometimes it was very slow. Maybe 2-4 calls in 48. Others it was non stop.

In the month before I left I had two shifts where we got 6 hours of interupted sleep for the whole 48. During one shift we were running calls for 40 consecutive hours. This was a time when we were at critical staffing levels. Crews were calling their supervisors pleading for mercy. My supervisor put one of the crews out of service for sleep, something that is not a policy at the company. Before they got back to the station a manager (from home) vetoed the decision and put them back in service. The supervisor put them back out of service and told the manager "you can keep putting them back in service and I'll keep taking them out. No one is getting hurt on my watch, and if they do, it's on you." They never got sleep, and were held over 6 hours that day, only allowed to go home when the EMT said he had no child care coverage. He doesn't have any kids.

I don't have a problem with 24s and 48s. But it needs to be supported by responsible management.