EMS Restructures Work Week for Medics

Shifting shifts

Beginning Oct. 2, most medics working at Austin-Travis County EMS will begin a new shift schedule: 24 hours on, with at least 72 hours off between each daylong shift. For the past decade, ATCEMS medics have operated on a hybrid schedule, working two 12-hour shifts and one 24-hour shift over a rolling seven-day period. (Medics currently work 96 hours every two calendar weeks.) According to ATCEMS Chief Ernie Rodriguez, who addressed his 500 field medics in an Aug. 5 memo, the shift is designed to increase the medics' "cumulative hours of rest opportunity" in hopes of decreasing a longstanding department-wide feeling of fatigue.

The change is expected to impact medics working ambulances assigned to 31 stations around Austin and Travis County, with trucks at four stations (three in the Downtown area and one at 7200 Berkman) continuing to operate on a 12-hour shift schedule due to demand in their respective areas. (Bidding for station and truck assignments took place last week. Rodriguez said the rotation plan is still developing.) ATCEMS's four demand units, deployed during the days' busiest hours, will continue on 12-hour shifts. Of the 31 involved stations, six somewhat-central stations will incur another change: For the time being, medics assigned to 3616 S. First, 6601 Manchaca Rd., 1201 Webberville Rd., 5710 N. Lamar, 8989 Research, and 1330 E. Rund­berg will begin their shifts at 8pm, instead of the standard start times of 6pm or 7pm.

The move to 8pm can be attributed to recent findings from 24/7 workforce consultants Circadian, who wrote in a Nov. 2015 audit of ATCEMS that medics see a peak in activity between the hours of 6 and 7pm. That spike often keeps field staff working beyond their scheduled clock-out times, thereby increasing feelings of fatigue. (Rod­ri­guez also wrote that the change of hour may "offer an easier transition between work and personal time off.") The decision to restructure the majority of medic schedules from the hybrid to more static 24-hour shifts, Rodriguez wrote, was a shared effort between department management and the ATCEMS Employee Association, who mutually agreed that "the number of days off between shifts plays a significant role in one's ability to recuperate."

In an email to the Chronicle, ATCEMSEA President Tony Marquardt confirmed Association support for the changes, writing that the previous shift to hybrid scheduling (see "EMS: Let 'em rest," July 21, 2006) came at a different time for local medics. "We were an all-paramedic system which allowed for more variety in scheduling options," he wrote. "The dynamic changed when the medic I rank was introduced, which increasingly diminished the viability of some of the advantages of that schedule." Medic I is ATCEMS's term for Emergency Medical Technicians, introduced locally in 2012, after 36 years in which ambulances were staffed only with paramedics, or medic IIs. Department policy mandates that ambulances be staffed with at least one medic II at all times, thereby restricting what was once seen as a dexterous advantage to the hybrid shift.

In addition to those changes, Rodriguez also announced the implementation of two more tools designed to help with fatigue management. The department has begun working with FirstWatch, a public safety technology vendor, to start monitoring workloads of each ambulance; Rodriguez said shift commanders will track workloads to see which medics have "run a number of calls without a sufficient break." Rodriguez said command staff will also implement a "non-punitive procedure" that will enable medics to take their ambulances off the road "when they feel overly fatigued and need an immediate break." The latter is rather interesting: Executive staff have traditionally been wary of pulling ambulances because of chronic department-wide understaffing, yet now see no issue with taking trucks out of service when overworked medics get too tired.

Marquardt's feedback and the mood gleaned from medics' Facebook comments snooped on by the Chronicle confirms that the move to 24-hour shifts is both popular and much needed. (For fear of retaliation, ATCEMS field staff routinely decline comment to the press, as was the case on this story.) While few medics would argue that working 24 hours in a row is immediately easier on the body than working two separate 12-hour shifts, there's a belief that the increase in consecutive hours off the street – between shifts – will go a long way toward restoring cumulative stamina.

The devil's advocate to that mindset would suggest that sending medics out for 24 hours at a time is unsafe for both medics and their patients, as a tiring medic is more likely to provide less-than-optimal care, at least according to Circadian's findings in a 2006 survey of ATCEMS medics.

Moreover, ATCEMS's current staffing situation, with 53 reported medic vacancies, suggests that medics working solely 24-hour shifts won't be afforded the advertised allotment of consecutive off-truck hours. They'll need to navigate ATCEMS's on-call list, which Marquardt reports to average out to one additional shift per medic per month, and the schedule for floater shifts is still developing, according to Rodriguez's memo. There's also overtime, a somewhat convoluted term at ATCEMS. Public Information Officer Mike Benavides told the Chronicle that, in July, 164 of 364 medics worked zero hours of overtime "beyond their normal work week," and that an additional 67 employees worked 12 hours or fewer. But those numbers may be misleading. Mar­quardt noted that staff vacancies required medics to fill 4,100 hours of service time in January – a whole lot no matter how many medics are working those hours. The department began a transition last year from 48-hour work weeks to 42 hours, though even that reduction is somewhat of a mirage until the department does something about its vacancy issues – something Rodriguez doesn't see happening for at least two years.

The totality of the situation has left some skeptic medics wondering why department executives would make a potentially unsafe decision solely because a field staff wants it. Marquardt referred to language in Circadian's 2006 study, which notes how there is no one single optimal shift system.

"Overall, in order to continue to be successful there must be adequate growth in resources to keep pace with demand and minimize rate [medic attrition]," said Marquardt. "Scheduling is a managerial function and always has been. We advocate for fairness in process and our staff being treated as the professionals that they are and given a say in matters that affect their working lives."

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EMS, ATCEMS, Ernie Rodriguez, Tony Marquardt, Mike Benavides

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