Texas medics working 24's and 48's

superGuitar

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Hey guys. Isn't necessarily only about Texas, but that's where I'll be working so if there are state-specific rules, I figured I'd ask about it specifically. I'm trying not to hijack any threads but I haven't seen this talked about specifically anywhere. I'm a canadian medic now transplanted to Texas and any day now I'll have my shiny new TDSHS license and finally get to start applying. I've been reading all the texas-related posts for a couple years now. I'm not tied to working in any one geographic spot, and I have a few favourites in mind. MCHD is the only service I know of that works the 24on/24off/24on/5off, which is the BEST work/life schedule I ever had and want it again, so they're my #1 on the list (for a couple reasons). Everything else seems mostly 24s and 48's.

Back home, we've pretty much stamped out shifts more than 12hrs, due to labour laws and safety and such. I have worked 24's, 48's for flights, but we would timeout at 14-16 hrs of service, and have mandatory 8hrs downtime. Which was sweet getting paid to have guaranteed sleeptime. Other services you would be placed on second-up or third-up status after working 12hrs, and then you just pray that both the other trucks dont go out while you're trying to sleep.
Is that how it works here? Do you have laws about working hours and rest time or can you potentially be taking calls for your entire 24hrs on? Surely you get some guaranteed sleep time for those pulling 48s, eh?

I'm not a priss, but I'm also not 20y/o anymore and my days of consistently screwing my circadian need to be more and more in my rearview than not. Thanks!
 

RocketMedic

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Sleep is for the weak, brother. We’re expected to run whenever the calls come. Sometimes there’s good days and you get to sleep a bit. Sometimes you raw-dog life with your face. It’s all variable.
 

FiremanMike

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Hey guys. Isn't necessarily only about Texas, but that's where I'll be working so if there are state-specific rules, I figured I'd ask about it specifically. I'm trying not to hijack any threads but I haven't seen this talked about specifically anywhere. I'm a canadian medic now transplanted to Texas and any day now I'll have my shiny new TDSHS license and finally get to start applying. I've been reading all the texas-related posts for a couple years now. I'm not tied to working in any one geographic spot, and I have a few favourites in mind. MCHD is the only service I know of that works the 24on/24off/24on/5off, which is the BEST work/life schedule I ever had and want it again, so they're my #1 on the list (for a couple reasons). Everything else seems mostly 24s and 48's.

Back home, we've pretty much stamped out shifts more than 12hrs, due to labour laws and safety and such. I have worked 24's, 48's for flights, but we would timeout at 14-16 hrs of service, and have mandatory 8hrs downtime. Which was sweet getting paid to have guaranteed sleeptime. Other services you would be placed on second-up or third-up status after working 12hrs, and then you just pray that both the other trucks dont go out while you're trying to sleep.
Is that how it works here? Do you have laws about working hours and rest time or can you potentially be taking calls for your entire 24hrs on? Surely you get some guaranteed sleep time for those pulling 48s, eh?

I'm not a priss, but I'm also not 20y/o anymore and my days of consistently screwing my circadian need to be more and more in my rearview than not. Thanks!
Would love to work a 24 with a mandatory 8 hour rest, where is this Eden?
 

RocketMedic

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A little more seriously now:

The animal you describe is not present in American EMS. It will not be found in our Pokédex. Our workplace protections and labor laws are vague at best for our field, and on a state/federal level, length of shift is wholly undefined and unregulated.

Individual counties and companies, of course, have their own policies. In Texas, the state actively doesn’t care; Governor Abbott is actively nuking existing local regulations but it doesn’t matter because they didn’t cover EMS anyways. Some services (MedStar Fort Worth, AMR Houston, UT Tyler, etc) run 12s, but those are straight SSM assignments- of those, only UT Health EMS still has a few 24 or 48-hour assignments in rural areas and those are paid less per hour and still post. Practically every 12 hour assignment will be in a truck the whole time. There is a possible exception for Galveston EMS, I thing TransportJockey mentioned they ran busy 12hour shifts out of stations but that was years ago. The vast majority of Texan paramedics are on long-hour assignments. There is no known state, county or local-level safety or fatigue control movement, board, policy or any other creation. Some, like Christus EMS, have (quasi)formal fatigue breaks you can call, but that is variable and suffers from the “you screwed everyone else” problem too, so peer pressure often interferes with good judgement.

As for Texas, it’s a big state. Which part of Texas? MCHD is Houston-area, but there are a lot of municipal, county, fire and private 911 services around there too and loads of IFT providers of various quality and schedule. I’m in the Austin area now. There are many of us here.
 
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superGuitar

superGuitar

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Would love to work a 24 with a mandatory 8 hour rest, where is this Eden?
Alberta, Canada man. The provincial health authority is for the most part eliminating all shifts that exceed 12hrs, with the exception of some hodunk rural services that would be near-impossible to staff with that 12hr model. So if you are on a sleepy rural 24hr car, once you've been doing calls for 14hrs or so, you call into dispatch and let them know you're timing out, and you are put out of service for fatigue. Boom, enjoy your 8 hour reset. Some people take it to the nth degree and will demand that a supervisor or another crew drive them back to their station because they timed-out at the city hospital and claim the fatigue clause for even driving home in out-of-service status.
Individual counties and companies, of course, have their own policies. In Texas, the state actively doesn’t care; Governor Abbott is actively nuking existing local regulations but it doesn’t matter because they didn’t cover EMS anyways. Some services (MedStar Fort Worth, AMR Houston, UT Tyler, etc) run 12s, but those are straight SSM assignments- of those, only UT Health EMS still has a few 24 or 48-hour assignments in rural areas and those are paid less per hour and still post. Practically every 12 hour assignment will be in a truck the whole time. There is a possible exception for Galveston EMS, I thing TransportJockey mentioned they ran busy 12hour shifts out of stations but that was years ago. The vast majority of Texan paramedics are on long-hour assignments. There is no known state, county or local-level safety or fatigue control movement, board, policy or any other creation. Some, like Christus EMS, have (quasi)formal fatigue breaks you can call, but that is variable and suffers from the “you screwed everyone else” problem too, so peer pressure often interferes with good judgement.
Thanks Rocket, this is exactly the kind of conversation I was hoping to generate, since our canadian system is so different and I still have so much to learn here. I am generally a less-is-more kind of guy when it comes to government control or overreach and appreciate when ultimate authority is generally left to the most local level of government, but it's pretty crazy to me that the fatigue conversation hasn't made it further than what it sounds like you're describing on a policy level. I remember as a newbie medic bragging (at least to myself) about how hard I was that I could manage a complex flight with vents and pumps and all that hero stuff, running on 30hrs on-duty, like it was some badge of honor. But I look back on that attitude now and just shake my head and thank God that I didn't make any career-ending mistakes after being awake for that amount of time. We teach it in EVOC and other driving courses that you can have quantifiable impairment from fatigue, and can even be held liable for that state of impairment, no different than ETOH.

I think it comes down to balance between those extremes of having no regulations or else having very strict parameters dictated to you. I would just hope that there is some mechanism that you can employ if you find for whatever reason you're not at the top of your game when the next call is coming in and you've been hoofing it all day already. Where I'm coming from, often that was just simply calling your sup and he could take out of the game for a cool-down, a 30min lunch break, or whatever, and it was just dealt with at the supervisor level.

I definitely understand how 24hrs are often way more feasible for sustainable staffing model than anything less, operationally. It's true, I may have become a little bit of a princess in my previous EMS life, so I will work myself back into thriving on those long-hour shifts, and the little tricks for making short naps count etc. And like you point out with posting vs responding from a hall, I would much rather work longer and have a chance of making back to the hall, than be condemned to having my butt parked in the front seat for the entire shift...but there are ways around that too, I suppose.

As for Texas, it’s a big state. Which part of Texas?
I'm sitting in Spring right now until my wife delivers our last kid, any day now. we'll sit put for a couple weeks to let her family get all their baby cuddles in, and then I'll be needing to live in my own house again :). Conroe area had been our plan, but tbh I could live almost anywhere in Texas that isn't a huge metropolis and be happy, especially central tx. Are you still Luling/Lockhart?
 

RocketMedic

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Yep, I am.

Spring has a lot of good local choices. The obvious ESD48 in Katy, ESD11 in Spring and MCHD/HCEC all offer reasonable staffing and 24s, ESD11 has a lot of 12s as well and is probably the second-safest of the bunch (behind ESD48, where adequate resources and a tiny-but-packed service area mean they can work well on a 24). Stepping out of the metro a bit, Lake Jackson EMS is fantastic and has pretty reasonable workloads on a 24 on/72 off schedule; I kinda miss it. Pearland FD is legit too. Cy-Fair EMS runs a fascinating 24-hour schedule with Kelly days that lets you choose your own income and it’s a good choice too…busy, but quite good and about as “safe” as a busy urban 24 can be.

Austin County EMS out in Bellville or Fayette County out of LaGrange is similar, but with 48/96 schedules. Both of those services have good reputations and reasonable workloads. There’s also Fort Bend with their 48/96, but that’s canned fatigue death at their rate/volume. Also gotta toss in recommendations for League City and (weirdly) Allegiance out in Liberty County, their assigned 911 trucks are relatively pacific assignments if you can get them. Don’t run a transfer rig though, you will be ran to exhaustion. Avoid CHI-Bryan like the plague, they run stand-up 24/48s with a LOT of LDTs and generally poor everything (although I’ve heard it’s somewhat better now with their new director).

Lockhart is busy but relatively OK- I got a solid six hours of sleep last night, although it’s been very busy. (We are hiring for a FT paramedic right now BTW). I like it here for the time being because we are trying to become an ESD and that may propel us to fantasy and significant improvements. PM me for details and honest advice.

Luling has a lot of other issues, 4/10 recommend.

Austin/Travis County is “good”, but with asterisks on it. Their lateral-entry program seems to have stabilized their massive staff bleed, but they’re still deeply understaffed and the new technique to mitigate forced overtime is to drop trucks out of assignment for the day, resulting in fewer units for the people on-shift. IIRC they are now paying double time for voluntary overtime pickups which is salving the burn of mandatory pickups, but it does still happen routinely to everyone there too. Expect to work 9-11 24-hour shifts a month at ATC, with little opportunity for rest. The overtime assignments can’t be consecutive though, so you’d be burning a middle day from your 24/72 for it. Their process seems somewhat ad hoc and random too, and for a lot of reasons, the ATC pay doesn’t really hold up in comparison to local COL, so you’re looking at needing that OT. It’s not terrible, buuutttt….

San Marcos/Hays is clawing for medics too, but they’re a little less in the hole than ATC. Forced overtime is a thing there too, twice a quarter, but isn’t a guarantee. Pay is less than ATC as well.

Williamson is going all-in on 48/96, with similar issues.

Lengthening shifts worked seems to be the usual answer to our staffing crisis here, with some of the more insane examples from StaffDash et Al being week-on week-off, etc.

I’m all about good EMS and Texas does allow a lot of clinical freedom, but I also think that what we gain in good medicine and professional latitude may be undermined by economics, geography and our own attitudes. If we as an industry and our state regulators (especially CA, MA, etc) would attack fatigue and staffing and it’s complications with the same fervor as they cut away at good medicine, I think we could have some good discussions and positive forward motion on things and provide better medicine more safely. Sadly, that’s a dollars conversation no one really wants to have, so we will keep wrecking things and making mistakes.
 

DrParasite

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MCHD is the only service I know of that works the 24on/24off/24on/5off, which is the BEST work/life schedule I ever had and want it again, so they're my #1 on the list (for a couple reasons).
24 on 72 off is even better... Esp if you take a shift off, and you are off for 7 straight...

Realistically speaking, the longer the shift, the fewer that calls you should have. So if you are running back to back to back, 12s are pretty much the max you want to do; technically 18 with OT. Studies have shown that after 20 hours of being awake, performance decreases significantly.

Can you do 24 hours straight? sure. Can you do 36? or 48? I'm sure it's happened. And if it's slow, and you get to sleep in a bed, by all means do so. Many/most fire departments are able to do that, which is why they can do 24 hour shifts with no problems.

Lets say you can call a fatigue time out; that means everyone else has to pick up the slack, as you have a finite amount of resources in a system. It's a smart thing to do, but when any EMS systems are staffed to have as many units on calls as they can, and an idle rig isn't making money.... well, that's where you run into issue.
 
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