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Inside EMS
by Inside EMS

Quick Clip: Should EMS end 24-hour shifts?

This segment tackles the pros and cons of working 24-hour shifts in EMS, and whether the industry should do away with them. What do you think? Sound off in the comment section below

By EMS1 Staff

Download this quick clip on iTunesSoundCloud or via RSS feed

In this week’s Inside EMS podcast quick clip, host Chris Cebollero and Kelly Grayson tackle the pros and cons of 24-hour shifts, and whether they should be eliminated.

The discussion stems from a story about a Ky. ambulance that struck three boys riding their bikes in a median. One boy died.

“I thought, well, man I hope another EMT didn’t doze off at the wheel and hit these kids,” Grayson said.

Cebollero notes that 24-hour-shifts are a staple, but also points out that there are challenges when it comes to delivering patient care when EMTs have been awake for so long, especially when there’s a high call volume.

“I don’t really know if they have a place in our career field,” Cebollero said.

Grayson agreed, saying the issue goes beyond concerns related to driving.

“There’s a definite link,” he said, “between fatigue, lack of sleep, and increased medical errors.”

Listen to the full episode: Inside EMS Podcast: Can community paramedicine save major EMS agencies?

About the author

Inside EMS, a podcast series that features hosts Chris Cebollero and Kelly Grayson, brings expert perspective to hot topics, clinical issues, operational and leadership lessons to EMS personnel and leaders to be safe and successful.

Inside EMS is available for download on iTunes, SoundCloud and via RSS feed.
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Bart Regan Bart Regan Friday, August 29, 2014 7:24:55 AM Absolutely!!!
Ispray Custom Tints Ispray Custom Tints Friday, August 29, 2014 7:49:15 AM No. I'm on a 72 hour shift as of this point, people you can handle a 24 hour shift .Yes it maybe hard at times but people that work in ems, get paid very little. Are you going to give us a raise for us going to 12 hour shifts. Almost every medic or EMT works 2 full time jobs just to make it by. Let's face it, if we wanted a higher paying job we could just go next door to the gas station and be making more. I work a average of 80+ hours a week. And we have a extremely high call volume district. Im sure things are going to change in the near future, people are going to complain about sleep deprivation and will always win. But would you rather go home for 12 hours get a 8 hours of sleep and do it again? Okay.. Fine sounds dandy huh? What happens when you get that long emergent transfer 20-30 minutes before shift change? Guess what if you work the next day, basically puts you on a 36. And what happens if it happeneds again the next day? There's a 48 you. Leave it alone. If you want 12s talk to your district and vote. Don't try to make it nation wide. Times are already tough with money. And your going to make it worse to the people working 2 full time ems jobs. And its going to cost your district more money... Why?.. Easy there going to have to hirer more people to cover more shifts. This being supplying more uniforms, vacation, benefits etc... What do you think its going to do to your pay? I'm not in this for the money by no means and I push my self to be a better caregiver every day, but that little bit of overtime does motivate me. Giving me nice things to keep my mind off bad calls. You all be the call. I'm sure its going to change soon, its been going on for years now. One more ambulance wreck after another all of them stating because they were tired so they can stay out of trouble. Its easy. Its a excuse. So us Americans use it.
Ispray Custom Tints Ispray Custom Tints Friday, August 29, 2014 7:51:11 AM And sorry I was accidentally logged on to my bosses work place. I'll repost with my name shortly
Sanford Frasier Sanford Frasier Friday, August 29, 2014 7:53:32 AM So long as there are enough techs to cover a 10 hr or 12 hrs shift then yes, absolutely!
Ispray Custom Tints Ispray Custom Tints Friday, August 29, 2014 7:53:56 AM My dads* work place.
Andy Young Andy Young Friday, August 29, 2014 8:04:22 AM They have to go!
Stefanie Donovan Stefanie Donovan Friday, August 29, 2014 8:20:08 AM I love my 24 hour shifts. It's the responsibility of the practitioners to make sure they take themselves off car if they are feeling fatigued. Even though you're scheduled to work a 24 hour shift, you can pull yourself off and get some rest. All services do this where I work to ensure our safety and our patients safety. Without 24 hour shifts, I'm afraid small towns and rural communities would have a hard time staffing ambulances.
Jeep Guy Jeep Guy Friday, August 29, 2014 8:20:19 AM Nope. If you as an employee are to tired to perform your job you need to take responsibility and go home. If it is a consistent problem consider working in a hospital or other setting.
Patrick McKeon Patrick McKeon Friday, August 29, 2014 8:38:09 AM Before leaving the Fire Department as a Rescue Captain I was responsible for reviewing all of the ALS calls run in the battalion and from a clinical standpoint, I can tell you that 24 hour shifts in a busy department are dangerous. I would see a clear difference from sharp, awake, and fresh paramedics at the start of a shift and the tired, sleep deprived paramedics running their 15th call at 3am. In my opinion, there is no need for this deployment in EMS, Paramedics are highly trained clinicians and things can get missed when fatigue sets in. Look at Residents in busy hospitals, mistakes often happen from lack of sleep.
John Greer John Greer Friday, August 29, 2014 9:05:03 AM My company works 48 and 72 hour shifts. We are mostly rural. As much as I hate such long shifts, the company pays crap and this is the only way medics can survive. EMT's only get paid for 16 hours a day.
John Tackett John Tackett Friday, August 29, 2014 9:27:30 AM I know it's crappy to say, but if people would stop working for the crap pay that BS would come to a halt real quick.
Frank Echevarria Frank Echevarria Friday, August 29, 2014 9:33:21 AM 12 hours at night is just as bad as 24 hours....I think ems should be more like the fire dept.... On a average 1 ambulance will cover 2 or more fire district.... I'm not say one is more port ant then the other but when u have 1 unit covering multi fire districts then we need to take a look at the need to add more coverage to help with the volume
Bill Malburne Bill Malburne Friday, August 29, 2014 9:34:49 AM I say yes, I also think think it could be based on the call ratio of any particular service. I've done 24's where I'm out the door at 7a and run straight to 7a the next day. Most out of fear of losing their job will not request down time for fatigue plain and simple. I also think busy services should be responsible for monitoring how long there crews have been running without a break. The younger folks may be able to pull an all nighter. Personally I'd prefer not to put my life in the hands of someone thats been up 22+ hours as much as I don't want to be responsible for theirs. 12's or 16's at the most.
Shragi Schupak Shragi Schupak Friday, August 29, 2014 9:44:31 AM As mentioned if your a busy agency then no 24's are not a good idea. I work for a busy agency and we do 8 hour tours. We're allowed 1 additional 8 hour tour a day or a maximum shift of 16hrs. As much as I enjoy my career, after 16 hours I just want to go home and rest. Fatigue does catch up to you and you need your rest. While on paper 24's look good, believe me its a recipe for disaster. The only time I worked more then 16 hours is when we have any kind of severe storm. Maybe then I'm able to get away with a few more extra hours.
Robin Hoode Robin Hoode Friday, August 29, 2014 10:02:39 AM THe service for which I work has both 12 and 24 hour shifts. The 24 hour shifts are suppose to be on "slower" trucks so that those working those truck actually get sleep. However, slow or not I will not work a 24 hour. I do not function well if woken from a sleep. I think that more errors probably do occur. However, I know some people love the shifts. I think it really depends on the run volume an the amount of rest on a typical shift one could get. Also, personal choice.
Chris Underwood Chris Underwood Friday, August 29, 2014 10:15:27 AM I will say this I have worked 24 hour shifts my entire career and I have noticed that over the last decade I have seen burnout increase, accidents increase, families torn apart etc. But the days where you run constantly then get a out of town trip say 3 or 4 hour one way transport time weigh heavy on the health of the crews, and over a period of time I have seen many people say they can't do it anymore... It's not that they don't have the drive to do it, but the fatigue that is ensued isn't worth the risk of making a mistake in care due to fatigue, heaven forbid wreck a ambulance that injures the public, crew members or patient... I think congress needs to enforce 12 hour shifts nationwide....
Steve Garrison Steve Garrison Friday, August 29, 2014 10:17:43 AM As with every other delima in ems' its going to depend on each department situation. If 24 hour shifts are stopped' ems will have to pay their employees at a much higher rate. Working multiple 24 hour shifts has been the only way to support ourselves. I love the job and would hate to quit after 12 years because Icacan't support my family.
Jerry Smith Jerry Smith Friday, August 29, 2014 10:41:33 AM I have worked for 5 different Ambulance Services and all have had 24 hr shifts. When I worked for the slower services 24 hr shifts were not a problem. But the last service I worked for was busy 24/7/365 it was not only Emergency but also Transport and all trucks did both. I had to take myself off of the 24's because I was worried of making a mistake or wrecking. We had an Accident where it killed the patient and severely injured the EMT attendant. I would not recommend a 24 hr shift (or longer) to anyone. I know there are people who can and do do it. I hope they have the common sense to say, enough is enough, if they can't function. Most Supervisors would understand if you felt you were unable to function properly due to excessive calls. And this service was fazing the 24's out when I retired, but like all services they have trouble staffing with qualified personal. I have heard some of the younger ones bragging on 24 to 72 hour shifts and I always hoped they got some rest in that time. Until there is more qualified people in our area there will be 24's at all the services.
Dustin Kent Dustin Kent Friday, August 29, 2014 10:49:38 AM I think the average call volume needs to be looked at. If it's high and there is no room for down time then the answers clear.
Jason Patterson Jason Patterson Friday, August 29, 2014 11:15:19 AM I love working my 24hr shift! Sometimes we get a good shift were you get by with running a few and there are days you get your butt handed to you. I feel that is part of the job we like, you never know what the day holds when you get to the station. Maybe if we put more units in the busy areas or had a slower station backup the busier ones. This could help with the fatigue. Maybe have a day 12hr truck in the busiest areas.
David Silfen David Silfen Friday, August 29, 2014 12:37:12 PM Our system has gone back and forth on the 24 hour issue. We have done 24/72 12 hours shifts modified Dupont ..any shift and I mean any shift that puts you into an overnight is just plain bad. If you do overnights and can't sleep, it is no better than a 24 hour shift. We have had trainings with Fellows from UNC Chapel Hill NC Neurology sleep center; they said there is not much of a difference. They pointed out if you can sleep on a 12 hour overnight and get startled out of a deep sleep, it is bad for your heart, bad for your brain and is bad for patient care. I actually prefer a 12 hour shift with no overnights.
Chasidy Kearns Chasidy Kearns Friday, August 29, 2014 12:49:37 PM I'm ready for 8 hour shift with nap time.
Andrew Ovenden Andrew Ovenden Friday, August 29, 2014 2:27:47 PM Well, I'd prefer to telecommute (which, when you really think about it) could actually take care of probably a third of our calls), but I don't think that's in the cards.
Aaron Sawyer Aaron Sawyer Friday, August 29, 2014 4:34:36 PM We can't make a living without the overtime that a 24/24 gives.
Edward Michael Edward Michael Saturday, August 30, 2014 7:43:15 AM I worked 24 hour shifts for 2 years and it was the worst. I fell asleep at the wheel several times and was not very sharp on a busy shift. It's dangerous
Edward Michael Edward Michael Saturday, August 30, 2014 7:44:36 AM You must be new!
Kiley Owen Kiley Owen Saturday, August 30, 2014 6:19:20 PM There is no option for "taking yourself off for fatigue" here....there are no reserve crews to take your place. Believe it or not we are short handed here. High call volume and 24s with no other option where I'm from.
Audrey Dixon Audrey Dixon Saturday, August 30, 2014 7:22:03 PM I have worked 24s and 12s. I depends on the system. Most of us miss our 24s. When we went to 12s. We did shift trades so we could still do 24s but in the Ambulances. By the time we get to the 4th day on the 12s. We are all burned out. People are calling off like crazy and they are mandating. People are angry and tired by the 4th day. We were less tired and we were not angry on the 24s. I still think that most of this exhaustion is from BS calls that wear people out. If the system was used right. There would be less calls and we would feel like we really are saving lives. Instead of being taken advantage of. Really helping out gives a natural high. Again I believe we keep losing focus on the real problem. A solution on cutting down on BS calls.
James Willbrandt James Willbrandt Sunday, August 31, 2014 1:37:19 PM EMS is to cheap to do away with 12,24,36 hour shifts. yes that's right 36 hour shift. EMS should be made to run 8 hour shifts only, take into account your ambulance has no running water, toilet, or a place to keep food and drinks. then look at their pay, EMS was the lowest paying job I ever had. even in high school I made more working part-time, then I did working overtime in EMS. WORST JOB EVER.
Jimmy Futrelle Jimmy Futrelle Sunday, August 31, 2014 2:42:56 PM You can work 24 hour shifts and still function well, and alertly, if it is managed correctly. 24 hour shifts are the only way some smaller, rural communities can afford to have Paramedic level care. There is a balance, but it requires leadership to find it and wisdom to make rules and policies for EMS that benefit all not just the select few with greater resources.
Ben Parsley Ben Parsley Sunday, August 31, 2014 3:51:01 PM You cant judge one shift by one particular service we run 5 trucks in our county 5000 runs a year. Averages to about 3 runs per truck per day. We cover a big county with some longer transport times since we do not have a major hospital in our county. Major city's are a differant world. There is not a blanket answer.
Ben Parsley Ben Parsley Sunday, August 31, 2014 3:54:54 PM Edward Christinzio after 30 yrs I am not new. I love my 24hr shifts. It all depends on the service you are in.
Nate McNamee Nate McNamee Sunday, August 31, 2014 4:53:11 PM I've run 10, 12, 24, and 48 hour shifts with no problems. I've seen people who couldn't do it or get burnt out on shift and it's understandable. 24 and 48 hour shifts are a strain but if you request them you should be up to do them, these shifts aren't for everyone if you don't feel like you can do 24 hour shifts don't request to be on them and stick to doing 12 hour shifts

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