Emergency Medical Services: The Death of the 24-Hour (or More) Shifts

A question was recently posted on a fire service listserv asking what the length of shifts for departments that provide EMS was. As you may have also read, D.C. Fire and EMS Chief Ellerbe has proposed eliminating 24-hour shifts for his department.

While 24-hour shifts have been the norm for quite some time, it’s not uncommon for large, busy agencies to work 10/14s, 12s or some other modified shift of less than 24 hours. Yet, in the western U.S., a number of departments have gone to a 48/96 schedule.

That’s right, 48 hours on, 96 hours off.

Most members love that schedule, but is it appropriate? This doesn’t even take into account an overtime shift or trade, in addition to the normal schedule, where a member may now be working 60 continuous hours or more.

How many hours are too many? How much rest are these members getting over the course of their shifts?

To complicate matters even more, an advertisement was placed in a national fire magazine this past summer for a prescription medication by a company whose tag line was, “Supporting those of you who stay awake for the rest of us.” This medication is touted as being used to “improve wakefulness in adults who experience excessive sleepiness due to shift work disorder (SWD).”

My concern is the message this is sending to those thousands of firefighters who read this magazine.

The precautionary statements for this medication state that

  • You shouldn’t operate a vehicle or perform other dangerous activities until you know how it affects you.
  • A possible side effect includes trouble sleeping.
  • It can cause mental symptoms, including depression, hallucinations, aggressive behavior and thoughts of suicide.

It’s federally controlled because it can be abused and become addictive.

And this is a medication I want my firefighters and paramedics taking while on duty to help them stay awake?

Maybe it’s time to truly evaluate the length of our shifts and the impact they’re having on not only our personnel, but our customers as well. While there have been a limited number of sleep studies involving the fire service, there have been a number involving sleep deprivation as a whole. From these studies, we know that sleep deprivation can cause lapses in attention, poor decision-making and reduced reaction times, and in some cases, it can cause us to function as if we were impaired by alcohol.

The Joint Commission recently published an article stating that in a study conducted on nurses, those who worked more than 12.5 hours in a shift were more than three times as likely to make errors or mistakes.

Quite frankly, I’m surprised that fire and EMS haven’t already been regulated away from shifts that are more than 12 hours. When we look at other professions—over-the-road truck drivers, medical residents, airline pilots and train engineers—they all have limitations on the maximum number of hours they can work before a mandatory rest period is required.

Even the U.S. Forest Service has a 2:1 rule in wildland firefighting, where a firefighter can work a maximum of 16 hours and then must have eight hours off.

So what makes us different?

We drive large apparatus, sometimes in inclement conditions; we’re making strategic and tactical decisions under pressure that involve lives; and our paramedics have to make drug calculations and life-or-death decisions. This looks pretty similar to the jobs listed above.

I can’t say there’s an increase in accidents, injuries, mistakes, etc., due to our shifts because I haven’t seen any definitive data that speaks to this one way or the other. However, a study might be something we really need to consider doing.

It’s always better to forge our own destiny, so if we’re proactive and get the data, we can help design the future. Will it result in saving the 24-hour shift? I can’t say. But at least we would have some input. Otherwise, someone else is going to do it for us, and we may not like the results.

We shouldn’t be relying on medications to keep us awake—especially one that can lead to dependence and abuse—and we shouldn’t even tolerate it being advertised as a solution. Our customers deserve so much more.

Regardless, if we’re not careful, we’re going to be told how many hours we’ll be allowed to work, and it will probably mean the death of the 24-hour shift.

Norris W. Croom III, EFO, CMO, is the deputy chief of operations for the Castle Rock (Colo.) Fire and Rescue Department. He’s been a member of the EMS Section since 1998 and currently serves as the section’s director at large.

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